Patterns in women's health: Gastrointestinal and gynaecological comorbidity.
By Teja Jaench (2016)
Following on from the clinical experience in women’s health, the investigator looks beyond the treatment room and into the realm of public health. The comorbidity between gastrointestinal and gynaecological systems appears prevalent in the Chinese medical setting. From the Hunyuan analysis, this relationship is described as the Yangming Jueyin Axis. What follows is an exploratory investigation assessing the extent to which the broader non-clinical community also exhibits this comorbidity. Reviewing the literature and conceptual frameworks, along with piloting a comorbidity correlation study, clear patterns emerged allowing for the development and distribution of the Western Sydney University women’s health study.
An epidemiological online survey was designed to assess gastrointestinal and gynaecological comorbidity, along with wider implications, in an international cohort of female participants. The four primary research hypotheses were:
1. Gynaecological variables are associated. Dysmenorrhoea is associated with other menstrual phenomena, such as menstrual heaviness and clotting, irregular menses, ovulation pain and premenstrual symptoms.
2. Dysmenorrhoea severity is positively associated with specific gastrointestinal issues (constipation, diarrhoea, bloating, abdominal pain, irritable bowel syndrome, nausea/vomiting, and reflux/heartburn).
3. Gastrointestinal and gynaecological symptoms are associated with infertility, risk of miscarriage, symptoms occurring during gestation, obstetrics interventions and complications, along with postnatal depression and difficulty breastfeeding.
4. There is a positive relationship between gastrointestinal and gynaecological symptom severity and mental health, specifically, increased symptoms are related to increased feelings of anxiety or depression, reduced social activities, and increases in the frequency of individually expressed emotions.
The Western Sydney University women’s health study was distributed over two months at the end of 2015 and beginning of 2016. An online survey instrument was designed and approved, and recruitment involved online snow-ball sampling using social media. An international sample (n=2035) of reproductive aged women (18-48 years) participated. General demographic data were collected, along with specific information regarding gastrointestinal, gynaecological, fertility, gestational and obstetric issues, and mental health issues.
The results show a strong positive association between gastrointestinal and gynaecological variables, along with positive associations with fertility, symptoms of gestation and obstetrics, and mental health.
Discussion and conclusion:
This study furthers the work of others in highlighting gastrointestinal and gynaecological relationships, revealing complex patterns of comorbidity which extend beyond symptoms of menstruation and digestion and into areas of fertility, gestation, obstetrics, postnatal issues and mental wellbeing. While limited in generalisability due to study design and recruitment, these results are suggested as motivators for interdisciplinary communication and collaboration as a means to improving patient-centred care. Bridging biomedicine with Chinese medicine, comorbidity and pattern differentiation may allow for improved patient-centred care, particularly in women’s health. Within CM research into women’s health, quantitative research may benefit from multiple outcome measures to assess the total benefit of CM interventions. Future qualitative research aims to go beyond the goal of medicalisation and look upstream—towards prevention. This study furthers the comorbidity hypothesis in women’s health, and points the way for further research.
Last Updated (Monday, 05 December 2016 20:33)