Gender-based differences and menstrual cycle-related changes in specific diseases: Implications for pharmacotherapy

Pharmacists should be aware of gender-based differences and menstrual cycle -related changes in six diseases: asthma, arthritis, migraine, diabetes, de pression, and epilepsy In general, women report symptoms of physical illnes s at higher rates, visit physicians more frequently and make greater use of other health care services than men, Whereas reasons for these gender diff erences are not fully clear, a combination of biologic, physiologic, social , behavioral, psychologic, and cultural factors most likely contributes. A significant percentage of women with asthma, arthritis, migraine, diabetes, depression, or epilepsy experience worsening of their disease premenstrual ly. The mechanism is unknown, but is speculated to be multifactorial becaus e of many endogenous and exogenous modulators and mediators of each disease . As part of general therapy for cycle-related exacerbations of any one of these disorders, patients should be encouraged to use a menstrual calendar to track signs and symptoms for two to three cycles; if cyclic trends are i dentified, the women should anticipate exacerbations and avoid triggering f actors. Cyclic modulation with pharmacotherapy may be attempted. If unsucce ssful, a trial of medical ovulation suppression with a gonadotropin-releasi ng hormone (GnRH) analog may be warranted. if that is successful, continuou s therapy with a GnRH analog and steroid add-back therapy or less expensive alternatives may be effective. IF pharmacotherapy is impractical, hysterec tomy and bilateral oophorectomy with estrogen replacement therapy is a last resort. Gender differences and menstrual cycle-related changes are importa nt areas for clinical and mechanistic research.