Dr. Diane Francoeur
OB/GYN, CEO, Society of Obstetricians and Gynecologists of Canada
Patricia Lee
Founder, CanFIB
Dr. Michelle Jacobson
Menopause Specialist
In this article, “woman/women,” “girl/girls,” and “her/she” refers to individuals born with a uterus. These problems apply mostly to cis women. Trans and non-binary individuals born with a uterus may experience concerns related to their internal and external genitalia which are not discussed in this article.
Understanding the intricacies of the reproductive health journey throughout one’s life and knowing how to advocate for oneself are critical.
From adolescence to menopause, each stage of a reproductive patient or woman’s life presents unique challenges and considerations. However, when we don’t talk about women’s health openly, the complexities are often overlooked, perpetuating the normalization of troubling symptoms and sidelining women’s health concerns. It’s time to shift this narrative and empower women to advocate for their well-being at every stage of life.
The reproductive health journey
When we consider women’s reproductive health, some topics might jump to mind: pregnancy, childbirth, and breastfeeding, for example. But the reproductive health journey is so much bigger than solely reproduction. It encompasses all stages of a woman’s life, plus their accompanying obstacles — from contraception to reproductive diseases to menopause.
“At birth, females have the highest number of eggs they ever will, but their ovaries are quiescent (dormant) and don’t produce significant levels of hormones,” says Dr. Michelle Jacobson, a menopause specialist with an interest in menopause oncology and hereditary breast and ovarian cancer syndrome. “At puberty, there’s a signal from the brain where cohorts of eggs/follicles start to be recruited in order to start ovulating and eventually a predictable ovulatory cycle is supposed to occur.” The reproductive journey has officially begun.
The challenges can begin early
The onset of puberty and menstruation can bring early health challenges in one’s reproductive journey.
“Puberty can sometimes be associated with bad surprises like discovering you have a bleeding disorder or an anomaly of your uterus or no uterus,” says Dr. Diane Francoeur, a practicing OB/GYN in a tertiary care centre (Sainte-Justine Hospital, University of Montreal) for 30 years and the CEO of the Society of Obstetricians and Gynaecologists of Canada (SOGC). “You may not have your period because you have problems with your chromosomes or ovaries. You may also not have your period regularly if you have lots of stress or a body fat issue (too low or too high).”
Girls may need period management at this early stage if they’re having any issues with pain, excessive bleeding, or other symptoms.
Addressing contraception and fertility
Next come sexuality awareness and the need for contraception, which is required as girls or women become sexually active, especially as heterosexual intercourse presents higher risk. Accessible contraceptive options are an important factor in ensuring that people can attain the contraception they need, while being empowered to consider their options and make their own choices. Misconceptions and stigmas surrounding birth control — for example doubts about its effectiveness, concerns regarding side effects or promiscuity, or the influence of religious and cultural beliefs — should be addressed in an open manner. Sexually transmitted infection (STI) and Human papillomavirus (HPV) screening are also important at this stage, notes Dr. Francoeur.
By fostering awareness and empowering individuals to challenge the status quo, we can pave the way for a future where every woman feels heard, supported, and empowered in her health journey.
“Next comes pregnancy and, unfortunately, the surprise that you may not be able to conceive or that you may have miscarriages, high-risk pregnancies, a difficult delivery, or the disappointment of having a Cesarean section or trouble with breastfeeding,” says Dr. Francoeur. “The standards are very high for new mothers. We’re seeing an increase in post-partum depression and addiction. Families are small and women don’t always have the support they need.”
Facing a lack of awareness
Beyond childbearing, many women in the reproductive years face challenges with conditions like endometriosis and fibroids. Endometriosis happens when tissue similar to the lining of the uterus grows outside of the uterus, causing inflammation and scar tissue in the pelvic region. It can have a significant impact on women’s quality of life, at times causing debilitating pelvic pain, heavy and painful periods, fertility issues, and a host of other symptoms. Fibroids, meanwhile, are growths (sometimes called non-cancerous tumours) that occur in or on the uterus. Like endometriosis, fibroids can lead to pain, heavy and painful periods, symptoms of anemia as a result of excessive blood loss, and more.
“Like a lot of people, I didn’t know what fibroids were until they hit me over the head,” says Patricia Lee, Founder and President of the Canadian Women’s Forum for Fibroids (CANFib). Lee notes that while most people understand what an enlarged prostate is, or erectile dysfunction, they’re ignorant when it comes to reproductive health issues affecting women.
This lack of understanding — and the absence of important conversations that should be happening — mean that many women are suffering in silence.
“When I first saw my GP about my extremely heavy periods, they were just like, ‘It’s a period, suck it up,’” says Lee. Realizing that her symptoms weren’t normal, Lee pushed to see a specialist, where she was diagnosed with fibroids.
Advocating for women
Lee started the CANFib Facebook group in 2012, recognizing the lack of discussion that was happening around fibroids, despite it being an incredibly common health issue affecting approximately one in four women over the age of 35. “People just flooded in,” she says. The group quickly grew to over 28,000 members.
Now, Lee is on a mission to spread information and is a dedicated advocate for research, awareness, and insurance coverage for fibroid treatments. She hopes to support other women living with fibroids before their symptoms get so bad that they’re hospitalized, as she was, and required to undergo a partial hysterectomy due to the severity of her symptoms.
“Trust your body and track your symptoms,” she advises. “If you feel that it’s not right, it’s not. It’s just not. If your doctor doesn’t listen, move to another doctor. Until someone listens to you, self-advocate. Be persistent.”
Menopausal challenges
As women get older and pass their reproductive years, the challenges can continue.
“In perimenopause, some women become bothered by menopausal symptoms and need hormonal support, and this may be true in menopause as well,” says Dr. Jacobson. “As women age, they also may have unique issues associated with an aging urogenital system like the genitourinary syndrome of menopause or pelvic floor dysfunction (prolapse or incontinence). If people are bothered by symptoms or if their health or functioning is affected, they should know they should speak with their HCP who can work with them to find appropriate treatment options.”
Challenging the normalization of pain
Speaking up if something feels wrong — and seeking support or treatment — is an incredibly important lesson for women and girls. Dr. Francoeur and Dr. Jacobson provide examples of symptoms that aren’t normal: heavy bleeding to the point where you can’t leave the house or are bleeding through a tampon and maxi pad in a short period of time, pain or bleeding after sex, pain that makes you vomit or miss work or school, and having bothersome hot flashes or night sweats that interfere with your functioning. If you’re experiencing any of these symptoms, they encourage you to talk to friends, family, or a family doctor — each of whom can help challenge the normalization of your pain.
“There’s a health care provider out there who will advocate for you, believe you, and help you,” says Dr. Jacobson. “Unfortunately, sometimes it can be an uphill battle to find that person. If you feel dismissed or that the advice you received is not correct, ask for a referral to the specialist of your choice, join advocacy networks, and document not only symptoms but also how you’re affected.”
By fostering awareness and empowering individuals to challenge the status quo, we can pave the way for a future where every woman feels heard, supported, and empowered in her health journey. Remember, your normal might not be the norm — so speak up, seek support, and prioritize your well-being.
If you have symptoms that don’t seem normal, talk to your physician to discuss your concerns and to learn about the available treatment options.Or learn more by visiting a relevant patient group:
canfib.org
vivre100fibromes.ca
endometriosisnetwork.com
menopausefoundationcanada.ca
thewhc.ca
This article was made possible with the support of Pfizer Canada.
