When Normal Is Not Normal – Let’s Talk about Women’s Health

Often it is women who take care of other people and support them – whether in the family or at work. But what about their own health? Menstruation-related complaints, vaginal infection, chronic diseases like endometriosis, or oncologic diseases such as breast cancer – many health-related issues may occur throughout a woman’s life. Although a lot of information is available, many topics and issues in the area of women's health are still taboo, and a lack of information as well as uncertainty remains high – sometimes leading to severe issues  being dismissed as “normal” or “simply part of being a woman”. 

We talked to Cecilia Caetano, Gynecologist/Obstetrician and Director of Menopause Management at Bayer, about the importance of education and why women should proactively talk more about their symptoms and be mindful of their health.

Why are there still so many taboos and myths surrounding women’s health issues? 

From my experience there are multiple reasons. Many of those topics are uncomfortable to discuss, even bringing shame to those who raise them. In general, problems below the belt are often not addressed. Even in modern societies, there is still a “culture of silence” when it comes to those topics. 

And if something is not talked about, it often leads to a lack of knowledge about conditions and diseases and to the development of myths - some of which are passed on over generations. And this in turn means that women often do not seek support and help because they believe that women’s health related issues are “normal”. So many women just don’t speak up and end up coping with debilitating conditions such as heavy menstrual bleeding, menopausal symptoms or endometriosis.
 

Even if they suffer and feel a strong negative impact in their quality of life, they accept it without looking for solutions because often their mother or grandmother had similar issues, and “it always has been this way”. And they never become aware that they have a medical condition which can, and should, be discussed and treated.
 

How can we overcome a ‘culture of silence’ in women’s health?

One key element is education: I strongly believe that with education comes empowerment. We need to educate women - and men -, whenever there is a chance – starting in school with young girls and continuing throughout women’s lives, since even adult women often lack knowledge on topics like heavy menstrual bleeding or menopause. The more girls and women know about their bodies and their health, the better they can assess when something is not normal - even if their peers say otherwise. 

I would encourage every woman to start a conversation. Talk to your family and friends and you’ll find out that you are not the only one facing those issues. Get over your shame and speak to your gynecologist. Your physician knows all those problems and is used to talking about them - you don't have to be uncomfortable with anything. Another possibility is to use the many forums and discussion groups on the internet where you can have a conversation with experts and other people affected. You will see that you are not alone. But be careful and make sure that you only follow information from reliable, scientifically based sources. Unfortunately, there are many unreliable sources of information out there, perpetuating myths and misinformation. When in doubt, ask your doctor for information and advice.
 

Earlier you mentioned heavy menstrual bleeding. What is meant by this exactly and why is it so underrecognized?

Heavy Menstrual Bleeding, or HMB,is a medical condition in which excessive menstrual bleeding interferes with a woman’s quality of life. On average, HMB affects one in three women at some point in their life. The problem is that many women never realize that they are bleeding too much: almost 60 percent of the women affected believe that their condition is a normal part of having a period, and some women even perceive this as “cleansing” and “healthy”.

In addition, the hygiene industry offers a lot of products that are designed for HMB alongside normal products, and women with HMB may also conclude that their menstrual flow is normal. Hence, women tend to cope with this condition instead of seeking treatment to gain relief. For the majority of women, there is no identifiable disease causing HMB, but it can also be a sign of diseases like uterine fibroids or bleedings disorders.

How can women tell when menstruation is not normal and when should they seek help?

It’s difficult for women to determine if they have a heavy period because menstruation is different from woman to woman and quantification of bleeding is also difficult. There are signs that indicate HMB, e.g. menstrual products need to be changed every hour or a woman needs to get up at night to change her protection. Further typical symptoms which often come with HMB are symptoms of anemia such as tiredness, fatigue or shortness of breath. The impact on the patient’s life is highly relevant. If a woman needs to organize her life around her period, this means something is not right and she should speak with her doctor and discuss options to improve the situation.

And since having a number to reference is often an easier way to start a conversation, Bayer developed an App called FlowCyclo, to help women quantify menstrual bleeding and inform them whether their bleeding is normal in volume or if there are any deviations that should be discussed with their doctor. In fact, digital health offers tremendous opportunities in Women’s Health, from education, to symptom identification and disease management. 
 

In your experience, what other complaints are also often ignored and when should women better talk to their doctor? 

Just as HMB, strong period pain or dysmenorrhea is also often considered as a normal part of having periods - but it can have a big impact in a girl’s and woman’s quality of life. And even more: it’s one of the leading causes of school absenteeism in young girls. 

Although usually harmless, period pain can also be an indication of diseases like endometriosis. This disease is caused by the settlement of tissue resembling the uterine interior lining outside the uterus and often remains undetected for a long time. 

And here we see a positive development which makes me very happy: more and more women - including some famous women - who suffer from endometriosis are now beginning to talk more openly about it and share their experiences - on social media for example - to draw attention to the disease and the impact that it has on the life of patients. Awareness is fundamental to improving diagnosis and medical care, and this example should serve as inspiration for other areas in women’s health.

Another complaint many women recognize but don’t talk about is vaginal infection. They feel ashamed or guilty because they think that this has something do with poor hygiene, which isn’t the case. In fact, vaginal infections, such as vaginal yeast infections or bacterial vaginosis, are among the most common gynecological diseases. Even though women who have a vaginal infection often know about it they are reluctant to seek help and instead use home-made remedies to deal with the symptoms. To break taboos and educate people on vaginal health, Bayer’s Canesten brand launched Vagina Academy, the first ‘shame-free school of intimate health’, on TikTok in Brazil. Italy has since launched on Instagram and more countries like UK, Netherlands and Australia will follow. By using popular social media platforms to share valuable health lessons, we hope to help young girls and women bust myths around intimate health and provide them with knowledge about how their body works and confidence in looking after their own health.

Is there any advice you would like to give women?

Yes, there are two important aspects, very close to my heart. First, no condition or disease should make you feel ashamed and result in a loss of self-confidence. Debilitating conditions like heavy menstrual bleeding, period pain or vaginal infection are not part of being a woman – they are real issues which can - and should - be treated.  I can only emphasize: “Normal” stops when common events like periods or menopause start affecting quality of life. So, don’t believe in myths but rather educate yourself and build a trustful relationship with your doctor.

 
Second: Start the conversation! Exchange on these topics with other women – you will see that you are not alone, and at the same time you will empower other women to speak up and get the support they need. 

After all, it’s up to us, women, to break the silence and create a culture of openness - it's about our health!

References

Dunselman et al., 2014; Parasar et al., 2017; Eisenberg et al., 2018; Nnoaham et al., 2011; Hurskainen R, et al. Acta Obstet Gynecol Scand 2007;86(6):749–57; Singh S, et al. SOGC Clinical Practice Guideline. J Obstet Gynaecol Can 2013;35 (5 eSuppl):S1-S28; https://www.who.int/news-room/fact-sheets/detail/breast-cancer