One size fits all. Not in my medical care, thanks
As we wrap up Gynecological Awareness Month and continue to examine how equity in medical research and medical treatment impacts our health, we’ve been struck by two ongoing themes advocating for yourself when you know something just isn’t right and getting your regular screenings on time are the most powerful tools we have in our own health.
Of course, you can’t do either of those without the knowledge and information you need and that we work to bring you each week.
This week Maggie is headed to the Women’s Health Innovation Summit in Boston. We can’t wait to share what she learns!
The journey continues.
- Maggie Ruvoldt & Stephanie Majercik
The Tasting Menu
Basics of Uterine and Endometrial Cancer
One Size Fits All Medical Training and Medical Trials Hurts Everyone
Your Pregnancy Care Team
As we continue to learn about gynecological cancers, this week we are sharing information on Uterine and Endometrial Cancers. These are complex topics and you’ll find links to more information and resources at the end of this piece.
There are multiple kinds of uterine and endometrial cancer and it is the most common of the gynecological cancers. The most common uterine cancer forms in the lining of the uterus - the endometrium. The main symptom to watch out for is abnormal bleeding, including spotting or any bleeding after menopause.
If you and your healthcare provider are concerned, a biopsy, MRI o CT scans, or transvaginal ultrasound can be performed. Your pap, while important, doesn’t detect uterine or endometrial cancer.
Endometrial cancer is often detected early and with treatment has a high success rate with a hysterectomy.
If you notice any abnormal bleeding, speak to your healthcare provider right away
Additional resources:
Foundation for Women’s Cancer information on uterine and endometrial cancer
Cleveland Clinic main page for Uterine Cancer
Verywell article on treatment for endometrial cancer
One Size Fits All Medical Training and Medical Trials Hurts Everyone
We’ve lamented here how frustrating it is that healthcare has often revolved men - the assumption being made that men and women experience symptoms, pain, medications, etc all the same. The medical community has learned - generally - that there are differences between men and women (shocking) and that more customized treatments or diagnoses must be considered.
We can also look at this from a different angle. Women may be more included now, but does that extend to all women? Using the same logic that women experience and present with symptoms differently than men, then women of different races, ethnicities, and skin colors, also will present with and experience symptoms differently.
Analysis of medical textbooks and included imagery have indicated that skin tones referenced overrepresent light skin tones and underrepresent darker skin tones. Specifically for external conditions, this underrepresentation can make it difficult for doctors to identify things like melanomas or abnormalities because they haven’t been taught what those look like.
This is just one contributing cause to many of the racial disparities in healthcare. Inclusion in clinical trials is also critical to reducing disparities. While the inclusion and participation of women overall is up, the inclusion of women of color has much room for improvement. Consider these stats from the Society for Women's Health Research article:
Participation of women in clinical trials is up in gynecological and neurology studies, but continue to be underrepresented in cardiovascular disease and infectious disease trials
8% of clinical trial participants in 2020 were Black or African American (yet they make up 13% of the US population)
Hispanic participation in clinical trials dropped from 18% in 2019 to 11% in 2020
A 2022 study outlines specific barriers to clinical trial participation, including systemic barriers and barriers in trial design, as well as specific action items to address barriers directly. Its a necessary start to ensuring that we’re getting greater representation of all people in clinical trials and medical education so that our system can provide better care for everyone – closing the gap in health disparities and care.
What can we do to change this?
Check out the Starr Coallition’s list of organizations promoting greater inclusion in healthcare
Continue talking about our experiences. Everyone’s journey with their health is different, and we can only continue to learn more about how these impact each other. Just because we may have the same diagnosis as someone, doesn’t mean we experience the exact same symptoms.
Your Pregnancy Care Team
One member of our team is obsessed with Call The Midwife. With an incredible 11 seasons (or series as they say in Britain), it got us thinking about all the people needed to truly support you through pregnancy and afterward.
Let’s take a look at the professionals who can be on your team.
Medical doctors There are different types of physicians who may care for you. If you are low risk a family medicine physician may be sufficient. Most people see an obstetrician (OB), who may have been their gynecologist to care for their reproductive health pre-pregnancy. If the pregnancy is higher risk, a perinatologist with their additional training and specialty in high-risk pregnancy may be the best option.
Midwife Several types of certification exist for midwives. Some are nurse midwives or midwifes requiring a graduate degree for certification. A certified professional midwife may only require a high school degree and additional training. Licensure requirements vary by state.
Doula Another professional with certification who you may consider is a Doula The support they provide through the process can be emotional, educational and physical. There is evidence that Doulas improve psychological as well as physical outcomes.
Here are some you might not have thought about before
Lactation Consultant One friend of ours expressed how hearing “Breastfeeding is the most natural thing in the world” left her feeling isolated and like a failure. Enter the lactation consultant. These certified professionals specialize in breastfeeding and chestfeeding. From issue of latching to breast engorgement to mastitis, there are myriad ways they can support the feeding part of your post-partum life.
Pelvic Floor Therapist On our wish list is that everyone gets a pelvic floor therapy evaluation postpartum. Your body goes through an enormous amount through pregnancy and delivery. Why not proactively find out if a pelvic floor therapist can help you with pain, incontinence or muscle issues?
Anesthetist Whatever your pain management plan is for delivery, you should discuss your options with your provider and even consider talking with a certified registered nurse anesthetist in advance.
Ultrasound tech or Sonographer Who hasn’t seen a movie or television scene with the ultrasound? Sure your doctor might do this but it might also be an ultrasound tech. They may not interpret the results but depending on the stage of pregnancy, they perform a critical role in assessing the health of baby.
What care team members would you add to this list?
Medical Term of the Week
We’ve become familiar with the term endometriosis, which is when cells similar to those in the lining of the uterus appear outside the uterus.
But what is the endometrium, from which endometriosis gets its name?
The endometrium is the tissue that lines the uterus. It plays a main character role in menstrual cycles - thickening and enriching with blood, which it then sheds if there is no pregnancy. And in pregnancy, it supports the placenta and fertilized egg.
The thickness of the endometrium changes over a lifetime and plays a role in fertility and uterine wellness.
The Latest
Ryan Reynolds lost a bet and won his health. He agreed to video his colonoscopy. They found a precancerous polyp and now he’s advocating for others to get tested (from NPR)
In one of the most concerning pieces we’ve read lately, the CDC found that more than 80% of maternal deaths in the U.S. are preventable. You read that correctly and can read more. (From USA Today)
Further supporting our pieces this week on no size fits all medicine, we found a recent article on the racial disparities in menopause fascinating. (from Healthline)