Breaking the Silence: Women's reproductive health by Annabelle Black

22 January 2021

Women have been let down by the healthcare system for too long. It is time to put an end to centuries of women’s reproductive health being under-funded, poorly researched and wholly dismissed. The saying ‘made by men for men’ rings a little too true in the UKs healthcare system, as thousands of women across the country are persistently misdiagnosed, falsely prescribed or blatantly treated as hysterical when they go to their doctors with reproductive and gynaecological health concerns. There is five times more research into erectile dysfunction, which affects 19% of men, than into premenstrual syndrome, which affects 90% of women. [1]


This parliamentary petition calls for more funding for research into endometriosis and PCOS which affect over 10% of women. At the time of writing the petition has had over 100,000 signatures meaning that Parliament will consider it for debate. The more people who sign it before the decision is made the more we can demonstrate just how many people want to see a change. If a debate is agreed this is only the first step, we must then encourage our MPs to support the motion.


40% of women with Endometriosis needed at least 10 GP appointments before being referred to a specialist and the average time taken for a full diagnosis is 7.5 years in the UK. Some women even reported that they were not treated with respect, nor were their complaints about extreme pain taken seriously, instead they were dismissed as ‘hysterical.’ To make matters worse, upon finally getting a diagnosis, a lot of women were not fully informed about their treatment; only 37.7% said they were told about long term side effects of treatment options. [2]


Speaking up about this issue is vital, because every day countless women are struggling whilst doctors ignore their worries. Maddy, now a 22 year old, shares her experience of navigating her way through the healthcare system and desperately trying to get doctors to give her the attention she knew she needed. After living with what she believed was ‘bad PMS’ for 6 years, experiencing “extreme depression, low mood, anxiety, cravings, headaches, bloating and exhaustion” she realised that being unable to do anything for four days every four weeks couldn’t be normal. The GP put her on SSRIs, which are used to treat depression, but her symptoms didn’t get any better, and she experienced adverse side effects. She said, “daily life became difficult as a result.”


Turmoil followed as she had numerous GP appointments, but no one took her symptoms seriously. “I would turn up sobbing. I was sometimes snapped at, told it was ‘just PMS, or recommended other SSRIs or contraceptive pills, which had only worsened my symptoms to the extreme in the past. No one was listening to me.” Her undiagnosed illness was making every day tasks impossible and intervening in important affairs. Maddy recalled that she “turned up to [her] final year university exam unable to think, stay awake or even focus.” She tells me with rightful resentment that, “no mitigation was given because the health condition was not officially recognised by the university.”


After deciding life couldn’t go on like this, from months of being dismissed, belittled and falsely prescribed medication, she did her own research into her symptoms. The term Premenstrual Dysphoric Disorder (PMDD) stood out to her as she identified with the daily struggles of women sharing their experiences. PMDD is a range of symptoms with varying severity that affect women a week or so before their period. Mind is a charity dedicated to those struggling with their mental health and offers insight into how those with PMDD are affected. One person on their website thinks, "The best way for me to describe it is that – once a month – I decided to press my own 'self-destruct' button and literally let my life (my normally very happy and satisfying life...) implode around me. Then when the dark thoughts lifted and completely cleared, I spent the next 2 weeks trying to pick up the pieces." Another recalls that, “It's exhausting to know that once it passes you have to brace yourself for it all to happen all over again in a couple of weeks' time.” 1-10% of women meet the strict DSM-V criteria for a PMDD diagnosis, but it can only be assumed it is more prevalent because many women don’t come forward. [3]


With a glimmer of hope after years of not knowing what she was suffering from she went back to the GP to talk to them about PMDD and her continuing symptoms. They shut her down. Telling her it was just ‘bad PMS’ and that she should try to calm down. However it seemed she had been kicked down one too many times and was simply not willing to accept life with this debilitating and silenced illness. With a firmer hand she went back and got referred to a specialist. Relief. After a year of telling GPs it was more than PMS; she had a referral. The UK’s healthcare system continues to ignore women for years, and lacks a dimensional understanding of hormone problems and newer terms like PMDD. If we taught girls early on what normal and abnormal menstruation is like, it may not have taken Maddy six years to realise something wasn’t right. She had been truly defeated by all the medical professionals she had yet spoken to, and eventually went to a private clinic, a privilege only some have the means to access. It took 16 months, countless unsuccessful GP appointments and a dent in the bank account, “to feel listened to for the first time in seeking medical help”. Maddy is now getting treatment she sees fit, but nothing will make up for the time she lost at GP appointments, unable to get out of bed or with missed university deadlines.


So where do we go from here?


It is well established that our current treatment of women's reproductive health in the UK is fallacious. There are knowledge gaps which are filled with artificial hormones and contraceptives that often have significant adverse side effects on women's mental health. Increasing funding into women's reproductive health is vital to closing these. Yet the Government has delayed two initiatives until later this year that would help to close this knowledge gap - the Women’s Reproductive Health Action Plan and the introduction of new Relationships and Sex Education requirements. The Government must commit to these being implemented this year.


The All-Party Parliamentary Group on Women's Health has also identified three interlinked steps that could, and should, be taken immediately.

1. Better health pathways for women experiencing reproductive health problems. This would speed up diagnostics and ensure that all possible treatments are fully explained to women, particularly the potential side effects of each treatment option.

2. More and improved information for women on their reproductive and sexual health throughout their lifetime.

3. Better sex education around menstruation and reproductive health in secondary school. [4]


Sources;

[1] https://www.researchgate.net/blog/post/why-do-we-still-not-know-what-causes-pms

[2] http://www.appgwomenshealth.org/inquiry2017

[3] https://cks.nice.org.uk/topics/premenstrual-syndrome/background-information/prevalence/

[4] http://www.appgwomenshealth.org/inquiry2017