Introduction Description: Migraine headaches are recurrent severe headaches that last for 4–72 hours and are accompanied by neurologic, gastrointestinal, and autonomic changes. These may or may not be preceded by a characteristic aura. Prevalence: Migraine headaches affect 15%–20% of women in the reproductive age. Approximately 10% of tension headache sufferers also have migraine headaches. Predominant Age: Migraine headaches—ages 25–55 years (peak, 30–49 years), first attack generally…

Introduction Description: Tension headache, now called tension-type headache, is the most common form of headache and is caused by abnormal neuronal sensitivity and pain facilitation and/or contracted muscles of the neck and scalp. Cluster headaches are a type of recurrent headache that are characterized as unilateral and “stabbing” and are associated with symptoms of histamine release such as nasal stuffiness, lacrimation, facial sweating, or eyelid edema.…

Introduction Description: Patients often experience hair loss in the early stages of pregnancy, in the immediate postpartum period, or in the postmenopausal years. For some, this may be of sufficient volume to cause concern or cosmetic problems. “Female-pattern hair loss” is the preferred term for hair loss in women. Prevalence: Of all postmenopausal women, 37% have some hair loss. Loss of hair at 1–2 months after…

Introduction Description: The reflux of gastric acid to the sensitive esophagus causing heartburn, the cardinal manifestation of gastroesophageal reflux disease (GERD). Prevalence: Common (10%–25% of adults in the United States). Predominant Age: Generally reproductive and beyond. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: The most common cause is decreased tone of the lower esophageal sphincter (LES). This is complicated in pregnant patients by the reduced…

Introduction Description: Gastritis is an inflammatory condition that affects the stomach lining and results in acute or chronic indigestion, bloating, “gas,” and heartburn. Gastropathy (noninflammatory) is usually caused by irritants such as drugs (eg, nonsteroidal antiinflammatory agents), alcohol, bile, circulatory failure, or chronic congestion. Prevalence: Common. Predominant Age: Any. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Generalized inflammation of the stomach lining, which in some…

Introduction Description: Any diseases that involve the gallbladder, most commonly because of the formation of cholesterol stones. Obstruction can result in either acute or chronic cholecystitis, leading to serious, sometimes life-threatening complications such as a gallbladder rupture. Approximately 20% of patients with acute cholecystitis develop infection. Acalculous gallbladder disease or biliary dyskinesia (functional gallbladder disorder) occurs without the presence of gallstones. Sclerosing cholangitis has an unknown…

Introduction Description: Fibromyalgia presents with chronic, widespread musculoskeletal pain, accompanied by fatigue, cognitive disturbance, psychiatric symptoms, and multiple somatic symptoms. Fibromyalgia is often associated with other conditions that may cause musculoskeletal pain, disruption of sleep, or psychiatric symptoms. Prevalence: 1.75%–5% of the population, increases with age. Predominant Age: 20–55 years. The most common cause of generalized, musculoskeletal pain in women of this age. Genetics: A number…

Introduction Description: Anorexia nervosa is a syndrome characterized by an altered body image, significant weight loss, and amenorrhea that are not caused by physical disease. Bulimia is an eating disorder characterized by an altered body image and recurrent binge eating, with or without purging, through self-induced vomiting, laxative abuse, or diuretics. Exercise excess is often a part of after-binge behavior. Both affect more women than men.…

Introduction Description: Dysuria is the painful passage of urine (symptom, not diagnosis). Prevalence: Common in women; 10%–20% of women per year. One-third of women during their lifetime. Predominant Age: Any increases with age. Genetics: No genetic pattern. Etiology and Pathogenesis Causes: Infection and inflammation in the urethra and suburethral tissues. (Inflammation of the bladder causes urgency; inflammation of the urethra causes dysuria.) Most urinary tract infections…

Introduction Description: Abdominal, pelvic, or vaginal pain that arises during sexual thrusting, especially with deep penetration. Prevalence: Approximately 15% of women each year (severe—less than 2% of women). Predominant Age: Reproductive age and beyond. Genetics: No genetic pattern. Etiology and Pathogenesis Causes Gynecologic —extrauterine (adhesions, chronic pelvic infection, cysts, endometriosis, pelvic relaxation [cystocele, urethrocele, rectocele, enterocele], prolapsed adnexa or adnexa adherent to vaginal apex, retained ovary…

Introduction Description: Primary dysmenorrhea is painful menstruation without a clinically identifiable cause. Secondary dysmenorrhea is recurrent menstrual pain resulting from a clinically identifiable cause or abnormality. Prevalence: Of all women, 10%–15% are unable to function because of pain; 90% have discomfort with at least one cycle. Predominant Age: Late teens to early 30s (primary), prevalence follows the occurrence of underlying conditions for secondary dysmenorrhea. Dysmenorrhea that…

Introduction Description: Domestic violence (domestic abuse) is a pattern of behavior that involves violence or other abuse by one person against another in a home or family setting. It may include physical, verbal, emotional, economic, and sexual abuse, which can range from subtle, coercive forms, to overt acts (see Chapter 19 , Abuse: Physical and Sexual). Prevalence: Over 32 million women in the United States have…

Introduction Description: Diverticular disease involves the herniation of the colonic mucosa through the muscular wall. These herniations are most common in the sigmoid and distal colon, increase in prevalence with age, and can lead to significant morbidity when rupture or abscess formation occurs. Diverticulosis is the presence of these herniations, whereas diverticulitis is the symptomatic state. Prevalence: 20% of patients, increasing with age to 40%–50% by…

Introduction Description: Depression is a biochemically mediated state in which anger, frustration, loss of pleasure, discouragement or hopelessness, and withdrawal predominate. This must be separated from normal stress reactions and grief. The term may be used to describe a mood state, syndrome, or mental disorder. Prevalence: Twenty million American adults per year; one in six to eight lifetime risk; 6%–14% of primary care visits; 2:1 female-to-male…

Introduction Description: An idiopathic inflammatory bowel disease characterized by transmural involvement resulting in severe gastrointestinal symptoms and significant morbidity. Prevalence: 2–10/10,000 people, slightly more women than men. Predominant Age: 15–30 years. Genetics: First-degree relative for 20% of patients; more common in Whites and Jewish population. Significant associations with NOD2/CARD15 variants. Etiology And Pathogenesis Causes: The inflammatory process in Crohn disease is transmural and involves both the…

Introduction Description: Constipation is the infrequent passage of hard stools, often associated with mechanical or other means to stimulate bowel movements. It is often also related to changes in the size, consistency, and ease of bowel movement in the subjective definition of constipation. Prevalence: Very common as a sporadic problem; 8%–10% of women. Predominant Age: Any; more common in youth and old age. Genetics: No genetic…

Introduction Description: Chronic pelvic pain has been defined as noncyclic pain of 6 or more months’ duration that localizes to the anatomic pelvis, anterior abdominal wall at or below the umbilicus, lumbosacral back, or buttocks and is of sufficient severity to cause functional disability or lead to medical care. It is often associated with negative cognitive, behavioral, sexual, and emotional consequences. Chronic pelvic pain can be…

Introduction Description: Cholelithiasis is the formation of stones in the gallbladder or biliary collecting system. Most stones (80%) are the result of precipitation of supersaturated cholesterol. Prevalence: 9% of women; 1 million cases per year. Predominant Age: 70% of patients are older than 40 years. Genetics: Ratio of women to men is 3:1; some races at greater risk (eg, Pima Indians). Pigment gallstones affect men and…

Introduction Description: Disease and dysfunction of the heart and vascular system, including coronary heart disease (CHD, 30%–50% of cases), atherosclerosis, heart failure, hypertension, cardiomyopathy, aneurysm, and stroke. Prevalence: Cardiovascular disease (CVD) is the number one killer of American women—annual deaths from CVD are 10-fold those of breast cancer. It is estimated that 48% of persons ≥20 years of age in the United States have early-stage CVD.…

Introduction Description: Asthma (from the Greek for “panting”) is an intermittent or chronic obstructive tracheobronchial condition that is characterized by wheezing or cough. Adult-onset asthma is more common in women and poses potential problems during pregnancy. Prevalence: 7% of the United States population, 4%–8% of pregnancies. Predominant Age: Adults aged 16–40 years (50% of patients are younger than 10 years). Genetics: Familial association with reactive airway…