replacing reactive with proactive care in women’s reproductive health
7 minute read
the way the current health system is set up, many women are told to deal with symptoms of these fertility-affecting conditions and to come back only when they’re thinking about starting a family. by then, though, it might be too late.
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treatment of polycystic ovary syndrome (pcos) and other reproductive health conditions that can affect fertility is often delayed until a person wants to get pregnant. the diagnosis delay for pcos alone is two or more years, leaving women to contend with symptoms that affect both their bodies and their minds.
but since the two go hand in hand, treating these conditions as they arise can actually preserve fertility, giving women the chance to plan for their futures while improving their current quality of life.
that said, the way the current health system is set up, many women are told to deal with symptoms of these fertility-affecting conditions and to come back only when they’re thinking about starting a family. by then, though, it might be too late.
interventions that can take place that can benefit fertility, such as speeding up diagnosis and improving insulin resistance and weight management in pcos and other fertility-related conditions, should happen as quickly as possible, regardless of whether a person does not want to have children right away.
“if we only start those after the patient has been trying to conceive unsuccessfully for several years, or even several months, we are pushing them back even longer to get to those answers,” said dr. noam raiter, a family physician and board-certified lifestyle medicine physician and medical advisor with july health, a virtual health service dedicated to fertility care. “it just might be a little more challenging for you.”
delayed diagnosis and dismissal develop distrust
delayed diagnosis of pcos and other reproductive disorders continues to be a significant barrier for people who want to address both their symptoms and plan for the future. pcos and other fertility-affecting conditions can start early on in a woman’s life, as early as the first menstrual period. however, many are not diagnosed until their 20s or 30s, or in some cases, into their 40s.
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but with the current setup in the healthcare system, it’s challenging for even the most well-meaning doctors to prepare and educate themselves on these topics.
according to dr. raiter, the ways in which these conditions can be treated today, based on up-to-date research, aren’t generally included in the current curriculum or residency programs, so oftentimes, physicians are forced to seek it out on their own for a better understanding.
“i find that we’re several steps behind,” she said. “the root of all of that is honestly access to education and not having clinicians have to seek out the education themselves once they’re done residency.”
the same lack of knowledge surrounding these issues is only compounded by the fact that women have been continuously dismissed for health complaints, a long and tired trend beginning in the very roots of medicine.
even if medical providers are well-meaning and aren’t trying to dismiss women, the system that trained them has primed them to either not recognize symptoms as abnormal or instilled an unconscious bias that comes out in appointments.
“beyond that, there’s societal stigmas. there’s sexism. women’s pain has always been dismissed, right? women haven’t always been involved in research studies the same way men have,” said dr. raiter. “so, i think that underpins a lot of things in ways we don’t always realize, even female physicians don’t think that they’re sexist or dismissing issues. we inherently are sometimes just the way the system has been created and the way that we’ve been taught certain subjects.”
mya clarke, a phd student at the university of waterloo and health outcomes researcher with july health, believes that these institutional barriers that have continued to thrive have not only made women feel dismissed during appointments—they’ve eroded trust in the system altogether.
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“it’s more than just one bad appointment or someone going in and a doctor saying, ‘come back when you’re trying to get pregnant,’ and sort of pushing that proactive response to be a reactive line. i think it’s more so this builds mistrust that women have within the system,” clarke said. “this delayed diagnosis is a result of this built mistrust within a system from years of being told that symptoms are normal or it’s just part of being a woman, and to come back when pregnancy is the goal.”
this distrust of their physicians and the healthcare system doesn’t just affect their views on health care. it can also alter how they see themselves.
“they begin to self-doubt their own bodily knowledge when they’re being dismissed,” said clarke. “then that also delays care even further because once you become doubtful of your own opinions on your body.”
women are taking their health into their own hands
looking at reproductive health only through the fertility lens early on will help people later in life when they’re starting to conceive. however, it does more than just help fertility. it improves quality of life along the way, something people who are told to wait until they want to get pregnant are often forced to sacrifice. pcos and other fertility-affecting disorders can cause symptoms that interfere with mental and physical health, as well as day-to-day functioning.
that’s why many young women have begun practicing proactive efforts on their own, using the internet and social media as their weapons for better health. things such as cycle tracking apps, online communities for people living with pcos and endometriosis, for example, are all easily accessible for many women.
“social media and the internet age are a massive part of that (approach). i think that we have started to tell women and push the narrative to plan for your own fertility and to plan for these sorts of things, but then the system hasn’t really given supportive, accessible ways to manage that and to understand that,” said clarke.
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this effort to take control of their own health journey can be empowering for many. more and more women understand options, such as freezing their eggs for later pregnancies, which is all a sign of the times.
“women have higher-paying positions these days. they have more disposable income of their own. they’re having children later. so, they’re in a better financial position to make these kinds of decisions now, where for many decades, women didn’t have the same access to finances as we do now to make a choice,” said dr. raiter. “and bodily autonomy, especially in canada. that’s something that we can’t take for granted, just the culture of feminism has propelled us to have access to these things.”
but there are still issues within the healthcare system that need to be addressed because it’s one thing to know about helpful options, while it’s quite another to provide self-care that should be given under the supervision of a physician.
“we can’t just rely on patients to do everything themselves,” said dr. raiter. “when patients don’t have a licensed clinician to kind of guide their journey, of course, the internet has a lot of positive information, but also lots of misinformation … i think we need to work on the proactive system from the medical side now as well to meet patients where they’re at, and part of that is not dismissing them when they come in.”
it’s also about having a “radar” for people who come in with symptoms that can present in these conditions and asking more questions.
“that’s where we can see a lot of growth in this field, if we start thinking before the patients even ask us,” said dr. raiter.
establishing a proactive approach to reproductive health
being proactive in one’s own health is great, but without a solid health care support system, women with these disorders or struggling with fertility are still only going to get halfway to healthy.
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and it isn’t just about ensuring that women can have children. it’s about quality of life, and rebuilding broken trust.
“if we can sort of build this bridge of trust in this space of (early) intervention, it can sort of tell patients that their health matters before there’s a crisis or before, if never, they’re trying to get pregnant or manage fertility because fertility is hormonal health and hormonal health is a part of everyday life and it’s a part of your cycle,” said clarke. “in that sense, it’s not necessarily about the outcome. it’s about everything that you live in between.”
to make the change and shift the narrative, the system and its health-care providers need to shake things up. some organizations, such as july health, are trying to pave the dirt road, but without a systemic change, the barriers faced by women will continue to cause issues.
at a high level, more funding for research needs to be put in place, along with better access to information and updates to medical school curricula to reflect new information that continues to pour in as technology and research improve.
funding for more reliable diagnostics is another important piece, as is greater access to care, which could streamline diagnoses for women who develop these conditions. at the physician level, it’s about continuous learning, whether that’s from new research or from patients themselves.
“try to learn one new thing a day. if a patient comes up and asks you a question about a certain gynecological condition … it might actually open you up to something that you haven’t heard of yet and lead you down to some more research of your own, which can improve your care for that patients and others down the line,” said dr. raiter. “(it’s) not trying to overhaul everything overnight, but trying to just listen to patients, read up to date research, keep our minds open to a field that’s evolving really quickly but also really slowly at the same time.”
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for physicians, being informed and open to learning as they go will improve how diagnostics and condition management unfold for patients, but it will also serve as a trust-rebuilding tool that allows women to view the system and their providers in a new light.
“early diagnosis is really health-care saying, the system saying, ‘i believe you,’” said clarke.
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