The Management of Chronic Gynecologic Conditions During COVID and Beyond - Episode 14

Provider Perspective to Address Dismissal and Normalization

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Supported by: AbbVie

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Panel of experts discuss provider perspective to address the stigma, normalization and dismissal of common non-malignant gynecologic diseases.

Ayman Al-Hendy, MD, PhD: What can we do from the provider side?

Linda Bradley, MD: Again, getting back to listening to the patients, I think we take very perfunctory histories. We F2 everything. How frequent are your periods? Every 28 days. How many days of your period? You know, we get those answers, but as Stacey mentioned, I think we need to look at how do your periods or do your periods impact the things that you enjoy in life. That can range from sports to travel, to meetings, those kinds of things. As a woman, periods can be a nuisance, but they should not impact the quality of your life. I think it’s no different than me asking a patient who is overweight or obese, how does your weight affect what you want to do? If you just pause and listen, and I know this is a little bit of a diversion, some people will say I cannot travel because I can’t walk through the airport, I can’t walk to the end of my driveway to get my mail, I can’t do certain things.

What I like to do is just to make sure we’re listening, and don’t just look at the end of the day at her CBC, with the hemoglobin of 11.4. That may be a patient who is eating 4 to 5 foods and taking iron but didn’t tell us, eating iron-rich foods and taking vitamin C. I like to just make sure we’ve asked questions. How do your periods affect your life? Is it keeping you from doing something? And then also ask, as she mentioned, some of the other questions like eating ice, their hair falling out, headaches, fatigue, and palpitations. Patients will look at you like how do you know I’m eating ice? I’m like I listen to your history. You’re bleeding like Niagara Falls, you know. Then you get their blood count back, and it’s very low.

I think you have to put it into context. What kind of pads? I had a lady the other day using 6 pads. If I didn’t ask her, I thought it was 6 pads a day; it is 6 pads at 1 time and changing 6 pads every hour. Clarification. What size pads? They’ll tell you they’re not using pads, they’re using diapers. I’ll ask, you know, what do you carry with you, and they’ll bring up purse, a satchel, or their backpack, and I’ll ask them, show me what you’re using. I think it’s the whole story. It’s impact, it’s the labs, and it’s the history. We didn’t mention also asking other things. Five to 10% of women have von Willebrand disease, and this bleeding may have been present since childhood because of that, without a family history, are there different degrees of von Willebrand disease? Making sure we try to ask for some things. When did the bleeding start? Is there a family history? Thyroid disease? I’ve picked up patients with a resident a few years ago, had leukemia with a platelet count of 6000, and she’s thinking her fibroids were the cause of her bleeding. We have to be really focused on that entire history, and looking at eyes, not eyes, look at nose and gum bleeding and easy bruising when you cut. Just kind of throw those questions out. Not to say no to every question means you don’t have X, Y, or Z, but at least in your mind, you’ve thought about things.

I just like to look at the impact of the bleeding, and, as she mentioned, is it eliminating you, taking you out of the circle of things to do things. I’ve seen residents and young doctors. They’re in med school, and they’re like, well, I would never choose surgery because I can’t scrub out to change my pad every hour. You see what I’m saying? Is it keeping you from doing something or reaching an aspiration? I have patients who say, oh, “if I’m going to be on my period and traveling; I’m in Cleveland, and if I’m on a plane and it has to sit on the tarmac for 2 hours, it’s going to be a bloody mess.” A normal woman shouldn’t have that.

Getting those interesting stories and finding out what conundrum does their period put them in and how protected do they feel that they are in; it’s like with coronavirus 2019 and buying up all the toilet paper so we all have toilet paper for our homes. Women are like I cannot leave without my backpack, and that’s kind of not normal. The word is stigma, embarrassment, and figuring out how these things are, and that’s not a normal behavior. To me, for the provider, it is just digging a deeper level, peeling back the onion so to speak, and not being so perfunctory that I close the chart, that everything is F2-ed because it doesn’t bring me any closer to her story. That, to me, has always been the most important thing and asking a few more questions.

Transcript edited for clarity.

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