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From the Desk of Dr. Moser: Women’s Health and Health Care

May was designated as Women’s Health Month, but women’s health is a critical topic all year. Writing in generalities about the half of the human race to which one does not belong may appear suspect to some, but having spent decades of my life as an OB-GYN, I feel obliged to offer a few observations.

For purposes of this essay I will refer to genetic and biologic health factors, which may be persistent in individuals with alternate gender identities. I will use the terms “women” and “female,” but my intent is inclusive. 

Most factors that will contribute to good health for women will do the same for men. One can’t argue with good nutrition, exercise, a healthy weight, and adequate sleep as goals for any of us. There are some variations even in these – women in their pre-menopausal years need more iron than men, for example, due to periods – but in general we can all benefit from them. 

On the other hand, where there are differences in our biology, there are significant differences in our health needs. Reproductive and sexual functions are not generally the center of our lives, though resulting offspring may become just that. But our bodies keep us in a state of readiness for those functions. For women, living with a more complex system, staying healthy requires some attention to those functions.

We are all influenced by our sex hormones, and testosterone has its share of undesired side effects. But the cyclic nature of estrogen and progesterone production can be uniquely challenging. Among the more common issues are irregular or excess bleeding and menstrual pain. They shouldn’t be ignored or accepted as “the way it is,” since they cause misery and may result in a serious anemia. The same symptoms may also be caused by physical factors that should be diagnosed and may need treatment.

These problems can usually be relieved under the care of a physician or nurse practitioner specializing in gynecology or women’s health. Regular visits with a women’s health provider are important for early detection of breast and ovarian disease and protection against cervical cancer. They also establish baseline data to help distinguish whether or not new symptoms are cause for concern, based on knowing one’s usual pattern. 

Birth control, if desired, is certainly not a women-only option. However, if female contraception is desired, consultation with a provider can help individualize the choice. For example, some options may simultaneously improve annoying menstrual symptoms while others may make them worse. Some are only suitable for long-term use while others can be discontinued easily. The right choice depends on knowing all the options and their pros and cons.

Breast health requires attention too. Breast cancer is obviously the greatest concern, and early detection significantly increases disease-free survival and options for treatment. Family history is a factor to know if possible and affects screening recommendations. BRCA-1 and -2 genetic markers can indicate increased risk for breast cancer and several other cancers, and testing is usually recommended if there is a family history. It is also available for people using 23andMe genetic tests regardless of family history. If it is used, a negative result should not be interpreted to mean zero risk. Mammography has been shown to improve detection in women over 50, but it is not as helpful under 40. Different health care organizations have varying recommendations for 40 to 50, and it is best to individualize with a women’s health professional. Self-exams are painless, free, can be done frequently, and may provide the first hint of a problem. So they remain a staple in breast screening.

Pregnancy ideally should be desired and planned well before conception. Proper nutrition including prenatal vitamins, avoidance of alcoholic beverages, smoking, and drugs are important. Weight loss involving unbalanced or extremely low-calorie diets should be avoided too. It is wise to obtain pre-conception consultation with a provider to review any chronic illnesses, family-related illnesses, current medications, and prenatal testing options related to maternal age. Prenatal care throughout pregnancy is a necessity to help ensure a safe and healthy outcome. If access to care is a problem, a call to a local hospital can provide a list of resources regardless of insurance or ability to pay.

Options for unwanted pregnancies include resources for prenatal care, delivery, and adoption, or for pregnancy termination. Early decision-making and getting help are crucial whichever course one chooses. The least healthy choice is to make no choice – nothing gets better, safer, or easier on its own as pregnancy progresses.

Fertility issues may be male or female and usually do not involve a threat to one’s physical health, but these can be a cause for great distress individually or for a couple. Fortunately there are many options and most couples can be helped successfully. It’s wise for both partners to have a general health checkup since some medical conditions can influence fertility. Diagnosing the cause usually starts with a gynecologist or fertility specialist, who can also coordinate the male evaluation.

Over time, men and women both experience diminishing sex hormone production. For women this obviously means the beginning of menopause, cessation of periods, often the onset of “hot flashes,” and some new health considerations. Many of these are individual decisions based on each woman’s general health and medical history, specific medical conditions, and personal preferences. Hormone replacement therapy is one such decision. Osteoporosis becomes a risk due to low estrogen, especially for women who are tall and slim, but everyone can benefit from weight-bearing exercise and adequate non-dairy calcium. A woman’s health provider can help decide whether testing or medication is advisable.

I’ve only touched briefly on a few of the many aspects of health and health care that women uniquely experience. Beyond these are many medical illnesses that may express themselves differently in women vs. men, including cancers (the top three for women are breast, lung, and colorectal), diabetes, hypertension, and complications of obesity. One needn’t dwell on them, but awareness helps us make good choices that help avoid them. A healthy lifestyle will help reduce the risk, and a regular health care provider is always a good partner for advice and early detection.

About Dr. Joseph Moser

Dr. Moser headshotDr. Joseph Moser is the Chief Medical Officer at University of Maryland Charles Regional Medical Center. He has over 40 years of experience in the health care field and now oversees all of UM Charles Regional Medical Center’s doctors on staff.

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