The Case for Cycle-Connected Care
By Dr. Stephanie McClellan, Tia Medical Director
What do women with IBS, endometriosis and anxiety have in common? The answer is rooted in women’s menstrual cycles — not the act of bleeding every month per se, but the sometimes-predictable, sometimes-sporadic internal dance of hormones that affects everything about being female from our brains to our bowels.
It may also explain why women are:
4 times more likely than men to have Lupus.
And 3 times more likely to have IBS.
And disproportionately affected by major anxiety and depression as compared to men.
The list goes on and on.
In 2018, we are just waking up to the (obvious) fact that women have fundamentally different healthcare needs than men—a result of a complex, interwoven web of physiological, anatomical and biosocial factors that make women distinct patients from men. Furthermore, our healthcare system’s tendency to treat the symptom instead of the root problem is especially problematic for women.
Hyperthyroidism? Take Tapazole.
Endometriosis? Here are some birth control pills.
Anxiety? Pop some Klonopin.
But, few practices or practitioners connect the dots between things. Not because they don’t want or don’t believe there could be connections, but because they don’t have the tools to draw connections. Specifically, they don’t have longitudinal cycle data.
This is the problem we seek to solve with Tia’s Cycle-Connected Care.
So, what is Cycle-Connected Care?
Cycle-Connected Care is the notion that the menstrual cycle — not just women’s periods, but our broader cycle and associated physiological and emotional manifestations — is the “5th vital sign” that should be considered amongst other data points and indicators when evaluating, diagnosing and treating any female patient. In layman’s terms, it’s a recognition that to be female, is to be cyclic.
This isn’t hippie-dippy stuff either. In fact, in December 2015, the American College of Obstetricians and Gynecologists issued an official opinion stating that menstrual history be used as a “vital sign” when evaluating the health of girls and adolescents. At Tia, we believe that cycle data is a vital sign for women across the reproductive age spectrum — from puberty to menopause. It’s the foundational element of our integrative care philosophy and the basis of the patient-provider relationship we will soon be cultivating in Tia Clinics.
Why is no one practicing Cycle-Connected Care today?
A simple answer: there’s a data problem. The female cycle is rooted in hormone fluctuations that go up and down throughout the month, and even throughout the day. The best proxies we have for evaluating menstrual cycles today are hormone testing via blood work, and human recall.
Putting aside the fact that hormone testing is both costly and inconvenient, it provides only a snapshot glimpse into a patient’s hormone levels at any given moment, failing to provide doctors like me with any longitudinal perspective.
Much more common is a reliance on recall — think: every time your doctor asks when your last period started, or how bad (really) your cramps are. The problem with recall is it’s fraught with human error and a tendency to bias responses based on recent or extreme events.
“Trackers” as a category have taken off in large part to solve this problem — wearables that passively track lifestyle factors like sleep and your steps, and quantified-self apps designed to let users self-report data from food intake to period quality. Technology, in turn, is supposed to do the legwork of analyzing this data, identifying changes, patterns, and even make predictions overtime.
While cycle trackers in and of themselves have created an entirely new category of “big data,” they fall short in one big way: they don’t connect to care.
Connecting to Care
Tia’s Cycle-Connected Care is about one thing: taking data — today, all self-reported, but overtime bio-metric and other types of data collected passively through wearables, diagnostic tests and more — and bringing that data to life in a clinical context in a useful, digestible way (key word: digestible!). These cycle-connected tools are not intended to diagnose or treat, but rather, aid the doctor and patient alike with a complete and comprehensive purview into a patient’s health. The foremost goal is to spark a meaningful conversation about one’s health and guide decision-making — a radical shift from treating women based on a snapshot moment-in-time to a broader “cycle-based” lens.
Importantly, we are building data-centric products to be utilized by doctors and patients in tandem — true “shared decision-making” tools artfully designed to enhance and not detract from the patient-provider relationship.
A philosophy. Not a discipline.
Cycle-Connected Care is a philosophy and not a discipline — one that we believe will be adopted by a wide range of practitioners that serve women from gynecology to naturopathy to fertility and more. The key to its success is developing tools that can bring this data to life not only accurately, but in a useful, human-centered way for patients and provider alike — blending the best of allopathic and naturopathic medicine, data science and design into a single, holistic product experience.