A team of researchers from George Mason University (GMU) in Virginia, USA, has partnered with The University of the West Indies (The UWI), Cave Hill Campus for a study of women’s health in Barbados to gain a deeper insight into the impact of certain conditions on their overall quality of life.
While much emphasis has been placed on maternal well-being, co-Principal Investigator at The UWI, Dr. Damian Best noted that there is a dearth of research on the island on other areas of women’s health.
“There is a huge knowledge gap when it comes to our local picture. And we don’t have any gynaecological registries, so we kind of don’t really know the burden of these gynaecological illnesses and by extension the prevalence.
“So often when we talk to each other, we use anecdotes … and we often have to draw on statistics from the larger countries: United States, UK and so on. So, any opportunity where we can capture the local experience, the Barbados population, I think it’s a welcome one until such time when we can get a registry,” Dr. Best said.
Associate Professor, Global and Community Health at GMU, Dr. Anna Pollack, is the co-Principal Investigator at GMU. The co-investigators are Drs. Helen Chin and Jenna Krall of GMU, Dr. Rashida Daisley of Ross University School of Medicine, and General Practitioner Dr. Laura Lovell.
Among the conditions of particular interest to the researchers are those affecting reproductive health, such as endometriosis and polycystic ovary syndrome (PCOS).
Endometriosis is a chronic disease in which tissue similar to the lining of the uterus grows outside of the uterus. In March 2023, the World Health Organization (WHO) estimated that 190 million globally were suffering from endometriosis.
The latest statistics from the WHO identify PCOS as a leading cause of infertility, and the condition is associated with several long-term health problems that affect physical and emotional well-being. The WHO estimates that eight to 13 per cent of women of reproductive age worldwide suffer from PCOS, and up to 70 per cent remain undiagnosed.
Dr. Best, a lecturer in Obstetrics and Gynaecology, said he has also observed many cases of PCOS in his practice.
“I would say that if I do a clinic at the university, which I do every month, maybe three quarters of the patients that I see end up having a diagnosis of PCOS … Similarly, in the QEH and in my private practice, I am seeing a lot of PCOS cases as well and maybe a sprinkling of endometriosis.”
He identified possible causes for this trend: “There is some thought that the pathology of PCOS has to do with insulin resistance and kind of almost want to marry that in some cases with increasing prevalence of obesity.
“The more obese somebody with PCOS is, the worse is their insulin resistance and the more likely they are to manifest symptoms. So, it may very well be that we don’t have any increased propensity to PCOS but because people are gradually becoming more obese, the manifesting symptoms are thus coming to light more often.”
Project coordinator of the study, Julia Mandeville, said this research is important, as there is a need for a clear understanding of the matters affecting women’s health.
“We also have associations with cardiovascular disease, diabetes, asthma. We know we have high rates of these [diseases] in Barbados, and we know that if we disaggregate the population by gender, more often than not, we tend to see women having a higher prevalence of these non-communicable diseases when you compare them with their male counterparts,” she stated.
Mandeville’s statements are supported by the 2015 Barbados Health of the Nation Survey that showed obesity is almost twice as high in women (43 per cent) than in men (23 per cent).
The PhD candidate at GMU and co-founder of the Barbados Association of Endometriosis and PCOS (BAEP) pointed to apparent racial biases in research, saying some medical providers are of the view that endometriosis does not affect Black women, and this often leads to a delay in diagnosis.
“On average, it takes two times longer for Black women to be diagnosed with endometriosis compared to non-Hispanic white women. You can put two and two together and you will see that the predominantly Black countries have not really been looked at in terms of endometriosis,” she said.
“We recognise that it seems that this is more prevalent in people of African ancestry than in any other population. The outcomes are typically worse for Black and Brown people [and] the quality of life is worse. So, all of these physical things in terms of infertility and pain, it’s important to measure those; but it’s also important to capture how does this affect your day-to-day life, inclusive of your physical pain. How does it affect you, in terms of how is it disrupting your work life, your academic life, your social life, the potential diagnosis of infertility also affecting you and navigating that with family and friends.”
Mandeville also highlighted a concerning trend among young girls: “In terms of what’s happening globally, particularly among people who are not white, they’re noticing Black and Brown girls are having periods at an earlier age, and also increased irregularities in terms of menstrual cycles,” she said, but cautioned that irregular periods are not necessarily an indication of PCOS.
“There’s a trend happening globally in terms of menstrual disturbances. So many things could be attributed to that: It could be literal environmental exposures in terms of endocrine disrupting chemicals — more of them are in the environment; but then it could also be social stressors, which can also contribute to the dysregulation of the endocrine system. So, I don’t think there’s one thing that can lead to [menstrual disturbances], based on what I’ve read.”
Two years after being diagnosed with endometriosis, Mandeville co-founded the BAEP in 2016 to raise awareness of the illness and to support women and girls who suffer from the condition.
She said her decision to pursue advanced studies was influenced by the need to advance the work in Barbados on women’s health and conditions that have been underserved and underrepresented.
