Question 1

What is endometriosis and why does it take so long to diagnose?

Accepted Answer

Endometriosis is a chronic condition in which tissue similar to the uterine lining grows outside the uterus — on the ovaries, fallopian tubes, bowel or elsewhere. It causes chronic pelvic pain, painful periods, pain during sex and infertility. It affects approximately 190 million women globally (WHO). The average diagnostic delay is 6-8 years because symptoms are often normalised or dismissed as "bad periods" by healthcare providers, and because diagnosis requires laparoscopy — surgical investigation.

Question 2

What is cervical cancer and how is it prevented?

Accepted Answer

Cervical cancer is caused by persistent infection with high-risk strains of HPV (human papillomavirus) — particularly HPV 16 and 18. It is the fourth most common cancer in women globally, killing approximately 350,000 per year — nearly all in LMICs. It is one of the most preventable cancers: the HPV vaccine, given to girls before sexual debut, is ~90% protective. WHO's 90-70-90 elimination strategy combines vaccination, cervical screening and treatment into an achievable elimination pathway.

Question 3

What is the WHO 90-70-90 cervical cancer elimination strategy?

Accepted Answer

WHO's three-pillar strategy targets: 90% of girls vaccinated with HPV vaccine by age 15; 70% of women screened with a high-performance test by age 35 and again at 45; and 90% of women identified with cervical disease treated (pre-cancer managed and invasive cancer managed). If these targets are reached and maintained, cervical cancer can be eliminated as a public health problem — defined as an incidence below 4 per 100,000 women — within decades.

Question 4

Why do women have worse outcomes after heart attacks?

Accepted Answer

Cardiovascular disease is the leading cause of death in women — killing more women than all cancers combined — but women have worse outcomes than men after heart attacks for several reasons: women more commonly present with atypical symptoms (fatigue, nausea, back pain) leading to delayed diagnosis; historical under-representation of women in cardiovascular trials meant treatment thresholds, drug doses and stent sizes were calibrated for male physiology; women are less likely to receive evidence-based treatments (aspirin, statins, thrombolysis) in a timely fashion; and age-at-event is typically older in women.

Question 5

What is PCOS and how does it affect health?

Accepted Answer

Polycystic ovary syndrome (PCOS) affects 8-13% of women of reproductive age, making it one of the most common hormonal disorders. It causes irregular or absent periods, elevated androgens (causing acne, excess facial hair, scalp hair loss) and polycystic ovaries on ultrasound. PCOS is a leading cause of female infertility. It is associated with insulin resistance, increased risk of type 2 diabetes, metabolic syndrome and long-term cardiovascular risk. Management is symptom-specific — there is no cure.

Question 6

What is gender-based violence and how does it affect health?

Accepted Answer

Gender-based violence (GBV) encompasses physical, sexual and psychological harm directed against someone because of their gender. WHO estimates that 1 in 3 women globally experience physical or sexual violence in their lifetime — predominantly from intimate partners. GBV causes immediate physical harm, long-term mental health sequelae (PTSD, depression, suicidality), reproductive health consequences (unintended pregnancy, STIs, pregnancy complications), and increased risk of chronic conditions including pain disorders and cardiovascular disease.

Question 7

What is the women's health research gap?

Accepted Answer

Until the 1990s, most clinical trials systematically excluded women "to avoid confounding by the menstrual cycle" — leading to treatment guidelines, drug doses, diagnostic criteria and even symptom descriptions based predominantly on male populations. This has been called the "Yentl syndrome" — women only receive appropriate cardiovascular care when they present like men. The US NIH Revitalization Act (1993) mandated inclusion of women in federally funded trials; many other countries have since followed, but the historical gap persists.

Question 8

What is menopause and how should it be managed?

Accepted Answer

Menopause is the permanent cessation of menstruation, defined as 12 consecutive months without a period — typically between ages 45 and 55. It is caused by declining ovarian function and oestrogen levels. Common symptoms include vasomotor symptoms (hot flushes, night sweats), sleep disturbance, mood changes, urogenital symptoms (dryness, urinary frequency) and increased bone loss. Menopausal hormone therapy (MHT) is the most effective treatment for vasomotor symptoms and is recommended for healthy women under 60 by major guidelines (IMS, NAMS, EMAS).

Question 9

What are the main causes of maternal death?

Accepted Answer

The five leading causes of maternal death (WHO 2023) are: haemorrhage (~35%); hypertensive disorders including pre-eclampsia and eclampsia (~22%); sepsis (~8%); complications from obstructed labour (~9%); and unsafe abortion (~4.7%). 95% of maternal deaths occur in LMICs, and at least 70% are preventable with timely, quality care — skilled birth attendance, emergency obstetric care and antenatal monitoring.

Question 10

What is female genital mutilation (FGM)?

Accepted Answer

FGM refers to all procedures involving partial or total removal of the external female genitalia or other injury to female genital organs for non-medical reasons. It is practised in 30 countries in Africa, the Middle East and Asia, with approximately 200 million girls and women alive today having undergone it. FGM has no health benefits and causes immediate and lifelong harm: severe pain, infections, complications in childbirth and sexual dysfunction. It is a violation of human rights recognised under multiple UN conventions.

Question 11

What is WHO's global strategy for women's health?

Accepted Answer

WHO's work on women's health spans sexual and reproductive health and rights (SRHR), maternal health, violence against women, gender equity in health systems, and conditions that disproportionately affect women (endometriosis, PCOS, cervical cancer, menopause). The Global Strategy for Women's, Children's and Adolescents' Health (2016-2030) provides the integrating political framework. WHO also leads the cervical cancer elimination initiative and co-chairs the UN Women Compendium on health.

Question 12

How does GMJ News cover women's health?

Accepted Answer

GMJ News covers cervical cancer elimination progress, endometriosis awareness, maternal health data, gender-based violence as a health issue, PCOS management evidence, and the WHO SRHR framework. The Georgian Medical Journal has published on women's health in the South Caucasus context, and PHIG's accreditation work directly engages quality of obstetric and gynaecological care in Georgian healthcare facilities.

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