Women’s health a hot topic for Vhi seminar

A discussion on hypothalamic amenorrhoea (HA) and how the condition can be spotted in general practice was one of the women’s health issues covered in the recent Vhi 360 webinar. Often caused by stress, a negative balance between exercise and nutrition, or other illnesses such as coeliac or Addison’s disease, HA refers to women not getting their period because of the suppression of the hypothalamic–pituitary–ovarian axis.

Dr Lucy-Ann Behan, consultant endocrinologist at Tallaght University Hospital, who led the discussion, recommended that patients who may have HA should be asked about their full history, as well as possible issues concerning energy deficits, stresses in daily life, mood, and symptoms that could point to other causes such as hot flushes, headaches and visual field issues. Investigations may also involve checking at primary care level for breast development, blood pressure and heart rate.

“Some people can be reluctant to consider that they might be in an energy deficit, so it might take a little bit of teasing out and it might take one or two visits,” said Dr Behan. “Especially, it can be easier to ask those questions or get a response when you have the biochemical evidence that actually, this is looking very like hypothalamic amenorrhoea, and you can tease it out with them gently.”

Similarly, when it comes to stress as a possible causal factor, the close relationship the family doctor has with their patients can be crucial to them opening up about personal issues. “That’s where I think general practice is key, because often you know the whole family, whereas when somebody comes to me, sometimes I’m seeing them in isolation and I don’t know necessarily what’s going on at home.”

The impact of the menstrual cycle on exercise has been a topic of interest to Dr Amélie Roland, a GP with Vhi 360, who spoke about relative energy deficiency in sport (RED-S). The syndrome occurs when athletes do not receive enough fuel through their food to support the demands of their sport or training.

While previously thought to primarily affect women, the syndrome’s early definition focussed on the interrelationship of low energy availability (i.e. the energy remaining for daily activity after exercise), menstrual function and bone density. However, in 2004 its definition was broadened to highlight the potential impacts of RED-S in men as well as women, which can include metabolic rate, protein synthesis and cardiovascular health.

Research has shown that, in young female athletes, RED-S can have a prevalence of up to 56 per cent, while up to 45 per cent of recreational female athletes are considered at risk. Cyclists, long-distance runners, ballet dancers and gymnasts are at higher risk of developing the syndrome, often due to greater pressure to be lean to improve performance.

Risk factors can be psychological or physical, including eating disorders, having a low-energy diet, overtraining, or using exercise as a way to lose weight. The condition’s symptoms can also be broad, ranging from fatigue and brain fog to poor bone health, amenorrhea in women or gastrointestinal issues.
As a result, the paths to diagnosis and treatment can be varied, and the importance of GPs getting a full history of their patients to help spot the condition was highlighted.

“Depending on how many symptoms they’re showing, they might need to decrease their exercise, which as you can imagine is a very difficult ask for keen athletes, so it’s very interesting to work with them on what’s recommended at this stage and what are they happy to do” Dr Roland explained.

Getting such vital information, however, can pose a challenge when patients have intellectual disabilities. Dr Fiona Belton, clinical lead for women’s health at Vhi 360, discussed managing women’s health in patients with such disabilities.

According to the 2022 Census, two per cent of the population has an intellectual disability, including more than 44,000 women and girls. Dr Belton highlighted the importance of good communication – both speaking and listening – when it comes to interacting with patients with an intellectual disability. She also recommends that the doctor speaks firstly with the patient, then bring in their carer or support person if needed.

“A lot of patients with intellectual disabilities will feedback that actually ‘the doctor doesn’t talk to me, they just talk to my mam or my sister’,” she told the webinar. “I think talking to them like they are somebody without an intellectual disability and tailoring it as needed is really important.”

Dr Belton also highlighted the importance of explaining what is involved in young women and girls as they go through puberty, so that the changes they experience are less frightening and overwhelming.

“Talking to the girls about their bodies and the proper names for their body parts and what they’re for helps to keep them safe, protects from abuse, and helps them to understand what they’re feeling,” she added.

On menopause, Dr Belton noted that women with an intellectual disability tend to experience it earlier. According to the Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA), women with Down syndrome tend to begin menopause before their forty-fourth birthday, while women with other intellectual disabilities go through it, on average, just before they turn 48.

“It has been well recognised that early or premature menopause increases the risk of all-cause dementia,” Dr Belton added. “Women with Down syndrome who had menopause before the age of 46 had an earlier onset and an increased risk of Alzheimer’s.”

However, in the IDS-TILDA study, just 40 per cent of women reported having symptoms, and less than half were aware of the menopause transition.

A further UK study reported that the level of understanding of menopause is generally low amongst women with Intellectual disability, However, it is thought that they experience symptoms of menopause similar to the general population. Carers and family members have reported feeling not trained or resourced, and it can be very difficult for them to know if menopause is causing the physical or psychological symptoms, or there are other causes.

She emphasised the importance of education among women with intellectual disabilities, their families and carers. Clinicians should also be aware of bone health and take note of vitamin D intake, as studies have shown that women with intellectual disabilities are often lacking in the vital organic molecule.

Last to address the webinar was Lorna Ross, Innovation Lead, Group Healthcare Office at Vhi Group. While many of us still grapple with technology’s capacity to transform healthcare, for Ms Ross, the concept is nothing new.

With 30 years’ experience in technology and industrial design, Ms Ross is no stranger to the concept of wearable devices. She attended her first wearable tech conference in the nineties before taking on roles with the US-based Defence Advanced Research Projects Agency, Motorola and MIT Media Lab.

However, it was through her role as head of the design studio at the famous Mayo Clinic that she became a driving force in healthcare innovation.

Today, she uses more than two decades of experience in health technology to advise Vhi on how the healthcare provider can drive innovation in delivering patient-centric care.

Ms Ross outlined the opportunities and challenges the health sector faces in the wake of ongoing digital transformation. She remarked how, in the wake of artificial intelligence, the relationship between humans and technology is evolving and, in some ways, magnifying biases through an ‘algorithmic cruelty’. This can often happen in AI and machine learning tools which depend on existing data that is often built on cultural stereotypes.

“The data that we’re feeding the algorithm is basically just amplifying an awful lot of cultural biases that we have already,” she told the webinar. “And so, some of these tools become magnifiers of bias. I think that’s really important when we think about healthcare, marginalised communities, and the assumptions we make.”

Ms Ross also spoke about the emergence of femtech as an example of how technology has developed to fill gaps that have historically existed in women’s healthcare and the challenges this presents as these ‘DIY’ tech solutions are not integrating into existing healthcare systems.

The presentations were followed by a Q&A session, facilitating follow up discussions on the topics raised about women’s health and the importance of the GP and patient relationship.

Information
Vhi 360 Hot Topics is a series of educational webinars focused on key subjects of interest to support the primary care healthcare workforce in delivering improvements to patient care in primary care settings.

These are conducted in partnership with MedCafe.ie. A recording of the recent Vhi 360 Hot Topics Women’s Health Webinar can be found on https://www.medcafe.ie/webinars/755.