Beyond Gynaecology, Why Women’s Health Needs A Different Approach

It is hard for most people and systems to imagine women’s health beyond pregnancy and childbirth, or the sporadic visit to the gynaecologist for a few odds and ends. And this is exactly what is broken about women’s health. Because women’s health is not only more than just gynaecology, it is also more than the female anatomy and the reproductive system. It is actually about unravelling, dismantling and rebuilding centuries of iniquities and misinformation embedded in the healthcare system.

In India, a woman changes 3-4 gynaecologists on average before she finds the right match. 80% of Indian women feel that they have faced either judgement, dismissal or incomplete information at least once, by a doctor. But we need to look beyond doctors and fix the context they are a part of. The over-clinical language, the poor medical understanding of conditions that exclusively or predominantly affect women, and testing equipment like the speculum which are not designed for comfort but for pain– these all continue to perpetuate a gender-blind delivery of healthcare.

“But health is health? Everyone should be healthy. Why focus just on women?” This has been a common refrain every time I have mentioned that I work in “women’s health”, or am founding a “women’s health company”. Many clinical sources define women’s health as a “broad term referring to physical and mental health problems that are of exclusive concern for women, and which are more common in women or which differ in presentation, severity, or consequences in women compared to men.”

This, however, is just a part of the picture and takes into account merely the clinical. We now know that a vast number of socio-cultural factors have direct impacts on women’s healthcare outcomes: allocation of research funding dollars, women’s access to education and finances, quality of mobility options, training of healthcare experts and also the role of family.

These are 5 reasons why women’s health needs a differentiated and biopsychosocial lens of treatment.

Women have different health events across life stages, which has important implications. Menarche, menstruation, pregnancy, postpartum health and then menopause. These are massive hormonal shifts in women, and all are accompanied with their own set of stigmas and additional responsibilities. These life events are also accompanied by impacts on mental health, changes in intimate relationships around women. So naturally, for the best healthcare outcomes for women as well as their families, these events not only require high-quality clinical care but also counselling, hand-holding and community support.

Women’s hormones which are known mainly to be related to sexual, reproductive and menstrual health functions, also play key roles for overall health. And therefore need to be managed holistically. For example, estrogen is always associated with menstrual health and fertility. But it is also an important hormone for heart health and blood pressure. It protects the brain by helping maintain proper blood flow. It assists in helping with memory and fine motor skills. Estrogen also helps protect against osteoporosis. That is why, during perimenopause when the body’s estrogen levels drop, women develop a risk of cardiovascular disease, might experience joint pain, and many women also report brain fog. Yet, women are not equipped with this information well in advance, nor are these correlations explained at length during this phase, inhibiting any preventative care measures.

Women’s health is not limited to reproductive health. Conditions that affect both men and women affect women differently. 45% of males with diabetes also develop erectile dysfunction due to nerve, muscle and blood vessel damage. However, women have a much greater chance of heart disease, kidney disease and depression – which makes it more life-threatening for women. Diabetes also worsens menopause symptoms. The combination of diabetes with this change in hormones can lead to further increase in blood glucose, weight gain and problems with sleeping.

One of the starkest differences with far-reaching consequences, however, happens in cases of cardiovascular health. "Women are much more likely to have atypical heart attack symptoms," says Dr. Lili Barouch, director of the Johns Hopkins Columbia Heart Failure Clinic. So while the classical symptoms, such as chest pains, apply to both men and women, women are much more likely to get less common symptoms such as indigestion. And these are routinely misidentified.

Medications and other common utility items are not tested sufficiently on women. This includes painkillers, sleep medication, blood thinners for heart health and anti-anxiety medication. Why is this crucial? Because men and women metabolise medicines differently. The impact of a certain medicine on the body can be differently affected in women by several factors, including higher body fat composition, lower body weight, lower enzyme activity in the intestines, and slower kidney function. Women are 47% more likely to sustain severe injuries in car crashes, even when using seat belts. This is because car safety testing is done with 50th-percentile male test dummies, optimizing safety for the muscle mass distribution and body shape of men.

Disasters, whether manmade or natural, affect women’s health very differently and it is an even more critical conversation in the wake of the climate crisis. There is a proven link between extreme weather and pregnancy complications. One study found a significant association between heat, fine particulate matter and adverse pregnancy outcomes like preterm birth and low birth weight. Women and girls are also held primarily responsible for water collection, devoting 200 million hours daily worldwide to collecting water. Limited access to clean water for hygiene and sanitation purposes increases women’s vulnerability to communicable diseases. According to the UN, 2 billion people in the world are now living in conflict zones, which again affects women and children disproportionately.

The COVID-19 pandemic revealed that if we don’t separate gender in research, we lose opportunities for clinical discovery. It took months for researchers and experts to begin exploring why female outcomes for this deadly disease were better than men’s. We need to look at social determinants of health and how the role of women in juggling jobs, child care and running a household impact their overall well-being. Advancing women’s health doesn’t just happen in the hospital or at a doctor’s office.

Swarnima Bhattacharya is the Co-founder & Chief Product Officer of Gytree. Views expressed by the author are their own