As the president of the Royal College of Obstetricians and Gynaecologists (RCOG) warns that women’s debilitating health problems are being routinely dismissed as “benign”, ministers are planning to publish the first women’s health strategy for England.
Here we look at four key areas of women’s health, and concerns over diagnosis times, treatment and outcomes.
Endometriosis and other gynaecological conditions
The inclusion of gynaecological conditions such as endometriosis, prolapse and heavy menstrual bleeding in the women’s health strategy has been widely welcomed. The medical profession has been criticised for being slow to diagnose some of these conditions and quick to minimise their health impact.
Endometriosis, a condition where tissue similar to the womb lining grows elsewhere, such as the ovaries and fallopian tubes, can cause severe pain and affect fertility. It is thought to affect about one in 10 women of child-bearing age.
There are treatments, including hormone medication and surgery, but women in the UK are diagnosed an average of eight years after the onset of symptoms, with long waiting times for treatment. “The time to diagnosis is absolutely shocking,” said Prof Anna David, the director of University College London’s Elizabeth Garrett Anderson Institute for Women’s Health.
Menopause and healthy ageing
In her 2020 review of a string of scandals in women’s healthcare, Julia Cumberlege, who chaired the inquiry, concluded there was a tendency for “anything and everything women suffer [to be] perceived as a natural precursor to, part of, or a post-symptomatic phase of, the menopause”.
As the taboo gradually lifts around the menopause, there has been a reappraisal of many of the health problems associated with it and a growing consensus that the NHS needs to deliver better care. This includes healthcare professionals acknowledging the impact of well-known symptoms such as hot flushes, but also recognising issues including mental health, recurrent urinary tract infections, prolapse and musculoskeletal problems linked to changes in hormone levels.
The government has already appointed an HRT tsar to address shortages of the drugs used to treat symptoms this year, linked in part to the doubling in the number of HRT prescriptions during the past five years. This increase in itself is a “good news story”, says Dr Edward Morris, president of RCOG, because it indicates “the right conversations are being had” between women and healthcare professionals.
Morris and others are now calling for broader changes to improve care and education about the menopause, including the establishment of women’s health hubs run by gynaecologists and specialist nurses.
Cardiovascular health
Cardiovascular disease is often perceived as a male illness but experts say this is a fundamental misconception. More women than men have strokes in the UK, more women die from stroke and there are risk factors (although not the primary causes) such as pregnancy, the contraceptive pill and HRT that are specific to women.
While heart attacks are more common in men, there is strong evidence of a gender gap in NHS care. Research by the British Heart Foundation (BHF) suggests women are 50% more likely than men to receive the wrong initial diagnosis for a heart attack, and more than 8,200 women have died needlessly in the past 10 years because they did not receive the same quality of care as men, the BHF estimates.
Experts believe opportunities to offer preventive interventions earlier are being missed. In particular, health during pregnancy is a strong indicator of subsequent risk. Pre-eclampsia, a condition that causes high blood pressure during pregnancy and after labour, is linked to a fourfold increase in future heart failure and twice the risk of coronary heart disease and stroke. Women who have had more than three miscarriages have been shown to be about five times more likely to later have a heart attack.
“Pregnancy is like a stress test that reveals how you’re going to be later in life,” said David. “You can start screening for these conditions and intervene. There’s a need for more joined-up thinking. That would be a really important piece of work to give back control to women.”
Social determinants of health
Women live longer than men. But, unlike men, their life expectancy in the UK’s most deprived areas fell in the past decade for the first time in 100 years. The findings, by a 2020 review of health equity in England, led by Prof Sir Michael Marmot, also found that healthy life expectancy in women in the most deprived areas outside of London declined and there was a greater rate of increase in health inequalities among women between the richest and most deprived areas. “Things have got worse for women over the past decade in the most deprived areas,” said Marmot. “That was deeply shocking and unexpected.”
Factors such as cuts to children’s services, transport and recreation, and increases in the cost of heating and food contributed to the trend, Marmot said: “The regressive way we implemented austerity was damaging to health and wellbeing and particularly to inequalities in health and wellbeing.”
He is among those calling for the women’s health strategy to take the broadest definition, rather than addressing primarily health conditions that exclusively affect women. “I’d like to see a women’s health strategy focus on the social determinants of health,” he said. “Don’t have a strategy that focuses on the tip of the iceberg. It’s not simply a matter of making HRT more readily available … Focus on the whole deal.”
