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Menopause: Can cognitive behavioural therapy help women navigate symptoms?

While some women approaching menopause feel depressed and overly emotional, others can become emotionally detached

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Cognitive behavioural therapy is used to treat a wide range of issues, but is it effective in helping women ride the menopause emotional rollercoaster?

“The pandemic has made mental well-being a public health must”, stated a 2021 report from the World Economic Forum, citing a number of initiatives aimed at boosting mental health awareness.

But while Covid has put mental health into focus, it has further widened the gender gap in accessing support.

New research suggests women are more prone to psychological problems, such as anxiety and depression, due to a combination of genetics and differences in roles and experiences in society.

During perimenopause, as many as eight out of ten women report symptoms in addition to their periods stopping, changing hormone levels only deepening feelings of depression and anxiety.

In the UK, it is estimated that around 13 million women are going through menopause or perimenopause with one in ten leaving their jobs due to the severity of the symptoms.

“We are talking about huge numbers of women who are at the peak of their career, experience and wisdom,” says Becky Cotton, ex-director of mental health policy at the NHS Confederation and founder of the digital therapeutics company Lumino.

Cotton, who is currently developing a CBT app for menopause symptoms, says the findings are worrying.

“GPs don’t have a lot in their toolbox. Apart from HRT, which is not suitable for everyone, they don’t have a lot of options. But what’s been really interesting to see was the openness to CBT as a treatment option.”

As part of her research, Cotton has found that women are not only open to CBT but many also believe that this type of therapy could help them in the long term.

“For some, going to see a therapist is not something they’re comfortable doing, so an app feels more private to them,” she explains.

Seren, an app delivering CBT adapted for the menopause, aims to help women deal with hot flushes, mood swings and sleep problems.

Becky Cotton, Lumino co-founder

“The central idea behind cognitive behavioural therapy is that our thoughts, our feelings, our behaviours and our physical sensations are all interconnected,” says Cotton. “CBT is about exploring some of those connections and understanding emotions and behavioural patterns.

“We know it’s great for people with anxiety, but what’s been fascinating about the evidence base that’s been building around it is that it can be particularly helpful for low mood, anxiety and sleep problems.

“That’s not to say it’s stopping them happening. But it can make us feel more in control of these symptoms.”

The British Menopause Society recommends CBT as a treatment option. Women are often offered HRT or alternative medication, but for those not suited to HRT or those in need of additional support, CBT-based therapy can be a great solution.

However, NHS waiting lists alongside the staffing crisis that prompted an ongoing pay dispute means that accessing CBT can prove extremely challenging.

“CBT requires a lot of clinicians who are not there and it can also be expensive,” says Cotton.

“Through digital therapeutics we are trying to solve both of these problems by making therapy much more affordable and accessible.”

The co-founder is now developing the app with the hopes of getting it approved by the NHS, as several other CBT-inspired apps have been over the last few years, including Sleepio, which provides CBT for sleep issues.

“For us, it’s all about impact and how we can partner with healthcare providers and expand access to support to as many people as possible.

“I think with digital therapeutics, we have a huge opportunity across lots of different clinical areas, menopause being one of them, but also across other healthcare areas. And that’s hugely motivating.”

Despite scepticism, Cotton hopes that apps like Seren will scale up support and help people access care in a way they haven’t been able to do before.

“There are a lot of apps that have very little evidence base behind them. Some of them are simply not seeking to meet the standards set out by the NHS or by medical device regulations and so, we don’t know what’s happening to people’s data.

“But I think we need to see a lot more. This is a huge global health inequality that millions and millions of women are experiencing. As developers, we need to raise our game and build products that will help and empower them.”

Lumino is recruiting beta testers ahead of its first pilots. Sign up now at seren.health.

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Could an adhesive device be the answer to perineal tears? This start-up thinks so

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Ditte Marie Fog Ibsen, co-founder and CEO of oasicare

A new device promises to provide midwives with a “third hand”, substantially reducing perineal tears, but could it really work?

“Simply surviving pregnancy and childbirth can never be the marker of successful maternal healthcare”, the World Health Organisation concluded after a damning report revealed that 287 000 women died in 2020 during and following pregnancy.

While maternal mortality rates are down sharply from where they were 20 years ago, research by United Nations shows that progress toward reaching the UN’s sustainable development goal of reducing maternal mortality has stalled.

According to the United Nations Population Fund (UNFPA), every two minutes a woman dies because of complications due to child birth or pregnancy.

But maternal mortality is not the only problem – for every woman who dies, there are about 20 to 30 women who experience injury, infection, or other birth or pregnancy related complication.

“Maternal mortality is only the tip of the iceberg when it comes to maternal health,” says Ditte Marie Fog Ibsen, co-founder and CEO of oasicare, a medical device start-up based in Copenhagen.

“Maternal morbidity is the hidden base, predominantly featured by perineal ruptures.”

Perineal ruptures are extremely common and expected complications of vaginal birth. In the UK, about 85 per cent of women sustain some degree of perineal trauma during childbirth.

Multiple studies have found that some women who experience severe perineal lacerations suffer long term psychological trauma and social isolation. However, the stigma around the topic means that many feel too embarrassed to seek help.

“Postnatal care is mainly focused on women with higher grades of perineal ruptures, downplaying the impact of lower grade ruptures on woman’s quality of life,” says Fog Ibsen.

“Short, medium and long-term complications are fairly common but rarely acknowledged or prioritised in the global health landscape.”

‘Women’s tears are not properly assessed’

Fog Ibsen and her friend, Julia Sand, were working as industrial designers creating solutions for midwifes when they realised the scale of the problem.

“We were trying to help midwifes manage their work-related musculoskeletal symptoms when we came across a even bigger problem: perineal ruptures.

“At the time, we didn’t know much about it, but we knew we had to do something about it.”

The duo began researching the issue and came up with a single-use medical device designed to protect the perineum and reduce uterine ruptures.

The product, which is currently being tested in several hospitals in Denmark, is adhesive and acts like a protective layer that prevents ruptures during childbirth.

“We are essentially trying to replicate the skin so we can prevent ruptures, which tend to happen when the vagina and perineum stretch during birth,” explains Fog Ibsen.

“We’ve made it very simple so that it can be easily applied and easily taken off.”

The interesting part, she says, is that women don’t actually notice it.

“That’s a quite good thing because there’s a lot of attention on the birth. The midwifes were a bit worried initially about the adhesive and whether it could last and stick to different types of skin, but so far it’s been great.”

The midwifes have played a crucial role in the product development process, helping the oasicare team identify issues early on and improve the device.

“We relied on their knowledge to get the balance right so that in the future we can give the product  to people who don’t have the same level of experience, but can still use it to prevent ruptures.

“The product is very easy to cut in, for example, so that midwives can adjust it easily.”

Currently, the team is not allowed to disclose any details about the efficacy of the product but a study, which is expected to conclude later this year, will establish how much the device could reduce ruptures.

“If all the studies go well and we get good data from the hospitals we work with we could see the product on the market in 2025,” says Fog Ibsen.

Her goal, however, is to launch the device outside Denmark where, she says, women desperately need it.

“In Denmark, I think, the midwives are doing a great job, but in other parts of the world the situation is very different. Women’s tears are not properly assessed, which means that despite having suffered serious tears they are being told that everything’s just fine.

“Our goal is to make the product available in countries like India, where a lot of women would benefit from it. It’s a simple device, but it can have such a big impact.”

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Could this app change the way we live and work?

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Imagine a tool that could help women align their daily schedules around their menstrual cycle – it exists thanks to two passionate tech entrepreneurs and start-up co-founders.

Elina Vale, chief executive officer and Rustam Galiev, chief product officer, are on a mission to dismantle society’s 24/7 work culture and replace it with an “evidence-based” approach where women can thrive – regardless of the menstrual phase they are in.

The concept, also known as cycle syncing, is a way by which women adapt their health and lifestyle habits to fit the four phases of their menstrual cycle, namely menstruation, the follicular phase, ovulation and the luteal phase. During these phases, it is thought, women experience changes in key hormone levels that can affect their mood, energy and productivity.

The idea isn’t new. In fact, the practice was introduced by nutritionist Alisa Vitti in her book WomanCode in 2014.

What is new, however, is the way Vale and Galiev adjusted the method to suit women’s needs in the workplace. The founders developed an employee benefits platform that claims to combine science, coaching and artificial intelligence to help female employees improve their productivity and performance by working with their menstrual cycle. 

The app, they say, combines a to-do list, habit tracker, period tracker and mindfulness app in one tool.

“The way women’s menstrual cycle works is very different from the common nine to five routine that we, as a society, tend to prioritise. That’s what we are challenging at Essence,” says Vale.

“We aim to provide women with a tool that allows them to think [of what they could do] based on the phases of their cycle and not just in the traditional work routine.

“We are looking at things such as the type of activity that you do, the intensity, your workload and what your needs are to balance your performance and wellbeing.”

While there aren’t many scientific studies to support cycle syncing, evidence does show that hormone fluctuations affect energy, mood, appetite and sleep.

Vale says there is some research on how each phase of the menstrual cycle affects the types of activities women do. “We know, for example, that in the follicular phase it’s better to start new projects and in the luteal phase it’s better to wrap them up.”

She also says there is evidence to suggest that cultivating an inclusive workplace and actively supporting employees could improve their wellbeing and unlock their full potential.

“An inclusive workplace has been shown to improve motivation and engagement. The problem is that currently, everything in the workplace is structured in a ‘gender neutral way’, which is, by default, very male-focused. From our research, we know that most women don’t know much about their menstrual cycle, so they don’t look at the month through the four phases of the cycle.

“However, we are trying to change this perception and help women think differently.”

The end goal, the founder says, is to make employers prioritise menstrual health in the workplace and take women’s needs seriously.

“Most companies have mental health and wellbeing programmes in place – we think menstrual wellbeing should be a part of that too.”

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‘Compliance is a journey’: how femtech companies could navigate privacy and clinical safety requirements

Most femtech companies understand the importance of privacy, but experts say they often fail to address it at the development stage

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Women’s health has never seen more prominence. Since 2016, when the term “femtech” was coined, the health sector serving half of the world’s population has been on an upward trajectory.

In the course of just a few years, more than 2,000 femtech companies and apps have sprung up to address women’s needs, including tracking apps, fertility solutions and menopause platforms.

In 2022, VCs invested US$1bn of funding into femtech start-ups, the second best year on record after the US$2bn raised in 2021.

Dealroom reported that in 2023 femtech companies were worth upwards of US$28bn, while current forecasts predicted that this rapidly growing industry would be worth US$103bn by the end of 2030.

However, the “taboo” nature of women’s health and gender imbalances in investment are providing obstacles to the industry – femtech attracted only one per cent of health tech investments in 2022.

On top of that, the sector also faces significant challenges around regulatory compliance.

“Femtech companies often struggle with the secure and lawful processing of personal data and access to data,” said Amy Ford, data privacy specialist and managing director at Kaleidoscope.

“Start-ups simply don’t have the guidance and regulatory support they need when they are developing and bringing products to market.”

This is especially a problem considering that femtech apps and products are collecting and processing a wide range of sensitive personal information, said Ford.

“Not processing personal and sensitive health data in a safe and lawful way could lead to an infringement on the rights and freedoms of women. These could be loss of control over their personal data, discrimination and profiling, reputational damage, loss of privacy, limited access to services, loss of anonymity, exclusion and bias and even surveillance by authorities.

“Failure to protect users’ data could cause irrevocable damage and life-altering changes to women and their families.”

The other challenge, the data privacy specialist said, is around lack of access to data.

“Not having enough data causes a detrimental impact to the development of products and services in the femtech industry,” she explained.

“The data may be inaccurate, and companies may not have the interoperability to link it with health records, leading to an awful lot of problems and stifling innovation.”

While most femtech companies understand the importance of privacy, they often lack the knowledge and experience to address it at the development stage.

“When femtech start-ups come to me, they don’t have the time or experience to handle compliance, they have many plates spinning, – they are unsure, nervous about privacy controls going wrong and just don’t know what to do,” said Ford.

“I think the hope and want is there, but they just need a little bit of help.”

There are ways, however, in which companies can access support and equip themselves with the knowledge they need to navigate privacy and clinical requirements.

London-based Kaleidoscope has data privacy and clinical safety experts who specialise in health, health tech and life sciences and is one of the few consulting firms specifically helping femtech companies optimise data protection, clinical safety and risk management.

The organisation, led by Ford, supports start-ups in achieving their strategic objectives, while lawfully and ethically processing personal data, assuring their digital products are clinically safe for deployment and ensuring compliance with legislation.

The team have in-depth knowledge of all aspects of the lawful utilisation and sharing of personal and sensitive data, experienced clinicians with a passion for digital safety, and have created robust governance approaches and systems that provide effective technical and organisational controls for organisations.

“Compliance is a journey and it is an ambition of mine to help and support femtech companies go through the ever-changing and complex regulatory area,” said Ford.

“By working with femtech organisations, we are sharing and transferring our knowledge and we are able to set up an effective privacy programme to help them understand what they need to do and eventually run their own privacy operations.”

Kaleidoscope’s mission, she said, is to ensure that the products that are brought to market are lawful and safe.

“The key is to build trust and provide much needed support to women going through their personal journeys at every stage of life. And that’s why we are here for start-ups.”

To help businesses navigate the complexities of privacy and clinical safety, Kaleidoscope is providing free webinars tailored to femtech companies. To find out more, visit femtechworld.co.uk/events.

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