3 big issues in women’s health

A person makes the shape of a heart using their hands, holding it over their abdomen.Health conditions that affect women and people with uteruses – heavy periods, endometriosis and low libido, for example – haven’t always been talked about as much as other health issues.

“For my generation, there was a lack of public education,” says Dr. Robyn MacQuarrie, an obstetrician and gynecologist in Bridgewater and lead of women’s and children’s health for the Northern Zone with Nova Scotia Health. “I heard nothing about menopause growing up – it’s like a blank space. Women have been taught to suffer quietly [through these conditions].”

That thinking has changed as people seek treatment and support for their symptoms. More openness and research mean better treatment options for things like heavy periods, says Dr. MacQuarrie.

Heavy periods
“We used to have very few management options for heavy or disordered bleeding – they could really only take out your uterus” she says. “Now, there’s the realization that women don’t have to suffer or have surgery because there are many other options.”

Tools like hormonal IUDs can help people with uteruses manage heavy bleeding by shortening or eliminating periods altogether. In older people, hormonal IUDs can help prevent uterine or endometrial cancer.

“Think of the uterus like a garden and the ovaries as providing fertilizer – the estrogen,” says Dr. MacQuarrie. “Progesterone is the gardener, so a surge of progesterone sheds the lining when you have your period.” A hormonal IUD releases a low dose of progesterone on an on-going basis. In other words, “with an IUD in place, instead of having the gardener come once per month, they move in, keeping the periods shorter or with no periods at all.”

No matter what symptoms you have or your age, tracking your menstrual cycle is key and provides info that can help your doctor. “Many women start skipping periods in their 40s, so it’s helpful to notice that change,” Dr. MacQuarrie says.

There are apps for that, including ones that also track your mood, fatigue levels and other symptoms – important clues when diagnosing other issues like premenstrual dysphoric disorder, a condition similar to premenstrual syndrome but more serious.

Endometriosis
Endometriosis is a chronic condition that affects about one in 10 people with uteruses, occurring when tissue similar to the lining of the uterus grows outside of the uterus. “Many people with it are able to manage with pharmaceuticals; less often, [some require] surgery,” says Dr. MacQuarrie.

“Many things relate to endometriosis, which is why it’s so challenging to treat. It can scar the pelvis, which can impact fertility.” Pain management options can further impede fertility, “so people may need to focus on either managing the pain or trying to conceive at any given moment.” A new clinic at the IWK Health Centre in Halifax is focusing on the condition and particularly challenging cases.

Decreased libido
Dr. MacQuarrie says low libido is one of the reasons patients going through menopause seek her care. “They come to me looking for Viagra for women. Some medications do exist, but they have significant side effects and must be taken long term.”

Dealing with decreased libido is challenging for many people because it involves relationships and, often, mismatched needs and expectations between partners. “It’s one of the hardest things I see people about and I wish I could do more. I advise them to dig into it and really look at the issues because there can be good solutions.”

Be direct
When seeking help from your doctor, be direct. “When you make the appointment, be honest about what the issue is,” Dr. MacQuarrie says.

“If it’s mood disruptions and marital issues associated with menopause, don’t tell the clerk it’s for your blood pressure. When your doctor knows what you want to talk about, they can attend to it from the get-go.” Some providers are less comfortable with treatments like hormone therapy, so you may need a referral to a specialist.

For Dr. MacQuarrie, it all comes down to helping patients get through the phase they’re in. “Patients often say to me, ‘It sucks to be a woman,’ but I think the opposite. We’re such complex beings with an amazing endocrine system. I try to help patients see it in a new light.”

Learn more

Yourperiod.ca – information from the Society of Obstetricians and Gynecologists of Canada
Come As You Are: The surprising new science that will transform your sex life by Emily Nagoski
The Vagina Bible: the vulva and the vagina, separating the myth from the medicine by Dr. Jen Gunter
The Menopause Manifesto: Own your health with facts and feminism by Dr. Jen Gunter
“Jensplaining with Dr. Jen Gunter” on CBC Gem

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