Interview with Barcelona-based English-speaking women’s health specialist Dr Victoria Howe

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You have a specific health programme for women’s health consisting of different diagnostics and prevention packs. Can you explain a bit about what it comprises?

In our Women’s Health Division, we are now offering very specific programmes that are targeting the most relevant women’s health medical issues, such as the menopause, stress management, digestive health, pregnancy support, cardiovascular risk etc. We have created a variety of ‘packs’, adapted to each patient’s needs, following a concierge medical pattern. This means we have an initial medical consultation with the patient and then we assess their needs and create a personalised program for them. The majority of programmes include a medical assessment, a physical examination, an ECG and blood tests.

What is the price for the assessment and are clients able to claim the cost back from insurance companies?

The price can vary depending on the consultation. I am the General Practitioner for women and their families. If the patient is looking for a women’s health consultation or would like to enroll in one of my programmes then this is also available. This will be included in the pack if the patient decides to go ahead with it. Insurance companies (there is a list on our website) reimburse the majority of our fees.

What services does a Women’s Health Specialist offer and what is your philosophy?

My philosophy is that the patient has to be approached as a whole, through education and counselling. The patient should be well-informed and able to participate in their own care. In the past number of decades, doctors have sub-specialised so much that we have forgotten to see the body as a whole and the patient as an individual. Instead, modern medicine has mistakenly treated patients as numbers and statistics that need to be cured. I believe that we need to take care of each person with time, communication, excellent care and a more nurturing approach. A Women’s Health Specialist does exactly this. Medicine is based not only on treating patients but also in preventing health conditions through lifestyle medicine.

What kind of impact does stress have on a women’s health?

Society is starting to be become more conscious of the importance of well-being and our mental state. Until now, stress has been overlooked and has not become an issue until we started to study the evidence and the impact it has on our health. Stress has been related to a number of medical pathologies including cardiovascular disease, mental disease, hormonal imbalance etc. I also believe that managing stress physically, emotionally and psychologically can also lead to a more productive life, improving our social skills, our personal relationships with family and friends and our levels of satisfaction with ourselves.

What advice would you give to someone who is suffering from stress and finding difficulty controlling it?

Stress is constantly in our lives. It can show itself as frustration while waiting in a traffic jam or a confrontation with someone, but it is your decision how you manage it and how you want it to affect your life. We have to learn to cope with the stressful elements that we encounter daily at work and at home and this is where we can help. We provide strategies, techniques and procedures to help you manage these stressful situations. It basically helps you change the way you look at things and identify the warning signs of stress. We restructure the processing of decisions and help the patient change any factors that are harmful in their lives.

Many women may suffer from hormonal imbalance and not be aware of it. What are the signs?

There are many signs that your body is not adjusting to changes in your hormone levels but we have to assess them carefully as they could be signs of some other pathology.

The main signs are:

  • Unexplained increase in weight and hunger
  • Loss of libido / vaginal dryness
  • Mood swings
  • Sleep disorder
  • Fatigue
  • Cycle related spots
  • Breast changes
  • Blood pressure changes
  • Night sweats

How do hormones change in a women’s body once you approach perimenopause?

Basically, when approaching the menopausal transition, estrogen and testosterone start to decrease. This could happen either progressively, abruptly or even continuously, which would explain the different degrees and severity of symptoms in women. It is important to pay attention to these hormones as well as other relevant hormones in your body to rule out other conditions.

Do you think that there is enough information available for women approaching the menopause or do you think there is still a stigma surrounding it?

Nowadays information for menopause / perimenopause is available for everyone and our scientific evidence for the reactions and physiology of this period of our lives is well documented. But it is certainly true that many women, especially those under 50, which is the average age for menopause, feel embarrassed, worry or are even scared at the prospect of starting menopause. We still feel young and fertile so the idea of the menopause sounds incredibly daunting. It is important to remember that every woman will encounter this process and it is essential to feel at ease with our bodies no matter what moment in life you are in.

Do you advise a combination of both conventional and alternative medicine for women who are suffering negative effects from the menopause?

Standard medical management is very useful for women with relatively serious symptoms that affect their daily lives. Many women, though, reject the risks associated with hormone replacement therapy which treat their menopause symptoms and instead seek relief from alternative sources. Although researchers are still studying and looking into many of these therapies so as to determine their safety and effectiveness, there is a series of well-known evidence-based alternatives that are recommended for patients suffering from the menopause / perimenopause. I am completely in favour of using either conventional or alternative therapies as long as my patients are aware that even natural substances have real physiologic effects, including potential adverse effects and drug interaction, which need to be supervised by a doctor.

What specialist care do you offer pregnant women that they may not find in the public system?

Our maternal / pregnancy programmes are focused on offering women who are trying to conceive, who are pregnant or new mothers, a ‘concierge’ doctor who will provide them with the medical advice they need. It is an innovative programme that provides support (together with their obstetrician / gynaecologist) based on personalised care and service. It combines a holistic maternity care with a ‘concierge-level service to ensure healthy and happy women throughout their journey. This type of medical care, quite popular in the USA, caught my interest after being pregnant and finding that many other mothers-to-be were finding themselves isolated or desperate for medical advice and guidance, especially those who were living abroad. Pregnant women find themselves asking the question “is this normal?” many times and resorting to the internet for answers. This is the reason I created this maternal programme for any woman who needs my help.

Do you think there are enough birth choices available to women in Catalonia?

I believe Catalonia has one of the best health systems, both private and public. I agree that sometimes women’s choices are not listened to and that some birth options are not that common here. The most important and key element in being pregnant is feeling confident with your birth plan and with the doctor / gynaecologist in charge of your birth. We need to create an environment with our health professionals in which there is respect and trust both ways.

How daunting can it be for a pregnant women whose doctor does not speak their language?

It can certainly be very daunting for any woman to experience birth in a foreign country. We are trying to create a secure and friendly clinic for all patients so they can feel at ease with us. We are becoming a reference clinic for expats, tourists and, more importantly, for any patient who wishes to receive a more personalised medical care.

You have also trained as a Digestive Surgeon and you have created a division of digestive health. To whom is it directed and what can you offer them?

The Digestive Health programmes that we offer target women who are suffering from very common and often overlooked issues, such as abdominal bloating, gas, constipation, heartburn and other gut imbalances. These symptoms are caused by conditions such as esophageal reflux, IBS, colitis etc but could also be related to the health of our digestive system and the chronic inflammation of its components. This could end up affecting other areas of your body, such as your skin, your immune system, your liver, your heart etc and we should try to find the ‘closest to perfect’ balance in our bodies so we can prevent and manage these cases. I offer patients a number of programmes that take care of the needs of each individual, while also studying their nutrition and digestive health profiling.