The Women's Health Activist Newsletter

Quarter 4, 2023

All the articles for the latest quarter four, 2023 issue can be accessed by scrolling down this page, or by jumping to the articles that interest you specifically by clicking on the headings in our handy table of contents below. Have questions? Something not working right? Send us an email at [email protected]. 

Table of Contents

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NWHN Values

We believe that...

  • Health is a human right.
  • Our gender identity, race, ethnicity, sexual orientation, disability, geographical location, socioeconomic status, insurance status, and/or immigration status should not dictate the quality of healthcare we receive.
  • This work is intersectional and must be conducted through a lens of diversity, equity, inclusion, and justice.
  • Lived experience and scientific evidence must drive health policy and shape healthcare.
  • Maintaining the integrity of our work is essential.

A NOTE FROM DENISE HYATER-LINDENMUTH, 

EXECUTIVE DIRECTOR OF THE NATIONAL WOMEN’S HEALTH NETWORK

Play Video

Happy Holidays from the NWHN!

The transcript for the video above is as follows:

"Hello, my name is Denise Hyater-Lindenmuth and I'm the Executive Director of the National Women's Health Network. I want to wish you a happy holiday season and to thank you for your continued support of our work.

Since January of this year, I've had the privilege to get to know many of you, learn of your stories, and understand why the National Women's Health Network is important to you. I'm also honored to lead an organization whose mission is to address health issues that that disproportionately impact women.

Our vision is to be a key resource for women's health care and to lead advances in advocacy and education. We will continue to be a voice for women when our voices need to be heard and included in vital conversations and decisions.

So please consider supporting us in our work by texting "NWHN" to 71777."

-Denise Hyater-Lindenmuth, Executive Director

Executive Director Denise

Deep Dives

Go below the surface on health topics you care about.

Weathering the Storm: Mental Health Realities for Aging Women in the U.S.

By: Janette Norrington (PhD) Volunteer Science Writer

 

In the U.S., aging women are likely to experience mental health challenges.

People are living longer than previous generations and it is projected that about 75 million Americans will be over age 65 by 2030. Women form the majority of the older population as they tend to live longer than men with an average life expectancy of 81 years old in the United States. Many older adults are at risk of developing mental health conditions, neurological disorders, or substance use problems. Over 20 percent of adults aged 55 and older experience some form of or co-occurring mental health conditions and older women are more likely to experience conditions such as depression and anxiety than older men. While many older women experience mental health challenges, these conditions are not an inherent part of aging and can have negative consequences for physical and emotional health.

What is the relationship between women, aging, and mental health?

Throughout their lives, women generally have poorer mental health than men in terms of depressive and anxiety symptoms and this continues into late life. Older women often have a higher prevalence of depression, anxiety, and dementia than older men and younger women. Mental disorders in later life manifest in different ways. While some older women experience a mental health condition for the first time, others may encounter new age-related mental challenges. Older adulthood is marked by a variety of important life changes and stressors; studies show that some older adults struggle to adjust and cope with these experiences, which can trigger or worsen mental health concerns.

Some common stressors and life experiences that older women face include: hormonal changes; loss of close family and friends; financial pressure; chronic health conditions; co-existing physical and/or mental health conditions. Mental health concerns are associated with impaired social and cognitive functioning, poor physical health, disability, accelerated aging, suicide, and early death.

What are the specific mental health challenges faced by aging women?

The mental health conditions below are growing more common in aging women – and this is not necessarily a normal part of getting older. Indeed, symptoms of these conditions are overlooked or explained away by providers and loved ones alike as normal aging or masked underneath co-occurring physical conditions. Further, symptoms of mental distress may present differently among older adults and can be confused with other conditions.

1.) Depression

Depression is a mental health condition that is characterized by an alteration in usual mood with sadness or a negative mood state such as irritability, despair, and anger. Women are more likely to experience depression than men across the lifespan, but the gap widens as women get older; in fact, women over age 70 years are 15 percent more likely to have depression than men the same age in the United States. Senior depression often manifests in physical psychosomatic symptoms such as persistent aches and pains, digestive problems, and reduced appetite in addition to the classic symptoms of persistent sadness, difficulty enjoying things they once loved, social withdrawal, and lethargy. Untreated late life depression is associated with a higher risk of cognitive decline and developing dementia and overall poorer health and function. 

2.) Anxiety 

Aging women experience anxiety more frequently than aging men with an estimated 2% of women aged 45 to 59 years reporting an anxiety disorder in the past year. All anxiety disorders, including social anxiety, phobia, and generalized anxiety, share features of uncontrollable worry and related behavioral disturbances that are excessive or disproportional to the problems or situations that are feared. Many aging women with anxiety have struggled with the condition since earlier in life, but the way it manifests may change over time. Aging adults with anxiety are more likely to experience extreme feelings of worry, loss of memory, poor concentration, irritability, hoarding, a fear of falling, and physical symptoms than younger adults. Anxiety disorders can lead to diminished functioning, cognitive impairment, disability, and early mortality.  

3.) Substance Abuse  

Substance abuse problems among aging adults are often overlooked or misdiagnosed, but these issues are increasing in aging women. Aging adults typically metabolize substances at a slower rate than those under age 65 years, making them more sensitive to effects of drugs and alcohol and more vulnerable to developing a substance use disorder. Seniors are prescribed more medications on average than younger adults and have a higher likelyhood of abusing them; in fact aging women are more likely to misuse prescription medications than alcohol. Binge drinking and heavy alcohol use is increasing among aging women with those age 65 years and older reporting binge drinking, or drinking more than four drinks on one occasion, four days in the past month. Long-term substance abuse can lead to mental health consequences such as depression, dementia, and social isolation as well as physical health conditions. 

4.) Dementia  

Dementia, a condition characterized by chronic or progressive deterioration in memory, thinking, behavior, and daily functioning, is more common in aging women than men. Alzheimers disease is the most common form of dementia and nearly two-thirds of Americans living with Alzheimer’s disease are women. There are currently no successful treatments to stop the progression of dementia and as life expectancy continues to increase dementia will likely increase in aging women, but there are treatments to slow the progression of the disease. 

Photo by Mariia Chalaya on Unsplash
Photo by Mariia Chalaya on Unsplash

What are the relevant risk factors for mental health challenges in aging women?  

There are a number of life experiences and stressors that affect women and mental health in late life. As people grow older, the amount of stress often increases while the ability to deal with it decreases, which can contribute to the development of mental health conditions. 

1.) Social isolation and loneliness  

Aging women may experience social isolation and loneliness as the result of life transitions, stress, and loss. As women have a longer life expectancy, they are more likely to be widowed and experience the death of loved ones, live alone, have a physical disability or chronic conditions, and caregiving responsibilities. Aging women may also experience an abrupt decrease in purpose-giving responsibilities with retirement, children moving out, and relationship changes with partners and friends. This can lead to the disruption of social networks, drastic changes in routine, and a sense of loss of independence and identity. Indeed, the data shows that women age 65 years and older experience increased isolation and lack of quality friendships and family connections than their male counterparts, which is concerning because social isolation and loneliness are associated with an increased risk of mental health conditions like depression, anxiety, and dementia.  

2.) Financial Stress  

Aging women often experience financial disadvantage and insecurity in retirement that puts them at risk for mental health challenges. Women earn less than men throughout their lifetime and are more likely to experience poverty in older age than men. Aging women are often widows who live alone and engage in unpaid labor, so many have fewer financial resources and less pension availability than their male counterparts. Financial insecurity is associated with mental health challenges like anxiety, increased stress, and barriers to treatment.  

3.) Menopause and Hormonal Changes 

Toward the end of a womans reproductive years, her hormones shift as she enters perimenopause and menopause which can lead to new difficulties regulating mood and managing mental health. Perimenopause is the transitional time around menopause and women on average enter menopause in their early 50s. During menopause, there is a significant drop in the production of the hormones estrogen and progesterone, and women often experience symptoms such as changes in mood, hot flashes, brain fog, fatigue, insomnia, and weight gain. The symptoms and hormonal changes can lead to depression and anxiety or reignite mental health problems in women who previously experienced mental health conditions. About 18 percent  of women experience symptoms of depression in the early stages of perimenopause and 38 percent of women in early menopause. Mood changes that are partially driven by hormonal changes during the menopausal transition typically ease after menopause, but these changes can cause difficulty for middle-age and aging women for years on end. 

4.) Cooccurring Physical and Mental Health Conditions 

As women age, they are more likely to experience multiple physical and mental chronic conditions which is associated with diminished mental health and quality of life. Aging women may experience chronic pain, urinary tract infections, chronic health physical conditions, disability, and frailty which are each associated with mood disorders. Women with overlapping mental health and/or physical health problems often take different medications to manage their conditions, but the drugs may interact with each other and inadvertently affect mood and mental health.  

5.) Caretaking  

Women often become caregivers for children and older family members, placing them at-risk  for increased stress and burnout. An estimated 65 percent of caregivers are women and female caregivers may spend 50 percent more time providing care than male caregivers. Women in midlife may be responsible for caring for minor children and elderly parents while older women often care for chronically ill partners and loved ones; for example, two-thirds of those caring for a loved one with Alzheimer’s disease are women. The stress of caregiving and balancing multiple roles can contribute to the onset of conditions such as depression, insomnia, and anxiety.  

6.) Ageism 

Aging women often experience age discrimination, or ageism, which can take an emotional and mental toll. Ageism is defined by stereotypes, prejudice, and discrimination related to old age, aging processes, and older adults. More women report age discrimination than men with almost 40 percent of women age 50 years and older experiencing discrimination based on their age especially in the workplace. Senior women with mental health conditions face a triple stigma of old age, being a woman, and living with a mental health disorder placing them at-risk for sexism, ageism, and ableism; discrimination of any kind is associated with chronic stress, depression, anxiety, and lower self-esteem.  

 

What are some strategies to combat poor mental health in aging women?  

There are several evidence-backed strategies and treatment options to support mental health in aging women: 

 1.) Social connection and engagement  

Social interaction and support is associated with reduced risk of mental health concerns in aging women. Many older adults experienced isolation during the COVID-19 pandemic, but technology presented opportunities for them to connect with friends, family, and other older adults. Engaging in the community and volunteering, participating in social activities based on social and personal interests, and attending senior programs and religious services can generate a sense of belonging and value. Meaningful connections and participating in things they enjoy can increase resiliency, and provide connection and purpose in aging women’s lives, which can fortify them against depression and anxiety.  

2.) Lifestyle changes  

Regular exercise, getting enough sleep, and nutritiousonal diets are associated with better mental health and brain function in older adults.  

Exercise: The CDC recommends that adults aged 65 and older should get at least 150 minutes of moderate aerobic exercise (such as brisk walking) a week or 75 minutes of vigorous exercise (such as jogging or hiking) a week. Older adults should also do strength training activities at least two days a week as well as flexibility and balance exercises regularly. Most adults over the age of 65 can exercise safely even those with chronic conditions and mobility challenges, but it still important to talk with your health care provider before starting a new exercise routine.  

Sleep: According to the National Institute on Aging, all adults should aim for 7 to 9 hours of sleep each night. Some strategies for improving sleep include: (1) follow a regular sleep schedule; (2)  Limit naps to 30 minutes or less in the early afternoon; (3) develop a bedtime routine; (3) avoid screen time in the bedroom; (4) keep your bedroom at a comfortable temperature especially if women are experiencing hot flashes or night sweats associated with perimenopause and menopause; and (5) avoid eating large meals and drinking caffeine close to bedtime.  

Diet: A nutritious diet generally consists of lean proteins, a variety of fruits and vegetables, whole grains, healthy fats, water, and limited added sugar and processed foods. A popular eating plan is the Blue Zones diet, which is based on research about the dietary habits of some of the naturally longest-lived and healthiest people in the world. The eating plan consists of a 95-100% plant-based diet with the majority of nutrients and fiber coming from leafy greens, healthy oils such as olive oil, beans and legumes, fruits, whole foods, nuts, whole grains, unsweetened beverages, and occasional red wine, fish, and eggs. It is also important to stay hydrated with water, unsweetened fruit juices, and low-fat or fat-free dairy or dairy-free alternatives. Before starting a new eating plan or taking any dietary supplements, older adults should consult with their health care provider for specific advice and plans. 

3.) Medical and mental health treatment  

Mental health treatment is aimed at promoting independence, minimizing symptoms, and improving well-being and quality of life. More than 80 percent of older adults with depression can be successfully treated with medication, psychotherapy, or a combination of both. A mental health care provider, especially one who specializes in the care and treatment of seniors, can identify effective treatments, identify conditions that present differently in older people, manage medications, and adjust treatment plans over time. Treatment can involve medication, therapy, stress reduction and management, and the learning of new coping skills. There are also mental health programs that specialize in senior care and psychotherapy such as Healthy IDEAS (Identifying, Depression, Empowering, Activities for Seniors) and PEARLS (Program to Encourage Active and Rewarding Lives). Lifestyle changes, mental health treatment, and social support can help women improve mental health at every age.  

 

Photo by Joshua Hoehne on Unsplash
Photo by Joshua Hoehne on Unsplash

What are some barriers to mental health treatment faced by aging women?  

Less than half of older women experiencing depression seek treatment and two-thirds of older adults with any mental disorder do not receive the services they need.  

Some of the key barriers for older women are:  

  • Inadequate insurance coverage 
  • Cost and affordability of care  
  • Physicians incorrectly attributing mental health symptoms to the normal aging process 
  • Ageism and stigma 
  • Lack of awareness about mental health issues, treatment options, and available services 
  • Caretaking responsibilities impeding ability to find time to devote to mental health treatment 
  • Shortage of trained geriatric mental health providers  

What are some trusted community and National resources to support mental health in aging women?  

Local agencies on aging, social workers, advocates and primary care providers are good places to start looking for information about aging women and mental health treatment. Community programs, senior communities, and local clubs are good sources to connect with others and activities that promote self-care and well-being. 

There are support groups that help older adults connect with others who are going through a similar health concern. Some examples include: Alzheimer’s Association, American Heart Association, Defeat Diabetes Foundation, Arthritis Foundation, Mental Health America, Far From Alone, and National Alliance for Caregiving.  

Community programs and volunteer groups that focus on different interests are great opportunities for aging women to socially connect with others. Some examples include faith or spiritually based communities, fitness centers, libraries, park and recreation centers, meetups, senior classes, and co-housing programs such as Generations United 

 

Some national mental health resources for seniors from the linked list on this line that the NWHN trusts include:  

  • General Mental and Behavioral Health Resources  
    • Administration on Aging  
    • Behavioral Health Treatment Services Locator  
    • Health in Aging  
    • National Council on Aging  
  • Anxiety and Stress 
    • Anxiety and Older Adults: Overcoming Fear and Worry 
    • Anxiety in Older Adults  
  • Community and Engagement  
    • engAGED 
    • Senior Community Service Employment Program 
    • Senior Corps  
  • Government Agencies and Services  
    • Eldercare Locator 
    • Preventive Services  
  • Counseling and Support Contacts  
  • SAMHSA National Helpline  
  • National Suicide Prevention Lifeline  
  • Warmlines  
  • Crisis Text Hotline 
  • Treatment Referral Routing Service  
  • Veterans Crisis Line 
  • Disaster Distress Helpline 
  • Mobile Apps 

 

Conclusion 

Mental health is a central part of women’s overall well-being and quality of life. While growing older may present unique mental health challenges for women, there are available resources and strategies to promote healthy aging and good mental health.  By acting today, aging women can thrive from taking care of their mental health through fostering relationships and enjoying purpose in their communities.  

Janette Norrington Headshot

Janette Norrington is a science writer in the Washington metropolitan area. She earned her PhD in Sociology from the University of Michigan and has strong experience in creating health content, scientific and plain language writing, and health research. Her areas of expertise include mental health, health disparities, chronic conditions, and health behaviors and health education. In her spare time, Janette likes to read, write fiction, cook, exercise, and spend time with family.

 From Diagnosis to Treatment: A Roadmap for Women Facing PCOS 

By: Rachel Grimsley, (RN, BSN, MSN)

 

Polycystic Ovarian Syndrome (PCOS)

PCOS is the most common reproductive endocrine disorder in women. It is a constellation of connected reproductive abnormalities, including disordered hormone production, lack of ovulation, and many cysts on the ovaries [4]. While it is often considered just a reproductive issue that can lead to infertility, it can also lead to obesity, insulin resistance, and diabetes [4].

Causes 

The causes of PCOS are complex and are not completely understood yet. They includes genetics, environmental factors, and family history.  

If you have PCOS, your hypothalamus-pituitary-ovarian axis, where the brain talks to the endocrine glands, becomes unbalanced [1]. This causes your ovaries and adrenal glands to make too many reproductive androgen hormones, like testosterone. When there is too much androgen in your body, the pituitary gland, which is a pea sized gland at the base of your brain [5], releases luteinizing hormones that stimulate ovulation in the ovaries. While we know this much, experts agree that there is more research needed to discover what causes this syndrome.   

 

Prevalence in Women  

PCOS affects one in 10 women of childbearing age, or eight to 13% of reproductive-aged women between 15 and 44, and up to 15% of reproductive women worldwide [1, 3, 4]. Studies have also found that if your mom had PCOS, then you are 5 times more likely to have it too [1]. 

Symptoms [3] 

If you have PCOS, you could experience: 

  • Irregular or missed periods 
  • Irregular hair growth, called “hirsutism” where hair grows on the face, chin, or parts of the body where men usually have hair 
  • Acne 
  • Hair loss, including male-pattern baldness 
  • Weight gain and difficulty losing weight 
  • Skin darkening along the neck, in the groin, and underneath breasts 
  • Skin tags 

Diagnosis 

If you have some of the symptoms above, it doesn’t always mean you have PCOS. Getting an actual diagnosis can be frustrating and take a long time, too. This is because there is no single test that will tell you that you have PCOS. A physical exam, blood tests, and ultrasound can be used to test for specific hallmarks. Your doctor will likely use the Rotterdam Criteria, which requires 2 of the 3 following findings to diagnose you [1].  

  • Hyperandrogenism, or higher than normal blood level of testosterone 
  • Chronic anovulation or ovulatory dysfunction, where you don’t ovulate regularly or at all 
  • Polycystic Ovarian Morphology, or multiple cysts on one or both ovaries 

You may need more blood tests to rule out problems with your thyroid, pituitary, and ovary or adrenal glands that can cause many similar symptoms of PCOS [4].  

Side note on ultrasounds: In as many as 32% of women polycystic ovarian morphology is found on ultrasound. This is especially true for adolescent girls. If you’re a teenager, it may be harder to diagnose you with PCOS. Because the prevalence of many cysts on the ovaries is so high in adolescent girls it is not recommended to use this as a diagnostic criterion until 8 years after periods have started [4].

Photo by Jonathan Borba on Unsplash
Photo by Jonathan Borba on Unsplash

Risks for Other Health Problems [1] 

  • Obesity affects 50-80% of women with PCOS. Depending on ethnicity and population, the risk of obesity is four times higher compared to women without PCOS  
  • Diabetes Mellitus 
  • Insulin Resistance 
  • High Cholesterol 
  • Heart Disease 
  • Infertility 
  • Sleep Apnea 
  • Depression and Anxiety 
  • Endometrial Cancer  

Treatment 

While there may not be a cure for PCOS, there are ways to manage many of the symptoms with some small and some big changes. The most important step is to take control of your controllables, and work on your barriers [6]. 

See a Pelvic Floor Physical Therapist 

For this article, I interviewed Dr. Megan Kranenburg, PT, DPT, Board-Certified Clinical Specialist in Women’s Health Physical Therapy. She is a pelvic floor physical therapist and fierce women’s health advocate that treated my pelvic pain after having an ovarian cyst surgically removed.  

As Dr. Kranenburg likes to put it, “what we’re dealing with here is sticky tissues.” She explains that for any chronic pelvic pain condition, like PCOS, endometriosis, irritable bowel syndrome, or adenomyosis, there is a cycle of injury that your body isn’t able to heal. When you have a monthly cycle of cyst development and possible rupture, the body sends out the big guns of your immune system, macrophages to clean up the tissue and histamines to support your white blood cells. An added challenge is that from experiencing this pain over and over, your nervous system builds up a fight or flight reaction that releases cortisol, your stress hormones. Cortisol works against your immune system and causes a snowball effect of pain, adhesions, and tight muscles in the pelvic region of the body.   

It is important to review pelvic anatomy. In your pelvic cavity you don’t just have ovaries and a uterus. There is a lasagna of tissues and organs layered in your pelvic cavity. You have your bladder, your small and large intestine, rectum, bones, ligaments, large arteries and veins, and large muscles, like the psoas muscle, which runs along the front of your spine and has nerves coming from your spine that go down your leg. When you have a chronic pelvic condition that causes pain or makes you tired and not want to move, all of these different body systems are affected. 

If you’ve ever had a painful period, ovarian cyst, or chronic pelvic pain, you probably know how your day looks. Curled in a ball, with a heating pad, blanket, ibuprofen, and TV. There might be chocolate thrown in too.  

What happens when you curl into that ball, especially if you are in that position most of the time from chronic pain, is those muscles and the tissue that surrounds and connects your muscles and organs, called fascia, gets tight. Having tight tissue is not good. The tight tissue pulls on other tissues, organs, and nerves when you move, causing pain. Sometimes the tissue is so tight you have constant pain. Because the tissues and muscles get tight, it also blocks circulation and drainage of fluid from below your pelvis, which could be causing swelling in your ankles, or even vulvar congestion.  

So, when Dr. Kranenburg sees clients with PCOS, pelvic pain, or a woman who is pregnant or just had a baby, what she focuses on as a PT, is how to address and treat your barriers.  

If your barrier is pain, she will break up some of those sticky tissues with manual therapy, where she gently massages around where it hurts to encourage movement of your fascia and organs. She also recommends trying a TENS Unit which can help distract your brain from pain and allow you to get your dishes done. You could lay on a small ball to encourage the muscle and tissue to gently release, try cupping, or psoas and hip flexors stretches.  

Photo by Otto Norin on Unsplash
Photo by Otto Norin on Unsplash

Control the Controllables By...

  • Getting some form of movement in every day. Something that brings joy, not pain [6]. 
  • If you don’t like your doctor, OBGYN, or pelvic floor therapist, try another [6]. 
  • Therapy can help. With today’s virtual options you can find the one perfect for you [6]. 
  • Weight loss. Obesity makes symptoms of PCOS much worse [1]. 
  • Cognitive Behavioral Therapy (CBT). CBT for weight loss can help. A study found improved anxiety, reduced depressed mood, and overall higher general health after a 4-month intervention in women with PCOS [1]. 
  • Birth control pills. The pill can help control irregular cycles, and the combo pills are better at treating hirsutism (hair growth) and acne, compared to progestin-only pills [1].  
  • Metformin may also be prescribed with birth control pills to help with insulin resistance and lower your risk for diabetes [1]. 
  • Bariatric surgery. Surgery is an effective treatment for obesity, but it isn’t the first line treatment. Bariatric surgery comes with risks related to the surgery, dietary complications, and pregnancy should be avoided for a year after surgery [1].  

Latest Research Related to PCOS 

There is good news on the horizon for those who have PCOS. In 2022, less than 10 years of modern genetic analyses confirmed that there are important genetic variations that form risk genes that can lead to neuroendocrine, reproductive, and metabolic dysfunctions. Additional studies have used the genetic data to link BMI, insulin, age at menopause, depression, and male pattern balding to the risk of PCOS. Additional analyses have demonstrated that PCOS shares a genetic architecture with type 2 diabetes, coronary artery disease, BMI, insulin levels, cholesterol and triglyceride levels, depression, and age of menarche (when periods start). With these findings of genetic links to PCOS, it is hoped that genomics will lead to diagnosis based on biologic mechanisms and genes, instead of diagnosis based on expert opinion or the Rotterdam Criteria. Women with PCOS have been underserved in diagnosis and treatment. If you have PCOS, you might have mistrust of the medical system, frustration, heartache, and poor health outcomes. As precision medicine moves forward, there is hope for a targeted therapy to reverse and ultimately prevent the development of PCOS. [4] 

R Grimsley HeadShot

Rachel is a freelance health writer, former tenured nursing professor and ER nurse, is a military spouse, and mom to 18-month-old twin girls. She earned her Master of Science in Nursing Education from Walden University and spent the last four years as a nursing professor specializing in pediatrics, geriatrics, and communications. She is passionate about women’s health and wants to spread knowledge and evoke change in government policy that supports all women.  

The Policy Pages

Updates on how we're making change at the highest levels of government.

A Summary of Action

By: Kristen Batstone, NWHN Policy Manager

The National Women’s Health Network works with members of Congress to improve the health and well-being of women across the life continuum. This article provides the highlights of our women’s health policy work. Please contact policy manager Kristen Batstone ([email protected]) with any questions or comments regarding the content.  

Women’s Health and the 118th Congress – Our Priorities  

In the 118th Congress, the Network’s top priorities include expanding access to family planning services, improving and diversifying perinatal and postpartum care, and increasing access to preventative screenings.  

Key Women’s Health Legislation:  

The Network is happy to see introductions and reintroductions of key women’s health legislation. You can learn more about key legislation the Network supports and why on our virtual bill tracker here. Other recently introduced women’s health bills include:  

Sexual and Reproductive Health:  
  • Access to Contraception for Servicemembers and Dependents Act: This bill would create contraception coverage parity for servicemembers and codify the Department of Defense’s new travel policy allowing pregnant people to travel out of state for abortion care.   
Aging Women and Health Equity:  
  • Menopause Research Equity Act: This bill bolsters federally funded menopause research and seeks to address unique challenges faced by women experiencing menopause 
A perspecive shot of the US capitol building with a blue sky and sun flare behind it
Photo by Bernd 📷 Dittrich on Unsplash

Activity on the hill... 

The Network Celebrates Reproductive Rights Win as Congress Advances a Clean NDAA Bill 

On December 7, The Network celebrated as the House and Senate advanced the final FY 2024 National Defense Authorization Act (NDAA) without several harmful anti-abortion and anti-gender affirming care riders that had been in previous versions. Earlier this year, the Network joined allied organizations in an advocacy push on Capitol Hill. The coalition banded together to educate Members of Congress and advocate against the extreme attacks against gender-affirming care and abortion included in the NDAA package that passed in the House this summer. As a reminder—the House NDAA sought to roll back new policies issued by the Department of Defense (DOD) that provide paid leave and travel assistance for service members stationed in states with anti-abortion laws on the books.  

Due to our efforts, the 2022 DoD travel policy will remain in place and servicewomen across the country will be able to take leave or travel out of state to access abortion care.  

 

The Network Convenes a Diverse Coalition of Women’s Health Organizations to Champion the Issues of Aging Women 

In October, the National Women’s Health Network convened the first-ever working group dedicated to advancing the health interests of aging women in the Older Americans Act (OAA). The Older Americans Act was first signed into law in 1965 and it was part of President Johnson’s “Great Society” initiative. The goal of this bill is to support older Americans to live at home and within the community with dignity and independence for as long as possible. As of 2020, more than 11 million older Americans and their caregivers benefit from the Older Americans Act (OAA) programs. The primary programs of the OAA include community service employment for low-income older Americans; training, research, and demonstration activities in the field of aging; and vulnerable elder rights protection activities.   

According to statute, the OAA seeks to serve older individuals with greatest social need; older individuals with greatest economic need; and older individuals at risk for institutional placement. Although the programs created by the Older Americans Act stand to benefit all aging Americans, there has been a noticeable lack of representation for aging women. Aging women comprise nearly 10% of the total U.S. population, and yet health issues that disproportionately affect older women often receive less attention from Congress and the media. At the Network, we are committed to connecting women to relevant consumer health information and we will continue to push for important federal policy changes. Stay tuned for more information about the working group’s priorities and ways to get involved.  

 

The Network Attends Press Conference for New Menopause Bill 

On December 13, the Network’s Executive Director, Denise Hyater Lindenmuth attended a press conference celebrating the introduction of the Menopause Research Equity Act. As one of the three M’s— menstruation, maternity and menopause—menopause is an important milestone in a woman’s life and yet it is often shrouded in shame and stigma. Part of this shame and stigma is fueled by a lack of available information about menopause and its symptoms. As women head into this next stage of their life they need to be prepared with the most up-to-date, relevant knowledge. Right now, many women can’t count on their providers for this information. The Menopause Research Equity Act hopes to address this issue.  

We look forward to continuing our work with Congresswoman Yvette Clarke to get this bill across the finish line in 2024. The Network is also looking forward to the introduction of other menopause-specific bills in the new year.  

 

Photo by Florian Pintar on Unsplash
Fiscal Year 2024 Appropriations 

First, a quick primer on the appropriations process: The president submits a budget to Congress for the federal government every fiscal year (October 1 through September 30). Congress must then pass 12 appropriations bills or pass a continuing resolution before the October 1st deadline to fund the government for the following year. The NWHN Policy Department is both closely monitoring this process and fighting every day to make sure that programs promoting the health and well-being of women are backed with federal dollars. Here’s where we stand:  

On November 14, Speaker Mike Johnson passed a laddered continuing resolution that would fund parts of the government through mid-January and others through early February. Notably, this stopgap measure does not include any harmful spending cuts and keeps the government open through the holidays. This is the second time this year that the government has narrowly avoided a government shutdown. Many are skeptical that a spending package will even be passed this year, and some politicians like Speaker Johnson are beginning to socialize a year-long continuing resolution. Although a year-long continuing resolution may look attractive because it will keep the federal government open, freezing funding levels could have potentially devastating outcomes for the U.S. economy and health care system. According to Senator Patty Murray, Chair of the Senate Appropriations Committee, a year-long CR could result in a 9.4% cut—or more than $70 billion in cuts to vital domestic programs that would prevent many families from putting food on the table or paying for rent.  

There are still many outstanding questions about how funding levels will be affected if the government fails to pass a spending package. For example, it is unclear how the 1 percent cut (a new rule negotiated by former Speaker of the House, Kevin McCarthy, during the debt ceiling fight) will affect funding levels if the government fails to pass a package once the laddered CR expires. 

To provide further context on how the House and Senate appropriations proposals will affect women’s health care, the Network has created a resource page that will be updated throughout the appropriations cycle.   

 

A Huge Win for Women’s Health Research...

On November 13, President Biden and First Lady, Dr. Jill Biden announced the first-ever White House initiative on women’s health research. For years, women’s health research has been chronically underfunded and undervalued. It has been the Network’s mission since our founding in 1975 to improve women’s representation in biomedical research and increase funding for women’s health research initiatives. We look forward to working with the First Lady, Dr. Jill Biden, President Biden and the Gender Policy Council on this initiative.  

To read more about this effort, check out the White House’s memorandum here and the Network’s statement celebrating this news here 

Network News

Can't-miss updates from Headquarters.

  In Case You Missed It...

By: Adele Scheiber, Director of Communications 

POLICY & ADVOCACY  

  •  The Network Celebrated the Black Women's Health Imperative's (BWHI) 40th Anniversary - On Friday October 13, NWHN leadership attended BWHI's 40th anniversary homecoming celebration in Washington, D.C. There we were able to make connections with effective community leaders and the mothers of Reproductive Justice. View pics here!

 

 

  • The NWHN responded to the Department of Health and Human Services Request for Information regarding the expansion of coverage to over the counter (OTC) preventive items and services available without a prescription by a health care provider such as the newly approved OTC contraceptive pill.

 

 

  • New Article: Mission Critical: Eradicating Health Disparities for Servicewomen and Women Veterans – In her latest article, policy manger Kristen Batstone details how this population is shortchanged on contraception, abortion, mental health, maternal health, and menopause care, and outlines some policy fixes within reach this congress.

 

  • The NWHN Released Statements on New White House Initiatives and Pivotal Abortion Court CasesSpecifically, the NWHN commended the New White House Initiative on Women's Health Research. We hope this initiative will address stark disparities in funding and attention that currently plague the landscape of women's health research, and we are excited to work directly with the Biden Administration to see that happen. Read our full statement here. We also applauded a court decision that empowered Title X providers to make abortion referrals. On Thursday, November 30th, the 6th Circuit Court of Appeals issued a decision on the Ohio v. Becera case that affirms the ability of Title X providers to make abortion referrals. Although the Network is pleased by the appeals court's decision, we recognize that this case is one of many attempts by anti-abortion advocates to disrupt abortion access. Read our full statement here.Finally, the Network issued a statement on December 13 urging the Supreme Court to  to Validate the safety of mifepristone as it prepares to hear oral arguments in Alliance for Hippocratic Medicine et al v. U.S. Food and Drug Administration. Read our full statement here. 

CONSUMER EDUCATION  

  • The NWHN Released Health Pro Tips for October, November, and December: In October, these tips focused on breast cancer, menopause, bone and joint health, and domestic violence. In November, we went deep on issues like diabetes, birth control, Native American health, and the plight of caregivers in the US. And in December, we bring you the best science, stories, and strategies related to HIV, disabilities, influenza, and human rights.

 

 

 

 

 

Young Feminist

Articles by the future, for our future.

Medicating Inequality: A Feminist Examination of Drug Costs  

By: Anna Ball, Generation Patient Health Policy Scholar  

Looking at the title alone, you may be thinking, what does feminism have to do with pharmaceutical justice? You may think that these subjects have nothing in common. After all, when we think of feminism, we think of girl power, equality, and women’s rights, and when we think of pharmaceutical justice, we think of “Big Pharma,'' insurance, and drug pricing. While these subjects seem to have nothing in common, that could not be further from the truth. After all, feminism and pharmaceutical justice have a common goal of equity.  A prime example of how feminism and pharmaceutical justice overlap is the history of obtaining access to birth control. Birth control access has long been a feminist issue and is an example of pharmaceutical justice, but feminist pharmaceutical justice extends far beyond birth control. 

Many alarming statistics show that pharmaceutical justice is a feminist issue. For instance, 30% of women cannot afford their medications, while less than 20% of men cannot afford theirs [1]. Kaiser Family Foundation’s 2022 Women’s Health Survey estimates  that more than half of American women ages 18-64  take at least one prescription medicine, including oral contraceptives, on a regular basis [2]. The use of prescription medication increases with age, as 40% of women ages 18-49 take at least one on a regular basis compared to about 70% of women ages 50-64 [2]. This statistic is something that is personal to me as I listen and help my aging mom navigate her new journey with Medicare and this includes comparing and negotiating drug costs for her health needs that we anticipate will grow as she gets older. 

Across class and racial divides, research has found even more troubling numbers.

In the same study mentioned earlier, the Kaiser Family Foundation reports about half of low-income women are not as likely to consistently take a prescribed medication when compared to higher income women [2]. They also found that women who are uninsured are not as likely compared to insured women [2]. Also, white women more frequently take prescription medications compared to women of color [2]. It is more common for women to put off their health care as well as skip medications [3, 4]. This is especially true for women of color, notably Black women, who also have higher rates of chronic diseases like diabetes, heart disease, cancer, and stroke [5]. Chronic diseases often come with higher prescription drug costs [5]. Justice and inclusion are key points in feminism and must extend to economic and health security for minority and at-risk women. 

Big Pharma’s price increases often disproportionately affect women. Genentech, a pharmaceutical manufacturer, increased the price of Herceptin, a breast cancer drug, by 78 percent from 2005 to 2017 [6].  At least one study found breast cancer  to be the most expensive cancer to treat with on average accounts for medication spending by the United States at 3.4 billion dollars [7].   A cancer diagnosis is devastating for anyone. How much more devastating is it to find out your type of cancer is the most expensive in the country and faces rising costs just to survive? 

Women with diabetes have higher out-of-pocket (OOP) costs and healthcare expenditures than their male counterparts, with women’s average total expenditures at $12,485 compared with $10,828 for men [8].

Many Medicare Part B and Part D drugs that could be considered for drug price negotiations also treat conditions that disproportionately affect women. Two examples of this pulled directly from the Medicare Part B and Part D list are medications for anemia Aranesp (Amgen) and Revlimid (Celgene) [9]. Women are twice as likely to be anemic (7.6 percent versus 3.5 percent for men), while moderate-to-severe anemia rates are five times higher for nonpregnant women [8]. Other examples include medications for asthma, Xolair (made by Genentech) and Symbicort (made by AstraZeneca). Women have a higher prevalence of asthma after menopause than men (9.6 percent compared to 6.3 percent, respectively) [9]. 

Besides pricing, drug and therapeutic clinical trials and studies have excluded women from their participant pool and this has a lasting effect. Studies have found that women are often overmedicated due to standard dosages for medications being  measured from trials using only male participants [10].  Underrepresentation in clinical trials is an issue that requires higher accountability. Sex equity will ensure women suffer from fewer adverse drug reactions, receive proper drug dosing, and receive equal treatment for health concerns [11]. Fertility and childbearing abilities are often seen as a barrier or expense, however, there are ways to overcome these barriers. Having women on research boards is crucial to including women through proper advertising and planning. In the Women Take Heart Project, valet parking and babysitting were provided as part of the study, and nearly 6,000 women took part in filling out questionnaires and getting bloodwork done [11]. So, it is not that women do not want to be in clinical trials; differnt needs must be addressed to support women’s involvement.

Who better to address these needs than women themselves? 

In addition, there are legal issues that can affect access to medication for women. One example is the case of biologics. Biologics treat autoimmune diseases that arise from living cells from plants, animals, and microorganisms or are made using DNA [12]. Autoimmune diseases cause the body’s white blood cells to attack otherwise healthy tissues and organs, including diseases such as Lupus, Rheumatoid Arthritis, and Autoimmune Thyroid Disorders (ATD) [13]. These diseases disproportionately affect female patients as approximately 80% of patients diagnosed with autoimmune diseases are female [12]. Some diseases, including Lupus, disproportionately affect women of color compared to white women [14]. Pharmaceutical companies take advantage of the legal patent system by creating patent thickets - where continuation patents extend the patent’s life, making generic options take longer to appear on shelves [15]. The result of patent thickets on biologics is that they often delay access to much needed, less expensive medical interventions due to delayed entry into the consumer market and high costs resulting from little to no market competition [16]. The Patent Act was sent to the Patent and Trade Office director in 2022 by a bipartisan group of senators asking for a single patent per invention to reduce patent thickets and lead to shorter times for generic drugs [15]. As a Lupus patient, I was shocked to find that even with insurance, the medications available to me have a host of side effects and could lead to a tolerance and stop working for my body. Biologics are more appropriate for my diagnosis but are still too expensive because patent thickets prevent them from reaching the generic market. 

Many women use prescription drugs not typically considered "women's drugs" and are therefore negatively affected by adverse drug reactions, improper dosages, and higher drug costs. Feminism and prescription justice are inextricably linked. We cannot talk about women’s health justice without considering inequities related to medication usage among women, whether related to birth control and reproductive health or to prescription drug costs, clinical trials, and legal issues. This is especially true in terms of class and racial divides, as women of color and low-income women will suffer the most from these inequities.  

So, how can you help with these issues? Call your local, state, and national representatives and senators about prescription justice. This makes an impact. If this makes you nervous, remember that a representative’s main job is to serve their constituents. They want to hear from you about how we can improve laws and injustices in this country, whether national, state, or local.  Another way to help? Educating yourself and informing others about this topic. Joining patients and prescription justice advocacy groups will give you firsthand knowledge of prescription justice and how to navigate a complicated health care system better.  

 

Anna Ball Headshot

Anna Ball (she/her) is a current second year Master of Public Health student with a concentration in Epidemiology at University of Delaware. When Anna isn’t studying or doing health policy advocacy, she can be found trying to find the best matcha latte, traveling , or reading.

Since You Asked

Answers to your burning health questions.

Since You Asked – Arousal Drugs

By: Rachel Grimsley (RN, BSN, MSN) 

 

QUESTION: What are some other, safer alternatives to Addyi, marketed as the female Viagra?  
 
ANSWER: The solution you are after might not be a pill.

What is Addyi? 

Addyi (flibanserin) is a novel medication approved for women diagnosed with Hypoactive Sexual Desire Disorder (HSDD) and works on the brain. It belongs to a class of drugs that has sedative properties, known as serotonin 1A receptor agonist and a serotonin 2A receptor antagonist [1]. HSDD is “characterized by low sexual desire that causes marked distress or interpersonal difficulty and is NOT due to: 

  • A co-existing medical or psychiatric condition 
  • Problems within the relationship 
  • The effects of a medication or other drug substance.” (per the Addyi FDA label) 

Addyi was not developed to enhance sexual performance or help all women have a better sex life. It is only licensed for premenopausal women who are diagnosed with HSDD [3].  

Advertised Benefits of Addyi 

For women diagnosed with HSDD, Addyi has shown that it can be helpful in some cases. In the clinical trials, women had improved sexual desire, an increase in satisfying sexual encounters, and women were having more sex while taking Addyi, compared to a placebo [3].  

However, the numbers reported have been criticized, as the original studies defined “clinically meaningful change” to include “minimally improved” [2]. The criticism continues that the numbers for “minimally improved” where much higher, and that numbers of women who experienced “much improved” or “very much improved” were substantially lower than the minimal group [2]. 

Addyi could be helpful for those with HSDD, but it is important to not lose the person as a whole being, and only focus on sexual desire. Wellness and relationship satisfaction needs to be studied with taking Addyi, to ensure women are not being pathologized into just symptoms [2]. It is also important to identify if women just want less sex than their partner [2] 

What are the Potential Risks of Addyi? 

In 2019, the FDA reviewed the initial studies that wanted to see if Addyi could be taken with alcohol. They found the initial studies excluded women whose blood pressure was too low for them to stand up when they took Addyi and had alcohol within two hours of taking it [1]. This posed a serious risk to women who have low blood pressure [1]. The FDA conducted a Risk Evaluation and Mitigation Strategy (REMS) and adjusted the label on Addyi to avoid alcohol within two hours of taking it. This is to prevent severe low blood pressure and passing out, which could lead to injuries like falls, head injury, and stroke from low blood pressure [1].  

Taking birth control also increases the risk of syncope and low blood pressure [3]. It is recommended to stop taking Addyi at least two days before starting birth control and to only start Addyi two weeks after stopping birth control [3]. 

Other common symptoms include [1]: 

  • Dizziness 
  • Sleepiness 
  • Nausea 
  • Fatigue 
  • Insomnia 
  • Dry Mouth 
Photo by Priscilla Du Preez on Unsplash
Photo by Priscilla Du Preez on Unsplash

What Are My Options to Raise My Sexual Desire?  

While Addyi is advertised as “the female Viagra,” clearly it is not. Women must be premenopausal and diagnosed with HSDD to be prescribed most medications that are available to help with sexual desire.  

The safest place to start looking for alternatives to Addyi is with your doctor. Start the conversation by stating what the problem is. There could be another medical condition happening that your doctor can help diagnose and treat, or they may recommend a local therapist with glowing reviews. So, if you are experiencing trouble in the bedroom, start by talking about it with a professional. They might recommend:  

  • Talking to a sex therapist for counseling [4]. 
  • Cognitive-behavioral therapy, mindfulness meditation therapy, and couples therapy [4].  
  • Reading books like Come as You Are by Dr. Emily Nagoski which takes a neuroscience lens to libido and understanding one’s own relationship to their body and sexual experiences.  
  • Taking other medications if you are diagnosed with HSDD.
  • A common treatment for HSDD has been testosterone [4]. This helps increase libido for women with low levels of testosterone and a decrease in sexual desire [4].  
  • Bupropion is a depression medication being tested as an off-label treatment for HSDD [4].  
  • Bremelanotide is a promising medication that can help men and women with sexual dysfunction [4]. Bremelanotide also works on the brain, but at different receptors than Addyi. After taking Bremelanotide, women with HSDD experienced more sexual desire, better feelings to arousal, and had more satisfaction when attempting to have sex. As an injection, it had very few side effects, the most common being a slight raise in blood pressure or skin darkening [4].  

 

We hope you found this information helpful. If so, please consider joining the NWHN family by becoming a member here. Have a question of your own? Email us at [email protected] 

The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. All content, including text, graphics, images, and information, contained on or available through this website is for general information purposes only. 

The continued availability of external resources is outside of the NWHN’s control. If the link you are looking for is broken, contact us at [email protected] to request more current citation information. 

Study Snapshots

Readable summaries of the latest medical research.

All Snapshots Researched & Summarized By: Grace Lee (MPH) NWHN Volunteer Health Officer 

Insulin Deserts: The Urgency of Lowering the Cost of Insulin for Everyone
This study emphasizes the persistent issue of unaffordable insulin in the U.S., despite recent efforts to reduce costs. It identifies 813 insulin deserts with high uninsured rates and diabetes prevalence, concentrating in the American South and South-eastern region of the country. The uninsured communities in these areas face additional challenges, such as lower income and limited internet access. The bipartisan Affordable Insulin Now Act of 2023 is proposed as a solution, capping insulin costs at $35 for both privately insured and uninsured Americans. The report argues for the necessity of this legislation, considering the high economic and health-related costs associated with inadequate insulin access, especially for vulnerable populations.

Medicaid’s Pandemic-Era Continuous Coverage Protections Helped Reduce Number of Uninsured Children
The U.S. Census Bureau's American Community Survey for 2022 showed a decline in the number of uninsured children, attributed to Medicaid's continuous coverage protection from the Families First Coronavirus Relief Act of 2020 during the COVID-19 pandemic. The uninsured rate dropped from 5.7% in 2019 to 5.1% in 2022. Medicaid is a significant source of child coverage, and administrative stability protected children from losing coverage during the pandemic. However, with the expiration of continuous coverage protections, the uninsured rate may rise again. In 2022, 3.9 million children were uninsured. With Medicaid’s continuous coverage, most states witnessed a decline in uninsured children, with Texas showing the most significant improvement. However, despite these improvements, 4 states saw an increase in uninsured children, with Iowa the highest increase at 27%. The demographic profile reveals improvements in uninsured rates across age, race, ethnicity, and income levels, though challenges persist. The report warns that recent declines in child Medicaid enrollment could reverse gains made during the pandemic.  

Black Women’s Maternal Health Solutions: A Multifaceted Approach to Addressing Persistent and Dire Health Inequities
The Black maternal health crisis, intensified by recent events like the Dobbs case and the pandemic, requires a multifaceted approach. Dismantling healthcare racial biases, supporting Black-led organizations, and implementing policies addressing social determinants of health are crucial. Community-based solutions rooted in Black Joy, resistance, and resilience are essential, along with transforming maternity care by addressing structural inequities and ensuring culturally centered, diversified care teams. Economic disparities impact Black women significantly, requiring measures to eliminate the wage gap and implement federal policies like the Pregnant Workers Fairness Act. Prioritizing perinatal mental health and ensuring access to reproductive healthcare are vital components of combatting the broader maternal health crisis. Finally, collecting intersectional data is key to understanding and addressing healthcare inequalities for Black, disabled birthing individuals, and improve comprehensive maternal care overall. 

Economic Impact Reproductive Restrictions in Florida
Laws and policies that limit access to reproductive health care have devastating and wide-ranging effects on women’s lives, families, and entire communities. Reproductive health restrictions in Florida, specifically abortion bans, have substantial economic consequences, costing the state billions of dollars annually. The enactment of a 15-week abortion ban, with additional 6-week restrictions, contributed to a $5.7 billion economic loss in 2022. The analysis suggests that removing these restrictions could lead to almost 358,000 more women entering the workforce yearly, enhancing Florida's economy. The economic impact underscores the need for reconsidering and lifting reproductive health restrictions in Florida to ensure that not only women, but also the rest of the state, are supported, and to strengthen the workforce and economy of Florida. 

 

Grace Lee Headshot

Grace Lee is a Senior Analyst on the Infectious Disease Infrastructure and Policy team at the Association of State and Territorial Health Officials (ASTHO). Her work focuses on healthcare-associated infections, antimicrobial resistance, and sexually transmitted infections. Outside of work, Grace is a board member for HopeLine, a crisis intervention and suicide prevention agency. In addition, she mentors undergraduate students at the University of Pittsburgh, her alma mater. Grace has her Master of Public Health in health policy from the University of North Carolina Chapel Hill and is based in Washington D.C. In her free time, she loves to travel, dance, bake, and powerlift.

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The National Women's Health Network thanks our members for their generous donations.

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