Women’s issues. They come in all shapes and sizes, none being welcome. Yet, come they do, and when they do, when women’s health troubles hit, it’s good to know that help is at hand at Cork University Maternity Hospital (CUMH).
There, amongst the highly trained and experienced specialists you might meet, are Ann Humphreys and Noelle Gill.
If ever mná na hÉireann (and I mean that in an inclusive sense, leaving nobody out) cast a wish for two of the most down to earth medics, to whom to turn in times of women’s parts problems, their wish was granted when the career fairy magicked this pair onto the nursing shift rotas at CUMH.
No warmer, more approachable, less judgmental women’s health specialists could you find in whom to confide your symptoms of malfunctioning body parts of the more intimate kind than in this pair of wise owls.
Both have many years of specialised women’s health nursing experience behind them, and both are currently working towards Masters qualifications to hone their expert skills.
Ann Humphreys, a candidate advanced nurse practitioner in urogynaecology and women’s health at CUMH, sees many women with incontinence of the stress or urge kind.
Stress incontinence can happen when pressure on the abdomen strains the bladder. We know this one: it can cause leakage when a woman coughs, sneezes, laughs or jumps.
Urge incontinence involves involuntary contractions of bladder muscles. This manifests in going a lot, with a sense of urgency. Sometimes it involves night waking for bathroom visits.
“If women have even one incontinence episode they can get so anxious,” says Ann Humphreys. “Many do bathroom mapping before going out. A Cork woman might know how many public toilets there are between Patrick Street and Curtain Street.
“For them, it’s an emotional burden, an embarrassment and a shame, with some waiting up to six years before disclosing it to their GP. To avoid risking a leakage episode in front of anybody, women may quit running, art classes, bingo or other forms of exercising and socialising. The isolation removes much joy from their lives and can be soul-destroying for them.”
Are intimate relations impacted?
“For some, leakage during penetration can occur,” she replies. “This can lead to their shying away from intimacy, or losing the desire for stimulation. Others can’t orgasm for fear of incontinence. Also, some women feel their femininity is ‘gone’ and that is devastating for them.”
Advising that the impacts on a woman’s quality of life can be physical, mental, personal, professional and financial, she adds: “Urgency and increased bathing can lead to slip and falls. Some women find themselves in nursing homes when family and carers cannot cope with increased burdens of additional washing, cleaning, laundry and care.
“Also, the cost of purchasing absorbent materials and medications, and of increased laundering costs and doctors’ fees can cause difficulty for many.”
But there’s good news: “There’s a wealth of treatment options,” says Humphreys. “We need GPs to start the conversation with women, to ask if they leak, by how much, and how that impacts their lives.”
Women can also help themselves. “Generally, 1.5 to 2 litres of fluid a day is enough,” she says. “There’s no need to drink 4 or 5 litres unless breastfeeding or running a marathon. Cutting back on caffeine, carbonated drinks and hot chocolate helps, as does avoiding energy drinks and going to the toilet ‘just in case’."
She’s passionate about banishing stigma around these issues and urging women to seek help for it: “Women shouldn’t be afraid to get help for incontinence. It is a common health issue. It is not normal though, so don’t accept it silently and avoid getting yourself assessed.
“Pilates is great,” she continues. “Try to avoid high impact exercises, lifting heavy weights and quitting smoking as the associated coughing won’t help.”
Noelle Gill is a candidate advanced nurse practitioner in ambulatory women’s health at CUMH.
“We've been doing ambulatory hysteroscopy here since 2007,” she says. “Back then we had a clinic one day a week, when we’d see approximately five patients.
“The service has now expanded to a five-day service with between 35 and 40 women being seen per week. Covid stalled a lot of things, but with additional newly trained staff, we are planning to utilise our second procedure room so as to see about 70 women per week.”
Many of the women Gill sees present with abnormal bleeding. “Also, intrauterine device insertion and removal,” she says. “Some of the treatments offered include medication for heavy periods and hormonal medication for postmenopausal heavy bleeding.
“Where appropriate, the oral contraceptive pill or a coil may be prescribed to reduce and regulate heavy periods. Coils may also be prescribed to women who are sensitive to hormonal medication.”
What happens when women don’t want hormonal treatment at all?
“Non-hormonal treatment options won’t regulate two periods a month or a period that lasts for ten or 12 days. They can reduce the heaviness, but not the duration of the bleeding.”
Like Humphreys, Gill is highly experienced in her area of speciality. In 2009 she worked at CUMH as a nurse, assisting a consultant in the ambulatory hysteroscopy clinic. Five years later she trained to be a nurse hysteroscopist. She has performed diagnostic hysteroscopy, IUD insertions and removals, and is well experienced at inserting cameras into women’s wombs for investigation purposes.
Asked how long are waiting lists for hysteroscopy, Gill replies: “We aim to see and scan post-menopausal bleeding patients in the PMB clinic within four weeks of their GP referral and the patient is then referred to and seen in the ambulatory clinic as required.”
This is excellent progress by any measure. Back in the day, these patients couldn’t be seen as outpatients, and generally went under general anaesthetic, even though some would have been in their 80s.
Since 2007, outpatient hysteroscopy has been available in a dedicated area at CUMH. Services provided include uterine polypectomies, small leiomyoma removal and retrieval of intrauterine devices. Initially, this service was consultant-led.
In surveys, 84% of patients were satisfied with the service of which 74% were carried out by nurse hysteroscopist. It was found that there was no difference in satisfaction and complication rates between doctors and nurse hysteroscopists.
That said, no woman looks forward to a camera procedure. For them, Gill has words of reassurance: “We try to make their experience as comfortable and relaxing as possible.
“In the new suite, we have ceiling murals and lovely wallpaper. We also have a staff member who remains at their side the entire time to talk to them and keep them as relaxed as possible.
“Local anaesthetic is offered if needed, as are gas and air. While the procedure is being done there can be banter and chat. Above all, we ensure patients are reassured and comfortable.
“Our main focus is improving patients’ health as efficiently as possible. We want them to know that their best interests are our priority. We want them to feel like they receive the best care possible.”