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The “5 Big Questions on the Under Fives’s” survey carried out by the Royal Foundation and Kate Middleton is the biggest survey of its kind with over half a million respondents [1]. In the past, Kate has demonstrated her passion for babies and children’s development and has seen first-hand how positive early years experiences can play a crucial role in childhood development as she says “they (the period from the womb to Age 5) are about the society we will become”[2].


This is welcome news for women and everyone with PCOS as it has highlighted that there needs to be improved translation of research, something that PCOS Vitality strives for. The report highlights the importance of the period from the time in the womb to age 5 both for physical and mental health. [2]. The intrauterine period is believed to be an important factor in the development of PCOS and obesity both of which can have a negative impact on reproductive outcomes [3]. For example, findings suggest that women with PCOS are at increased risk of pre-eclampsia and gestational diabetes and obesity has an additive negative effect on both [4][5].


With this in mind, we would welcome future specialised support for women with PCOS during pregnancy and postnatally given these increased pregnancy complications risks and a substantially increased risk of postnatal depression in those who have had miscarriages or medical assistance to conceive [6].


Other highlights from the report are that only 10% of parents take time to look after themselves prior to birth and 7 out of 10 parents feel judged by other parents. In relation to the Covid19 pandemic, parental loneliness has risen from 38% to 63% after the first lockdown and 40% of parents feel that community support has increased during the pandemic, with deprived areas hit hardest with only 33% experiencing added support[2].


Overall, the study highlights the need for further education about the importance of intrauterine programming and child development up to age 5 in relation to health and a need for more support to ensure good mental health and wellbeing in raising children.

The Duchess has demonstrated commitment to bring about changes in this area and Kensington Palace has announced that she plans to build on her findings in 2021 so we will be watching this space!


© PCOS Vitality 2020


References

[1] Royal Foundation, (n.d.). https://mk0royalfoundatcnhl0.kinstacdn.com/wp-content/uploads/2020/11/STRICTLY-EMBARGOED-UNTIL-0001-HRS-FRIDAY-27-NOVEMBER-2020-IPSOS-MORI-ROYAL-FOUNDATION-EXECUTIVE-SUMMARY.pdf (accessed November 27, 2020).

[2] O. Sweet, J. Long, L. Evans, L. Lindley, G. Welch, J. Barlow, N.C. Eisenstadt, P. Leon Feinstein, P. Peter Fonagy OBE, A. Gregoire, D. Holmes CBE, P. Eamon McCrory, E. Vainker, The primary research, analysis and reporting was conducted by Ipsos MORI The Duchess of Cambridge’s Early Years Steering Group Research participants, n.d.

[3] C.J. Glueck, N. Goldenberg, Characteristics of obesity in polycystic ovary syndrome: Etiology, treatment, and genetics ☆, Metabolism. (2018). https://doi.org/10.1016/j.metabol.2018.11.002.

[4] R. Valdimarsdottir, A.K. Wikström, T.K. Kallak, E. Elenis, O. Axelsson, H. Preissl, S.J.K.A. Ubhayasekera, J. Bergquist, I.S. Poromaa, Pregnancy outcome in women with polycystic ovary syndrome in relation to second-trimester testosterone levels, Reprod. Biomed. Online. (2020). https://doi.org/10.1016/j.rbmo.2020.09.019.

[5] G. Mills, A. Badeghiesh, E. Suarthana, H. Baghlaf, M.H. Dahan, Polycystic ovary syndrome as an independent risk factor for gestational diabetes and hypertensive disorders of pregnancy: A population-based study on 9.1 million pregnancies, Hum. Reprod. 35 (2020) 1666–1674. https://doi.org/10.1093/humrep/deaa099.

[6] W.A. March, M.J. Whitrow, M.J. Davies, R.C. Fernandez, V.M. Moore, Postnatal depression in a community-based study of women with polycystic ovary syndrome, Acta Obstet. Gynecol. Scand. 97 (2018) 838–844. https://doi.org/10.1111/aogs.13332.

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The existence or appearance of a hymen cannot indicate a person’s sexual experiences. This belief is deeply entrenched in cultural ideologies and is not informed by medical practice. The hymen, a tiny membrane, is socially constructed in such a way that it is used to control women’s sexuality and gendered roles of “good wives” or “good mothers” which can be determined by virginity testing [1].


A recent inquiry, carried out by the BBC, found at least 16 clinics here in the UK who are offering “virginity testing”. Some also offer hymen-repair surgery costing up to £3000. In the past five years at least 69 hymen-repair procedures have been carried out according to NHS England. These tests are a form of control when girls and women are being coerced into having the tests. There have been calls for these types of surgeries to be banned. According to the World Health Organisation, virginity repair surgery is carried out in over 20 countries.


Research suggests that due to the highly variable nature of the size, shape and appearance of hymens, it is impossible to establish whether a hymen is intact in relation to past sexual intercourse [2]. Furthermore, it is widely known that the hymen can break for many various reasons including, for example, physical exercise or inserting tampons. Nevertheless, the pressure on some women to have intact hymens is immense and has spurned the development of so called “hymen repair kits” with fake blood and tweezers which are sold online for a tidy profit.


There have been calls to make these practices illegal as they reinforce shame and control over women’s bodies. The fact that hymens are being repaired surgically and certified is another falsehood. It is key that education programmes within schools and society educate on issues such as hymen reconstruction so that society can acknowledge that it is time to banish this patriarchal practise to the past [3].


If you have been affected by these issues you can contact Karma Nirvana who support victims of honour-based abuse and forced marriage. Karma Nirvana’s UK helpline is Tel. 0800 5999 2471 and it operates from Monday to Friday from 9am to 5pm. If you are in immediate danger please call 999. Their website is www.karmanirvana.org.uk


© PCOS Vitality, 2020

[1] S. Delgross, The Mythological Role of the Hymen in Virginity Testing, 2019.

[2] F.A. Goodyear-Smith, T.M. Laidlaw, What is an “Intact” Hymen? a critique of the literature, Med. Sci. Law. 38 (1998) 289–300. https://doi.org/10.1177/002580249803800404.

[3] Controversial “virginity tests” sold by UK clinics - BBC News, (n.d.). https://www.bbc.co.uk/news/newsbeat-55078634 (accessed November 27, 2020).



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  • PCOS Vitality (c)



Menopause, a prominent topic surrounding women’s health, was subject to discussion with the Women’s Health APPG webinar. Chair, Jackie Doyle-Price, led the discussion which covered many areas including the impact of Covid-19 on provision of care. We heard from GP Dr Anne Connolly who highlighted how GPs are currently adapting during the pandemic and stressed the important role they have in supporting women going through Menopause. Also discussed was the increasingly collaborative work that medical professionals are engaging in to help improve services. Benefits can be had from medical professionals sharing their practices and uniting commissioning decisions. It is encouraging to learn of the pioneering work being done at Women’s Health Hubs in local primary care networks.


Patient, Diane Giddy, kindly shared her personal perspective of services which highlighted many gaps including the need to listen to patients. Diane relayed the debilitating symptoms she encountered during Menopause and how this affected her both physically and psychologically. The discussion raised the issue of misdiagnosis due to lack of awareness of the wide range of Menopause symptoms. There exists a risk that women may be treated for other things, joint pain is one example, without the realisation that the problem is attributable to the Menopause.


Diane also pointed out the need for women to have the right information and support from the off as it can affect life choices especially for those of a younger age. Dr Anne Connolly agreed that there needs to be proper signposting for Women’s Health and acknowledged the dangers of Google searching and its effects on how women learning about their bodies.


Discussion led to the question of what is impeding progress in this area. The panel chair raised the question of menopause being a taboo and how stigma surrounding women’s health can compound progress and the ability of women to access care. This is particularly pertinent for women who experience menopause at a younger age. Access to HRT must be available for those experiencing early menopause. There is a need to educate women and to have open conversations about menopausal symptoms in order to tackle the stigma. Diane Giddy added that a Preventative Programme may help women live happier and healthier lives.

With regards to consent in women’s health, there are currently some innovative pilot schemes being carried out in maternal healthcare. It is hoped that they may be rolled out across gynaecology and orthopaedics in the future. These schemes broaden the issue of consent. Consent needs to be more than a quick signing of a piece of paper just before a procedure. Women and everyone need to have proper discussions before consent is reached. Sarah Wilkinson spoke of emerging opportunities for digital growth in women’s health and for women seeking care to become more digitally literate. Sarah mentioned a new initiative designed to produce a broad spectrum of data on devices and implants for women. This is very never more relevant than now in the wake of the Cumberledge report on harm.


In all, the webinar highlighted the welcomed efforts of primary care, GPs and NHS digital in helping to move things forward for women and everyone with regards to menopause and HRT within the current pandemic restrictions. While there is a lot of great work ongoing there is still a long way to go. We need to tackle the stigma of Menopause and women's health generally and increase education both in healthcare professionals and women and everyone themselves. Thanks to the organisers for the opportunity to participate.


© PCOS Vitality 2020



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