Women are enduring years of pain due to a lack of awareness surrounding reproductive conditions, which means their symptoms are often “normalised”, according to a new report.
These conditions, such as endometriosis, heavy periods and adenomyosis, are often dismissed due to “medical misogyny” and a lack of education surrounding them, says the Women and Equalities Committee of MPs, which found it can take years for women to receive a diagnosis and the correct care for gynaecological conditions.
As a result, women are left to endure pain and discomfort that “interferes with every aspect of their daily lives” while their conditions worsen, the committee’s latest report says. And it singled out GP surgeries, highlighting a “clear lack of awareness and understanding of women’s reproductive health conditions.”
Committee chairwoman Sarah Owen said up to one in three women live with heavy menstrual bleeding, and one in 10 have conditions such as endometriosis or adenomyosis.
“Our inquiry has shown misogyny in medicine is leaving women in pain and their conditions undiagnosed,” she said. “Women are finding their symptoms dismissed, are waiting years for life-changing treatment and in too many cases are being put through trauma-inducing procedures. All the while, their conditions worsen and become more complicated to treat.”
Miss Shazia Malik, a consultant obstetrician and gynaecologist at The Portland Hospital (part of HCA UK), agrees that it can take many years to diagnose women’s gynaecological problems, but stresses that putting this down to ‘medical misogyny’ is too simple.
“It’s true that women do suffer for many years and are often under-diagnosed or diagnosed very late,” she says, “but I think it’s very simplistic to put it down to medical misogyny or lack of interest from doctors, or lack of concern.
“Historically with endometriosis, for example, there’s plenty of evidence that it takes up to 10 years to diagnose, and part of the reason is that girls and young women are often conditioned to think period pain is normal.
“Unfortunately, girls are not armed with enough knowledge about their periods, or about what’s abnormal and when to seek help.”
But what gynae symptoms are not normal and need medical attention?
1. Heavy prolonged bleeding
Malik says any bleeding that affects your ability to function normally in your day-to-day life is not normal. “Your period should not be ruling your quality of life or your ability to function as a human being,” she says. “That could mean heavy periods that cause flooding in your bed and clothes, or that stops you going to school or work or playing sport because you’re too embarrassed in case you have a leak or you can’t get to the toilet.”
She says bleeding or period pain shouldn’t mean you have to stay in bed or make you so anaemic that you’re constantly exhausted, and she adds: “You shouldn’t have to change your period protection every hour, or wear double protection at night or during the day. That is not normal.”
2. Extreme pain
Pain shouldn’t be so severe that it makes you vomit or take time off school or work. “That is not normal,” stresses Malik. She says if the pain’s relieved with two paracetamol or ibuprofen, that’s okay. “But if you’re having to take multiple painkillers and it’s affecting your day-to-day activities, that’s not normal.
“If you’re getting persistent pelvic pain that isn’t related to either ovulation or just your period, it needs to be investigated.”
3. Painful sex
If you can’t have sex or insert tampons because it’s too painful, it’s not normal, says Malik.
4. Abnormal vaginal discharge
Abnormal vaginal discharge crosses between potentially benign symptoms, like bleeding and pain, and red flag symptoms that are potentially something more serious, says Malik.
“If you’ve got abnormal discharge that has a smell or has changed colour and isn’t normal for your menstrual cycle, or is associated with a temperature, painful sex, abnormal bleeding or pelvic pain, that’s not normal because it could be a sign of an STI, a polyp or cancer,” she says. “If it’s not your normal discharge, it needs to be investigated, particularly if there’s blood in it.”
5. Pain when opening your bowels during your period
One thing that’s been missed for many years is that it shouldn’t be really painful to open your bowels during your period, says Malik, who stresses that could be a sign of endometriosis.
6. Bleeding between periods
Bleeding between periods or after sex isn’t normal, says Malik, as it can be a sign of infection, a polyp, fibroids or cancer, or of an ectopic pregnancy.
7. Bleeding after menopause
Bleeding more than a year after your last period when you become menopausal is, says Malik, “an immediate red flag that needs to be investigated – those symptoms should never be ignored.
8. Persistent bloating and other symptoms
Another symptom that shouldn’t be ignored is persistent abdominal bloating, which may occur with other symptoms. Malik says: “Bleeding after sex or between periods, persistent abdominal bloating, or weight loss, or feeling a lump in your tummy can be a red flag for cancer such as ovarian cancer.
“Abdominal bloating and pain with heavy periods can also be a sign of fibroids.”
9. Persistent itching and lumps
Another red flag, says Malik, is abnormal lumps and bumps around the vagina or vulva, and itching. “If you’ve got an abnormal bump or persistent itching and discomfort associated with a lump, that can be an infection and, very rarely, a sign of vulval cancer.”
Malik adds: “Teaching women about their anatomy, and what’s normal or abnormal about their genital region is really, really important, and we should empower them not to feel ashamed or uncomfortable about symptom health and diagnosis.”
