Gender medicine: Why gender plays a role in cardiology

Gender medicine, or gender-sensitive medicine, is a modern medical approach that systematically takes into account the biological and psychosocial differences between the sexes in the prevention, diagnosis and treatment of diseases. For a long time, the male body was considered the standard in medicine and science, which meant that the special health needs and disease processes of women were often overlooked. In our cardiology practice, the Gender medicine is not a niche topic, but an integral part of our aspiration to practice precise, personalized and advanced cardiac medicine for all our patients.

What does gender medicine mean in practice?

With the Gender medicine It is not about treating men and women fundamentally differently, but about knowing their respective biological and physiological characteristics and including them in medical decision-making. This leads to better and more individualized medicine for everyone. The differences affect not only the reproductive organs, but practically all organ systems, especially the cardiovascular system.

This approach means concretely:

Recognition of different symptoms: Diseases can manifest themselves differently in women than in men.
Consideration of different risk profiles: Certain risk factors have a different weighting for women than for men.
Adaptation of therapies: Medication can work differently in women and have other side effects.
Differentiated interpretation of diagnostics: Standard values for laboratory parameters or imaging procedures may differ.

The application of the principles of Gender medicine is a quality feature of modern, informed and patient-centered care.

Gender medicine in the heart: typical differences in cardiovascular diseases

Nowhere are the findings of the Gender medicine as relevant as in cardiology. Cardiovascular diseases are still the number one cause of death in women, yet they are often diagnosed later and less frequently than in men. This is also due to the fact that the diseases manifest themselves differently.

Key areas with relevant gender differences in cardiology:

Symptoms of CHD and myocardial infarction: Women are more likely to show „atypical“ symptoms that do not immediately suggest the heart.
Type of vascular disease: Women suffer more frequently from diseases of the small coronary arteries (microvascular dysfunction), which are often not visible in a standard cardiac catheter examination.
Effect of risk factors: Diabetes mellitus or smoking increase the relative risk of heart disease in women more than in men.
Side effect profile of medications: Women are more likely to report side effects with common cardiovascular medications, which requires careful dosage adjustment.
Autoimmune aspects: Autoimmune diseases that occur more frequently in women (e.g. lupus, rheumatoid arthritis) are associated with an increased risk of heart disease.

Gender medicine and heart attacks: different symptoms, different risks

The classic image of a heart attack - a middle-aged man clutching his left breast with severe chest pain - is strongly anchored in the media, but unfortunately only half the truth. Women often experience a heart attack completely differently. Ignorance of these differences can lead to a life-threatening delay in diagnosis.

Comparison of heart attack symptoms

The following table compares the classic symptoms with those that are more common in women. It is important to emphasize that women can also have classic chest pain and men atypical symptoms.

Symptom	Typical description for men	Common description for women
Chest pain	Often described as devastating, pressing or constricting behind the breastbone.	May be absent or felt as pressure, discomfort or tightness.
Pain radiation	Classically in the left arm, the jaw or the back.	Frequent radiation into the right arm, between the shoulder blades, into the upper abdomen or neck.
Accompanying symptoms	Cold sweat, paleness, fear.	Severe, unexplained tiredness, nausea, vomiting, shortness of breath, dizziness.
General feeling	Often perceived as a clear, dramatic event.	Often misinterpreted as an upset stomach, flu or pure exhaustion.

Knowledge of these differences is a central aspect of the Gender medicine and can save lives. Any unclear, sudden, severe symptoms in the upper body accompanied by nausea or shortness of breath should also be considered a heart attack in women.

Gender medicine in drug therapy

Women and men differ in body weight, fat and muscle percentage as well as in the activity of certain liver enzymes. All of this influences how a drug is absorbed, distributed and broken down in the body (pharmacokinetics) and how it works (pharmacodynamics).

In cardiology, this means that when prescribing medication, the principles of Gender medicine must be observed:

Dosage: Due to their often lower weight and different metabolism, women may need a lower dose of certain medications to achieve the same effect with fewer side effects.
Side effects: With some medications, e.g. certain diuretics or ACE inhibitors, women report side effects more frequently. A gender-sensitive approach takes these reports seriously and actively looks for more tolerable alternatives.
Hormonal status: The female hormonal cycle or the menopause can influence the effect of cardiovascular drugs.

Our approach: How we integrate gender medicine into treatment

In our practice Gender medicine is not a theoretical concept, but part of everyday life. Dr. Raphael Bruno and his team are aware of gender-specific differences and integrate this knowledge into every step of patient care.

Attentive anamnesis: We listen carefully and also take „atypical“ complaints, which are more common in women, seriously and classify them correctly.
Differentiated diagnostics: We know that an inconspicuous exercise ECG or an inconspicuous cardiac catheterization in women does not always rule out heart disease with certainty, and consider further diagnostics if necessary.
Individualized therapy: We adapt the drug therapy not only to the clinical picture, but also to the patient's gender, age and concomitant illnesses in order to achieve the best efficacy with the lowest rate of side effects.

This approach enables more precise and therefore better medicine for everyone.

Frequently asked questions about gender medicine

Here we answer frequently asked questions about this important and modern field of medicine.

Is gender medicine the same as gynecology?

No, not at all. Gynecology is the specialty that deals with the female reproductive organs and obstetrics. The Gender medicine is a cross-sectional subject that deals with gender differences in all medical disciplines - from cardiology to oncology and neurology.

Do men also benefit from gender medicine?

Yes, absolutely. Gender medicine does not just mean „medicine for women“. It also uncovers diseases that are more common or different in men (e.g. abdominal aortic aneurysm), or investigates why men have a poorer prognosis for certain diseases. It is about a more precise consideration of all genders.

Why has medicine been dominated by male subjects for so long?

There are historical reasons for this. For a long time, women of childbearing age were systematically excluded from clinical trials out of concern about possible influences on pregnancy. It was also wrongly assumed that the results of male test subjects could simply be transferred to women. The Gender medicine is working to close this knowledge gap.

How do hormones such as oestrogen affect the heart?

The female sex hormone oestrogen has a protective effect on the blood vessels. It keeps them elastic and has a positive effect on blood lipid levels. This natural protection is lost after the menopause, which is why the risk of cardiovascular disease in women increases rapidly thereafter and even overtakes that of men.

Are the standard values in the laboratory always the same for men and women?

No. There are different standard ranges for many laboratory values. A well-known example from cardiology is cardiac troponin, a marker for a heart attack. Here, lower limit values apply to women, as they often release lower quantities of this protein in the event of a heart attack. The application of gender-specific threshold values is an important aspect of the Gender medicine.

I am a woman and have classic chest pain. Is that possible?

Yes, of course. The Gender medicine works with statistical frequencies, not with rigid rules. The „classic“ pain of destruction in the chest is also an absolutely serious heart attack symptom in women. It is important to emphasize that other, „atypical“ symptoms can also be present in women.

Does gender medicine change with age?

Yes, while hormones play a major role in younger women, many risk profiles adapt to those of men after the menopause. Nevertheless, certain differences, e.g. in anatomy or metabolism, remain throughout life and must be taken into account in diagnostics and therapy.

Are there also differences in healthy ageing?

Yes, women live longer on average, but suffer more frequently in old age from chronic, non-fatal illnesses that impair their quality of life. Men have a higher risk of dying earlier from serious events such as a heart attack. The preventive approaches of the Gender medicine take these different processes into account.

Is gender medicine a recognized scientific discipline?

Yes, gender-sensitive medicine is now an established field of medical research and teaching. There are numerous chairs and institutes around the world that deal with this topic, and the findings are increasingly being incorporated into official medical treatment guidelines.

As a patient, where can I find reliable information on gender medicine?

Reputable sources include university hospitals with relevant institutes, the German Society for Gender-Specific Medicine (DGesGM) and patient-oriented information from foundations such as the German Heart Foundation, which are increasingly providing information on this important topic. And, of course, by talking to your doctor, who is sensitized to this topic.

Personalized medicine that sees you as an individual

The consideration of the findings from the Gender medicine for us is an expression of respect for the individuality of each patient. It is a decisive step away from „one-size-fits-all“ medicine towards truly personalized care. At our practice, you can be sure that we will assess your symptoms and findings in the context that is relevant to you in order to provide you with the best possible treatment.