Pelin Batur, MD works in Cleveland Clinic’s Department of Subspecialty Care for Women’s Health, within the Ob/Gyn & Women’s Health Institute. She is a Professor of Ob/Gyn & Reproductive Biology at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. Her areas of expertise include menopause, medically complex contraception (including menstrual migraine and menstrually associated neurologic conditions), osteoporosis, and sexual health. She sat down for a chat to help us understand women’s complex health needs.
Read the Q&A with Dr. Batur below.
WAM: Often when we think of women’s health, we think of health concerns that affect biological females exclusively—pregnancy, periods, menopause, etc. How has our understanding grown about what women’s health is beyond issues of reproduction? What do physicians really mean today when they talk about women’s health?
Dr. Batur: Women’s health really is understanding how genetics, lifestyle habits, and hormones combine to impact various diseases. For example, how do certain complications of pregnancy (such as preeclampsia) impact women’s cardiovascular risks, which then impacts whether she can safely go on hormone therapy after menopause? It also means having expertise in “orphan diseases”. These are diseases that really have no subspecialty home. A great example is menstrual migraines, which are often debilitating for many women. There are concerns that contraceptive dose of hormones with estrogen may increase stroke risks in those who have migraines with aura. (Aura is specific type a neurological disturbance that can accompany migraines.) However, the contraceptive doses of hormones are overall very safe, and may even help these headaches. Given that most neurologists don’t get training in hormones, and most gynecologists don’t get training in headaches, the counseling and treatment options a migraine sufferer receives may greatly differ based on the doctor that she sees.
WAM: We know that women are at double the risk of developing Alzheimer’s disease when compared to men. What are some other conditions that we see more frequently in women?
Dr. Batur: Outside of the sex specific diseases such as breast cancer, cervical cancer, ovarian cancer etc., there are many types of diseases that impact women more frequently. Of those impacted by an autoimmune condition, 3 out of 4 are women (there are close to 80 autoimmune conditions, such as lupus, rheumatoid arthritis, etc.). Migraines, osteoporosis, irritable bowel syndrome, urinary tract infections all disproportionately impact women. Although strokes impact both sexes, they are more likely to kill women than men. Many mood disorders, such as anxiety and depression, are reported to be more common in women. Because these conditions impact all humans, I do wonder whether these mood conditions are more commonly diagnosed in women because of patient comfort in bringing up the topic, or perhaps even the bias of some clinicians to assume this is the reason for a woman’s symptoms. I think there is room to tease this science out a bit better, thinking about these potential biases.
WAM: Why do we see so many of these diseases developing in women during midlife? What do we think the connection may be to changes in her brain and body during the years leading up to and through menopause?
Dr. Batur: We do know that our sex hormones produced in the ovary, i.e. estrogen and progesterone, help with the risks of a variety of diseases. As estrogen levels drop, protection from some of these medical conditions is lost. This is why women who have premature menopause (estrogen loss before the age of 40), have increased risk of multiple neurologic, cardiovascular, and bone diseases.
WAM: What kind of specialized care should women and people assigned female at birth seek out at each stage of the lifespan?
Katie Batur: Women’s health is such a broad term, it can be difficult as a patient to know where to seek help. There are some of us that have done subspecialty training in the area of women’s health, but there are far too few of us to care for all those who needs subspecialty services. Luckily, depending on a woman’s needs throughout her lifespan, she has a variety of resources. It is always important to have an established relationship with a good primary care doctor. There are national shortages of primary care doctors because there is a lot of burden on these clinicians within our US healthcare system. That being said, staying connected with a good primary care doctor has been shown to decrease death rates in patients being cared for by these clinicians, underscoring the importance of preventative care throughout the lifespan. Similarly, just because a Pap test may not need to be done yearly for most individuals, this doesn’t mean that a young woman shouldn’t see her gynecologist on an annual basis. An annual visit is much more than just getting a Pap test, it encompasses important discussions about ways to prevent disease, as opposed to catching it after it has started.
National subspecialty societies oftentimes have names of practitioners available on their websites. For those who need answers regarding reproductive health hormones, there is a growing subset of gynecologists that have subspecialty training in “complex family-planning”. This means they have more in-depth understanding of how contraceptive dose hormones impact health risks and tolerability in women (before menopause). After menopause, discussions about hormone therapy, menopause management should be with someone who understands the complexities of this phase of life.
The North American Menopause Society (now called the Menopause Society, menopause.org), has a list of menopause certified clinicians across the world. Throughout the lifespan, many of these problems impact sexual health. The International Society for the Study of Women Sexual Health (isswsh.org) has a list of clinicians with special interest (not necessarily special training) in helping navigate sexual concerns. Most importantly, patients should look for a doctor who is willing to discuss the pros and cons of a variety of options, and help let the patient make their own decisions. Too often, patients are simply told what to do, as opposed to open conversations about risks and benefits of different approaches, which may impact hormonal and sexual health.