[Physiological and Pharmacological Characteristics of Women].

Abstract

This review article summarises current knowledge on gender-specific differences in physiology and pharmacology and discusses their clinical relevance. Historically, women have often been regarded as a "deviating norm" in research, clinical studies and practice. Gender-specific medicine closes these gaps by systematically recording differences in the endocrine system, metabolism, immune system and pharmacokinetics/pharmacodynamics and integrating them into diagnostics, therapy and prevention. For this purpose, a literature search was conducted, taking into account review articles and primary studies on the above topic.Gender-specific differences in haematology and homeostasis influence transfusion decisions, perioperative volume control and haematological risk assessment. Throughout a woman's life, oestrogen and progesterone modulate vascular tone, lipid and glucose metabolism, and inflammatory processes. Premenopausal women benefit from the cardioprotective effect of oestrogens; postmenopausal women, on the other hand, exhibit increased vascular vulnerability. The higher body fat percentage, differences in fat distribution and lower muscle mass in women influence various metabolic pathways. Numerous functions of glucose and lipid metabolism are modulated by oestrogen, resulting in the maintenance of energy homeostasis, the reduction of oxidative damage, lipid-induced inflammation and excessive fat accumulation, and the prevention of nitrogen excess.Women have a more innate and adaptive immune response, but are also more frequently affected by autoimmune diseases. Women also differ from men in their perception and processing of pain, with women often experiencing pain more intensely and for longer periods of time. Regarding to pharmacokinetics and pharmacodynamics, women show differences in bioavailability, distribution, metabolism and renal clearance. This leads to higher plasma levels or altered effects of drugs. Individual risk assessment and drug dosing in therapies are therefore necessary. In conclusion, taking gender-specific differences into account in perioperative, emergency medical and pain therapy contexts enables more precise diagnostics, safer medication, optimised analgesia and improved patient safety. There is a future need to integrate these differences into guidelines, perioperative algorithms and clinical studies in order to minimise gender-specific outcome differences.