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Introduction
 
In my forty years as a practicing physician, I have seen few fields explode in the vast amount and diversity of information as the subject of women’s health. And where women’s health goes, so go the pharmaceutical companies, searching for new treatments for one of their largest group of consumers—women. Hardly a day goes by that we don’t hear about the latest developments in promising new drugs for breast cancer, menopause, cardiovascular disease, rheumatoid arthritis, reproductive health, and dozens of other topics that affect women either exclusively or in greater numbers than men. The sheer number and variety of prescription drugs—5,200 at last count—make them a complex and powerful force, and one that is virtually unavoidable for most women during almost every stage of their lives.
 
Fortunately for women, this explosion of information coincides with unprecedented access to that information. From her morning newspaper to the evening news to the hundreds of thousands of women’s health links on the Internet, a woman no longer has to rely only on her doctor to find out almost everything she wants to know about the medicines she’s taking.
 
But with all that information comes responsibility—and often confusion. There is no doubt that prescription drugs are a mixed blessing. They save lives, and they can also threaten them. Along with the good news about prescription drugs comes the cold, hard fact that prescription and nonprescription drugs kill more than 100,000 Americans every year, and another 2.1 million are hospitalized for adverse drug reactions. This year’s miracle drug becomes next year’s horror story with the ultimate unhappy ending—a prescription drug recall due to associated deaths and disabilities—leaving a bewildered public wondering which drug will be next, and if it is already in their medicine cabinets.
 
Women have a huge stake in this scenario. The proliferation of specialists means that more women are seeing more doctors more often. In the past, a woman might have had one general practitioner and an ob/gyn. These days, women are streaming into the offices of oncologists, neurologists, rheumatologists, urologists, psychiatrists, allergists, and cardiologists in unprecedented numbers. Chances are they’re walking out with one or more prescriptions in hand, along with the very real possibility that none of their doctors knows about the others—and the corresponding prescriptions—unless their patients tell them. The changing environment of managed care also plays a part in this scenario. At the very time when doctors should be spending more time with their patients—especially female patients— HMOs are limiting that time, resulting in increasingly shorter office visits.
 
Add to that the women-only health care issues—pregnancy, breast-feeding, hormone fluctuations, menopause, vaginal infections, a host of minor and major ailments, along with constant reminders to do breast self-exams, get annual Pap smears and pelvic exams, use effective birth control, practice safe sex, and take enough calcium. It’s no wonder that women can easily become overwhelmed at the prospect of being told repeatedly to take a more active role in their own health care. And so every day, millions of women take millions of pills based on nothing more than blind faith and implicit trust in the doctors who prescribed them.
 
It is good to trust your doctor. Working with your doctor in a relationship of mutual respect and honesty is even better. No woman should have to be alone in the management of her drug therapy, but she may have to become more informed and assertive to ensure that she is getting the maximum benefits with the minimum adverse reactions. Weighing the benefits against the risks is an indispensable aspect of drug management.
 
What do I suggest to women with regard to working with their physicians, nurses, physician’s assistants, nurse practitioners, and pharmacists in order to use prescription drugs safely and wisely?
 
It’s very simple. Despite major technological advances, computerized diagnostics, and state-of-the-art products and services, what high-quality health care comes down to remains constant: one-on-one communication; the open and honest exchange of information with all of your health care providers, and never settling for less. Most doctors are doing their best in an assembly-line environment where they, too, are overwhelmed by information and time constraints. But an intelligent doctor welcomes an intelligent patient—one who is actively involved in her health care and who works with her doctors to make every office visit an informative and productive one:
 
The average office visit is eight to ten minutes, so you need to stay organized and on the subject. Write down your questions and/or list of symptoms. Give your doctor an overview so you both will know exactly what you want to accomplish in that visit. “I have three things I need to discuss with you.”
 
Take notes or use a tape recorder, or take along a friend who will help you remember what was said.
 
Always tell your doctor if you are pregnant or trying to become pregnant. This is essential when prescription drugs are involved, as little is known about the effects of most drugs on a woman’s reproductive system.
 
Inform your doctor of any drug allergies you have, or if you’ve experienced severe side effects from any drug. Drugs in the same category can cause similar reactions. When you’re having a prescription filled or refilled, also tell your pharmacist about any drug allergies or serious side effects.
 
Take a complete list of every prescription and nonprescription drug you are taking, along with vitamins, herbal remedies, and dietary supplements. Never assume that any doctor knows all of the medications you are taking.
 
Provide a complete medical history, even if some of it is painful or embarrassing. This information may prove crucial in deciding which drug to prescribe.
 
When a doctor prescribes a drug, ask the following questions:
 
How long will I need to take it?
 
What common side effects can I expect, and when should they be considered severe?
 
What are the consequences of long-term use?
 
What is the exact brand name and generic name, and is it safe to take the generic equivalent?
 
Are there any specific medicines, food, or drinks (especially alcohol) that may interact with this drug or interfere with its effectiveness?
 
If you have a doctor who won’t listen to you, who looks at your desire for accurate information as a personal threat to his or her expertise, who treats your very real symptoms as purely emotionally based or hypochondriacal without taking the appropriate tests, and most important, won’t give you satisfactory answers about any drug you are taking—then it’s time to find another doctor. Nothing is more important than your health, and for women that means being armed with as much information as possible and working with doctors and all other health care providers to make sure that any drug therapy—whether it’s one pill or ten—is exactly the right one for you.
 
In my job as clinical professor, teaching at New York University School of Medicine, I am pleased and delighted to see that half of my class is female—a far cry from the days when a single woman in an otherwise all-male class was the norm. This increase in the number of women doctors will undoubtedly influence the future of women’s health care for the better.
 
But in the end it will all come down to you, the patient. The best patients are active, not passive. The best questions are informed, not random. The massive amount of information on women’s health will continue to proliferate at breakneck speed. Although no book should ever be used as a substitute for the advice of a medical professional, women will continue to need every resource they can find to make sure they are getting the best medical care possible. The Women’s Pharmacy is just a part of that, and one that we hope will be a useful addition to your health care library.
 
Robert L. Rowan, M.D.
Clinical Professor, New York University Medical School