Reproductive Psychiatry: Beyond Perinatal Health

Abstract

Gender and sexual minority women represent a traditionally underserved but growing segment of the older adult population, and advances in equity and inclusivity will further enhance both visibility and medical-psychological competence on the part of the healthcare team caring for these individuals. In support of this, principles of intersectionality can be used to explore how the overlapping systemic stressors these patients experience affect medical, psychological, and social outcomes.Tools for vascular risk stratification, more apt dietary recommendations, better explanations for sex differences, and unique treatment options deserve more attention in the female population. A concept called normal-weight obesity has been explored in literature and suggests that there is a need for an updated measure of adiposity, other than BMI, to better gauge the risks of stroke and other vascular risk factors. For prevention of dementia, the MIND diet has been the most promising of many interventions but fails to address the rampant progression of sarcopenia; and therefore, recommendations for protein intake require more specificity. Current literature suggests that sex differences in dementia incidence are related to estrogen withdrawal, decreased cognitive reserve, longer life expectancy; however, it is also important to note that, women tend to be disproportionately more affected by the diagnoses of obesity, diabetes, and HTN. For prevention, estrogen therapy in research has suggested a “critical window hypothesis” indicating that it must be delivered within the immediate perimenopausal period, age 50 to 63, as after this it may increase risk of dementia; but, most of these meta-analyses do not reflect this.There is a wealth of data describing long-term care needs across all groups of older adults, however among gender and sexual minority women the evidence is more limited; by analyzing the disparities which exist for these individuals, formalized guidance may be developed which offers an opportunity to tailor care planning across every stage of the caregiving continuum. Perhaps nowhere is this more relevant than in the unique needs of aging transgender women, particularly as it relates to the medical endocrine management and psychologic support important to accomplishing successful aging in this group.Psychologically, current cohorts of older women have lived most of their lives in paternalistic societies, with less access to education and economic means which contribute to the development of social status, economic independence, and societal influence across their life-span. Additionally, sexism contributes to discrimination against women and to their marginalization throughout the life span. As a result, women who have a limited education and or less opportunity for career advancement may resort to informal work, work for lower wages, or be financially dependent upon a male partner, which can lead to insufficient economic security in late life.Reproductive health in the aging population is frequently overlooked when it comes to risk stratification, diagnosis, and prevention of dementia especially as it relates to our female and LGBT communities. These factors must be addressed to address these disparities in patient outcomes.