Three Key Health Issues Impacting Women's Wellbeing

Women’s health encompasses a wide range of critical issues that profoundly impact quality of life and overall wellbeing. This article delves into three essential areas of women’s health: managing conditions like endometriosis, recognising the importance of regular Pap smears, and understanding the signs of abnormal uterine bleeding. Additionally, it sheds light on urinary incontinence—a common yet often overlooked issue, particularly in later years—and explores the profound impact of domestic violence on women’s mental and physical health.

Endometriosis, Pap Smears, Uterine Bleeding, and Hysterectomy

Common Symptoms of Endometriosis and When to Seek Medical Advice

Endometriosis is a condition that affects many women, but it often remains undiagnosed due to its varied symptoms and the fact that many patients may have a normal-looking ultrasound. The most common symptoms include pain during periods, ovulation, bowel or bladder activity, and discomfort during intercourse. Some women may also experience bleeding between periods or struggle with infertility.

It's essential to seek medical advice if you find yourself needing frequent pain relief during each menstrual cycle, or if the pain starts to interfere with your normal activities, including social, work, and relationship aspects. Early consultation is vital because endometriosis can significantly impact quality of life if left untreated.

The Importance of Regular Pap Smears

Pap smears are a critical part of women's health screening, particularly for the early detection of cervical cancer. With the introduction of the new cervical screening test, it is now recommended that women start Pap smears at the age of 25 and continue every five years. Regular screening is essential for detecting any abnormalities early, which can be crucial in preventing the progression of cervical cancer.

Recognising the Signs of Abnormal Uterine Bleeding

Abnormal uterine bleeding can indicate various underlying health issues. Key signs include needing to change period protection more frequently than every 3-4 hours, passing blood clots, and experiencing symptoms of iron deficiency, such as fatigue and weakness. These symptoms should not be ignored, as they could signal more serious conditions that require medical attention.

Medical Reasons for Recommending a Hysterectomy

A hysterectomy, which is the surgical removal of the uterus, is often recommended when conservative management options for conditions like excessive bleeding, pain, or prolapse have failed. This includes both non-surgical and less invasive surgical treatments. The decision to undergo a hysterectomy is significant and typically follows a thorough evaluation of the patient’s symptoms and overall health.

Impact of Hysterectomy on Hormonal Balance and Menopause

The relationship between hysterectomy and menopause is complex. Traditionally, an open hysterectomy has been associated with an accelerated onset of menopause, especially when the ovaries are removed. However, current medical understanding suggests that unless there is a risk of ovarian cancer, it is beneficial to preserve the ovaries during a hysterectomy until the age of 65 to maintain hormonal balance. Moreover, newer surgical techniques such as laparoscopy and robotic surgery appear to avoid the early onset of menopause, offering better outcomes for women undergoing this procedure.

The Hidden Strain: Urinary Incontinence and Its Impact on Women's Health and Healthcare

Urinary incontinence in women is a significant health issue in Australia, not only affecting the quality of life for many women but also imposing a substantial economic burden on the healthcare system. Incontinence costs the Australian government approximately $1.6 billion per year, with the majority of these costs related to care in residential aged care facilities. It often affects older women, who may wake up at night needing to urinate and are at risk of falling due to weakened bones from osteoporosis.

The pelvic floor, a group of muscles and ligaments that support the bladder and other pelvic organs, can become damaged or weakened for various reasons. As women age, their pelvic floor ligaments naturally weaken. Pregnancy and pelvic surgeries, such as hysterectomies, can also stretch or damage these ligaments, leading to problems with bladder function. This can result in symptoms like frequent urination, urgency, incontinence, and difficulty emptying the bladder completely.

Treating these issues has become more challenging in recent years. In the past, surgical mesh was commonly used to repair pelvic floor problems, but due to concerns about safety, most mesh products have been removed from the market. Now, only a few specific mesh procedures are allowed, and they can only be performed by specially accredited surgeons in certain circumstances. For many women, non-mesh surgical options or non-surgical treatments, like pelvic floor physiotherapy, bladder retraining, or medications, are available.

Some women also suffer from recurrent urinary tract infections (UTIs), often due to incomplete bladder emptying, which can be related to pelvic floor issues. Maintaining a healthy lifestyle and regular exercise can help, and a simple solution like a vaginal pessary, a device that helps support the bladder, can also restore bladder function to a more normal state. This approach can provide significant relief for many women dealing with bladder dysfunction and pelvic floor prolapse.

Spotlight on Domestic Violence and Its Impact on Women's Wellbeing

The Reality of Domestic Violence in Australia

In Australia, domestic violence is a widespread issue. According to the Australian Bureau of Statistics (ABS), one in six women (approximately 1.6 million women) have experienced physical or sexual violence by a current or former partner since the age of 15. Additionally, on average, one woman is murdered every week by a current or former partner. These statistics highlight the severe and ongoing nature of domestic violence in the country.

Recognising the Signs

Healthcare providers play a critical role in identifying and supporting women experiencing domestic violence. Often, the signs are subtle—such as anxiety, depression, avoidance of eye contact, or frequent visits to the GP for unexplained headaches or pains. These symptoms could indicate underlying trauma, especially when no physical cause is found. Recognising these signs is the first step in providing the necessary support to women in need.

Barriers to Healthcare Access

One of the most insidious aspects of domestic violence is how it limits a woman's ability to access healthcare. Coercive control by an abuser can prevent women from attending medical appointments or lead them to neglect their health due to the constant stress of living in survival mode. This issue is particularly acute for women on temporary visas, who may be ineligible for healthcare—a situation sometimes exploited by abusive partners to maintain control.

The Impact of Chronic Trauma

The long-term effects of domestic violence extend beyond immediate physical injuries. The chronic stress associated with living in a violent environment can lead to significant mental health issues and the development of chronic health conditions. This stress is exacerbated by delayed symptom recognition and limited access to healthcare, often resulting in severe and long-lasting health problems. Research indicates that women who have experienced domestic violence are twice as likely to experience anxiety and depression compared to those who have not.

Providing Support and Breaking the Cycle

Organisations like Open Support offer crucial assistance to women affected by domestic violence. They use tools like the K10 assessment to monitor distress levels and provide necessary referrals to medical professionals. In-house counselling and psychological support, both individually and in groups, are integral parts of the recovery process. Additionally, encouraging women to obtain a mental health care plan as part of their overall case management helps ensure long-term support and rehabilitation.

Long-Term Outcomes

Rehabilitation for women who have experienced domestic violence is a challenging but achievable goal. With consistent support, education, and mental health care, many women successfully break free from the cycle of violence. At Open Support, the success rate is promising, with only a small fraction of women returning to their abusers, highlighting the effectiveness of comprehensive, targeted support in empowering women to rebuild their lives.

This article was written in collaboration with three specialist experts, A/Prof Vince Lamaro, Gynaecologist and Dr David Ende, Urologist at St Vincent’s Clinic, and Karen Devins, Domestic Violence Program Manager at Open Support.