Book Review

Women's Health: Hormones, emotions, and behavior

N Engl J Med 1998; 339:779-780September 10, 1998

Article

Women's Health: Hormones, emotions, and behavior
(Psychiatry and Medicine.) By Regina C. Casper. 329 pp. New York, Cambridge University Press, 1998. $74.95. ISBN: 0-521-56341-0

Gone are the days of the standard 70-kg man. The differences between men and women in health, illness, and lifestyle have encouraged the development of women's specialty clinics and new (sometimes premature) standards of treatment. This book is a timely, refreshing, and comprehensive set of reviews of the complex interactions between psychosocial and physical aspects of women's health. Women's Health could become a useful annual review of this area of escalating research interest, of ongoing longitudinal studies of women's health, and of findings generated since 1993, when the Food and Drug Administration lifted its ban on drug trials in women. Though directed to primary care practitioners, this book will also be useful to psychiatrists, gynecologists, endocrinologists, and those who study sex in the social and behavioral sciences.

In addition to the editor, Regina C. Casper of the Department of Psychiatry and Behavioral Sciences at Stanford University, many of the contributors are women whose daily clinical encounters provide an experiential background for their reviews. The focus is on illnesses that occur uniquely in women by virtue of biology (reproductive disorders); those for which the incidence is significantly greater in women than in men (depression, anxiety, eating disorders, breast cancer, and thyroid disorders); and those in which sex differences are important but not so apparent (cardiovascular disease). Some of the best chapters are those on breast cancer and on cardiovascular disease because of the complexity of these problems. The reader learns, for example, that in the United States, cardiovascular disease is the leading cause of death among women, as it is among men (with equal rates after the seventh decade), but that women have been excluded from randomized, controlled studies of risk factors because fewer young and middle-aged women than men have coronary artery disease.

This book is a reminder of the need for individualized treatment. For instance, supplemental estrogen can be a mood-lifter or it can induce panic and depression, depending on the woman who takes the medication. There is no correlation between low estrogen levels and affective disorders. Also of interest in the study of women's health is the way that facts may not change a commonly held notion. A good example is the belief that hormonal imbalance produces premenstrual dysphoric disorder, despite the many double-blind, controlled trials demonstrating that hormone adjustment is an ineffective treatment.

The tables are excellent reference guides for comparing available data on controversial topics. They are not as useful for telling clinicians what to do, and there are too few guidelines about psychiatric and psychotherapeutic interventions. The observation that women have more psychiatric disorders, coexisting conditions, and refractory illnesses than do men is an implicit call for a more comprehensive and creative understanding of prevention and treatment in women. This book is an important step in that direction.

Roberta J. Apfel, M.D., M.P.H.
Harvard Medical School, Boston, MA 02115