Mercedes Febles: "When children are older and life is full, many women start to feel worse"

ManacorMercedes Febles is the head of Gynecology at Manacor Hospital. A few days ago, she presented the Es Mujer initiative in Madrid, a comprehensive national strategy for women's health, with the aim of addressing the distinct physiological stages and conditions of women in a unified way, such as menstruation, fertility, endometriosis or fibroids, or menopause. The presentation at the Congress of Deputies seeks to give visibility and institutional support to the project.

How was the project conceived?

— It is a national-level strategy that emerged from the Spanish Society of Menopause. Immediately, several more scientific societies joined, some patient platforms that have some chronic diseases, and finally the industry and commercial companies that have specific products for women.

From what need?

— Women, throughout our lives, have different situations that we can call physiological: menstruation, pregnancy, fertility, and then menopause, which greatly worsens women's quality of life. This is a very different gap compared to men, who do not have these situations and their quality of life does not change as much. From here, a strategy was developed, mainly focused on the quality of life that menopausal patients were losing, and then an attempt was made to integrate the rest of the situations to encompass all pathologies or all circumstances.

How will it be applied?

— Right now there isn't an overnight solution. The idea is to give visibility to women in general. The idea is to achieve that specific pathologies are not seen, but a whole.

What phases does it address?

— The timeline more or less begins with when the period arrives and premenstrual syndrome. The breasts hurt more, the stomach starts to bother... Then the fertility part must be included: patients who want to get pregnant or who get pregnant at older ages because we work more and, therefore, there are more problems to achieve it. Assisted reproduction techniques are increasingly resorted to and it is lived with much anguish; there are many patients who fall into depression and need help, and the couple experiences it badly. Thus, this reproductive life also ends up being seen as pathological when in essence it is a normal thing.

Let's talk about endometriosis and fibroids

— They are two pathologies that are very relevant: endometriosis, which causes a lot of chronic pain, and uterine fibroids, which are benign tumors that have no long-term repercussions, but which greatly increase bleeding. They are patients who end up anemic and it is a chronic pathology that in a way decreases when you enter menopause. That is why there are many therapies to reduce pain and also bleeding in both fibroids and endometriosis.

Is menopause the most traumatic stage?

— It becomes like a very important block where patients start to have hot flashes, they don't sleep, they have decreased libido... they notice it a lot. It's a problem, a big difference between men and women when they reach 50 years old, especially in relation to libido; patients experience it very badly and all this is due to the decrease in estrogen when they enter menopause.

At the best moment of their lives...

— Sure, when your children start to get a little older, you can work, you have a full life and suddenly you start not sleeping, going crazy, having problems with your partner... Menopause is probably the stage that most deteriorates women's quality of life, because it takes many years until the patient accepts her situation a little: you lose estrogen, you start gaining weight and you can't lose it, you don't sleep because of hot flashes, you wake up at night and, therefore, during the day you have less concentration, you have brain fog, you forget things more, just when you are at your best moment, indeed.

Was it a minimized problem?

— Gynecologists, until now, saw it as just another part of a woman's life: "this is menopause, you have to put up with it with a fan." But recently there have been many recommendations that have highlighted the benefits of administering hormones to menopausal women to improve hot flashes and their quality of life. There are hormones that can be administered transdermically, for example. Patients are told that they can improve their quality of life and especially protect their bones, improve long-term osteoporosis, and reduce cardiovascular risk. All of this can be improved by giving hormone therapy for some years, before the age of 60. As I have explained to you, from when we get our period until it stops, this is where the strategy, the project of encompassing all of this, arises.

Has perception changed?

— I think two things are happening here: until very recently, almost 90% of gynecologists were men. Now in the medical degree program, it's the opposite, 90% are women. So I think, on the one hand, women have started becoming gynecologists and don't have exactly the same perspective. And on the other hand, society has changed. We live longer, women are occupying more and more positions of professional responsibility and need to be much more active. Before, menopausal women stayed more at home, and now they occupy high-level positions. I think these two things are happening: that the person attending you is a woman and understands it more, and that life has changed. I remember my mother at 50: she probably didn't do what 50-year-old women do today. Also, there's a bit of Instagram culture. We all want to look great, we all see ourselves as very cute, it seems like we're 30 and not 50. And everyone takes good care of themselves, takes many supplements, and that's why a 50-year-old woman isn't the same as before.

How can all this be applied, in this case at Manacor Hospital?

— Starting to set up some consultation that has a more integral approach to women's health, not a consultation for fibroids, not a consultation for endometriosis... because in fact, now it happens that a patient who comes for reproduction, for example, has a fibroid: so they start asking her for tests, then they pass her to the fibroids consultation for me to treat the fibroid, and so on. But of course, we also forget that we want the best professional in each aspect. Starting to have slightly more integrated consultations that can cover all these physiological situations of women would be the first step. Probably also starting with menopause, which is what most affects quality of life. Right now we don't have a specific menopause consultation; there are other hospitals that are already starting to implement it. It's the sum of a lot of little things that improve your life: sleeping a little better, having fewer hot flashes, being able to go to work more calmly. All this improves your quality of life.

Will it be a reality?

— I would really like it. The problem is also that, as we know, we lack gynecologists. We have to cover 24-hour assistance, so we don't have enough resources to do everything we would like, but probably having a menopause consultation to improve quality of life would be important. This would mean that if we focus more on women's quality of life in a comprehensive way and not on their pain or specific symptom, we would have a somewhat more cross-cutting consultation.