Spotlight on Women's Health

I’m currently the Deputy Chief Consultant and National Director of Comprehensive Women’s Health for the Office of Women’s Health Services in the Veterans Health Administration, part of the VA. I’ve been with the VA for 26 years. I’m a General Internal Medicine doctor by background, and I still have an active practice, seeing women veterans one half day a week in the West Haven, Connecticut VA Healthcare System.

I’ve been working in VA health care for 26 years, and I’ve been working with women veterans for at least 20 years. The population of women veterans using VA services has tripled over that time period, so we now have over 700,000 women enrolled for VA care. Initially women veterans were considered a special population in VA, and at many sites, women’s health services weren’t readily available. That has all changed dramatically with the implementation of comprehensive women’s health care across our system in the last 10 years.

We now have designated women’s health primary care providers and women’s mental health champions in all VA health care systems. We provide full gynecology services (196 gynecologists across the system) and mammography and breast cancer treatments either on-site or in the community (60 sites have on-site mammography). Women veterans are also eligible for maternity care and delivery services that are covered by VA and provided through community care.

Over the last ten years, we have expanded our understanding of the effects of military service on women’s lives and women veterans’ health care needs. Women veterans (especially those using the VA system) have been increasingly understood as a very resilient population, but a population that is/has been at risk of physical and mental trauma. As in the general population, some patients in the VA are very healthy, but others suffer from complex mental and physical co-morbidities. The most prevalent conditions we see in the VA among women veterans using VA care are musculoskeletal conditions, followed by mental health and cardiovascular conditions.

Women veterans’ health is not unique, but as a population, women veterans may have had some unique experiences and exposures. These include very positive aspects such as readiness, fitness, and resilience as well as the many skills they’ve acquired during their military service. In addition, there can be negative consequences such as exposure to occupational hazards and trauma. We have to keep all of these risks and exposures in mind as we provide care. As health professionals, we must screen for things like traumatic brain injury, sexual trauma, and the mental health consequences of trauma exposure, including post-traumatic stress disorder (PTSD). We must also be mindful of the possibility of musculoskeletal injuries, often from chronic wear and tear on women’s joints, and risk for chronic pain syndromes. In terms of reproductive health, research shows that PTSD can increase rates of pre-term delivery, so it is especially important for OB-GYN providers to be aware of military service.

The time of leaving the military and transitioning to civilian life can bring additional challenges to women veterans who are sometimes lacking social support, feeling a lack of recognition for their service, and dealing with family stresses.

Finally, in terms of cardiovascular health, we know that men and women veterans are usually in good shape when they leave the military because of physical fitness and weight requirements, but it is easy to let health habits slip. We see a lot of weight gain and development of cardiovascular risk factors after veterans leave service and enter VA care. It is important for health professionals to talk with their patients about these risks and the lifestyle changes needed to prevent heart disease.

A lot of women veterans get their medical care from community health professionals. These health professionals may not think to ask about whether a woman has served in the military, and because of that, they may not screen for the experiences and exposures that I’ve discussed above. By screening and identifying issues early, health professionals can engage women veterans in treatment and prevention and connect them with VA resources as needed. Also, having experienced trauma can impact the way a woman responds to or engages in health care experiences, so it is important for health professionals to ask women about trauma history and to practice with this in mind.

I think it is important for health professionals to know how to take a military history, which includes asking if women served in the military, their location of service, and military occupation. They should be aware of screening for combat and sexual trauma, depression, and PTSD. Knowledge of principles of pain management, including pain self-management, and trauma-informed care are particularly important. Health professionals should also be aware of the services that VA provides for women veterans and know how to help veterans get enrolled and utilize VA benefits and services. Knowledge of important numbers like the Women Veteran Call Center (1-855-829-6636), the National Suicide Prevention Lifeline (1-800-273-8255), and the National Call Center for Homeless Veterans (1-877-424-3838) would also be important.

The National Meeting on Active Duty and Veteran Women’s Health is an important collaboration between the Office on Women’s Health, the VA, the Substance Abuse and Mental Health Services Administration, and the U.S. Department of Defense. It brings together clinical and behavioral health professionals and researchers for a full day of presentations on active duty service women and women veterans’ health issues with a goal of educating health professionals about the health effects of military service and VA resources.

I hope that health professionals will go back to their practices with a recognition and respect for women veterans and be aware of common health conditions in women veterans and the unique risks and exposures that women veterans face that can impact their health and health care. I hope that this meeting will change their practices so that they always ask their patients if they’ve served in the military.