Does women’s health need a complete overhaul?

Menopause and other stages of female health are increasingly discussed in the aesthetics and medical sectors, leading to significant steps forward in education. But, as reporter Becki Murray investigates, can more be done?

At the first Menopause in Aesthetics (MiA) conference held in February 2023 at the Waldorf Hotel in London, the trends report panel felt defined by a powerful statement given by Dr Shirin Lakhani: “women’s health needs a complete overhaul.”

Delivered during lively discussions around how the aesthetics industry can better support women during menopause, the comment neatly summarised why any such dialogue – both in aesthetics and the wider health service – should not be separated from women’s broader medical concerns. Menopause has been driving conversations around female health provision over the past few years. But, it’s not the only aspect that needs discussing.

“Traditionally, women’s health has been ignored,” reasserts Dr Lakhani, who is the founder of Elite Aesthetics. “I think throughout history, women have only been seen as the vessel to have children and everything else surrounding that has been neglected. Even today, when you look at how women are treated during pregnancy, it’s all about producing a healthy baby, and then the woman is left to fend for herself. The attitude towards women’s health does need reform.”

Beyond maternal health, there are arguably many issues facing women that are under-addressed. That includes “sexual and reproductive health, heart disease, osteoporosis, screening for cervical and breast cancer and urinary tract infections”, according to GP and women’s health specialist at The London General Practice, Dr Angela Rai.

“There are so many issues,” agrees GP and founder of ESK Skincare, Dr Ginni Manseng. “Firstly, there’s the problem of getting timely diagnoses of significant women’s health issues. That includes endometriosis, polycystic ovarian syndrome, and perimenopause; all are underdiagnosed.” Likewise, “equitable access to appropriate evidence-based treatments remains elusive. It’s also a struggle to overcome negative stereotypes which adversely affect women’s access to high-quality healthcare.”

One main stereotype is the perception that women’s pain is overstated or hysterical. “New research suggests that women’s tolerance is actually higher than a man’s, but women’s pain is still often minimised, starting from puberty,” reveals Dr Lakhani. “With conditions such as polycystic ovaries or endometriosis, there are delays in diagnosis, as women are told it’s all in their head. On average, a woman goes through eight years of suffering before an endometriosis diagnosis.”

If they do go on to have children, there are misconceptions about post-birth conditions, such as incontinence, pelvic floor dysfunction and prolapses too. “The attitude of the health service is ‘do some pelvic floor exercises and get on with it because it’s ‘normal’. But we shouldn’t let women’s suffering be normalised,” explains Dr Lakhani. This normalisation is also causing an education gap: “A lot of women I speak to don’t realise they have incontinence, because they just see leaks as a natural consequence of childbirth.”

Moreover, even the contraception pill – often seen as a symbol of female liberation – can accidentally lead to knowledge disparities. The pill is commonly utilised, not just for birth control, but also for heavy periods and acne. Yet, starting hormonal birth control fairly young can also mean you aren’t necessarily aware of your natural cycle or actively able to acknowledge underlying conditions; this is delayed until a woman struggles to get pregnant.

Simultaneously, there’s confusion and sometimes fear about certain healthcare solutions, including the side effects of hormone replacement therapy (HRT) and the efficacy of alternatives such as bioidentical hormones (BHRT).

“It’s really difficult because even the leaflet that comes with HRT quotes the higher risk of breast cancer and strokes,” says Dr Lakhani. “But new research shows that the risks could have been previously overstated and starting HRT earlier on in perimenopause could be better than waiting until you’ve gone through most of the hormonal changes. Yet, to start it, patients need to recognise their symptoms and then receive the right advice from healthcare professionals.”

“So much happens to women that just doesn’t happen to men when they experience andropause,” continues Dr Lakhani. “There needs to be more awareness and support so that they don’t drop out of work and stop having healthy, active lives, especially as we’re expected to live a lot longer – my children’s generation is mostly expected to survive past 100. People might think they can’t turn on the television without hearing about menopause, but for every positive piece, you get three negative ones as a backlash, including opinions about how women should shut up, because previous generations just got on with it. That shouldn’t be an acceptable view anymore. If we look at how women are affected post-menopause, in terms of their bone health and mental health, you can see why we need to address that when women come into the clinic.”

For many, resolving women’s health concerns may appear as solely a healthcare issue, but events such as the Menopause in Aesthetics Conference demonstrate how powerful it can be when doctors come together to discuss women’s health. “So many people there were interested and not all of them worked in women’s health services. They just wanted to learn about how they can support their patients,” reveals Dr Lakhani.

“Many doctors who practice in aesthetics have developed a natural interest in menopause, as so many women who present with wrinkles are of the age where lower oestrogen levels are turbo-charging skin ageing,” agrees Dr Manseng. “Doctors and nurse practitioners have realised that to holistically help women, they can do so much more than just treat their skin. Menopause and aesthetics do naturally go together.”

So, how can the aesthetic industry help its clients and help change the future of women’s health?

EDUCATE YOURSELF

It’s about acknowledging that as a practitioner you might have your shortcomings when it comes to female health. Understanding your limitations in the space, educating yourself and collaborating with experts is the first step to better supporting your clients.

“Knowledge about prescribing evidence-based treatments for menopause can allow women to access safe and effective fixes for the symptoms that distress them, like hot flushes, depression, insomnia, genitourinary problems and weight gain,” says Dr Manseng. “I would encourage my fellow practitioners to join the British and/or International Menopause Society to allow their patients a choice of evidence-based treatments for their symptoms.”

EDUCATE CLIENTS

Every consultation is an opportunity to gain a holistic picture of a client’s lifestyle and educate women on potential influencing factors, especially if the procedure is linked to ageing. It’s also a chance to discuss how treatment results can be influenced by biological processes – for example IPL for someone with polycystic ovarian syndrome or collagen-stimulating treatments during perimenopause when collagen levels deplete rapidly.

You can then signpost individuals to people who can further help them if required. “Giving women choice and empowering them to take control of their symptoms is a win for women and an incredibly satisfying ‘job’ for treating clinicians,” says Dr Manseng.

DEMYSTIFY TREATMENTS

Previously vulval and vaginal procedures were approached with either a degree of shame or with scandalous intrigue, but that’s shifting. “We’ve worked hard to present them in a way that’s functional, so women are less afraid to ask for help,” says Dr Lakhani. “We aren’t talking about ‘designer vaginas.’”

Technology has also improved. Empower RF and Morpheus8 V are two devices recommended by Dr Rai: the former is a non-invasive device designed to target stress, urge, and mixed urinary incontinence and weak pelvic floor muscles. The latter uses localised radiofrequency and microneedling to improve the health of vaginal cells and lubrication.

That said, such devices need to be in the right hands: “I worry that the increased interest in vulvo-vaginal health means companies may put out equipment that isn’t suitable or safe,” says Dr Lakhani. “It’s also important that practitioners don’t jump on the bandwagon. If you can’t diagnose red flags for vulvo-vaginal health, you shouldn’t be treating the area, because often you’re the only person being shown it that’s got any medical knowledge.”

EDUCATE EARLY

We may be playing catch-up in our support for women’s health, but we can negate that going forward by campaigning for robust school-based education. “I remember when I was at school, you’d hide your tampons up your sleeve, whereas the younger generation is a bit more open. We should be using that to educate them about intimate health, starting with the correct terminology; using silly names just perpetuates the stigma. I’m campaigning for improved education on pelvic floor health too, including having Kegel exercises as part of physical education. Girls and boys can benefit from them,” says Dr Lakhani.

Thus, through normalising women’s health within the aesthetics space, we can have a much more open conversation about it at all ages. Reform may take time, as success relies on widespread education, plus cultural and medical perception changes, but with the empowerment of the menopause movement behind them, women shouldn’t have to continue to suffer in silence.