Comprehensive women’s healthcare in chiropractic through a woman’s physiological journey
The percentage of women entering the chiropractic profession has been steadily increasing since the early 1990s, from about 13.3% to more than 31% in 2019, proving a new opportunity for comprehensive women’s healthcare. This growth in practitioners has brought with it additional perspectives on patient populations and treatment, ultimately helping chiropractors to better provide patient-centered, holistic care.
A female majority of patients
According to the National Board of Chiropractic Examiners (NBCE) 2020 practice analysis, 57% of chiropractic patients are female, and nearly 46% of those patients are between the ages of 30-64. As females comprise the majority of the population that chiropractors treat, framing female chiropractors as primary physicians can be beneficial to patients and to the chiropractic profession as a whole.
For example, chiropractors often treat a wide range of health issues and conditions — biomechanical issues, nutritional concerns, and disease prevention and risk factors, to name a few — in their female patients, who often seek chiropractic care because they want a practitioner who will treat their body in its entirety. It is imperative that chiropractic practitioners consider the whole patient when creating a treatment plan because there may be underlying factors that can impact their health and well-being.
It’s also important to conduct a thorough history of each patient, as a woman’s physiological journey can help tell where she has “been” and where she is “going.” Forgetting to look backward when talking to female patients can cause practitioners to miss important pieces related to the patient’s current state of health.
Comprehensive women’s healthcare: Treatment in adolescence
Although middle-aged women make up the majority of patients chiropractors treat, adolescent girls are experiencing more musculoskeletal pain than ever before. Determining the cause of the pain is of utmost importance, as adolescents are more likely to carry it with them as they age if it is not resolved.
Pain that commonly affects young girls includes musculoskeletal pain in the neck and low back, headaches and abdominal pain, and is often attributed to the changes their bodies experience as they age. Additionally, in recent months, many chiropractors have seen increased pain in young girls due to the growing use of technology during the COVID-19 pandemic. It is suggested that adolescents use technology for no more than two hours per day; because of COVID-19, however, many schools transitioned online, so adolescents are using technology more than ever before. This contributes to increased musculoskeletal pain, as many students did not have a proper work area, causing text neck, poor posture and a lack of ergonomics.
In addition, the age at which a female has her first period can affect her health later in life. A young woman who experiences precocious puberty, or who menstruates before the age of 12, has a 50% increased likelihood of breast cancer and is more likely to be impacted by polycystic ovary syndrome (PCOS) and other metabolic syndromes. Precocious puberty can affect the age of menopause and can be caused by childhood obesity, ingestion of animal proteins and exposure to endocrine-disrupting chemicals.
When it comes to treating young adults, specifically females, wellness and prevention are incredibly important. Identifying risk factors early can impact how they progress on their physiological journey. Chiropractors should educate parents on diet and exercise, as one in three American teens are overweight. Being overweight directly impacts cardiovascular health (obesity in children under the age of 13 can cause heart disease to develop as early as age 25), causing high cholesterol, diabetes, precocious puberty and asthma, so it is important to develop and encourage healthy diet and exercise habits from a young age as part of comprehensive women’s healthcare.
Female risk factors
As women age, they are at a greater risk for cardiovascular disease, so it is essential to educate patients on signs and symptoms of heart disease and on prevention and lifestyle interventions to avoid heart disease. When female chiropractors are framed as primary physicians, they can offer tips and advice to help patients live an overall healthy lifestyle.
As health care providers, it is imperative to ask the difficult or uncomfortable questions about a patient’s health history in order to treat them properly. For example, pelvic floor dysfunction can happen to anyone, not just older women. In fact, women as young as 15 years old have experienced pelvic floor dysfunction, and, contrary to some misconceptions, a woman does not have to have had children or have been pregnant to experience it. Pelvic floor dysfunction can lead to urinary incontinence, which is one of the most embarrassing topics for women to discuss, even with their health care provider.
It is the responsibility of the health care provider to break the barrier of discomfort and create trust with a patient to have open and honest conversations, because that will inform and shape the treatment plan. Chiropractic care can significantly impact urinary incontinence, but if it is unknown that a patient is struggling with this issue, it may never be resolved.
Uniqueness of treating female patients
There are many unique aspects to keep in mind when treating female patients, like social determinants of health, which are often missed by chiropractic providers. Social determinants include a patient’s ability to access quality health care — are providers available in their area? Do they have transportation to and from appointments? Are there financial barriers at play? Social determinants can also include the patient’s ability to make educated health care choices and decisions as well as the patient’s relationships with friends and family.
Where a patient lives, works, learns and plays can also impact their well-being. For example, do they live near green space where they are able to get out and walk? Do they work in a building that causes environmental exposure? These are questions that need to be asked to better inform patient care.
Additionally, as health care providers, it is necessary to not dismiss a patient’s pain. Regardless of age or background, women’s pain is often dismissed, especially when it comes to chronic pain. Women perceive pain differently than their male counterparts and are more likely to experience chronic pain than men. Chronic pain patients seek a provider who will listen and truly help them, and it is important to remember that the same issue doesn’t always create the same pain in two different patients. Investigate all aspects of a female’s pain, because it might not only be related to the musculoskeletal system but also to other contributing factors in regard to comprehensive women’s healthcare.
Educate and make patients part of their own care
Remembering to keep patients at the center of care is so important, but especially when treating women. Let patients be part of their care by making choices about their health care treatment.
Chiropractors should also educate and empower their female patients, as they make the primary household health care decisions across the country. Chiropractors can play an important role in educating patients to make good choices for themselves and other members of their family and should empower their patients by helping them advocate for themselves and for the care they need, want and deserve.
Maintaining an evidence-informed practice is of the utmost importance. Base care in evidence and research by finding methods proven to work and referring to outside sources when needed. The ACA Council on Women’s Health is a great resource when looking for information or direction on treating female patients. The Women’s Health Council’s mission and vision is to support and help practitioners treat their female patients in the best way possible, and the council provides practitioners with the materials and knowledge they need to do just that. The purpose of the council is to increase education, care and awareness of conditions that specifically impact women’s health; identify and support research and evidence-based practice as it relates to women’s health; and determine relevant quality measures and standards for women’s health. This, among many other resources, can greatly benefit the care of female patients while improving the chiropractic profession as a whole.
As the majority of chiropractic patients are women, framing female chiropractors as primary care physicians can be beneficial to patients and to the chiropractic profession in comprehensive women’s healthcare. Treating the whole female patient, while keeping in mind her physiological journey and all that impacts it, will result in superior patient care. Being attentive, asking questions and truly listening to patients will always lead to the best possible outcomes.
KRISTINA PETROCCO-NAPULI, DC, MS, FICC, FACC, is a strong advocate for women’s health and the assistant dean of the College of Chiropractic at Logan University and the president of the American Chiropractic Association’s Council on Women’s Health. She earned a bachelor’s degree in health sciences from the University of Arizona and a Doctor of Chiropractic from New York Chiropractic College. She then attended Syracuse University, where she graduated with a Master of Science from their Graduate School of Education with a concentration in instructional design, development and evaluation. An experienced speaker, she has presented at over 100 conferences, conventions, ceremonies and symposiums, and her work has been published more than a dozen times.