Women's health

Jason Abbott · Kirsten I Black · Elizabeth Marles

As this issue of the MJA is published, the world will be celebrating International Women's Day on 8 March 2025 and the rights of women continue to be critical to health. As a general practitioner working in the sphere of women's health for several years now, I have seen the gradual shift towards a more conservative view of women's health and a lack of equity around the management of chronic health issues. Hormone replacement therapy to treat menopause, for instance, continues to be out of reach for many due to high costs and poor access. More broadly, women continue to have experiences with a health system that is often invalidating and traumatic. The impacts of these are especially worse for women from socially disadvantaged backgrounds, Indigenous women, immigrants and refugees, and women with disabilities. Menstrual issues are a common presentation in primary care and, despite their high prevalence and impact on daily functioning, they continue to be under‐reported and undermanaged. In this issue of the MJA, Wilson and colleagues (https://doi.org/10.5694/mja2.52596) report on heavy menstrual bleeding in a cohort of women participating in the Australian Longitudinal Study on Women's Health from young adulthood to midlife. The prevalence of heavy menstrual bleeding increased from 17.6% at age 22 years to 32.1% at 48 years. Almost a third of the cohort reported heavy menstrual bleeding by middle age that has a significant impact on mood and social and physical functioning. Mean health‐related quality of life scores for women who reported heavy menstrual bleeding were lower in all domains and for the summary mental health and physical health scores than for women who reported never or rarely experiencing the condition; the differences were greater for women who often experienced heavy menstrual bleeding. Although the study was unable to examine conditions such as a history of fibroids or adenomyosis as a cause for heavy menstrual bleeding, most middle‐aged women in Australia struggle to access progesterone‐producing implants due to the cost and lack of access to the service (https://www.bayer.com.au/en/womens‐health‐collaboration). Worse, if the condition fails to respond to hormonal measures, as noted by my colleagues and I, women struggle to access gynaecological care for further treatment in the current cost‐of‐living crisis. Kirkman and colleagues (https://doi.org/10.5694/mja2.52602), in their research article in this issue of the MJA, found that of the 80 clinical guidelines in Australia they examined, there were varied levels of inclusiveness in dealing with sex and gender matters in health care and most guidelines were at the lower end of the inclusiveness scale. The majority of the 80 guidelines (46 of them) made no mention of clinical practice concerning gender. Only 12 developed ideas of gender in any detail, including discussion of topics such as gender inequality, transgender health and intersectionality. The remaining 22 either implied aspects of gender awareness without stating this or mentioned “psychosocial” or “cultural” considerations that could relate to gender, demonstrating at least awareness of the contexts within which people live. This has been a persisting issue for vulnerable populations that most guidelines are developed with a heteronormative focus on cisgender males. The lack of gender‐ and sex‐specific guidelines has likely impacted the understanding of the pathophysiology underpinning common clinical conditions in women such as endometriosis and adenomyosis. The MJA continues to publish important and innovative research into issues affecting marginalised and vulnerable communities. In this issue, Dissanayake and colleagues (https://doi.org/10.5694/mja2.52593) have published research examining the impact of Hope for Health, a culturally sensitive four‐month program supporting self‐managed health improvement based on dietary and lifestyle change for a community in northeast Arnhem Land. The program was led by a local steering committee of Yolŋu women, supported by a small Balanda (non‐Indigenous) team. The program, delivered in Yolŋu language and concepts, provided knowledge about metabolic health and the causes of modern lifestyle diseases. This information was shared in a supportive setting to encourage and allow people to make informed choices about how to manage the challenges of dietary and lifestyle improvement in their own way. Participants made tangible changes to their weight, but, most importantly, health behaviours that are linked to better health outcomes were improved. The intake of breads and cereals and sugar‐sweetened beverages declined, and the amount of walking and moderate and vigorous physical activity increased by a median of 103 minutes per day. The program's focus on integrating healthy bodies and networks of kin, healthy governance, vibrant language and ceremony, and a healthy environment were seen as central to its value and benefit. Clinical research is unlikely to provide long‐lasting improvement in health outcomes if it does not consider the needs and voices of the most marginalised and disadvantaged people. Doing so needs to become a national priority, as an increasing number of Australians struggle to maintain good health in these financially trying times.

Aajuli Shukla

Many women experience symptoms that have a substantial impact on their physical and mental health-related quality of life.

Louise Wilson · Tessa Copp · Martha Hickey · Bec Jenkinson · Susan J Jordan · Rachel Thompson · Gita D Mishra · Jenny A Doust

Guideline developers should consider the role of sex and gender to enable equity and inclusiveness in health care

Maggie Kirkman · Tomoko Honda · Steve J McDonald · Sally Green · Karen Walker‐Bone · Ingrid Winship · Jane R W Fisher

Cathy Latino · Oyekoya T Ayonrinde

Renuka Shanmugalingam · Angela Makris

Madeleine M Cosgrave · Catherine A Brumby · Matthew A Roberts · Lawrence P McMahon

Aletta E Schutte · Markus Schlaich

Women's health is an essential aspect of global public health that is not only crucial for the individuals affected but also has far‐reaching implications for family dynamics, community cohesion, and overall economic stability. While, globally, complications during pregnancy and childbirth remain a leading cause of morbidity and mortality among women of reproductive age, women's health encompasses broad areas of health and wellbeing including non‐communicable diseases (NCDs), mental health, and gender‐based violence. In these areas important health disparities exist among women and between genders at local, national and global levels. Tackling these health gaps requires an appreciation of their historical, social, environmental and economic roots. This issue of the MJA is dedicated to women's health. Ramson and colleagues (https://doi.org/10.5694/mja2.52452) set the scene with a discussion on the opportunities afforded by maternal care contexts for addressing NCDs. Low‐ and middle‐income countries struggle with a mix of NCDs and other health challenges, with evidence indicating that women in these regions experience higher rates of multimorbidity compared with men. The authors explain that a life course approach to women's health, with a focus on addressing NCDs early, can improve maternal and child health outcomes, necessitating enhancements in sexual, reproductive, maternal, newborn and child health services. They propose that policy recommendations should include establishing standardised definitions for NCDs to improve data collection, focusing on primary prevention strategies, integrating care services, addressing inequalities, and providing global guidelines for the management of NCDs in maternity care. A noteworthy area of concern in Australian women's health is equitable access to contraception and family planning services, which is a particular challenge in rural and remote areas where health care services may be limited (https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/ReproductiveHealthcare/Report/Chapter_2_‐_Enhancing_access_to_contraceptives). Research by Perkins and colleagues (https://doi.org/10.5694/mja2.52438) explored general practitioners’ views on postpartum contraception counselling and provision during postnatal checks. Three themes were generated: preferences for counselling timing, the provision of long‐acting reversible contraception (LARC), and opportunities for improving postpartum care. Participants expressed a desire to discuss contraception but had differing opinions on the timing of these discussions, often feeling that postpartum checks were not the ideal moment. While most recommended intrauterine devices (IUDs) and implants as preferred contraceptives, barriers such as long waiting times and insufficient training for IUD insertion limited their provision. Recommendations for improving postpartum contraception care included enhanced training opportunities, financial incentives for general practitioners, and multidisciplinary collaboration among health care professionals. A research article by Grzeskowiak and colleagues (https://doi.org/10.5694/mja2.52451) analysed the dispensing patterns of category X medications among women aged 15–49 years in Australia from 2008 to 2021 and their concurrent use of hormonal LARC and other contraceptives. LARC overlap with category X medications was only present for 13.2% of study participants, highlighting insufficient usage of effective contraceptive methods. The authors argue that strategies are required to enhance the uptake of LARCs among women using category X medications, including addressing barriers to LARC access, education on contraceptive options, and ongoing monitoring of contraceptive practices. Gender‐based violence is an ongoing societal challenge in Australia, with one in six Australian women experiencing physical or sexual violence since the age of 15 years (https://www.abs.gov.au/statistics/people/crime‐and‐justice/personal‐safety‐australia/2021‐22). In a research article, Galrao and colleagues (https://doi.org/10.5694/mja2.52436) aimed to determine the prevalence of intimate partner violence and reproductive coercion through standardised data collection in Australia. A cross‐sectional study was conducted with female clients aged 16 years and older attending a Perth sexual health clinic from March 2019 to March 2020, involving demographic data extraction and screening questionnaires. In this study, 2623 clients participated, with 17.3% reporting having experienced intimate partner violence (16.3%) or reproductive coercion (5.3%). The study revealed higher rates of both forms of abuse among specific demographics, including Australian‐born women and those with female partners, emphasising that clinicians should be open‐minded when assessing risk of abuse in order to identify and support affected individuals. In summary, women's health issues are influenced by various factors, both globally and within Australia. As we strive for gender equality and health equity, understanding the unique needs of women and the barriers many face is crucial in developing effective interventions and policies. There is a need for commitment from all stakeholders, including governments, health care providers, and communities, to advance women's health as a shared priority.

Francis Geronimo

General practitioners are well placed to facilitate discussions about contraception with women who have recently given birth

Jenna K Perkins · Sharon James · Danielle Mazza · Jessica R Botfield

Naomi CA Whyler · Sushena Krishnaswamy · Michelle L Giles

The proportion of births to Victorian women with obesity rose during 2010–2019, particularly in regional areas

Yvonne E Baker · Glyn Teale · Vidanka Vasilevski · Alemayehu Mekonnen · Linda Sweet

Improving their social and emotional wellbeing could help reduce the number of Aboriginal people in Australian prisons by reducing recidivism

Pat Dudgeon (Bardi) · Ee Pin Chang · Joan Chan · Carolyn Mascall · Gillian King (Noongar) · Jemma R Collova · Angela Ryder (Noongar)

Affordable and accessible testing to measure omega-3 levels is paramount to reduce preterm births

Joanna YX Fu · Carol A Wang · Elyse C Mead · Jason Phung · Maria Makrides · Craig E Pennell