We need to transform women’s healthcare to tackle “medical misogyny”

A new report by the House of Commons Women and Equalities Committee highlights the scandalous “medical misogyny” that has been affecting women in the UK for far too long.1 The report highlights an urgent need for education and training of healthcare professionals to speed up diagnosis and treatment of reproductive health conditions which are devastating the lives of many women. Another recent report by the NHS Confederation, in partnership with the charity Create Health Foundation, tackles the unique health challenges faced by women and the effect this has on the UK economy.2 It describes how a lack of investment in conditions such as endometriosis and menopause costs the UK economy billions each year due to absenteeism from work, and presenteeism, which is characterised by lower levels of productivity. The report shows that, for every additional £1 of public investment in obstetrics and gynaecology services per woman in England, there is an estimated return on investment of £11.2 The report also found that areas with higher ethnic diversity have poorer access to women’s health services, and areas with higher levels of deprivation have worse outcomes.

There is an issue in the current attitude of healthcare professionals to common health problems experienced by women. A survey showed that almost one in 10 women have to see their GP more than 10 times before they get proper help and advice for menopausal problems.3 A lack of proper initial investigation is costly for women and also the economy. For example, the NHS Confederation report calculates that women experiencing heavy menstrual periods cost the exchequer £4.7 billion a year in absenteeism and £418 million a year in presenteeism.2

The personal toll that heavy periods have on women’s quality of life can also be considerable and significantly affect women’s health and wellbeing.4 Sadly it is not always treated in primary care with the seriousness it deserves. Failure to make an early diagnosis leads to prolonged suffering for the woman and ultimately could lead to more expensive treatment such as endometrial ablation or even hysterectomy. The economic and wellbeing costs associated with these treatments can be substantial, especially if, as so often occurs, there is a delay in diagnosis.

To tackle these unique health challenges faced by women, the previous government announced that it would spend £25m over two years to set up women’s health hubs in England to provide intermediate care, “where services are more advanced than typically seen in primary care, but are for health issues which do not necessarily need a referral to secondary care.”56 The plan was to establish and develop at least one women’s health hub in every integrated care board by the end of December 2024.67

However, we are yet to see tangible results. Firstly, this sum of money is derisory if it is supposed to provide improved care for conditions ranging from menstrual and menopausal problems, pelvic pain, endometriosis, contraception services, cervical cancer screening, screening for sexually transmitted diseases and HIV, breast pain assessment, and preconception care, all leading to “improved health outcomes and reduced health inequalities.”6 Extending the indications for referral to these hubs will make them lose focus and be less efficient, and there is no need to duplicate services already adequately provided by family planning clinics and sexual health clinics. Women’s health hubs should focus on conditions that require more time to unpick than is afforded by a 10 minute visit to a general practitioner. Women with heavy or painful periods or pelvic pain require an early diagnosis and referral for treatment.

From reading the core strategic specification for women’s health hubs,7 one cannot escape the conclusion that this initiative is unlikely to deliver what is required by women. The plan states: “Hubs do not have to be a building or specific place; they may employ digital resources to provide virtual triage or consultations, or alternatively they may make use of existing facilities, for example GP surgeries or community centres.”7 Women with menstrual problems or pelvic pain, menopausal symptoms, urinary incontinence, and prolapse need a consultation with a professional experienced in women’s healthcare in a dedicated physical space with access or referral to an ultrasound scan and a blood test to give them a diagnosis before commencing treatment or being referred for secondary consultant care.

However, the concept of women’s health hubs is an excellent one and has been embraced by the Royal College of General Practitioners.8 The new government should invest strongly in women’s health, and these hubs may be part of that. These hubs should be placed strategically to provide services throughout the country, taking into account local needs, especially in deprived and ethnic minority communities. They should be served by experienced staff and have an ultrasound machine with skilled staff to use it. The report by the NHS Confederation clearly demonstrates that a lack of investment in women’s health is costing the UK economy billions of pounds per annum, as well as impacting heavily on women’s quality of life.

Tackling this problem adequately and closing the “gender health gap” requires serious investment to be beneficial, but it will be cost effective in the long term.