Women's Healthcare: A Provider's Perspective

At a time when it seems everyone is considering the future of healthcare in the United Statesits affordability, quality, and accessibilityI am heartened to have the opportunity to share my perspective as a womens health provider, along with some useful health information and hope for the future of womens health as I see it.

For over 20 years I have practiced as an OB/GYN in Wisconsin. I have spent some of this time in a Madison group practice, some as a college health provider, some as a physician volunteer in Honduras and Haiti, and some as the cofounder and medical volunteer at Share the Health Free Gynecology Clinic for uninsured women. All this while serving as a teacher and mentor to future health providers. My perspective is a unique mix of experience and an unrelenting drive to understand and make sense of things.

I find it particularly perplexing why conversations that include contraception often suddenly end with so little said. Unspoken assumptions of sexual activity stop all except the bravest from uttering a word, let alone a complete thought. Sadly, this ends the sharing of the truth about contraception, which really centers around disease prevention and management, not preventing unplanned pregnancy. But because of the assumption of the latter, minds jump to sex, muting any and all health-focused conversations. These conversations need to happen, and this is my attempt to start one.

Cancer destroys lives and families. For our mothers, wives, sisters, and daughters, prevention is available for most gynecologic cancers, including ovarian, uterine, and cervical.

Ovarian cancer kills over half the women it affects, and there are no early warning signs. Unlike breast, cervical, and uterine cancer, cancer of the ovary is rarely detected before it is widely spread. This deadly cancer affects 1 in 70 women, and kills nearly 70 percent of those it affects, including comedian Gilda Radner and civil rights leader Coretta Scott King. Like breast cancer, ovarian cancer can run in families by a genetic predisposition, and similar to breast cancer, more than 85 percent of women who get ovarian cancer do not have this genetic risk. Random bad luck. Unlike breast cancer, we cannot find a lump on our ovary and we have no early detection test like a mammogram. But there is a prevention pill. Contraceptive pills can reduce the lifetime risk of deadly ovarian cancer by as much as 30 percent if used for five years or longer in the reproductive years. It does not have to be five years in a row, just a total of at least five years provides the additional benefit. The point to embrace, contraception prevents cancer.

Endometrial cancercancer of the uterine liningis most commonly a result of excessive growth of the lining and is prevented with progesterone, a protective hormone that prevents and treats overgrowth. Progesterone prevents cancer and is widely used for this purpose when birth control is prescribed for women who are at increased risk due to less progesterone to balance their estrogen. This happens to most women in their later reproductive years as they ovulate less often and, as a result, have less postovulation progesterone but normal estrogen levels. This mismatch of estrogen and progesterone also happens for women with polycystic ovarian syndrome (PCOS) because of less frequent ovulations. A third group of women who are at increased risk of endometrial cancer are obese women, but not because of infrequent ovulation. Fat cells make weak estrogen, and this stimulates the uterine lining beyond the control of the bodys progesterone. The result can be heavy periods lasting weeks, which is a problem on its own and also a sign of increased cancer risk.

Thankfully, progesterone comes in almost every form of contraception: pills, patch, vaginal ring, shot, implant, and an intrauterine device (IUD). All forms are highly effective in preventing endometrial cancer, so take your pick. Not to belabor the cancer prevention point, but colon cancer risk is also reduced with the contraceptive pill. If we change the conversation about contraception to include cancer prevention, cancer prevention could be the primary reason for most womens use of contraception, and pregnancy prevention would be the side benefit.

Like contraception and cancer, Planned Parenthood deserves to be seen from this cancer-prevention perspective and not through the narrowed lens of pregnancy services. Planned Parenthood serves our country as a safety net for cancer- prevention services for womenmany women. Since 2002, Wisconsin has had a pap screening and contraception program for low-resource women (Family Planning Only Services), and many women who qualify for these services rely on Planned Parenthood for cancer-preventing care. We need to change the national conversation about Planned Parenthood to increase support for this work, not reduce it.

Share the Health supports the prevention work that Planned Parenthood provides by performing colposcopy and LEEPs to uninsured women with abnormal paps, and by performing endometrial biopsies and ultrasounds for uninsured women with abnormal uterine bleeding. Reviewing referrals to Share the Health, I can attest to the high-quality care women receive in southern Wisconsin through Planned Parenthood. We are healthier as a community because of it. Cancer-preventing care happens to include contraception because contraception prevents cancer.

I encourage all of us to have these conversations in a meaningful way, at meaningful times, with people that are meaningful to you and your community. I hope this article gives you ideas on how to start the conversation. For more information about the Wisconsin Family Planning Waiver Program and Well Woman Program and to see if you qualify for program resources, please visit ShareTheHealthWI.org .

Mary S. Landry, MD, is president and cofounder of Share the Health Free Gynecology Clinic, Inc., and is an associate professor of obstetrics and gynecology at University Health Service Womens Clinic at the University of WisconsinMadison.