Protect Yourself From a Wrong Diagnosis

3 Commonly Misdiagnosed Health Conditions in Women

By Steve Horowitz, Special to Lifescript

Published January 12, 2012

By Edward C. Geehr, M.D.

In the quest to cure what ails you, doctors sometimes don’t consider the health differences between the sexes. That may lead to a wrong diagnosis. Here are 3 medical conditions often overlooked in women and tips on how to protect yourself. Plus, test your smarts with our women’s health quiz…

1. Heart DiseaseNausea, shortness of breath and sharp chest pain are common symptoms of cardiovascular disease. In women, though, they might be blamed on anxiety or heartburn.

Many physicians still assume women under 55 years old seldom have heart attacks, says Hardy Schwartz, M.D., medical director of non-invasive cardiology at the Sarasota Memorial Heart & Vascular Institute in Florida.

That means women who show symptoms of heart disease are almost seven times more likely to be misdiagnosed than men.

“Part of the problem is that so little research has been done on women, although it’s getting better,” he says.

Why it’s hard to diagnose: “Health care for women has traditionally focused on screening for breast, ovarian, cervical and other cancers,” says Norma Keller, M.D., clinical chief of cardiology at Bellevue Hospital in New York.

“But ironically, heart disease is the No. 1 killer of women over 45, killing 1,400 women every day.”

That’s more deaths than all cancers combined.

Most heart attacks are caused by coronary artery disease, usually the result of arteriosclerosis.

This buildup of plaque causes arteries to harden and narrow, which prevents the flow of blood and can result in a heart attack.

Women manifest different symptoms of heart disease than men, particularly if they’re suffering from coronary microvascular syndrome (CMS), reports the Journal of the American College of Cardiology.

In women with this condition, plaque collects in small arteries of the heart, which can be overlooked in routine angiograms.

How to prevent misdiagnosis:Women who experience heart disease symptoms – pressure or burning in the chest, shortness of breath, irregular heartbeat, dizziness, sweating, fatigue and nausea – should ask their doctor about a nuclear stress test or stress echocardiogram, Schwartz says.

Also, just as they do for cancer, women should get screened for heart disease and be aware of their risk factors:

  • Find out if your parents or grandparents suffered from heart disease.
  • Monitor your blood pressure regularly, especially if high blood pressure runs in your family.
  • Have your cholesterol measured annually, more often if it’s high.
  • If you smoke, quit.
  • If you’re obese, lose weight. Exercise 30-40 minutes at least four times per week.
  • If you’re diabetic, take your insulin as instructed, eat a balanced diet low in sugar and engage in daily exercise, such as walking.

2. FibromyalgiaAbout 10 million Americans – mostly young women – suffer from fibromyalgia (FM).

It’s often called an “invisible” illness or disability because symptoms may seem unrelated and conventional medical tests typically come back normal.

But fibromyalgia is a chronic condition marked by widespread pain, intense fatigue, heightened sensitivity and needle-like tingling of the skin, muscle aches and spasms, weakness in the limbs and nerve pain.

People with FM may also have problems sleeping and deficits in short-term memory.

For more on fibromyalgia, click here.

Its cause is unknown, although some experts believe stress or genetics play a role.

Pain may worsen because of increased stress, excessive physical exertion, lack of deep sleep, and changes in humidity and barometric pressure.

One theory suggests that decreased levels of serotonin, a neurotransmitter that regulates sleep patterns, mood, feelings of well-being, concentration and tolerance to pain, may be a factor.

Why it’s hard to diagnose:“Symptoms vary from person to person,” says Bart Price, M.D., who practices internal medicine in Florida.

“They overlap with other diseases and there are no definitive blood tests for it.”

FM is diagnosed by eliminating other conditions, but that’s why patients often get a wrong diagnosis.

Other disorders, such as chronic fatigue syndrome, depression, Lupus, Lyme disease and thyroid conditions, can produce similar symptoms.

It’s also relatively rare: Only about 2% of the population has been diagnosed with FM.

There’s no universally accepted cure for fibromyalgia, but prescription muscle relaxants and nonsteroidal anti-inflammatory drugs are recommended.

Mild exercise and sleep may reduce pain and fatigue, some studies suggest.

Heat applied to the painful areas also may help, as well as physical therapy, massage and acupuncture.

How to prevent misdiagnosis: Be persistent with your doctor, Price says.

Ask questions about your symptoms, request blood tests to rule out other diseases and seek a second opinion from a rheumatologist if necessary.

If you suspect you have FM, here are 8 important questions to ask your doctor:

  • Have you checked for fibromyalgia?
  • What can I do to ease my symptoms?
  • What medications can I take?
  • What drugs, foods or activities should I avoid?
  • What alternative therapies or stress management techniques might help me?
  • Do you recommend counseling?
  • How do I explain my condition to others?
  • Are there clinical trials in which I can participate?

3. Thyroid DiseaseThyroid disease is one of the most often undiagnosed and misdiagnosed diseases.

It may affect up to 27 million Americans, according to the American Association of Clinical Endocrinologists; more than 50% of them go undiagnosed.

In fact, 1 in 8 women will develop a thyroid condition in their lifetime.

The thyroid gland regulates the pace of the body’s metabolism through the production of hormones. Hypothyroidism (associated with a slow metabolism) occurs when the thyroid fails to produce hormones triiodothyronine (T3) and tetraiodothyronine (T4).

Symptoms of hypothyroidism include:

  • Weight gain
  • Facial puffiness
  • Fatigue, depression
  • Dry skin
  • Brittle nails
  • Hair loss
  • Development of a goiter
  • Hoarseness
  • Increased sensitivity to cold
  • Constipation, muscle pains
  • Cramps heavy menstrual flow
  • Slow heart rate or congestive heart failure

With hyperthyroidism (associated with an overactive metabolism) T3 and T4 are overproduced.

It can be caused by Graves’ disease (an autoimmune defect) or inflammation of the thyroid.

Symptoms of hyperthyroidism include:

  • Weight loss
  • Hot flashes
  • Nervousness
  • Anxiety
  • Fine or brittle hair
  • Increased sensitivity to heat
  • Rapid heart rate
  • Difficulty sleeping
  • Frequent bowel movements
  • Muscular weakness and lighter menstrual flow
  • Eyes bulge with Graves’ disease

Why it’s hard to diagnose: “The symptoms are non-specific and come on gradually,” says Joseph Rand, M.D., a board-certified endocrinologist.

“The condition is typically genetic and there are no other identifying risk factors.”

Undiagnosed and untreated thyroid disorders can lead to elevated cholesterol levels, heart disease, high blood pressure and depression.

A blood test determines diagnosis, and hormone replacements can be taken in the case of hypothyroidism, Rand says.

With hyperthyroidism, doctors typically prescribe drugs to block the overproduction of thyroid hormone, radioactive iodine to destroy overactive thyroid tissue or surgery to remove the gland.

How to prevent misdiagnosis: 

  • Be aware of risk factors, which include a family history of thyroid disorders and having radiation or neck surgery.
  • Perform a self-check for an enlarged thyroid. Drink a glass of water in front of a mirror. If you see a lump on the thyroid (located below the larynx or Adam’s apple) and just above the collarbone, contact your physician for further diagnosis.
  • Pay attention to your symptoms.
  • Keep a journal to track your progress and note any changes in health you experience.
  • Maintain follow-up appointments and an ongoing dialogue with your physician about how you are feeling.

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