Women's heart disease shows itself the same as heart disease in men, right? And the same for diabetes? Not so, according to those practicing in women's health care.

"Sometimes diseases in women don't present with the typical symptoms," said Sarah Freeman, Ph.D., ARNP, FAANP and director of the Family and Women's Health Nurse Practitioner programs at the Emory University Nell Hodgson Woodruff School of Nursing.

"For years, women were not included in research studies; the gender differences are just starting to be examined."

Over the past 30 years, women's health has evolved into a complex — and specialized — field that can be challenging to health care providers. Freeman said the primary difference is that women's health has gone beyond the "navel to the knees" practice of gynecology and obstetrics to include a more holistic approach.

"As we move into [practicing] more evidence-based medicine, research shows us that women's health issues are different from men's," she said. "New data comes out all the time; it's challenging to keep up with all the new information. I'm a big believer in the Internet."

A good source of up-to-date information about women's health for nurses and for patients, Freeman said, is the National Association of Nurse Practitioners in Women's Health. The group's Web site (www.npwh.org) contains a variety of information about the latest studies in women's health.

Freeman teaches "Issues in Women's Health" at Emory, a course that's required for nurse midwives and nurse practitioners in the women's health nursing program. It's an elective for other nursing students.

At Kennesaw State University, Vanice Roberts, DSN, RN and associate dean of the College of Health and Human Services, will teach "Women and Health" this winter. Offered as an elective to students from all majors at KSU, the class list of books on its syllabus ranges from "No More Hysterectomies," by Vickie Hufnagel to Betty Friedan's newest book, "The Fountain of Age."

Roberts also uses the book, "The New Our Bodies, Ourselves," published by the Boston Women's Health Collective.

"‘Our Bodies, Ourselves is a classic reference book that I have used as the textbook for this course several times," she said. "It can be quite radical, but it makes for great class discussions."

For Roberts, the class is about more than teaching about physical symptoms and health-care issues specific to females. "This is not a birthing babies course," she said.

Her approach covers lifestyle development and systems issues so that students learn about health issues and the social, economic and cultural influences.

For example, she uses "The Beauty Myth" by Naomi Wolf to open discussion about teen eating disorders, talking about what society deems beautiful and encouraging discussion about why these standards are harmful.

"The most exciting aspect of this course for me is when it becomes comfortable to discuss issues from an intellectual perspective and to question the status quo. I push the group to look at issues from a pro and con perspective," Roberts said.

"This opens their minds to oppositions and facilitates their ability to be conversant on controversial issues. An outcome to this type of process is that it often identifies a hidden strength for some students."

Understanding cultural and environmental influences and pressures on women in regards to their health also is an aspect Misi "Grace" Nteff stresses in her beginning nursing course on health asssements.

The Clayton College & State University nursing faculty member and family nurse practitioner sees a more serious problem in both women of childbearing age and middle-age women: neglecting their health, especially their heart health.

"Many women don't have health insurance and have not had a total good checkup," Nteff said. "Their dental health is poor, their cardiovascular health is poor — they are not following through with regular health maintenance to keep their heart healthy.

"They are not finding time to exercise and to eat right," she added.

During community health screenings she reports that many women in their mid-40s have high total cholesterol and elevated blood pressure.

"I believe they are overwhelmed with their day-to-day demands," she said. "Their priority is placed toward their kids, but there's no balance."

Nteff and the faculty at the nursing school is seeking community alliances with the Clayton County Health Department as well as other organizations, to help guide women without health insurance to available resources, she said. She has brought in students from developing nations to talk frankly about cultural differences, such as female circumcision, first-hand. Discussion and interaction is encouraged.

Kennesaw State's Roberts also sees the need to take women's health care to a new level.

That's being helped by a endowment from WellStar Health System. Part of those funds have been earmarked for women's health.

"I hope that is can be used for a woman's scholar, perhaps a full-time researcher," said Roberts. "It's important that we continue to examine women's health issues from many perspectives — treatment, sociological, psychological, economic, political and cultural.

"All of these areas influence our health and how care is delivered."

— Rebecca Rakoczy contributed to this story.