There are many lessons to take from the COVID-19 pandemic as we prepare for the inevitable next contagion. One of the most obvious is the impact of social determinants of health on the ability to weather novel viruses. Despite a long history of the products of inequity, it is again clear how the health of the community influences the outcome for the individual. Nurses throughout the world have an enduring record of filling the role of caring for all, routinely crossing social, cultural, and economic divides in settings from acute care to clinics to the home. Each country and region has its own accounts of legendary nurse leaders such as Lilian Wald, who in 1893 created a nurse-managed clinic in the poorest of New York City neighborhoods to promote the health of women and children. These leaders have been at the forefront of overcoming insufficient institutional support and artificial barriers to nursing practice in broadening and extending care to the marginalized. Now, as then, nurses provide hands on care and bridge gaps leading to better health through education and advocacy.
Yet the world’s regions remain at different levels in meeting the health needs of women. In high resource areas, there is investment in reproduction control and perinatal care. In other regions, there is a lack of even menstrual care. In most of the world, there are large gaps in the delivery of care to the estimated 1.2 billion women during and after the menopause transition. This breakdown in care for menopause related symptoms increases total healthcare costs and health vulnerability. Both the failure to alleviate menopause symptoms and the management choices may negatively impact concurrent health issues including respiratory conditions, body weight, diabetes, and cardiovascular disease. While menopause is universal, the experience is diverse, influenced by culture, socioeconomics, lifestyle, body morphology, and opportunities for health. In the subcontinent of India and in Africa, the median age of the final menstrual period is the mid-forties. Europe and North America report the oldest median age of approximately 51 years. Symptom profiles differ with North America and Europe describing predominantly vasomotor symptoms and other continents focusing on myalgia/arthralgia. Worldwide, the cluster of vasomotor symptoms, sleep disruption, and myalgia/arthralgia dominate with 75-85% of women experiencing symptoms. As the menopause transition may coincide with the peak of women’s financial productivity and responsibilities as multi-generational caregivers, many women struggle to find care while continuing to manage their busy lives.
Nurses can embrace this diversity and reach out to these women, providing the anticipatory guidance and modification of health risk factors that women desire and deserve. Advanced practice nurses are trusted clinicians who stand ready with the expertise and skills to deliver optimum menopause transition and women’s health care. All nurses are perfectly poised to once again be leading voices in respecting the rights of women to receive the best of healthcare at all stages of life and in alleviating negative social determinants of health. International funding of nursing and the removal of artificial barriers to practice are essential today and tomorrow in improving the basic health of the community, leaving the world better positioned for the next global health threat.
Patricia Geraghty, MSN, FNP-BC, WHNP is the Director of Women’s Health and Coordinator of the comprehensive Pelvic Pain Program in a multi-disciplinary practice, CARE Walnut Creek, in Walnut Creek, CA, USA. She is a nurse practitioner with over 20 years of experience in women’s health. She translates complex health information into practical and achievable plans that make women’s lives better. Ms. Geraghty attended the University of California, Davis for undergraduate studies in biological and behavioral development, and started her career as part of a neuropsychology research team at the National Institutes of Health in Bethesda Maryland. She then did a MSN in Women’s Health Nurse Practitioner followed by a post-masters Family Nurse Practitioner credential at the University of California, San Francisco. Ms. Geraghty was the founding coordinator of the Family Nurse Practitioner program at Holy Names University in Oakland, California, where she continues as clinical faculty. She speaks and publishes nationally on topics pertinent to women’s health across the lifespan. She is a member of the Medical Advisory Board for Sharecare, Inc., the North American Menopause Society, Nurse Practitioners in Women’s Health and the American Academy of Nurse Practitioners.