As part of National Women’s Health Week, Michelle Berlin, M.D., M.P.H., and Renee Edwards, M.D., M.B.A., co-directors of the OHSU Center for Women’s Health, shared their thoughts on how women can best advocate for their health.
What positive trends do you see in women’s health?
Berlin: Women are talking more openly about women’s issues that affect health. For example, fighting the rape culture, protecting reproductive rights, racial and gender inequalities, domestic and sexual violence, among others. There’s a heightened awareness about the bigger threats to women’s health like repeal of the Affordable Care Act. Women are getting better at advocating for their own health and making health care decisions that are best for them and their families. But there’s a lot more to be done.
How could the current national dialogue hurt women’s health?
Edwards: There are currently 22 women’s health preventive screenings mandated through the ACA and they are at risk of going away. It’s basic things like maternity care and birth control. Women’s health is everybody’s health and we are putting the health of future generations at risk.
What trends in women’s health worry you?
Edwards: One trend that worries me is what young women are doing to their vaginas and vulvas, like plastic surgery, vaginal steaming, vaginal lipstick, labial trimming, etc. These types of treatments change the natural microbiome of the vagina and can actually predispose women to problems such as infection or scarring.
What should women think about when choosing a health care provider?
Berlin: Choose a health care provider that you’re comfortable with so that you can really tell them what’s going on. Women shouldn't have to feel ashamed or embarrassed when talking to their health care provider. They should find a provider they feel is there to help them achieve their health goals, not judge their choices. It’s our responsibility as providers to build that trust so that we can get to the root cause of other health issues.
Edwards: OBGYNs are generally more likely to screen for reproductive-based needs but not other conditions, whereas primary care providers are more likely to counsel on preventive health and screen for non-reproductive-based conditions. Primary care doesn’t always catch everything and OBGYN also doesn’t catch everything. By having both OBGYN and primary care at the Center for Women’s Health, we bridge between the two.
What is the secret to women staying healthy?
Edwards: It is not a secret! It’s the things your mother taught you – eating well, getting sleep, exercising. Pregnancy is also a stress test for woman’s health. Often times the conditions that women experience in pregnancy, such as hypertension or gestational diabetes, show up later in life as a potential chronic health condition. So it’s important to pay attention to these things in pregnancy for continued monitoring by a provider to maintain future health.
What should you know about your family’s health history?
Berlin: The things we generally ask our patients are about history of cardiovascular disease, cancers, menopause (when did it happen for your mother), reproductive health, or anything else that seems to run in the family. Women are often better at knowing and asking these things, and they need to share them with their providers. We suggest that families talk about these kinds of things when they are together, like at Thanksgiving dinner.
What questions should providers be asking their female patients?
Edwards: We know that many women are not only caring for themselves, but they are caring for aging parents and their own children, leaving them little time for self-care. We should be asking women how they are caring for themselves and work with them to prioritize their own health. They also make 80 percent of health care decisions, and so a lot of the burden is on them, with little support. There are often other issues going on behind the scenes that affect health, and health care providers won’t know this unless they are asking the right questions.
Berlin: When it comes to women as the primary caretakers, I think of what they say on airplanes: put your oxygen on first and then give it to your child. If you don't take care of yourself, you won’t be able to take good care of your loved ones.
What is the biggest barrier to women’s health?
Berlin: Changing behaviors. One of the most important things that matter to women’s health is behavior, and that is often the hardest thing to change. It's a lot easier to get a blood test or take a pill than it is to exercise. It’s the human condition. Women often look at what’s right in front of them, not what could happen 20 years down the road. That’s why women still smoke. But we have to understand the why (for example, stress, depression, etc.) so that we can change the behavior. If women are seeing health care providers more regularly, it’s also easier to change behaviors because it keeps it top of mind.
What are the benefits of going to a center dedicated to women’s health?
Berlin: It’s an unusual model and we think people get better care this way. Services are co-located, but more importantly, health care teams and specialists can easily talk to each other. This allows us to better coordinate care and care for the whole person, not just a specific health care need. We know that 34 percent of our patients also see more than one provider in the Center for Women’s Health and so the patients also see it as a way to get unified services.
You are co-directors, which is uncommon. Why does this model work for the Center for Women’s Health?
Edwards: Michelle and I have different levels and types of interests and expertise, and people that we know across campus. So it makes us stronger because it expands our reach. We recognize that as a value and not a threat. When we don’t agree, it forces us to compromise and think through issues. The Center for Women’s Health itself is a multidisciplinary center. By design the intent is to look at the full complement of services that are important to woman and their health care needs. We do our best to either provide them in on site or through complementary services. The fact that we’re accustomed to working like that in a leadership style also speaks to how we create a multidisciplinary environment.
Berlin: We have complementary skillsets and networks. It’s us. There are a lot of men and women who can’t pull this off. We didn't really know each other that well before we started, at least in this capacity. We chose this co-director model. We can also divide and conquer. We each came to this from different backgrounds, one from a strong foundation in clinical administration and the other in public health of women. Putting all that together provides dimensions that are not what one would normally think of.
Michelle Berlin, M.D., M.P.H., is co-director of the OHSU Center for Women’s Health; professor of obstetrics and gynecology, medical informatics and clinical epidemiology in the OHSU School of Medicine; and professor of public health in the OHSU-PSU School of Public Health.
Renee Edwards, M.D., M.B.A., co-director of the OHSU Center for Women’s Health; and associate professor of obstetrics and gynecology in the OHSU School of Medicine.