A rapid evidence map of womens health
Authors: Edwards Deborah , Csontos Judit , Gillen Elizabeth , Lewis Ruth , Cooper Alison , Edwards Adrian 
Published: November 2022

The rapid evidence map focuses on identifying the nature and extent of published literature on the following topic areas: healthcare professionals communication with women about womens health issues and broader health problems during clinical encounters; access to specialist healthcare; endometriosis; menopause; womens health and mental health issues, and mental health issues associated with specific conditions related to menopause or menstrual health (adenomyosis; endometriosis; fibroids; heavy menstrual bleeding, polycystic ovary syndrome and premenstrual dysphoric disorder).

The purpose of this rapid evidence map was to identify research gaps and priorities that will be beneficial to womens health in Wales. The rapid evidence map uses abbreviated systematic mapping or scoping review methods to provide a description of the nature, characteristics and volume of the available evidence.

There is a lack of primary and secondary research that explores communication between women and healthcare professionals within primary and secondary care settings. Secondary research evidence exists but there are gaps in the evidence base regarding access to services providing minor gynaecological procedures and pain management, or care for menstrual health and wellbeing, endometriosis, polycystic ovarian syndrome, menopause, heart conditions, autoimmune diseases, hypermobility spectrum disorders, myalgic encephalomyelitis, long COVID, fibromyalgia, skin conditions, or palliative and end of life care, which are priority areas identified by the Womens Health Wales Coalition (2022). There are no active funding calls exploring these topics.

Regarding endometriosis, there is a lack of review evidence regarding education and resources for health care professionals and doctors to reduce diagnostic times and improve care. There is an evidence gap for primary research regarding information, support interventions and tools for women with endometriosis to help them manage their symptoms and improve their quality of life.

A substantial amount of secondary evidence exists on menopause along with a plethora of research priorities around treatment and symptom management. It was beyond the scope of this work to determine if any research had been conducted in these priority areas since the production of the guidelines and recommendations.

There is a lack of research recommendations and review evidence that address mental health issues and specific issues that affect a womens menstrual health such as adenomyosis, fibroids, heavy menstrual bleeding and premenstrual dysphoric disorder.

Funding statement

The Wales Centre for Evidence Based Care was funded for this work by the Wales COVID-19 Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government.

Wales COVID-19 Evidence Centre (WCEC)

Rapid Evidence Map: Women’s health

Report number – REM 00045 (October 2022)

Rapid Evidence Map Details

Review conducted by

Wales Centre For Evidence Based Care

Review Team

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Deborah Edwards

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Judit Csontos

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Elizabeth Gillen

Review submitted to the WCEC

October 2022

Stakeholder consultation meeting

24thOctober 2022

Rapid Evidence Map report issued by the WCEC

November 2022

WCEC Team

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Adrian Edwards, Ruth Lewis, Alison Cooper, Micaela Gal involved in drafting the topline summary, reviewing, editing, publication process.

This review should be cited as

REM00045. Wales COVID-19 Evidence Centre, Rapid Evidence map: Womens health. October 2022

Disclaimer

The views expressed in this publication are those of the authors, not necessarily Health and

Care Research Wales. The WCEC and authors of this work declare that they have no conflict of interest.

Rapid Evidence Map: Women’s health

Report number – REM00045 (October 2022)

TOPLINE SUMMARY

What are Rapid Evidence Maps?

Our Rapid Evidence Maps (REMs) use abbreviatedsystematic mapping or scoping review methodsto provide a description of the nature, characteristics and volume of the available evidence for a particular policy domain or research question. They are mainly based on the assessment of abstracts and incorporate an a priori protocol, systematic search, screening, and minimal data extraction. They may sometimes include critical appraisal, but no evidence synthesis is conducted. Priority is given, where feasible, to studies representing robust evidence synthesis. They are designed and used primarilyto identify a substantial focus for a rapid review, and key research gaps in the evidence-base. (N.B. Evidence maps are not suitable to support evidence-informed policy development, as they do not include a synthesis of the results.)

Who is this summary for?

Health and Care Research Wales

Background / Aim of Rapid Evidence Map (REM)

The Welsh Government Research and Development Division intends to run a commissioned funding call on understanding and tackling gender inequalities in health and social care in Wales. The purpose of this REM was to identify research gaps and priorities that will be beneficial to women’s health in Wales to inform the proposed funding call. It was decided, based on a preliminary review of the literature, feedback from an NHS public consultation exercise in Wales, and further discussion with the stakeholder group, that the REM would focus on identifying the nature and extent of the literature on the following prioritised topic areas:healthcare professionals’ communication with womenabout women’s health issues and broader health problems during clinical encounters;access to specialist healthcare;endometriosis;menopause;women’s health and mental health issues, and mental health issues associated with specific conditions related to menopause or menstrual health(adenomyosis; endometriosis; fibroids; heavy menstrual bleeding, polycystic ovary syndrome and premenstrual dysphoric disorder). Research gaps in other areas and health conditions, in which women might also experience inequality, were not explored in this REM.

Key Findings

Extent of the evidence base

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Communication within health care encounters: The evidence base included one systematic review (of endometriosis) and nine primary studies. The primary studies focused on breast cancer (n=2), maternal medicine (n=3), perinatal mental health (n=1), gynaecological conditions (n=1), and non-specific conditions (n=2). Three studies focused on specific populations: urban Africans, Iraqi Muslim refugees, and undocumented migrants. Planned and ongoing NIHR funded projects include clinicians’ perspectives of listening to women’s health, menstrual and gynaecological conditions, menopause, and women’s cancers

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Access to specialist healthcare: The evidence base consisted of 19 reviews and 9 protocols. Conditions covered were maternal medicine (n=8), sexual and reproductive health (n=5), cancer and cancer screening (n=4), perinatal mental health (n=4), mental health (n=2), HIV (n=2), and non-specific conditions (n=3). Specific populations investigated were refugees or displaced people (n=6), those in differing social, economic, and environmental circumstances (n=4), physical disabilities (n=3), homeless (n=2), migrants (n=2), experiencing intimate partner violence (n=1), and minority ethnicity black (n=1). The reviews focused on barriers and facilitators (n=10), barriers (n=5), experiences (n=3), mapping the evidence (n=3), factors (n=2), management (n=1), facilitators (n=1), predictors (n=1), associations (n=1), and prevalence (n=1).

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Endometriosis: The evidence base included 121 systematic reviews covering different topics including medical management (n=22), surgical management (n=15), biology/molecular (n=12), risk factors (n=11), and comorbid conditions (n=9). Research priorities were identified by the James Lind Alliance (JLA), NICE guideline, a Wales-specific primary study (Boivin et al 2018), and researchers within the field (n=2). Recent UK funding calls were identified covering laboratory research, aetiology of endometriosis and uterine disorders, and medical and surgical management.

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Menopause: The evidence base included 108 systematic reviews covering different topics including hormonal therapies (n=17), homeopathic therapies (n=13), non-hormonal therapies (n=10), genitourinary symptoms of menopause (n=7), alternative therapies (n=6), and lifestyle interventions (n=6). Research priorities were identified as part of a NICE guideline, by the British Menopause Society, and researchers within the field (n=3). Recent UK funding calls were identified covering reproductive and menopausal health, testosterone for the treatment of symptoms, women’s reproductive health in the workplace, and women’s health hub landscape.

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Women’s health and mental health issues: The evidence base included 37 reviews covering: perinatal mental health (n=23), general mental health (n=9), polycystic ovary syndrome (n=3), and intimate partner violence (n=2). Some reviews focused on specific populations including women in prison, women in inpatient mental health services, mental health of migrants and refugee women, and mental health of women from different minority groups. Recent UK funding calls were identified covering: young women’s mental health, women and partners who have experienced pregnancy not ending in live births, and perimenopause and the risk of psychiatric disorders.

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Mental health issues associated with specific conditions related to menopause or menstrual health: The evidence base included 10 systematic reviews covering: polycystic ovary syndrome (n=4), endometriosis (n=4) menopause (n=1), and menstruation (n=1). The reviews focused on prevalence (n=4), associations (n=4), and management (n=2).

Recency of the evidence base

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The review included evidence available (from 2012, 2018, and 2021) up until September 2022. (Separate searches were conducted for different topics, with variable time limits due to the varying volume of research published in certain areas.)

Summary of the evidence gaps

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There is alack of primary and secondary researchthat explorescommunication between women and healthcare professionals (HCPs)within primary and secondary care settings.

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Secondary research evidence exists but there aregaps in the evidencebase regardingaccess to servicesproviding minor gynaecological procedures and pain management, orcare for menstrual health and wellbeing, endometriosis, polycystic ovarian syndrome, menopause, heart conditions, autoimmune diseases, hypermobility spectrum disorders, myalgic encephalomyelitis, long COVID, fibromyalgia, skin conditions, or palliative and end of life care, which are priority areas identified by the Women’s Health Wales Coalition (2022). There are no active funding calls exploring these topics.

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Regarding endometriosis, there is alack of review evidenceregardingeducation and resources for HCPs and doctorstoreduce diagnostic timesandimprove care. There is anevidence gapfor primary research regardinginformation, support interventions and toolsfor women with endometriosis to help themmanage their symptomsand improve theirquality of life.

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A substantial amount of secondary evidence exists onmenopausealong with aplethora of research prioritiesaroundtreatment and symptom management. It wasbeyond the scopeof this REM todetermine if any researchhad been conducted inthese priority areassince the production of the guidelines and recommendations. Researchers in the field would like to see primary research conducted in the area ofquality of life.

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There is alack of researchrecommendations and review evidence that address mental health issues and specific issues that affect a women’s menstrual health such asadenomyosis, fibroids, heavy menstrual bleeding and premenstrual dysphoric disorder.