Young Women’s Health

Key people: Prof Martha Hickey, Dr Yasmin Jayasinghe, Dr Jennifer Marino, Dr Jane Girling

Overview

Health conditions in children and adolescents have the potential to redefine a young person’s perspective and thereby eventually enrich quality of life. They can also create challenges by causing young people to feel different to their peers, self- conscious about treatment-related effects and concern about forming close friendships, all of which can have a long-lasting consequences. Conditions that concern gynaecological, sexual and reproductive health can particularly have an impact. It is now well understood that gynaecological needs of children and adolescents are very unique, and relatively understudied. Benign ovarian masses, benign breast lumps, cervical dysplasia are all very common yet ovarian cancer, breast malignancy, and cervical cancer are very rare. Research can assist to characterise the nature of gynaecological malignancy in the young, thereby allowing appropriate prevention, detection and management, and minimising over-investigation and management that could adversely impact on fertility and body image. In addition, research in the young is important as interventions have the potential to significantly impact on the direction a young person’s life takes.

Research projects

Human Papillomavirus and cervical cancer in young women

Key people: Dr Yasmin Jayasinghe, Prof Suzanne Garland, Prof Sepehr Tabrizi, Dr Jeff Tan, Mr David Wrede

In line with the World Health Organisation (WHO) recommendations, the Australian cervical screening guidelines will change in 2017 to make the onset age of cervical screening 25 years. As from 2017, the guidelines will also recommend HPV testing every five years. There are several reasons for these changes. Australia was the first country to introduce a federally-funded school-based national HPV vaccination program in 2007. As a result we have seen a decline in HPV infection, genital warts and high grade epithelial abnormalities of the cervix in vaccine-eligible-age women. Furthermore we have an increased understanding of HPV infection in the young, being largely transient, causing cervical changes that have the potential to regress. Repeated surgical treatments to the cervix have the potential to cause future obstetric complications. We have demonstrated that in a pre-vaccination cohort of more than 4000 women under 25 years of age attending for Pap abnormalities, where over 14000 colposcopies were undertaken, 0.1 per cent had a cervical cancer. Thus it is important to avoid investigation and treatment for abnormalities that have the potential to regress, but it is also important to prevent cancer occurring in those at risk. With key research leaders at the Centre for Women’s Infectious Diseases, histology and survival of cervical cancers of young women have been assessed, as well as environmental exposures in childhood and adolescence (including sexual abuse), which shed light on those at risk for early-onset of the disease. Genotyping of cancers in young women has been undertaken at the WHO HPV Reference Laboratory at the Women’s to estimate the effectiveness of the HPV vaccine in this group who will not be routinely offered screening in the future. Post vaccination surveillance is being undertaken to estimate the effectiveness of the vaccine in a colposcopic population. Importantly, evaluation of attitudes and acceptance of young Australian women, and Australian health providers to cervical screening changes has been undertaken in order to inform targeted education before the introduction of this significant change in public health policy.


Menstrual Concerns in Young Women – A dad’s perspective

Key people: Dr Yasmin Jayasinghe and Dr Jane Girling

Menstrual pain not only impacts on the individual girl/woman, but also on her family.  Conversely, the attitudes of the family towards menstrual pain may have a significant impact on how the girl/women views, understands and manages her symptoms. To date, there is no literature available that considers the father’s perspective of menstrual pain.  Information on the father’s perspective may help identify specific areas where education may help a father support and advocate for his daughter.  Ultimately, understanding men’s views more generally may help overcome current taboos surrounding menstruation and dysmenorrhoea.

The aims of this study are to understand the father’s perspective on menstrual period pain and to identify how the father’s perspective impacts on the daughter’s perception and management of menstrual pain. The study will involve girls attending the Adolescent Gynaecology Clinic at the Royal Children’s Hospital and their parents and will address the father’s understanding and attitude towards menstrual pain, its cause and management, and the impact of their daughter’s symptoms on day-to-day activities. 

This is the first study considering the father’s perspective on menstrual pain and will help to identify key areas of clinical need to assist fathers to support their daughters.


Ovarian masses and breast disease in young women

Key people: Dr Yasmin Jayasinghe

Most paediatric ovarian masses are benign. Therefore, surgical management is conservative in order to preserve fertility and ovarian function. Malignancy must be recognised early in order to improve outcome. This study runs across the adult and paediatric centres and examines the clinicopathological characteristics of ovarian masses in women under 21 years of age. Predictive features of malignancy are being examined and include risk of malignancy indices and imaging modalities.

Adolescence is a common time for the presentation of both congenital and acquired breast conditions. Anxiety and embarrassment may hinder a young person from disclosure when there is a concern. Most breast masses are benign and can be managed conservatively. However diagnosis of breast carcinoma can have a worse prognosis in young women compared to older women due to delayed diagnosis and a poor index of suspicion. Research undertaken with leaders at the Mayo Clinic has shed light on the nature of breast conditions in the young and lead to guidance for clinicians regarding evaluation and management.


Young Female Health Initiative

Key people: Prof Suzanne Garland, Prof John Wark, Dr Yasmin Jayasinghe

A collaboration with the Women’s Centre for Infectious Diseases and the Royal Melbourne Hospital, the Young Female Health Initiative [SB1] uses e-technologies in health studies and health interventions. The YFHI study was the first to report the feasibility and cost-effectiveness of recruiting representative populations for health studies via Facebook. It is now a longitudinal study examining all aspects of young women’s health and wellbeing, how they relate to each other, and the underlying driving factors in health-related behaviours. This is allowing interventions to evaluate whether these can modify outcomes.


RAINE Study: Risk-taking behaviours

Key people: Prof Martha Hickey, Dr Jennifer Marino

The Western Australian Pregnancy Cohort (RAINE) Study is one of the largest pregnancy cohorts in the world. It was established between 1989 and 1991 to evaluate the safety of ultrasound in pregnancy. The cohort recruited 2868 live births from 2900 pregnancies. Clinical and questionnaire data were collected at 18 and 34 weeks’ gestation, and ages one, two, three, five, eight, ten, 14, 17, 18, 20 and 22 years. The 27-year follow-up is ongoing.

With Professor Roger Hart of the University of Western Australia, Professor Hickey leads the RAINE Reproductive Health Special Interest Group. Professor Hickey’s projects with RAINE include hormone exposure before birth, menstruation in teenagers, Polycystic Ovarian Syndrome (PCOS), and with Dr Jennifer Marino, predictors of the age of menarche and sexual risk-taking in adolescence.

Taking risks is a normal part of adolescence and often seen in areas such as sports, travel and relationships. However, risk taking can have deleterious consequences when pushed too far or when health is affected. Risk taking behaviour of concern includes binge drinking, driving when drunk or with peers, smoking, drug taking, risky sexual behaviour, disordered eating, law breaking. Unhealthy risk taking (called health-risk behaviour) contributes to accidental injuries, drug overdose and dependence, mental health disorders, unplanned teenage pregnancy, sexually transmitted infections (STIs) and other adverse social, emotional and physical health outcomes in adolescence and adulthood.

Early life and childhood factors that might influence risk taking behaviour in adolescence are not known. The RAINE Study is uniquely placed to observe the transition from adolescence into adulthood and associated health -risk behaviour. These unique data indicating early predictors of risky behaviour in adolescence and young adulthood may help determine how and at what ages interventions may be effective.

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