The 47-year-old professional woman wasn't sleeping well. She was skipping menstrual periods and fighting the combined forces of anxiety and depression. By the time she was examined by reproductive endocrinologist Marian Damewood, she was taking Prozac and Xanax to manage her mood swings.
Like a lot of women in their 40s -- many of whom must deal with children, careers and their changing bodies -- the patient said she did not understand her symptoms, but couldn't afford to keep "losing it."
A simple blood test revealed that her symptoms were related to perimenopause -- the transitional years leading up to menopause. During this period, which often begins in the late 30s, hormonal changes can produce such physical effects as hot flashes, mood swings, headaches and irregular periods with uncharacteristically light or heavy bleeding.
With Damewood's help, the patient realized she didn't need Prozac or Xanax. She needed hormone replacement therapy. Too often, however, physicians attribute women's complaints to mental rather than physical causes.
Many women must seek help from several physicians before finding the right treatment for their health problems, says physician Susan Swedo, scientific director of the National Institutes of Mental Health.
Swedo and her colleague, psychiatrist Henrietta Leonard, wrote "It's Not All in Your Head" (HarperSanFrancisco, $25) to inform women about their most commonly misdiagnosed health problems. The book examines such conditions as depression and postpartum blues, chronic fatigue, headaches, PMS, anxiety and panic disorders. It lists the symptoms of various conditions, discusses what they can be mistaken for and explains treatments.
A chapter on attention deficit disorder, for instance, shows that the illness is far more common among adult women than previously recognized. ADD can cause lifelong difficulties with attention, concentration and organization. While girls with ADD must work twice as hard as their classmates to keep up, so must career women. Adults with ADD are often described as "spacey" and "disorganized" but usually do not show the motor hyperactivity associated with the disorder.
Another chapter examines such anxiety disorders as phobia, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder and generalized anxiety disorder. With an estimated 23 million people suffering from them, anxiety disorders have become the most common form of mental illness in the United States, according to the National Institutes for Mental Health.
Certain conditions, like panic disorder, affect more women than men. "One day, out of the blue, a person suddenly has chest pain, shortness of breath, numbness, tingling, dizziness, stomach disorder. She can get extremely panicky and go the emergency room where she is told her blood pressure is elevated, but her heart looks fine," says Una McCann, chief of the unit of anxiety disorders for NIMH.
"Unless the woman has a very savvy G.P., it's quite possible for this condition to be overlooked or for someone to say, 'It's stress anxiety.' And then it happens again. It's not uncommon for patients to make numerous trips to the emergency room."
"It's Not All in Your Head" is filled with similar tales of women's frustrating searches for help.
"One woman told us about searching for five years before she found a physician who correctly diagnosed her symptoms as coming from multiple sclerosis," Swedo says. "Another woman with fibromyalgia started trying to get help in her 40s and couldn't find it until she was in her 60s."
Damewood, who is medical director of the Women's Resource Center at Greater Baltimore Medical Center, says physicians often dismiss the concerns of women who are starting early menopause.
"There are subtle changes in estrogen levels, for instance, which can occur at night and lead to changes in sleep which increase irritability and anxiety," she says.
"When a woman is ovulating only two months out of the year, she may find herself in a continual state of PMS. Headaches and conditions like irritable bowel syndrome can also be exacerbated.
"It's important for women to get a hormonal assessment prior to just chalking off menopausal symptoms to anxiety. A good RTC number of the new patients I see in the 45 to 50 age group are on drugs like Prozac and Pamelor and Xanax. And very few of them have a major depressive illness."
Swedo and Leonard point out that many medical conditions can masquerade as psychiatric conditions. Vitamin deficiencies and viral infections, for instance, can cause symptoms identical to those found in common psychiatric disorders.
And they explain the growth of neuropsychiatry, a field that has torn down the scientific barriers between body and brain.
"What has been discovered in the past 10 years is that psychological disorders typically have a biological basis," Swedo says. "They have discovered that experience and relationships impact on the brain and the mind and change the way the brain works."
The book explains why someone who is suffering from anorexia, for instance, cannot simply "see" the wisdom of eating more.
"You can't truly control how your brain functions," Swedo says. "We think we can control our mood. But if you lose a parent or lose a job, you can go outside on a sunny bright day and it's not going to lift you out of that depression. It's the same thing when the depression is biologically-based."
Swedo says women can learn more about their health from such hospital-linked centers as the Women's Resource Center at GBMC that usually offer seminars, classes, support groups and physician referrals.
"There aren't enough women talking back to their doctors," she says. "Women need to move away from being victims to being partners in their health care."
The most commonly misdiagnosed conditions in women, according to the authors of "It's Not All in Your Head," include:
Panic disorder: Twice as common in women as in men, this condition is often mistaken for a heart attack because it can produce hot flashes, rapid heartbeat, nausea, shortness of breath, ligh-headness, dizziness and tingling in the hands and legs. It can be treated successfully by medication and by behavioral pschotherapy.
Thyroid disease: Decreased thyroid levels can often cause fatigue in women, especially those in their late 20s to early 40s. Often misdiagnosed as classic depression, hypothyroidism can also lead to depression, weakness, weight gain, constipation, inability to tolerate cold temperatures and thinning hair. Determined by a blood test and treated by hormone replacement.
Anemia: Fatigue is likely to be the only symptom of this condition. Women who have it may also be pale, and feel dizzy and weak. A blood test can determine anemia. Some of its causes include deficiencies in iron or zinc, a deficiency in B vitamins and an inherited form of anemia.
Other physical conditions that can cause classic symptoms of depression are:
Such endoctrine problems as diabetes or pituitary, adrenal or thyroid disorders.
Cancer, even before the diagnosis is made.
Infections, especially with virus like Epstein-Barr.
Neurological disorders, such as Parkinson's disease, Alzheimer's disease and strokes.
Such collagen vascular diseases as systemic lupus.
Deficiencies or excessive amounts of certain vitamins and minerals.
Susan Swedo and Henrietta Leonard, authors of "It's Not All in Your Head," will speak about commonly misdiagnosed women's health problems at 7: 30 p.m. Oct. 17 at Bibelot's Bookstore, 1819 Reisterstown Road, Pikesville. (410) 653-6938.
Pub Date: 10/15/96