Marginalisation of women within the healthcare system - how female health issues are overlooked, misdiagnosed and stigmatised

I would like to begin by asking you to envision yourself in this woman’s situation.

You wake up in agony - as if a shard of glass is twisting, digging into your abdomen, relentlessly stabbing you without cease. You double over in agony, curled in the foetal position praying for the pain to end. But it doesn’t. Waves of agonising torture cuts through you like a knife, and your breath grows shallower and shallower and shallower. Amidst the surges of pain, desperate, you succumb and call your GP for a same-day appointment, yearning for any form of respite from this hell. You count down the harrowing hours to your appointment. Finally, you sit down with your GP. You explain what’s happened. You await a response – an answer to everything. This is what you hear.

“It’s just a heavy period. Nothing to worry about.”

The narrative I just painted is not a work of fiction; rather, it mirrors the stark reality faced by millions of women globally. The common dismissal of severe menstrual pain as "normal" or "just part of being a woman" contributes to a prevailing culture of neglect surrounding women's health concerns.

Such a simple answer to this indescribable pain seems almost absurd, right? Because it is. The assertion that that the pain experienced by the patient is merely akin to “normal period cramps” is dangerously inaccurate. Such responses stand as a testament to the critical need for a more nuanced and empathetic understanding of women’s pain by healthcare professionals.

Female health conditions such as endometriosis, which cause pain often far worse than what was earlier described, have an average diagnosis time of 7 and a half years. That is 7 and a half years of unrelenting agony. Shockingly, 75.2% of all endometriosis patients report being misdiagnosed with another physical or mental health condition.

Imagine that. Imagine knowing there is something wrong with your body but not being able to fix it. Worse, imagine - instead of being heard and understood by your doctor - you are simply passed off as having anxiety or depression, because you are overexaggerating your pain. Endometriosis affects 1 in 10 women. That is 190 million people suffering. And that is just endometriosis alone. There is a plethora of female health issues such as PCOS, dysmenorrhea, amenorrhea, adenomyosis and so many more that affects millions and millions of women. Yet, how come so many of these women are left unheard, left untreated, and left to suffer in silence?

Let’s look at the history. It is without a doubt that this flawed perception of female health has stemmed from a history of blatant sexism. Gender-biased diagnosing traces back to around 4,000 years ago when women were disproportionately diagnosed with hysteria. Hysteria, derived from the Greek term "hystera" meaning “uterus," initially described excessive emotions. Ancient Greek beliefs on hysteria, and its attribution to female anatomy, have left a lasting imprint on modern perceptions of female health.

We are in the 21st century, yet, remnants of these archaic views linger in societal attitudes and influence medical perspectives. There is still a stigma associated with female health issues due to the historical association of women with madness. This has led to a lack of a comprehensive understanding of female health, impacting the diagnosis, treatment, and discourse surrounding women's wellbeing in contemporary society. Women are not seen to be in genuine pain. They are seen to be hysterical.

Many may argue that I am being hyperbolic. We are told by the media that we have “reached the peak of healthcare”, and we that should be celebrating this. But allow me to remind you - until 1993, clinical research and trials excluded women. This has evidently left a female-shaped blind spot in medicine. We, as a society, need to work on creating more support tailored to women's unique physiological and biological characteristics. Ineffective patient-doctor communication is a key determinant in the marginalisation of female health issues. In a survey from April 2022, 4 in 5 women expressed how there have been times where they have not been listened to by healthcare professionals. Thousands of examples were submitted. Many women stated that their symptoms were dismissed upon first contact with their GP, forcing them to advocate for themselves persistently in order to secure a diagnosis which took them months to years of fighting. Even if a diagnosis was secured, opportunities to ask questions or have their personal preferences heard were rare.

Not only is this incredibly dehumanising and tribulating, but it is a legal and ethical breach.

The medical ethics principle of non-maleficence is the obligation of a physician to do no harm to their patient. The constant dismissal of women’s pain violates this principle, and nothing is being done to prevent this. There is one main resounding solution to all of this: just by believing. Believing that a woman is in pain, believing that what is happening is not normal, believing that whatever it is should not be left untreated. Just by believing women we can create such a world of difference for female patients because it will allow for quality care and trust between patient and physician.

As we reflect on the journey from the clinical trial exclusion of women to the current challenges in patient-doctor communication, it becomes clear that changes are imperative. Advocacy, education, and reform are vital components of a collective effort to destroy stigmas and taboos. It is our shared responsibility to create an environment where the unique health needs of women are acknowledged, researched, and addressed with the seriousness that they deserve.