Women's health

What is different for women#

Women live longer than men, 81.4 versus 76.5 years in the US in 2024, but spend more of those years in poor health: across 183 countries, the gap between lifespan and healthy lifespan was 2.4 years wider for women. Much of medicine was built on data from men; women were only 38.2% of participants in cardiovascular trials from 2010 to 2017.

Heart disease and pregnancy history#

An under-recognized killer#

Heart disease killed 304,970 US women in 2023, about 1 in 5 female deaths, and a woman's lifetime risk of coronary disease at 40 is about 1 in 3. Yet in AHA surveys, the share of women who knew it was their leading cause of death fell from 65% in 2009 to 44% in 2019, with the steepest drops among younger, Hispanic, and Black women.

Women are also treated less aggressively. In a national registry of 5,693 adults who qualified for a statin, women were less likely than men to be prescribed one (67.0% vs 78.4%) and more likely never to have been offered one. Their heart attack symptoms more often include nausea and breathlessness (warning symptoms). The optimal heart plan (low ApoB, blood pressure under 120/80, Lp(a) measured once) is the same for both sexes and lives in Heart and blood vessels. What is specific to women is a set of risk factors that calculators leave out.

Women-specific risk enhancers#

Risk enhancers raise risk beyond what a calculator such as PREVENT estimates. The 2026 ACC/AHA cholesterol guideline names preeclampsia, gestational hypertension, gestational diabetes, preterm delivery, menopause before 40 or 45, PCOS, and chronic inflammatory disease.

These links are observational, but strong and consistent enough that the AHA calls a history of pregnancy complications a prompt for "more vigorous" prevention Strong.

The optimal approach Moderate: treat any of these like a family history of early heart disease. Measure ApoB, blood pressure, and HbA1c every year from your 20s or 30s, ask for your 30-year PREVENT risk (risk calculators), set a lower bar for starting a statin (when to start treatment), and get your first coronary calcium scan by 45, or around 40 if you also have high Lp(a), diabetes, or a strong family history. Guideline minimum: the 2026 guideline asks clinicians to record them and weigh them in statin discussions.

Pregnancy as a lifelong risk signal#

How your body handles pregnancy is an early readout of future risk. Hypertensive disorders appeared in 13.3% to 15.9% of US delivery hospitalizations from 2017 to 2019. In 2.2 million Swedish mothers, five common complications all raised ischemic heart disease for up to 46 years, only partly explained by family factors, and three or more complications meant 2.3 times the risk in the first decade.

The optimal plan if you have been pregnant:

1. Write down your history and give it to every clinician: preeclampsia, gestational hypertension or diabetes, delivery before 37 weeks, a small baby, placental abruption, or pregnancy loss, all on the AHA's list. The AHA flags the handoff from obstetric to primary care as a weak point.
2. After high blood pressure in pregnancy, take a week of home blood pressure readings every 3 months, aim for under 120/80, and get yearly ApoB and HbA1c.
3. After gestational diabetes, the ADA recommends a 75-gram glucose tolerance test 4 to 12 weeks after delivery, then screening for life every 1 to 3 years Moderate; optimal is a yearly HbA1c. With prediabetes, intensive lifestyle change or metformin cut progression by 35% and 40% over 10 years Strong (prediabetes).
4. Breastfeed if you can and want to. The ADA recommends it after gestational diabetes partly for a lower later risk of type 2 diabetes Moderate.
5. In a future pregnancy at high risk of preeclampsia, the USPSTF recommends 81 mg of aspirin a day after 12 weeks (grade B) Strong. Tdap is in infections and perinatal depression screening in mind.

PCOS and endometriosis#

Diagnosing PCOS#

Polycystic ovary syndrome affects 10% to 13% of women, and the WHO estimates that up to 70% are undiagnosed. In May 2026 a global consensus renamed it polyendocrine metabolic ovarian syndrome (PMOS), because the "cysts" are paused follicles and the condition reaches well beyond the ovaries. As of October 2026, the criteria are unchanged.

The 2023 international guideline, backed by the Endocrine Society, ASRM, and ESHRE, diagnoses adults with two of three features, after ruling out causes such as thyroid disease or high prolactin:

Ultrasound and AMH are not used for teenagers, for whom there are no reliable criteria.

Metabolic risk in PCOS#

The guideline says women with PCOS have a higher risk of type 2 diabetes "regardless of age and BMI", should be considered at increased cardiovascular risk, and have a markedly higher risk of endometrial cancer before menopause, when long gaps between periods let the uterine lining build up. Sleep apnea, depression, anxiety, and eating disorders are also more common.

The optimal plan Moderate builds on the guideline's schedule:

• A 75-gram glucose tolerance test at diagnosis and every 1 to 3 years (the guideline prefers it because HbA1c misses cases), with a yearly HbA1c between.
• ApoB and lipids every year (the guideline minimum is at diagnosis), and yearly blood pressure.
• Screening for depression and anxiety, and for sleep apnea if you snore.
• Treatment matched to your goals: the combined pill for irregular cycles and excess hair, metformin with a BMI of 25 or more, and GLP-1 drugs plus lifestyle change for excess weight, all options the guideline lists.

Endometriosis#

Endometriosis is tissue like the uterine lining growing outside the uterus, causing inflammation, pain, and scarring. It affects about 10% of reproductive-age women, roughly 190 million, and diagnosis takes 4 to 12 years on average. Symptoms include severe period pain, pain with sex, chronic pelvic pain, heavy bleeding, bloating, and trouble conceiving. Period pain that keeps you home is not normal.

The 2022 ESHRE guideline dropped surgery as the diagnostic gold standard: clinicians should use ultrasound or MRI, ideally read by someone experienced, and may start hormonal treatment without surgery, though negative imaging does not rule it out. For pain, combined hormonal contraceptives, progestins, a hormonal IUD, or an implant are recommended Strong, with GnRH drugs second because of side effects. Endometriosis is not linked to more cancer overall, and ESHRE advises no extra screening. It is linked to 62% more coronary disease, partly through earlier hysterectomy and ovary removal, so count it as a heart risk enhancer Moderate.

Contraception and long-term health#

The overall cancer balance of the pill is neutral to favorable: in a UK study of 46,022 women followed for up to 44 years, ever-users had less colorectal, endometrial, ovarian, and blood cancer, a small rise in breast and cervical cancer that faded within about 5 years of stopping, and no new risks later in life Strong.

The CDC's 2024 eligibility criteria rate estrogen-containing methods an unacceptable risk with migraine with aura, smoking 15 or more cigarettes a day at 35 or older, blood pressure of 160/100 or higher, or a past blood clot with ongoing risk; progestin-only methods and IUDs usually remain options. Mood matters too: in over 1 million Danish women, combined pill users were 23% more likely to start an antidepressant, an observational link. If your mood drops on a method, switch.

Fertility and egg freezing#

How fertility changes with age#

Female fertility declines gradually from about 32 and more rapidly after 37, according to ACOG and ASRM, as egg numbers fall and more eggs carry chromosome errors. They advise an evaluation after 6 months of trying if you are over 35, and right away over 40. Both partners should be tested; see Men's health.

The optimal approach Moderate: if you might want children, have a fertility planning conversation by your early 30s. Cover your timeline, cycle regularity, PCOS or endometriosis symptoms, and whether egg freezing fits. If you could become pregnant, take 0.4 to 0.8 mg of folic acid a day (USPSTF grade A) Strong.

What AMH can and cannot tell you#

Anti-Müllerian hormone (AMH) is made by small ovarian follicles and tracks how many eggs remain. ASRM's 2020 opinion is that it predicts how many eggs a stimulation will yield but is a poor predictor of reproductive potential apart from age Strong. In 750 women aged 30 to 44 who had just started trying, those with a low AMH (under 0.7 ng/mL) were just as likely to conceive within 6 cycles (65% vs 62%) and 12 cycles (84% vs 75%). Use AMH to plan egg freezing or IVF. A low result is not a fertility verdict, and a normal one does not buy time.

Egg freezing by age#

Egg freezing uses hormone injections to mature several eggs, which are retrieved under sedation and frozen. ASRM says planned freezing is most likely to succeed before 38, that each frozen egg has about a 2% to 12% chance of becoming a baby, and that nothing is guaranteed; its 2021 guideline found insufficient evidence to predict birth rates precisely.

Source: a 2017 counseling model built from IVF patients, not from women who returned for frozen eggs. In 231 women who froze at one New York center at an average age of 38, banking about 10 mature eggs per retrieval, only 38.1% had used them 10 to 15 years later, and 33.8% of those with a final outcome had a baby. Freezing in your early to mid-30s is a reasonable personal choice Moderate, best bought early.

Pelvic floor health#

The pelvic floor is the sling of muscles supporting the bladder, uterus, and bowel. In a US exam survey, 23.7% of women had a pelvic floor disorder (15.7% moderate to severe urinary leakage, 9.0% fecal leakage, 2.9% prolapse), rising from 9.7% at 20 to 39 to 49.7% at 80 and older, and with each birth. About one-third of women leak urine after childbirth, and lifetime risk of surgery for incontinence or prolapse is 20% by 80. Stress incontinence comes with coughing, sneezing, or jumping; urgency incontinence is a sudden need you cannot hold.

Training also prevents leakage: in continent pregnant women it cut incontinence by 62% in late pregnancy and 29% at 3 to 6 months after birth Moderate.

The optimal approach: see a pelvic floor physical therapist after childbirth, or at the first sign of leakage, pressure, or pain with sex, rather than waiting years. A therapist checks that you are using the right muscles. Guideline minimum: the ACP recommends training as first-line treatment once you have stress incontinence.

Midlife: menopause, bone, and breasts#

Perimenopause basics#

The average US age of menopause is 52, and the transition usually begins between 45 and 55. Plan by your early to mid-40s: put symptoms, bone density, blood pressure, and ApoB on your yearly agenda. Hormone therapy is reasonable for symptoms and bone protection under 60 or within 10 years of menopause; the USPSTF's grade D applies only to preventing chronic disease. Details are in planning ahead. The AHA calls the transition a time of accelerating cardiovascular risk, with rising LDL and more abdominal fat, so recheck ApoB after your final period.

Bone loss around menopause#

In the SWAN study, bone loss began about a year before the final period and was fastest until two years after. Over 10 years, women lost 10.6% of spine density and 9.1% at the hip, most of it in those three years.

The optimal DEXA plan Weak:

1. A baseline hip and spine DEXA in your 40s, before or early in the transition. This goes beyond guidelines, but it shows your reserve before the fast loss begins and informs the hormone therapy decision (who should be screened).
2. Repeat by result (how often to repeat): a normal scan again in 3 to 5 years and early in menopause, every 2 years from 65, and every year with a T-score of −2.0 to −2.5, when about 10% of older women reached osteoporosis within a year.
3. Load your bones with heavy lifting and impact work (building and keeping bone, women and bone). A body-composition DEXA every 1 to 2 years can track muscle and visceral fat alongside.

Guideline minimum: the USPSTF recommends DEXA at 65, or earlier after menopause if a risk tool shows elevated risk.

Breast density and screening#

Nearly half of women 40 and older who get mammograms have dense breasts, which hide cancers and raise risk; your report says whether yours are. The optimal plan, in breast cancer screening, is a risk assessment by 25, a yearly mammogram from 40, and yearly supplemental MRI if dense. Alcohol is a modifiable breast cancer risk (alcohol).

Iron, autoimmunity, and research gaps#

Iron deficiency#

Iron deficiency often goes unnoticed because hemoglobin can stay normal while stores run low. In US data from 2003 to 2020, 38.6% of females aged 12 to 21 were iron deficient (ferritin under 25 ng/mL) and 6.3% had anemia. In US women, hemoglobin starts to fall once ferritin, the stored-iron test, drops below about 25 ng/mL, well above the WHO's older cutoff of 15. Risk rises with heavy periods, pregnancy, plant-based diets, endurance training, and blood donation. Heavy bleeding means a period longer than 8 days, soaking a pad or tampon every 1 to 2 hours, or clots larger than a quarter, and deserves evaluation.

The optimal approach Moderate: ferritin with a blood count every year while you menstruate, sooner with heavy periods, before pregnancy, or with fatigue or restless legs. Find the cause of a low result, and do not take iron without testing (blood tests). Guideline minimum: the CDC advises an anemia check every 5 to 10 years, which misses deficiency without anemia.

Autoimmune disease#

In 22 million UK patients, 19 autoimmune diseases, in which the immune system attacks the body's own tissue, affected 10.2% of people (13.1% of women, 7.4% of men), and 64% of new diagnoses were in women. No screening test is recommended without symptoms, so act on clues: joint swelling, rashes, dry eyes and mouth, unexplained fatigue or weight change, and family history (thyroid, celiac). In the VITAL trial of 25,871 older adults, vitamin D at 2,000 IU a day lowered autoimmune disease by 22% Moderate (Supplements).

Women in clinical trials#

Federal law requires NIH-funded research to include women and analyze results by sex in large Phase III trials, but women remain underrepresented in coronary, heart failure, and arrhythmia trials. Women also have adverse drug reactions nearly twice as often; in 86 drugs, 76 reached higher blood levels in women, which predicted the extra side effects. Ask whether a dose was studied in women, and report side effects early, including with drugs aimed at aging, several of which extended life only in male mice (the ITP results).

Your prevention timeline#

Each row adds to the basics for everyone: strength and aerobic training, no tobacco, little or no alcohol, good sleep, and a yearly visit (Building your care team).

Action plan#