Advances in Women's Health

A decade ago, Mary L. Rosser, MD, PhD, an obstetrician gynecologist in the Department of Obstetrics and Gynecology at NewYork-Presbyterian/Columbia University Irving Medical Center, conducted a study that showed that many women view their OB/Gyn physician as their primary care doctor. “We have a very close relationship with our patients and so we have a unique opportunity to talk to them about their health as they age. With this in mind, in 2018 we established the Integrated Women’s Health program to provide routine gynecology care and to further develop a comprehensive well-woman program,” says Dr. Rosser, who is Director of Integrated Women’s Health and the Richard U. and Ellen J. Levine Assistant Professor of Women’s Health (in Obstetrics and Gynecology) at Columbia.

Dr. Mary Rosser

Dr. Rosser’s team includes obstetrician gynecologists Hoosna Haque, MD, and Paula A. Randolph, MD, and Lauren Golfer, WHNP, a board-certified women’s health nurse practitioner, who develop a personalized healthcare plan based on each woman’s individual needs, lifestyle, and genetic profile. “We work with patients to treat the whole woman, recognizing that there is no one-size-fits-all approach to any patient’s care,” says Dr. Rosser.

The Integrated Women’s Health program includes:

• Communication and coordination of care with healthcare providers throughout NewYork-Presbyterian/Columbia
• Screening and strategies for managing and reducing future healthcare risk factors, including pregnancy complications, cardiac disease, cancer, and mental health issues
• An emphasis on healthful and active lifestyles, proper nutrition with referrals to nutrition experts, managing weight, stress reduction, exercise, and minimizing unhealthy habits

Transitions to Better Health

A practicing obstetrician gynecologist for more than 20 years, Dr. Rosser is also a North American Menopause Society Certified Menopause Practitioner, as are all the members of her team. Primary care is an area of particular interest for Dr. Rosser, who educates and encourages women to take an active role in their own health care, partnering with their care provider. “While we emphasize the whole woman throughout her life course, we have also narrowed our focus to two major transitions in her life where we believe we can make an impact – the postpartum period and menopause.”

“Women are busy and trying to put one foot in front of the other. And so if they do come in for that first postpartum follow-up, oftentimes it’s just a quick visit. However, a pregnancy with complications that might include diabetes, fetal growth restriction, preterm delivery, or preeclampsia or hypertensive disorders of pregnancy all need to be addressed during the postpartum period,” says Dr. Rosser. “We know these conditions can lead to long-term health issues. If we can make an impact at the time where women have been nurturing their pregnancy with a nutritious diet and help them to continue on a healthful road, it will greatly benefit them in the future. It’s a good time to make healthy changes in one’s life. And there are also positive effects for the whole family, because mom dictates what her family eats, where they go for care, and so on.”

Individuals with pregnancy-related Medicaid coverage have typically lost their benefits 60 days after the end of pregnancy. However, with the efforts of the American College of Obstetricians and Gynecologists (ACOG) and other advocates for women’s health, the American Rescue Plan Act now makes available an additional pathway, effective April 1, 2022, that allows states to extend Medicaid coverage from 60 days to one year postpartum. “Some 30 percent of issues that lead to major problems with women occur in that postpartum period,” says Dr. Rosser. “They can happen in the first two weeks, then the first six weeks, but can last up to a year. That’s why Medicaid expansion for coverage is very important. We need to have the time to explain and monitor these diseases, making sure that women understand what kind of complications they had during pregnancy so that they can intervene with mostly lifestyle interventions.”

Menopause is another time of transition where women can reset and focus on themselves and make changes to live a more healthful life moving forward, notes Dr. Rosser. “Up until that point women have been taking care of children, aging parents, their careers, and so many things collide at the same time that perimenopause and menopause occur. Again, it’s a good time for women to step back and take stock of what’s going on in their lives and what they can do to optimize their health.”

“Our goal is to ensure every woman gets the care she needs and is encouraged to take an active role in her own health and well-being. Our patient-centered approach involves coordination with specialists from across NewYork-Presbyterian/Columbia to optimize health outcomes throughout the course of a woman’s life.” — Dr. Mary Rosser

A Focus on the Whole Woman

Heart disease is another area of interest for Dr. Rosser, who served as Chair of the Women and Heart Disease Physician Education Initiative for District II of ACOG and is a member of the Medical Leadership Team of the Go Red for Women movement of the American Heart Association. She is also ACOG’s liaison to the American College of Cardiology.

“Heart disease is the number one killer of women, more than any of the cancers combined,” says Dr. Rosser. “It’s not just an older person’s disease or a man’s disease. We know that women can experience heart issues differently than men and the symptoms may be different. We also know that women’s symptoms are more often dismissed. And so that’s where we are trying to educate and empower women to know those symptoms before they occur.”

Dr. Rosser and her team have incorporated women’s mental health screening into their program, referring a number of women with depression and anxiety to specialists within NewYork-Presbyterian/Columbia. “In the last year, three women were flagged for having suicidal ideation and were immediately referred for further evaluation or hospitalization,” she says.

Dr. Rosser and her colleagues recently completed a pilot study that incorporates embedding questions on genetics into a patient’s electronic medical record. “For example, if a woman has Ashkenazi Jewish family history and has a mother who had breast cancer at 35 and a maternal grandmother who had breast cancer at 40, we can refer her to Dr. June Hou, a gynecologic oncologist who oversees Columbia’s hereditary breast and ovarian cancer screening program in our department. We also plan to expand screening to include other areas, such as cardiovascular genetics.”

“Our goal is to ensure every woman gets the care she needs and is encouraged to take an active role in her own health and well-being,” adds Dr. Rosser. “Our patient-centered approach involves coordination with specialists from across NewYork-Presbyterian/Columbia to optimize health outcomes throughout the course of a woman’s life.”