Considerations when treating women patients and holistic female patient health and safety
Patients often seek chiropractic care because they want a practitioner who will treat their body in its entirety. As chiropractors, we have a unique opportunity as gatekeepers of care for our patients, helping them to achieve their definition of optimal health. While each patient is unique and requires a customized care plan, there are several things chiropractors should consider to differentiate care for female patient health, as females represent 57% of chiropractic patients overall according to the National Board of Chiropractic Examiners (NBCE) 2020 practice analysis.
Providing comprehensive women’s health care begins with a thorough patient history. In addition to the chief complaint and history of the present illness, practitioners should ask female patients about:
- Menstrual history, including age at menarche, last menstrual period and menstrual pattern
- Perimenopause/menopause, including bleeding pattern, vasomotor symptoms and hormone replacement therapy
- Cervical and vaginal cytology, including most recent Pap smear result and history of abnormal Pap smears
- Fertility/infertility, including desire for future fertility or difficulty conceiving in the past
- Obstetric history, including each pregnancy and the outcome as well as maternal, fetal or neonatal complications
- Past surgical history, including how procedures were performed
- Social determinants of health, such as a patient’s ability to access quality health care, relationships with friends and family, and where a patient lives, works, learns and plays
- Mental health and stress levels
Because physical, mental and emotional health are all connected, conducting a comprehensive patient history up front better informs patient care and helps chiropractors determine when it is necessary to co-manage care with other skilled providers.
There are several issues specific to female patient health that doctors of chiropractic can bring more awareness of to our patients.
Female patient health and heart disease
This is the leading cause of death (1 in 5 deaths) for black and white women in the United States, according to the Centers for Disease Control and Prevention (CDC). Heart disease is concerning because women often ignore the symptoms, which may include fatigue, thoracic spine pain and lower extremity edema.
Infertility
Among heterosexual women aged 15 to 49 with no prior births in the U.S., about 1 in 15 (19%) are unable to get pregnant after one year of trying (infertility), according to the CDC.
About 1 in 4 (26%) women in this group have difficulty getting pregnant or carrying a pregnancy to term (impaired fecundity).
Menstrual cycle/Dysmenorrhea
In recent years, cycle syncing has become a common conversation among women. This involves syncing one’s work and leisure activities, exercise and diet with the four stages of the menstrual cycle. When women understand hormone shifts, they have a greater opportunity to maximize hormone impact.
This can benefit all women, but also can have a greater impact on those who have polycystic ovarian syndrome (PCOS), are overweight, are tired frequently, have low libido and those who are trying to conceive.
Pelvic floor dysfunction and urinary incontinence
Many people believe pelvic floor dysfunction only happens postpartum or in perimenopause, when in fact females experience pelvic floor dysfunction at any time — even as early as adolescence. This may include pain in the pelvic region during activities, losing control of the bladder or bowels, difficulty emptying the bladder or bowels, waking at night to urinate or experiencing urgency to urinate.
Further, there are multiple types of dysfunction. Stress incontinence is abdominal pressure from any cause such as coughing, sneezing, jumping or walking; overactive bladder syndrome or urge incontinence is defined by urinary frequency plus urinary urgency and nocturia with or without involuntary loss of urine, and mixed incontinence is a combination of stress incontinence and overactive bladder syndrome. Women may find it challenging or embarrassing to talk about these issues, which makes it even more important for chiropractors to ask the critical screening questions.
Perimenopause/menopause
On average, women in the U.S. begin menopause between the ages of 48-55, with perimenopause beginning 3-5 years prior. Smoking, surgical removal of ovaries and uterus, chemotherapy and ethnicity can all impact the age at which women experience menopause, which comes with a multitude of potential symptoms.
It’s important for chiropractors to understand this large physiological transition and evaluate patient needs accordingly. For example, DCs can advise on dietary choices and/or supplements that can ease symptoms, consider different types of manipulation therapy and perform specific labs/diagnostic testing most appropriate for this phase of life.
Female patient mental health and stress
While diagnosing and treating mental health is not part of a doctor of chiropractic’s scope of work, it is important for DCs to know how to recognize the signs and symptoms and provide resources if needed.
Women tend to have more layers of stress at times than their male counterparts, and this stress can have a direct impact on how the patient responds to the care that they need, want and deserve from chiropractic practitioners. As you’re conducting the patient history, look for key indicators of stress, anxiety or depression that may manifest as complaints such as difficulty sleeping, rapid heart rate or restlessness. Have conversations with your patients about decreasing stress by meditating, practicing yoga, spending time outdoors and moving their body regularly in a way that they enjoy.
Chronic pain
As health care providers, we must 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 regarding comprehensive women’s health care.
Provide a safe environment for patients
With all patients, providers should focus on providing compassionate care. This includes making eye contact; sitting at the same level; being present, empathetic, respectful and supportive; and acknowledging challenges the patient has faced in his or her lifetime, especially recently living through a pandemic.
Patients, and women especially, tell us things when they feel safe, comfortable, empowered and like they have a choice in their care. It is our duty as providers to create an environment for female patient health that fosters these feelings for our patients.
KRISTINA PETROCCO-NAPULI, DC, MS, FICC, FACC, is a strong advocate for women’s health. She’s 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.
