Women's health through the life course
Also known as: women's health, female health, gynaecological health, reproductive health, menstrual health
Women's health covers the care of organs that change every month and at every stage of life: periods, contraception and fertility, pregnancy, the menopause, the pelvic floor, screening for cervical, breast and bowel cancer, and illnesses that behave differently in women. Care follows anatomy, so trans men and non-binary people with these organs need the same care.
The menstrual cycle sets the rhythm of the reproductive years: cycles of about 21 to 35 days are typical, and the NHS counts regular cycles anywhere from 21 to 40 days as normal. Bleeding heavy enough to disrupt daily life, pain that ordinary painkillers do not control, and bleeding between periods, after sex or after the menopause are all worth reporting. Endometriosis, fibroids and polycystic ovary syndrome lie behind many such symptoms. Heavy periods are the commonest cause of iron deficiency anaemia before the menopause, so a full blood count and ferritin are checked when bleeding is heavy or tiredness persists.
Contraception works by stopping ovulation (the combined pill, patch, ring, implant and injection), by thickening cervical mucus and thinning the lining (progestogen-only pills and the hormonal coil, which also lightens heavy periods), by barrier (condoms, which also prevent sexually transmitted infections), or permanently by sterilisation. Before a planned pregnancy, folic acid is advised from before conception through the first 12 weeks, and smoking, alcohol, long-term conditions and regular medicines are reviewed. Antenatal care checks blood pressure and urine; afterwards the pelvic floor, mood and bleeding need attention.
The menopause is 12 months after the last period, on average around 51 in the UK, with the perimenopause running for years before it. Falling oestradiol brings hot flushes, night sweats, disturbed sleep, low mood, joint aches, vaginal dryness and urinary symptoms. Hormone replacement therapy relieves them, with a progestogen added for anyone who still has a uterus, and vaginal oestrogen treats local symptoms. Bone loss is fastest around the menopause and cardiovascular risk rises after it; chest pain is still the commonest sign of a heart attack in women, and accompanying breathlessness, nausea or pain in the jaw, back or arm are more often attributed to something else.
Cervical screening covers everyone with a cervix from 25 to 64 in England and tests first for high-risk HPV. Breast screening offers a mammogram every three years from 50 to 71; trans women are eligible after at least two years of feminising hormones, and trans men who have not had chest surgery remain eligible. Invitations follow the gender you are registered as with the GP, so anyone registered as male will need to ask rather than wait for a letter. Bowel screening posts a home kit for a faecal immunochemical test to those in the eligible age range. Screening is not a test for symptoms: a new lump, a nipple or skin change, or bleeding after the menopause needs prompt examination.
Effects on the body
| System | Effect |
|---|---|
| Reproductive | The cycle, fertility and pregnancy depend on the ovaries and uterus; endometriosis, fibroids and polycystic ovary syndrome are common causes of pain, heavy or irregular bleeding and difficulty conceiving |
| Endocrine | Oestradiol and progesterone rise and fall each month, climb steeply in pregnancy and fall at the menopause, and those shifts change bones, skin, sleep, mood and the vagina |
| Skeleton | Bone density peaks in early adult life and falls fastest in the years around the menopause, so osteoporosis and fragility fractures are commoner in women |
| Heart | Cardiovascular risk rises after the menopause; chest pain remains the commonest sign of a heart attack in women, and accompanying breathlessness, nausea or pain in the jaw, back or arm are more often attributed to other causes |
| Urinary | Pregnancy, birth and the fall in oestrogen weaken pelvic support and thin the urethral lining, so urinary infections, stress incontinence and prolapse are common and treatable |
| Lymphatic & immune | The national programmes cover cervical, breast and bowel cancer; there is no screening test for ovarian or womb cancer, so persistent bloating, feeling full quickly, new pelvic pain or any bleeding after the menopause need assessment rather than waiting for a screening invitation |
Guidance
- Know your own pattern and report change: bleeding heavy enough to disrupt daily life, pain that ordinary painkillers do not control, new irregularity, bleeding between periods or after sex, and any bleeding after the menopause
- Attend cervical screening from 25 to 64; it is for everyone with a cervix, including trans men and non-binary people, who may need to ask for it if registered as male
- Attend breast screening when invited, and ask for it rather than wait for a letter if you are registered as male: trans women are eligible after at least two years of feminising hormones, and trans men who have not had chest surgery remain eligible; get a new lump, skin dimpling, nipple change or blood-stained discharge checked promptly whatever the last mammogram showed
- Choose contraception with a clinician rather than by reputation: methods differ in how they work, how they affect periods and what suits your health history, and emergency contraception works best the sooner it is used
- Before a planned pregnancy take folic acid from before conception through the first 12 weeks, stop smoking, avoid alcohol, and have long-term conditions and regular medicines reviewed
- Train the pelvic floor lifelong: squeeze as if stopping wind and the flow of urine, hold and release, several times a day, during and after pregnancy, and keep it up for at least three months before judging the benefit
- Talk about menopausal symptoms rather than tolerating them, and get any bleeding after the menopause assessed urgently; hormone replacement therapy, with a progestogen if you have a uterus, and vaginal oestrogen are effective for most people; discuss the benefits and risks for you, including the type and route of oestrogen
- Protect bone and heart from midlife onwards with weight-bearing and strength exercise, enough calcium and vitamin D, no smoking, moderate alcohol, and blood pressure and cholesterol checks