Ob-gyns: Know how serving in military affects treatment

Laurie C. Zephyrin, MD, MPH, explains how military deployment can delay treatment.

Laurie C. Zephyrin, MD, MPH, explains how military deployment can delay treatment.

The number of women serving in the US military is greater than ever, and today there also are 2.2 million female veterans, so ob-gyns must be aware of the challenges of treating these growing patient populations.

The trauma of combat duty not only affects the reproductive health of women, it affects their mental health, with issues ranging from sexual violence to post-traumatic stress disorder. In addition, women on active duty face unique logistical challenges of dealing with hygienic management of menstruation, urinary tract infections, bacterial vaginosis, and unplanned pregnancies.

These many issues were addressed Monday, May 6, at the Annual Clinical Meeting by Laurie C. Zephyrin, MD, MPH, in the Clinical Seminar “Effects of Military Service on Reproductive Health: Optimizing Reproductive Health for 2.2 Million Women Veterans.” Dr. Zephyrin is director of reproductive health, women’s health services, Veteran’s Health Administration (VA).

“Expanded roles and the lack of defined front lines have exposed military women to intense combat situations,” Dr. Zephyrin said. The number of women using VA services has more than doubled—to 360,000—since 2000.

Ob-gyns should consider that deployment could delay treatment or evaluation for contraceptive management, menorrhagia, endometriosis, or uterine fibroids as women carry heavy gear and work in extreme temperatures, she said. In addition, the rate of abnormal Pap test results  is elevated.

“You must be knowledgeable about family planning and contraceptive considerations for deployed women,” Dr. Zephyrin said, adding that combat exposure after childbirth doubles the risk of depression.

Female veterans older than 45 now make up 58% of women using VA services, so ob-gyns also need to be aware that older female veterans may have been affected by their service, too, she said.

“Knowing who in your population is a veteran is an important question to ask. You have to ask the question, ‘Have you ever served in the military?’ because most women do not identify as being a veteran,” Dr. Zephyrin said.