I love Women’s Health
Over the years I had seen thousands of girls and women with their pelvic health issues, but the demand was outstripping my capacity to see everyone who wanted to be seen. So in 2015, when driving up a different street to my usual route and saw an interesting shop for sale, I decided to arrange for an inspection. When I walked into the building on Hampstead Road, Highgate Hill, and walked into the last room at the end of the building and saw this beautiful painting of a woman (above) on the wall – I took it as a sign.
Buy the building! This is meant to be!
I bought the shop and used it to not only continue my women’s health career, but also to expand and employ more pelvic health physios and mentor them as my legacy to my profession. I was definitely out of my comfort zone, as I had worked by myself for so many years that I wasn’t sure I felt happy about that responsibility, but I have been privileged to employ some amazing women, who felt as passionately about women’s health as I did. The decision to expand was totally the right thing to do.
It may seem natural that being a woman I should be passionate about womens health. I do have a vested interest, being a woman, but over the years the passion has grown as I have seen so many women suffer needlessly with neglect of relatively simply-treated conditions. It makes me curious about why women’s health can be so neglected?
Historically, medical studies have excluded female participants and research data has been collected from males and subsequently generalized to females. One of the most startling examples of this is with respect to heart attacks (myocardial infarctions). Recent studies have shown that women having a heart attack present differently to men and as such are often under-investigated and more poorly managed. This can result in more major adverse events and often in younger women. (1)
Other studies have had serious implications for whole generations of women. This story follows below.
Menopausal Hormone Therapy
Sculpture in Taormina, Sicily, Italy
Like many people, I find art inspirational and when I saw this sculpture in Taormina, Siciliy, I felt it epitomised the daily struggle women have with fatigue as they multi-task their way through each day. Between holding their career together, holding their inner family and outer families together, trying to keep up the required exercise to stay fit, happy and healthy, and completing the shopping for the entire family and friends’ birthdays and Christmases, life can be devastatingly exhausting for women.
Of course, exhaustion and fatigue can also be due to hormone turmoil and the perimenopause is a time to start understanding this link. Unfortunately when I was 51, we were all terrorised by the Women’s Health Study – a large study which demonised hormone replacement therapy (HRT) as it was known in those days. My generation missed out on the benefits of Menopausal Hormone Therapy (MHT) as it is known today. Much more is understood about the need for peri and post menopausal women to consult their GP and specialist doctors (such as a gynaecologist and endocrinologist) about the latest and most up-to-date information about MRT. Jean Hailes is a website devoted to women in Australia and here is the link to Jean Hailes handout on MRT.
It is definitely out of my lane to give the pros and cons of MRT, but I thought my contribution would be to post some information about one of my very favourite treatment strategies for many of the conditions I treat – local oestrogen.
What are some of the benefits of local oestrogen in Women’s Health
Local oestrogen can be an incredible asset to women as they navigate the peri-menopausal period. Importantly, it should be seen as a forever thing once started in the post-menopausal period unless of course there are medical reasons why it shouldn’t be used. It helps pelvic floor function, bladder function, vulvo-vaginal architecture, vaginal lubrication – just an all round superstar for women.
However, local vaginal oestrogen can also be helpful through different life-stages for women. One of those stages can be whenever you are breast feeding.
Breastfeeding may suppress your monthly menstrual cycle due to high levels of prolactin (a breastfeeding hormone) competing with oestrogen and progesterone production. As time progresses following the birth, the atrophic vaginal tissues can not only impact on prolapse and incontinence, but also may cause dryness and subsequent pain with intercourse. If you are having any of these issues with breastfeeding, talk to your GP or obstetrician about potentially using local oestrogen. It is stopped when your periods return or you stop breastfeeding.
Another stage is when you become peri-menopausal and post menopausal. It is useful for plumping up the urethral and vaginal tissues which helps with continence control and with comfort in the vagina with penetration during intercourse. Any changes in the ability of the sphincter mechanisms to provide good urethral closing pressure will contribute significantly to stress incontinence and insidious leakage. It is also helpful for prevention of urinary tract infections (UTIs) and essential when you are wearing a pessary for pelvic organ prolapse.
The urethral sphincter mechanism also deteriorates with ageing due to decreased vascularity and will benefit from oestrogen supplements locally to help after menopause with maintaining urethral closing pressure. Discuss the use of local oestrogen cream or ovules (Ovestin) or tablets (Vagifem) inserted into the vagina with your general practitioner or specialist if you are having continence issues, wearing a pessary or having painful sex. You raise it with them if they don’t raise it with you! Even oncologists who treat breast cancer patients may give permission for some women to continue with local oestrogen, but each individual woman must consult their oncologist about this.
ALERT: Mona Lisa Touch Therapy laser treatment
Since 2013, a non-surgical, non-hormonal alternative to vaginal atrophy has been available in Australia and around the world. This is a laser treatment (Mona Lisa Touch Therapy) which claimed to stimulate the body’s regenerative processes to create more healthy and hydrated cells and to improve the vascularity of the vaginal mucosa. Having had laser treatment to my bottom lip for two basal cell carcinomas, I was aware of the rejuvinating qualities of laser.
However on 11th February, 2025, the TGA has withdrawn support for any form of vaginal reguvination machines or therapy using laser. See the link here to the report’s recommendations published by the TGA.
Diet and Menopause
I have just listened to an amazing podcast from Michelle Lyons, and Irish Pelvic Health physiotherapist whose podcast is called Celebrate Muliebrity. Her latest one is on Food, Mood and Menopause (Episode 69) with Dr Trish Heavey. I thoroughly recommend any woman listen to this, but particularly those who are peri/post menopausal.
I hope these titbits help you start some conversations with your medical practitioners.
References:
(1)Merone L et al. (2022) Sex Inequalities in Medical Research: A Systematic Scoping Review of the Literature. Women’s Health Report 3(1): 49-59 doi:10.1089/whr2021.0083