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Opinion

The impact of menopause and ageing on urinary incontinence in women

By Lydia Zeller, CEO at Pelvital USA

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Lydia Zeller, CEO at Pelvital USA

The natural processes of menopause and ageing are not the biggest challenge women face when it comes to incontinence. The biggest challenges are the historic silence and assumption that our only options are pads or surgery.

One of the most rewarding aspects of my role as CEO of Pelvital is amplifying the conversation around women’s health, especially on historically stigmatised topics like urinary incontinence (UI) and menopause.

If you suffer from bladder leaks, you’re not alone. Research from 2022 shows more than 60 per cent of US women suffer some form of bladder leaks. It is unacceptable that an issue impacting over half of women has historically been kept quiet and stigmatised.

Women are led to believe that bladder leaks are a natural part of being a mum or growing older. That is not true. Although bladder leaks are common, they are not normal, and women should not accept them as such.

Fortunately, there are effective options for treating leaks and education is the first step in self-advocacy – one of the reasons why I love talking about this topic.

First, let’s talk about the different types of UI. Stress urinary incontinence presents as accidental leakage associated with activities like sneezing, laughing, coughing, or jumping.

Urge incontinence (including overactive bladder) involves the sudden urge to urinate followed by involuntary loss of urine. Mixed incontinence is the combination of stress and urge incontinence. Stress urinary incontinence (SUI) is the most common form and is often caused by weakened pelvic floor muscles.

While one in three mothers report SUI within three months of childbirth, UI prevalence indisputably increases with age: 62 per cent of women in their 40s have UI compared to 68 per cent of women in their 50’s, 72 per cent in their 60s and 83 per cent in their 70s.

But does menopause cause incontinence? Yes and no.

Menopause is defined as the natural event of a woman’s final menstrual cycle. It is associated with reduced functioning of the ovaries due to ageing, resulting in lower levels of oestrogen, progesterone, and testosterone.

While these steep hormonal drops don’t directly cause incontinence, they cause thinning of the tissues in the pelvic floor muscles during perimenopause (the time around menopause when your ovaries gradually stop working).

Combine this thinning with common unresolved pelvic floor weakness or injury (e.g. caused by pregnancy, childbirth, pelvic surgery, falls) and/or with common changes associated with ageing (e.g. lowered fluid intake, lowered activity, constipation) – and urinary incontinence can result.

Stress urinary incontinence is most often caused by weak pelvic floor muscles – and menopause-related changes exacerbate that weakness.

Pelvital on-staff pelvic health doctors of physical therapy Shravya Kovela and Leah Fulker describe how this works in a blog on the menopause / incontinence connection: Weak pelvic floor muscles are unable to contract properly to close the urethral sphincter where urine escapes the body.

When paired with hormonal changes of menopause and the resulting changes in tissue flexibility or elasticity of the vulva, vagina, and urethral sphincter, urinary incontinence will appear or worsen.

Furthermore, discomfort in the vulva and vagina associated with menopause-related vaginal dryness or pain may lead pelvic floor muscles to compensate, worsening urinary incontinence.

Interestingly, menopause and ageing do not equally impact incontinence. Menopause transition has been found to correlate with stress urinary incontinence, whereas increasing age and risk factors such as anxiety, BMI, and new onset diabetes correlate with both stress and urge incontinence. And new onset of SUI is highest in perimenopause as opposed to postmenopause.

But the natural processes of menopause and ageing are not the biggest challenge women face when it comes to incontinence. The biggest challenges are the historic silence and assumption that our only options are pads or surgery.

Tragically, according to the Study of Women’s Health Across the Nation (SWAN) – a historic study to define menopause transition and “characterise its biological and psychosocial antecedents and sequelae in an ethnically and racially diverse sample of midlife women” – fewer than 40 per cent of incontinent women even seek treatment from their healthcare provider.

Women are uncomfortable bringing this topic up with their providers and when they do, too often are dismissed without options.

Menopause gaslighting is occurring to women because historically there has been a significant lack of clinically proven conservative options for women who do not wish to have surgery.

Pelvic floor physical therapy has been the shining light here, but a mere one per cent of physical therapists specialise in the pelvic floor, resulting in significant access gaps.

The continued uptick in virtual pelvic health physical therapy options is a big positive, increasing access and enabling women to fit treatment into their lives. Similarly, evidence-based in-home treatment options allow women flexibility and clinicians the ability to extend their clinic walls and deliver conservative care at scale, with outcomes very similar to surgery.

This conversation is incomplete without mention of economics and gender equity. Not only has research into women’s health been historically massively underfunded, but women bear disproportionate out-of-pocket costs.

Specific to UI, 70 per cent of costs are borne by the woman. And that is also completely unacceptable. I am proud to be part of the growing cohort of femtech companies creating change and step by step moving towards broad access and insurance coverage. Women deserve no less.

Lydia Zeller is CEO at Pelvital USA, Inc., a Minnesota based femtech company providing products to restore pelvic floor health. Flyte by Pevital is an FDA-cleared novel in-home treatment for female urinary incontinence.

Opinion

‘We are not allowed to talk about our bodies’: why we need to address social media censorship

By Clio Wood, women’s health advocate and founder of &Breathe

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Social media censorship is just another example of women’s issues being sidelined and women being made, yet again, to feel small.

The gender data gap is huge and, if you’ve ever read the great Caroline Criado Perez’s book, Invisible Women, you’ll know what I mean. It touches every day of a female life.

That impact includes social media too. Because while the social media platforms are notoriously secretive about their internal workings, it’s a pretty safe bet that social media algorithms, like most of the rest of life, are built on male data and trained on male behaviours.

This means that as long as women have different behaviours and priorities of what they want to see on these platforms, we’re going to find it a struggle.

Meta and Tiktok are silencing women’s health and sexual wellbeing content. Censorship harms women’s health: it increases women’s pain, and disempowers women, which in turn means the gender health gap cannot close. What annoys you when you’re on your phone scrolling has long-lasting impact for us and our children.

I’ve experienced this censorship first hand on Instagram, with my reach being restricted for simply posting a body confidence reel of me dancing in a bikini.

That in itself – one example of many – is infuriating, but what’s especially galling is that everyday men’s health topics are left uncensored, and hyper sexualised women’s bodies, unsolicited “dick pics” and fake accounts using nearly naked female profile pictures are making their way into social media feeds and inboxes unchecked. The hypocrisy of the situation is clear.

All the while charities are being forced to use male nipples instead of female ones, and female-led period brands are losing hundreds of thousands of pounds when their ad accounts get deleted.

Creators, charities, medical practitioners and brands are being censored constantly through algorithms picking up words like sex, vagina, vulva, or period. Which are all normal human functions or body parts and integral to these creators’ missions. You can’t be a period care brand without talking about periods.

CensHERship aims to alter the trajectory of the current algorithms and end the routine censorship of women’s health content online

Creators end up using written symbols and numbers to disguise these words and bleep them out in speech to try to get around this censorship.

It’s examples like this that finally led me – after many years of finding this situation ridiculous – to do something about it.

Together with Anna O’Sullivan, we’ve created CensHERship, a campaign which aims to alter the trajectory of the current algorithms and hopefully restore some balance to what is allowed on social media. Our ultimate aim is to bring the platforms to the table for discussion by this time next year.

We launched a survey in late January 2024 to try to collect as much information as we can about the incidences of muting and censorship that female creators are experiencing, whether they are educators, charities, brands or medical professionals. The results emphasised that this is a widespread issue taking in all of women’s health and sexual wellbeing.

In tandem we hosted an intimate roundtable to launch the CensHERship campaign and found, to our astonishment, that the problem goes much deeper than social media. Women’s health and sexual wellbeing brands are being refused bank accounts, insurance and being kicked off payment platforms without warning.

Social media censorship is just the tip of the iceberg. It’s just one more example of women’s issues being sidelined and women being made, yet again, to feel small.

We’re not being allowed the freedom to talk about our own bodies and health, because speaking up goes against the male-gaze archetype of the female role and body. Let’s end CensHERship once and for all.

Clio Wood is a women’s health advocate, journalist, author and Founder of &Breathe.

Anna O’Sullivan is a communications and marketing professional and writes FutureFemHealth 

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Opinion

Revolutionising women’s health: the rise of femtech innovations

By Jo Barnard, founder and creative director of Morrama

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In the fast-evolving landscape of female technology, 2024 is poised to mark a pivotal year in growth and innovation.

Investors are increasingly recognising the vast potential of a typically overlooked audience, which encompasses 45+ year-old women with disposable income and actively seeking solutions.

As the femtech sector continues to gain momentum, we can anticipate the introduction of innovative features, products and services – such as intelligent menstrual cups, connected pads addressing menstrual cramps and wearables with hot flush detection capabilities, all with an growing focus on the unique needs of the individual.

Removing the guesswork through data

Whilst we mustn’t devalue leading medical advice on female health – including period complications, fertility, and menopause – they can feel like one-size-fits-all treatments that are only offered in the more severe cases. In reality, women’s health is a very personal and nuanced journey. The next few months promise the advent of smarter versions of pre-existing products, in an effort to help women understand their bodies better.

Take Emm, for instance. The company created a menstrual cup embedded with sensors to track menstrual flow, providing users with valuable insights into their menstrual health.

Similarly, wearables such as FemSense utilise advanced algorithms to predict ovulation with 99.7 per cent accuracy. These cutting-edge digital and physical devices help unlock new insights into the complexities of the female body, paving the way for more informed decision-making and improved health outcomes.

Addressing gaps in conventional treatments

While the femtech sector continues to push the boundaries of innovation, it also seeks to address long-standing gaps in the provision of medical solutions for various female health issues.

Conventional treatments, such as contraceptive pills for managing period pains, IVF for fertility problems or hormone replacements for menopause often fall short in meeting the diverse needs of women.

Against this backdrop, femtech brands are pioneering a more specialised and inclusive approach – as highlighted by brands like Tina, which I explore into more detail below – tailoring products to specific demographics, including people of colour, individuals with physical constraints and those with distinct religious beliefs.

Prioritising design, technology, and user experience

Central to the femtech revolution is a strategic focus on design and technology, aimed at enhancing the quality of life for women across the globe. Leading brands such as Emm, Embr and Tina are at the forefront of this movement, developing solutions that not only empower women but also drive positive societal change.

Tina’s aim, for example, is to create inclusive design for all bodies and abilities, engineered with anatomy in mind. Their tampon applicator takes into account correct angles and depth, and prides itself in being “first-period friendly”, reducing the stigma surrounding women’s health for the next generations.

These brands can only achieve this by opening up the conversation and incorporating feedback from diverse communities in order to deliver products that resonate with women from all walks of life.

In addition, this year’s Consumer Electronics Show (CES) in January offered valuable insights into the evolving landscape of femtech, where innovation is not solely defined by radical disruptions but by incremental improvements to existing products and services.

Highlights from the show included: Movano Health’s Evie Ring, a smart health ring utilising AI to analyse women’s menstrual and sleep data; and Vivoo’s new at-home smart UTI test, showing that a dipstick test can be beautiful and utilising the capabilities of smartphones to give more accurate readings.

With femtech brands historically focusing on function over aesthetics, it’s positive to see companies considering smarter delivery mechanisms, more thoughtful design and more personalised educational pathways. The result is that women feel more empowered and valued as individuals.

Importance of research and evidence-based practice

However, as femtech continues to grow and develop, it’s also crucial not to lose sight of the importance of scientific rigour and evidence-based practice. For every truly science-based solution there will inevitably be a flood of lower quality copycats and brands promoting products that serve only as a placebo.

Building trust in femtech solutions requires a commitment to transparency, accountability and continuous improvement. Only by investing in rigorous scientific enquiry can we ensure that femtech products and services meet the highest standards of safety, efficacy and reliability.

A bright future for femtech

I’m excited for the future of femtech. As we look ahead to the next few months and beyond, let us embrace innovation, inclusivity, open-mindedness and evidence-based practice as our guiding principles.

More than ever, the industry has the potential to usher in a new era of personalised, proactive and women-centred healthcare, making a meaningful impact on women’s quality of life as well as the broader population as well.

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Opinion

How the UK’s ‘pharmacy first’ policy will change women’s healthcare

By Katherine Bridges, head of brand and clinical lead at the pharmacy app Charac

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On the January 31, the UK government will roll out its long-awaited “pharmacy first” policy, a measure designed to cut the size of the NHS backlog – which currently stands at around 7.6 million patients.

With “pharmacy first”, patients suffering from various lesser ailments – such as sore throats and shingles – will be directed to their local pharmacy as their first port of call.

Pharmacies will also be able to supply certain prescription medicines. It is hoped that this will ease pressure on Britain’s seriously overstretched hospitals and GPs.

The policy is set to transform healthcare provision in the UK, which is important for women’s health across the country. If the policy can be carried through successfully, women’s access to NHS will improve in a number of ways. The success of “pharmacy first” will, however, rely on a big technological upgrade to Britain’s 11,500 high-street pharmacies.

Improving women’s access

This shift of several key medical functions to Britain’s pharmacies will give women easier access to important medicines and treatments. For instance, under “pharmacy first” patients will be able to pick up prescription medicine for urinary tract infections (UTIs) from pharmacies; previously this required a GP appointment beforehand.

This change will be especially valuable for women, given that this ailment disproportionately affects women, with roughly 50 per cent experiencing one over the course of their lives.

Crucially, under the new policy, women will also be able to purchase contraceptive pills at their pharmacies without seeing a GP. It is vitally important, but easily prescribed and administered medications such as this that will see “pharmacy first” freeing up countless of hours of GP and hospital time.

Further, the reduction of pressure on GPs and hospitals will improve women’s access to critical medical procedures and treatments. For instance, the policy will put a dent in the NHS’s mastectomies backlog, which is currently putting thousands of women in the UK at a greater risk of breast cancer.

Femtech critical to making a success of “pharmacy first”

Of course, “pharmacy first” represents a very large administrative and operational task for Britain’s high-street pharmacies.

It is uncertain whether these pharmacies, in their current state, will be able to meet the challenge. Community pharmacies are often small and family run. As such, they find it difficult to afford key labour-saving technologies that cut costs and free up time.

These pharmacies’ internal systems are often ramshackle and antiquated. Many still run on paper, making everything from prescriptions to payroll arduous and time-consuming.

It is clear that these pharmacies will need to undergo a big technological upgrade as the policy is rolled out this year. Femtech will play a key role in this effort.

Femtech technologies could help pharmacists manage the transition to a greater scope of provision. For instance, femtech companies, such as Vivoo’s at-home women’s UTI test, could help pharmacists manage the task of treating this common women’s ailment.

Another would be the online self-assessment system Tuune, which matches women to the contraceptive treatment appropriate to their particular hormonal profile.

Innovations like these will be an essential part of women’s healthcare in the age of “pharmacy first”, driving efficiencies in high-street pharmacies and expanding women’s access to treatment.

The future of health tech will empower women

Other health technologies will help amplify the impact of femtech. Apps, such as Charac, offer a dashboard for both pharmacists and their customers, allowing customers to book pharmacy appointments and get their prescriptions delivered to their door.

These kinds of accessible, integrated health tech systems that will prove so valuable in the age of “pharmacy first” will also help improve patient outcomes for women. One of the primary hindrances to better healthcare for women is a lack of information and access.

Research by the Department of Health and Social Care revealed that around 85 per cent of British women did not feel comfortable talking to their GPs about their physical health, and a similar percentage can remember an occasion where they did not feel listened to by medical professionals.

Similarly, knowledge of women’s health issues is often low: less than one in five UK women felt that they had enough information on menstrual health, and less than one in 10 felt they knew enough about gynaecological conditions.

What’s clear is that a lack of information and access is leading to worse health outcomes for women than men, but health tech can make a valuable contribution – streamlining appointments and prescriptions, raising public awareness of health conditions and the treatment services that women can access and making patient outcomes and healthcare more equal.

As “pharmacy first” becomes policy, we have a chance to use the latest developments in femtech and health tech to both make a dent in the NHS backlog, and to put women’s healthcare on a surer foundation.

Katherine Bridges is head of brand and clinical lead at the pharmacy app Charac.

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