We’re living in a historic time for women and women’s rights, and healthcare is no exception. In response to shifting clinical guidelines, research discoveries and medical advancements, along with socio-cultural issues like the #MeToo movement, here’s what five practitioners had to say about the biggest changes they’re seeing in women’s healthcare.
Medical director and president of the Reproductive Medicine Institute
We’re seeing amazing advances in IVF success rates. The process has gone from being about 1 in 100 in the days of Baby Louise in 1978 to having success rates as high as 60 percent to 70 percent. Egg retrievals and embryo transfers, once complex ‘surgical’ procedures, are now performed in outpatient settings throughout the world, requiring minimal anesthesia and virtually no recovery time. IVF has become a highly successful and very low-risk procedure for the treatment of infertility.
With the advancement of egg freezing, we’re also witnessing what’s essentially the ability of women to program their own biological clocks. In 2012, new guidelines from the American Society for Reproductive Medicine determined that egg freezing would no longer be considered an experimental procedure. The move is expected to help cancer patients preserve their fertility, by pushing more insurers to pay for their procedure, and also to boost banking of donated eggs, similar to sperm banking).
Social egg freezing is another option for women who would like to delay starting a family and have the option to have biological children later in life. Previously, it was thought that a woman’s fertility, while always in a state of perpetual decline, did not truly accelerate its downhill progression until the age of 35. However, recent studies have clarified that a significant reduction in both quantity and quality of eggs can be seen starting at the age of 28. This process can be dramatically sped up in the setting of genetic predispositions (carriers of BRCA or FMR mutations), lifestyle factors (smoking) and exposure to chemotherapy or pelvic radiation therapy. Such exposures not only increase the risk for future infertility but may also increase the risk for premature menopause. Egg freezing has gained popularity as a means to extend female fertility.
New York City
The fields of women’s health and reproductive psychiatry are shifting away from the term “postpartum depression” as a catch-all for psychiatric conditions in the postpartum. Instead, we’re beginning to use the term “perinatal mood and anxiety disorders,” or PMAD. This language change to PMAD really captures two things: First, it redefines the timeline for psychiatric conditions among moms. While the term “postpartum depression” limits mental illness to the time after delivery, PMAD includes the full spectrum of a woman’s mental health, from the time she becomes pregnant through the time after she delivers. This change in semantics is important because the reality is that both pregnancy and the time after delivering a baby are higher risk times for all psychiatric conditions.
That’s another reason for the change in language to PMAD. While sadness is certainly common during pregnancy and postpartum, we also see a lot of clinically significant anxiety and worry — in fact, this is so typical that many clinicians don’t necessarily see perinatal anxiety and depression as two distinct conditions. The PMAD term is more inclusive of what a mother’s mental health experience can look like, from mood disorders like depression to anxiety disorders like general anxiety disorder, panic disorder, post-traumatic stress disorder and obsessive-compulsive disorder.
As a trauma-focused therapist, I work frequently with clients who have experienced sexual violence or trauma. In light of the #MeToo movement, I’ve seen so many doors open in how women share their own stories of sexual trauma, both in therapy and in public. For some of my clients, sharing in the collective story and being heard and validated by other survivors is huge. Sharing their experiences, either just by using the hashtag on social media or by telling more detailed stories, has helped them open the door for deeper conversations.
The other side of the trend is that hearing others’ stories of sexual assault can be re-traumatizing. Seeing the news of sexual abusers being accused and the accusers having to prove that their memories are real and that the sexual assault wasn’t their fault can be very traumatic. For some survivors, it mimics their own experience. Trauma-informed therapists are now talking with clients in session about the potential of being re-traumatized. Therapists are also sharing their concerns online and encouraging their clients take care of themselves if the media coverage becomes too much.
I hope the awareness created by #MeToo will help practitioners show more compassion, acceptance and caring towards those survivors who come forward regardless of when the assault occurred.
Assistant professor of clinical genetics at the Fox Chase Cancer Center
About 10 percent of breast cancers are attributed to breast cancer genes that are passed through families. For many years, the conversation about breast cancer genetics has been centered on the BRCA1 and BRCA2 mutations. Through research and many years of following families with BRCA1 and BRCA2 mutations, we now know that these are the most important genes for increasing one’s risk of breast cancer.
But we have also recently learned that these two genes do not explain the whole story of breast cancer genetics. Several other genes have been discovered that increase one’s breast cancer risk, although to a lesser degree than the BRCA mutations. These genes include ATM, BARD1, CHEK2, PALB2, NBN and NF1. Knowing whether you carry one of these mutations is important, because carriers of some of these mutations need to have intensified breast cancer screening that includes annual breast MRI in addition to annual mammogram. These more recently identified breast cancer genes don’t expand breast cancer treatment options at this time, or serve as an indication for preventative surgeries. But as we learn more about them, that could change.
For women with BRCA mutations, consensus guidelines now recommend annual breast cancer screening, including both breast MRI and mammography, as well as consideration of bilateral prophylactic mastectomy (removal of both breasts). Additionally, it’s recommended that women who carry these genes undergo a bilateral salpingo-oophorectomy (removal of the ovaries) given the elevated risk of ovarian cancer also associated with these genes.
Ob-gyn and associate professor of obstetrics and gynecology at The University of Tennessee Graduate School of Medicine
I think one of the biggest stories for women’s health is the attention to maternal mortality. I am concerned that the media coverage of U.S. hospitals and labor and delivery may not provide a balanced picture. From every action I see, hospitals are working diligently to provide not only great care, but also a great birth experience, while always making the prevention of maternal morbidity and mortality a leading goal. As a labor and delivery director, we share, refine, drill and discuss management protocols for obstetric hemorrhage, hypertension and other emergency situations. We are also fortunate to have laborists, who are ob-gyns whose only job on a given day is to work on labor and delivery. Laborists remain vigilant and available, providing extra eyes, hands and resources during our busiest hours.
While we focus on reducing U.S. maternal mortality rates, I hope we stay concentrated on supporting mothers in their first year after giving birth. I also hope we praise the work and forward progress that hospitals and labor and delivery teams are making to provide quality care.
Responses have been condensed and lightly edited.