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Female predominant diseases
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Many [[Immune system|immunological]] and [[Nervous system|neurological]] diseases disproportionately affect women. == Epidemiology == Roughly 80% of patients with [[autoimmune disease]] are women.<ref name="Fairweather2004">{{Cite journal | title = Women and Autoimmune Diseases1 | date =Nov 2004| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3328995/|journal=Emerging Infectious Diseases|volume=10|issue=11 | pages = 2005–2011 | last = Fairweather | first = DeLisa | author-link = | last2 = Rose | first2 = Noel R. | authorlink2 = |doi=10.3201/eid1011.040367|pmc=3328995|pmid=15550215|access-date=|issn=1080-6040|quote=|via=}}</ref> Over the last decades, the ratio of women to men with [[Multiple sclerosis|MS]] has increased markedly, representing a true increase in MS among women but not men.<ref name="Harbo2013">{{Cite journal | title = Sex and gender issues in multiple sclerosis | date = Sep 2013| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3707353/|journal=Therapeutic Advances in Neurological Disorders|volume=6|issue=4 | pages = 237–248 | last = Harbo | first = Hanne F. | author-link = | last2 = Gold | first2 = Ralf | authorlink2 = | last3 = Tintoré | first3 = Mar | authorlink3 = |doi=10.1177/1756285613488434|pmc=3707353|pmid=23858327|access-date=|issn=1756-2856|quote=|via=}}</ref> [[ME/CFS]] and most autoimmune diseases are more common in women and both are characterized by increased [[inflammation]].<ref name="CDC-causes">{{Cite web | url = https://www.cdc.gov/me-cfs/about/possible-causes.html | title = Possible Causes {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | last = | first = | authorlink = | date = 2019-01-18 | website = [[Centers for Disease Control and Prevention]]|at=Immune System Changes|language=en-us|archive-url=|archive-date=|url-status=|access-date=2019-04-13}}</ref> == Mechanisms == === Immune system === '''Summary of sex differences in innate and adaptive immune responses'''<ref name="Klein2016">{{Cite journal | title = Sex differences in immune responses | date = Oct 2016| url = https://www.nature.com/articles/nri.2016.90|journal=Nature Reviews. Immunology|volume=16|issue=10 | pages = 626–638 | last = Klein | first = Sabra L. | author-link = | last2 = Flanagan | first2 = Katie L. | authorlink2 = |doi=10.1038/nri.2016.90|pmc=|pmid=27546235|access-date=|issn=1474-1741|quote=|via=}}</ref> {| class="wikitable mw-collapsible mw-collapsed" !Immune component !Characteristic !In Females (relative to males) |- |'''Innate immune system''' | | |- |[[Toll-like receptor]] (TLR) pathways |[[TLR pathway]] gene expression |Higher |- | |[[Toll-like receptor 7|TLR7]] expression |Higher |- | |[[Interleukin 10]] (IL10) production by [[Toll-like receptor 9|TLR9]]-stimulated [[peripheral blood mononuclear cell]] |Lower |- |[[antigen-presenting cell]]s (APCs) |APC efficiency |Higher |- |[[Dendritic cell]]s |[[Toll-like receptor 7|TLR7]] activity |Higher |- |[[Macrophage]]s |[[Toll-like receptor 4|TLR4]] expression |Lower |- | |Activation |Higher |- | |[[Phagocytic capacity]] |Higher |- | |Pro-inflammatory [[cytokine]] production |Lower |- | |[[Interleukin 10|IL10]] production |Higher |- |[[Neutrophil|Neutrophils]] |[[Phagocytic capacity]] |Higher |- | |[[Toll-like receptor|TLR]] expression |Lower |- |[[Natural killer cell|Natural killer cells]] |NK cell numbers |Lower |- |'''Adaptive immune system''' | | |- |[[Thymus]] |Size of thymus |Smaller |- |[[T cell]]s |[[CD4]] T cell counts |Higher |- | |[[CD4]]/[[CD8]] T cell ratio |Higher |- | |[[CD8]] T cell counts |Lower |- | |Number of activated T cells |Higher |- | |[[T cell]] proliferation |Higher |- | |[[Cytotoxic T cell]] |Increased activity |- | |[[Th1]] versus [[Th2]] cell bias |Th2 cell bias in females, Th1 cell bias in males |- | |[[Regulatory T cell]] numbers |Lower |- |[[B cell]] |B cell numbers |Increased |- | [[Immunoglobulin]]s | Antibody production |Higher |} === Hormones === Women with these diseases may experiencing a worsening of symptoms at specific points in their [[menstrual cycle]], particularly just before or around their periods.<ref name="Zierau2012">{{Cite journal | title = Role of female sex hormones, estradiol and progesterone, in mast cell behavior | date = 2012-06-19| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377947/|journal=Frontiers in Immunology|volume=3 | pages = 169 | last = Zierau | first = Oliver | last2 = Zenclussen | first2 = Ana C. | last3 = Jensen | first3 = Federico|doi=10.3389/fimmu.2012.00169|pmc=3377947|pmid=22723800|issn=1664-3224}}</ref> [[Estradiol]] and [[progesterone]] induce [[mast cell]] maturation and degranulation,<ref name="Zierau2012" /> which may contribute to the symptoms of a wide range of allergic and mast cell-mediated diseases. === Genetics === == Diseases == === Asthma === In humans, a much higher [[asthma]] prevalence was found in women at reproductive age as compared to men. Serum levels of [[estradiol]] and [[progesterone]] have been directly correlated with the clinical and functional features of asthma. Around 30–40% of women with asthma experience a worsening of symptoms near their period. Postmenopausal women receiving hormone replacement therapy have an increased risk of new onset of asthma.<ref name="Zierau2012" /> == Social impact == === Treatment options === === Research funding === === Stigma === Men and women with these diseases are at risk of [[Stigma|stigmatization]], dismissal, minimization and [[psychologization]] of their symptoms.<ref name="Goudsmit1993">{{Cite journal | journal = Health Psychology Update | url =https://books.google.co.uk/books?hl=en&lr=&id=E1afUMVG0VEC&oi=fnd&pg=PA7 | title = All in her mind! Stereotypic views and the psychologisation of women's illness | last = Goudsmit | first = Ellen M | date = 1993|volume=12 | pages = 28-32|language=en|quote= | author-link = Ellen Goudsmit|issue=|doi=|pmc=|pmid=|access-date=|via=}}</ref> == List of diseases == Below, a list of diseases that predominately affect females. {| class="wikitable sortable mw-collapsible mw-expanded" !Conditions !% female !Ratio (F:M) !US prevalence !NIH funding !NIH funding per patient |- ! colspan="6" scope="colgroup" | '''Neurological diseases''' |- |[[Alzheimer's disease]] |65% | |5,000,000 | | |- |[[Empty sella syndrome]] | |5:1<ref name="Aruna2014">{{Cite journal | title = Partial Empty Sella Syndrome: A Case Report and Review | date = Apr 2014| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990803/|journal=Indian Journal of Clinical Biochemistry|volume=29|issue=2 | pages = 253–256 | last = Aruna | first = P. | author-link = | last2 = Sowjanya | first2 = B. | authorlink2 = | last3 = Reddy | first3 = P. Amaresh | authorlink3 = | last4 = Krishnamma | first4 = M. | authorlink4 = | last5 = Naidu | first5 = J. N. | authorlink5 = |doi=10.1007/s12291-013-0369-1|pmc=3990803|pmid=24757313|access-date=|issn=0970-1915|quote=|via=}}</ref> | | | |- |[[Idiopathic intracranial hypertension]] | | | | | |- |[[Migraine]]<ref name="Vos2015" /> | | | | | |- |[[Myalgic encephalomyelitis|Myalgic Encephalomyelitis]]/[[Chronic fatigue syndrome]] |60-66%<ref name="Lim2020">{{Cite journal | title = Systematic review and meta-analysis of the prevalence of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) | date = 2020-02-24| url = https://doi.org/10.1186/s12967-020-02269-0|journal=Journal of Translational Medicine|volume=18|issue=1 | pages = 100 | last = Lim | first = Eun-Jin | last2 = Ahn | first2 = Yo-Chan | last3 = Jang | first3 = Eun-Su | last4 = Lee | first4 = Si-Woo | last5 = Lee | first5 = Su-Hwa | last6 = Son | first6 = Chang-Gue|doi=10.1186/s12967-020-02269-0|pmc=PMC7038594|pmid=32093722|issn=1479-5876}}</ref> |1.5:1 to 2:1<ref name="Lim2020" /> up to 4:1 (CDC)<ref name="CDC-epidemiology">{{Cite web | url = https://www.cdc.gov/me-cfs/healthcare-providers/presentation-clinical-course/epidemiology.html | title = Possible Causes {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) | last = | first = | authorlink = | date = 2022-01-21 | website = [[Centers for Disease Control and Prevention]]|at=Immune System Changes|language=en-us|archive-url=|archive-date=|url-status=|access-date=2022-02-01}}</ref> | | | |- |[[Multiple sclerosis]] | |1.8:1 to 4:1<ref name="Jorgensen2012" /><ref name="MS-who">{{Cite web | url = https://www.nationalmssociety.org/What-is-MS/Who-Gets-MS | title = Who Gets MS? (Epidemiology) | last = | first = | date = |website=National Multiple Sclerosis Society|archive-url=|archive-date=|url-status=|access-date=}}</ref><ref name="Vos2015">{{Cite journal | last = Vos | first = Theo | last2 = Feigin | first2 = Valery | last3 = Degenhardt | first3 = Louisa | last4 = Ferrari | first4 = Alize J. | last5 = Whiteford | first5 = Harvey A. | date = 2015-02-06 | title = The Global Burden of Mental, Neurological and Substance Use Disorders: An Analysis from the Global Burden of Disease Study 2010| url = https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0116820|journal=PLOS ONE|language=en|volume=10|issue=2| pages = e0116820|doi=10.1371/journal.pone.0116820|issn=1932-6203|pmc=4320057|pmid=25658103}}</ref> | | | |- |[[Postural orthostatic tachycardia syndrome]] (POTS) |80-85%<ref name="Dysautonomiafacts">{{Cite web | url = http://www.dysautonomiainternational.org/page.php?ID=180 | title = 10 Facts Doctors Should Know About POTS | last = | first = | date = April 19, 2018 | website = Dysautonomia International|archive-url=|archive-date=|url-status=|access-date=}}</ref> | | | | |- ! colspan="6" scope="colgroup" | '''Endocrine diseases''' |- |[[Graves' disease]] | |5:1<ref name="Jorgensen2012">{{Cite journal | title = Childbirths and risk of female predominant and other autoimmune diseases in a population-based Danish cohort | date = May 2012| url = https://research.regionh.dk/files/36818048/J_rgensen_JAutoimmunity_2012_38_J81_Childbirths_and_risk_of_female_predominant_and_other_autoimmune_diseases_in_the_Danish_population.pdf | journal=Journal of Autoimmunity|volume=38|issue=2-3| pages=J81–87 | last = Jørgensen | first = Kristian Tore | authorlink = | last2 = Pedersen | first2 = Bo Vestergaard | authorlink2 = | last3 = Nielsen | first3 = Nete Munk | authorlink3 = | last4 = Jacobsen | first4 = Søren | authorlink4 = |doi=10.1016/j.jaut.2011.06.004|pmc=|pmid=21813263|access-date=|issn=1095-9157|quote=|via=}}</ref> | | | |- |[[Hashimoto's thyroiditis (hypothyroidism)|Hashimoto's thyroditis]] | |8:1<ref name="Jorgensen2012" /> | | | |- ! colspan="6" scope="colgroup" | '''Rheumatological diseases''' |- |[[Fibromyalgia]] | |7:1 [[Fibromyalgia#1990 ACR criteria|ACR 1990 Criteria]] and 2:1 [[Fibromyalgia#2010 ACR criteria|ACR 2010 Criteria]]<ref name="fibro-medscape">{{Cite web | date = 2021-09-14 | title = Fibromyalgia: Practice Essentials, Background, Pathophysiology| url = https://emedicine.medscape.com/article/329838-overview#a5 | website = Medscape | first = Chad S | last = Boomershine|editor-first1 = Herbert S|editor-last1 = Diamond}}</ref> and CDC<ref name="FibroCDC" /> 1.5:1<ref name="Hauser2018">{{Cite journal | last = Häuser | first = Winfried | last2 = Rasker | first2 = Johannes J. | last3 = Perrot | first3 = Serge | last4 = Walitt | first4 = Brian | last5 = Wolfe | first5 = Frederick | authorlink5 = Frederick Wolfe | date = 2018-09-13 | title = Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias |url =https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203755|journal=PLOS ONE|language=en|volume=13|issue=9| pages = e0203755|doi=10.1371/journal.pone.0203755|issn=1932-6203|pmc=|pmid=30212526}}</ref> |4 million<ref name="FibroCDC">{{Cite web | url = https://www.cdc.gov/arthritis/basics/fibromyalgia.htm | title = Fibromyalgia {{!}} Arthritis | date = 2018-04-03 | website = [[Centers for Disease Control and Prevention]]|language=en-us|access-date=2022-02-01}}</ref> | | |- |[[Rheumatoid arthritis]] | |2.4:1<ref name="Jorgensen2012" /> | | | |- ! colspan="6" scope="colgroup" |'''Gastrointestinal diseases''' |- |[[Primary billary cirrhosis]] | |4:1<ref name="Jorgensen2012" /> | | | |- |[[Celiac disease]] (IBD) | |1.6:1<ref name="Jorgensen2012" /> | | | |- |[[Irritable bowel syndrome]] (IBS) |72%<ref name="Eijsbouts2021">{{Cite journal | title = Genome-wide analysis of 53,400 people with irritable bowel syndrome highlights shared genetic pathways with mood and anxiety disorders | date = Nov 2021| url = https://www.nature.com/articles/s41588-021-00950-8|journal=Nature Genetics|volume=53|issue=11 | pages = 1543–1552 | last = Eijsbouts | first = Chris | author-link = | last2 = Zheng | first2 = Tenghao | authorlink2 = | last3 = Kennedy | first3 = Nicholas A. | authorlink3 = | last4 = Bonfiglio | first4 = Ferdinando | authorlink4 = | last5 = Anderson | first5 = Carl A. | authorlink5 = | last6 = Moutsianas | first6 = Loukas | authorlink6 = | last7 = Holliday | first7 = Joanne | last8 = Shi | first8 = Jingchunzi | last9 = Shringarpure | first9 = Suyash | last10 = Voda | first10 = Alexandru-Ioan | last11 = Farrugia | first11 = Gianrico|language=en|doi=10.1038/s41588-021-00950-8|pmc=|pmid=|access-date=|issn=1546-1718|quote=|via=}}</ref> | | | | |- ! colspan="6" scope="colgroup" | '''Musculoskeletal diseases and disorders''' |- |[[Osteoporosis]] | | | | | |- ! colspan="6" scope="colgroup" | '''Systemic illnesses''' |- |[[Sjögren's syndrome]] | |7.5:1<ref name="Jorgensen2012" /> | | | |- |[[Systemic lupus erythematosus]] | |5.2:1<ref name="Jorgensen2012" /> 4:1 to 12:1 (CDC)<ref name="CDC-sle">{{Cite web | url = https://www.cdc.gov/lupus/facts/detailed.html | title = Systemic Lupus Erythematosus (SLE) {{!}} Lupus | last = | first = | authorlink = | date = October 17, 2018 | website = [[Centers for Disease Control and Prevention]]|language=en-us|archive-url=|archive-date=|url-status=|access-date=2022-02-01}}</ref> |161,000 to 322,000<ref name="WH-lupus">{{Cite web | url = https://www.womenshealth.gov/lupus/lupus-and-women | title = Lupus and women | last = | first = | authorlink = | date = | website = Office on Women's Health|archive-url=|archive-date=|url-status=|access-date=2022-02-01}}</ref> | | |- |[[Temporal arteritis]] (Giant cell arteritis) | |2.3:1<ref name="Jorgensen2012" /> | | | |- ! colspan="6" scope="colgroup" | '''Connective tissue disorders''' | | | | | |- |[[Ehler's Danlos Syndrome]] Type 3 (hypermobile type) | | | | | | |- |[[Systemic sclerosis]] | |3.7:1<ref name="Jorgensen2012" /> | | | |- ! colspan="6" scope="colgroup" | '''Mental health disorders''' |- | [[Anxiety|Anxiety disorders]]<ref name="Vos2015" /> | |1.2:1 to 3.2:1<ref name="WHO2009">{{Cite journal | title = Cross-National Associations Between Gender and Mental Disorders in the World Health Organization World Mental Health Surveys | date = 2009-07-01| url = https://doi.org/10.1001/archgenpsychiatry.2009.36|journal=Archives of General Psychiatry|volume=66|issue=7 | pages = 785–795 | last = Seedat | first = Soraya | last2 = Scott | first2 = Kate Margaret | last3 = Angermeyer | first3 = Matthias C. | last4 = Berglund | first4 = Patricia | last5 = Bromet | first5 = Evelyn J. | last6 = Brugha | first6 = Traolach S. | last7 = Demyttenaere | first7 = Koen | last8 = de Girolamo | first8 = Giovanni | last9 = Haro | first9 = Josep Maria | last10 = Jin | first10 = Robert | last11 = Karam | first11 = Elie G.|doi=10.1001/archgenpsychiatry.2009.36|issn=0003-990X}}</ref> | | | |- | [[Depression|Major depressive disorder]] (depression)<ref name="Vos2015" /> | |1.6:1 to 2.4:1<ref name="WHO2009" /> | | | |- | [[Functional neurological symptom disorder|Functional Neurological Disorder (FND)]] (Conversion disorder) | | | | | |- | [[Post-traumatic stress disorder]] (PTSD) | |1.3:1 to 6.4:1<ref name="WHO2009" /> | | | | |- ! colspan="6" scope="colgroup" | '''Other diagnoses''' |- |[[Asthma]] | |3:2 (adults), 7:9 (children, less predominant in girls)<ref name="asthmastacks">{{Cite web | url = https://stacks.cdc.gov/view/cdc/109086 | title = Asthma Surveillance — United States, 2006–2018 {{!}} MMWR Surveillance Summaries /70(5) | date = Sep 17, 2021 | website = [[Centers for Disease Control and Prevention]]|access-date=2022-02-01}}</ref> |24.8 million (current asthma) | | |- |[[Chronic lyme disease]] | | | | | |- |} == See also == * [[Autoimmune disease]] * [[Menstrual cycle]] * [[Menstrual problems in ME/CFS]] == Learn more == * [https://www.amazon.com/Doing-Harm-Medicine-Dismissed-Misdiagnosed/dp/0062470809 Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick] by [[Maya Dusenbery]] == References == {{Reflist}} [[Category:Triggers and risk factors]] [[Category:Core topics]] [[Category:Epidemiology]] [[Category:Ethics]]
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