Nausea, heartburn, indigestion. All are common symptoms of a widespread condition many of us deal with. Acid reflux affects an estimated 60 million Americans at least once a month. And while it’s an equal-opportunity annoyance, women may not realize the root cause worsening theirs. And that could be deadly.
In its simplest form, the condition involves acid traveling up from the stomach and into the esophagus. It happens when stomach pressure is greater than the lower esophageal sphincter allows. When the barrier is broken and reflux occurs, symptoms like chest pain, heartburn, trouble swallowing and nausea are common. Acidic and fatty foods are major culprits, as are chronic conditions like hiatal hernia, obesity and gallstones.
Though women aren’t necessarily at a higher risk for developing acid reflux, certain gender-specific conditions can worsen or prolong its effects. Pregnancy—and the anatomic mechanics that go along with it—is a common cause of reflux among younger women. As the uterus grows in the second and third trimesters, it pushes everything closer to the chest cavity. Progesterone has been shown to lower esophageal sphincter pressure, creating a weaker barrier between the esophagus and the stomach.
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“Women of childbearing age may also notice acid reflux when they take birth-control pills, which can cause an increase in progesterone,” says Dr. Giancarlo Mercogliano, a gastroenterologist at Lankenau Medical Center.
Hormonal changes during and after menopause can also contribute to reflux symptoms, starting with weight gain. Extra fat carried in the middle of the body inches stomach acid closer to the esophagus, which can be damaged by continual reflux.
“As women age, our secretions tend to get drier, and we’re not clearing things out as well as we used to,” says Dr. Joyann Kroser, a gastroenterologist at Crozer-Chester Medical Center. “We gain a little more weight after our fifth decade, and it’s harder for women to lose it as the metabolism changes.”
Stress is also a significant trigger. The American Psychological Association reports that, historically, women report higher levels of stress than men. That can cause the “brain-gut” connection to fluctuate, resulting in the production of more stomach acid. “That fight-or-flight reaction from stress triggers the acid pumps in the stomach, which respond accordingly,” says Kroser.
If not properly managed, chronic reflux—or gastroesophageal reflux disease —can have severe effects. The continual erosion of the esophageal lining may cause chronic cough, dentine hypersensitivity or the erosion of dental enamel, and inflammation of the throat. Stomach and esophageal cancer are a real, if statistically minor, threat.
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Perhaps one of the most difficult tasks in treating acid reflux is getting patients into the doctor’s office in the first place. An abundance of over-the-counter treatments—coupled with symptoms closely associated with indigestion or other common maladies—can make identifying a serious problem more difficult. “Even as physicians, we’re guilty of not paying very close attention to these symptoms sometimes,” says Dr. Elizabeth Rock of Phoenixville Hospital. “If patients don’t get better in a relatively short period of time, we have to really start investigating the deeper medical issues.”
Even more ominously, that burning sensation in a woman’s chest cavity could be mistaken for a bout of reflux when, in fact, she’s having a heart attack.
“For most men, when they’ve had a heart attack, they’ll tell you it feels like someone is sitting on their chest,” Rock says. “Heart attacks in women often present differently and feel like acid reflux. They don’t have that crushing pain.”
While women are more likely to get screened for heart conditions, they’re also more inclined to think it won’t happen to them. “We counsel people to seek medical advice if they have symptoms more than three times a week,” Kroser says. “You have
to look at how it’s affecting your quality of life.”
For women, especially, this should be a top priority. “They’ll just say ‘Oh it’s just a little pain. It’ll go away,’” says Rock. “And it will no longer be something that will go away.”
See page 4 for “Warning Signs of Heart Attacks in Women” …
Warning Signs of Heart Attacks in Women
2. Shortness and/or loss of breath
4. Cold sweats