Women experiencing painful reproductive health conditions such as endometriosis, adenomyosis and heavy menstrual bleeding are frequently finding their symptoms ‘normalised’ and their ‘pain dismissed’ when seeking help, a new report by the Women and Equalities Committee (WEC) has warned.
WEC’s report focused on women’s reproductive health conditions and found that despite such conditions being highly prevalent in the UK, accessing diagnosis and treatment can take years, leaving women and girls to “suck it up” and endure pain and discomfort that interferes with every aspect of their daily lives, including their education, careers, relationships and fertility, while their conditions worsen. Many are resorting to expensive private healthcare, it added.
Pervasive stigma associated with gynaecological and urogynaecological health, a lack of education and ‘medical misogyny’ has contributed to poor awareness of these conditions, the report concluded. This is mirrored, it added, in a lack of medical research, treatment options, specialists, and the de-prioritisation of gynaecological care as evident by waiting lists, which have grown faster than any other specialty in recent years.
The report cited a “clear lack of awareness and understanding of women's reproductive health conditions among primary healthcare practitioners”, particularly when those conditions occur in young women and girls. It called on the NHS to “urgently implement a training programme to improve the experience” of accessing treatment and diagnosis for women and girls with reproductive ill health. Improving early diagnosis, including through the provision of follow up appointments, must be a priority to prevent a deterioration of symptoms.
Improvements in diagnosis times should be made a key performance indicator for the Women's Health Strategy for England, it said, adding that progress since the strategy was published in 2022 has been too slow, lacking an implementation plan and resource. Healthcare practitioners, who are currently under significant pressure, “lack sufficient understanding of the range and suitability of treatment options available” to treat reproductive health conditions, the report found, as it recommended the NHS must take steps to ensure practitioners keep up to date with the full range of diagnostic and treatment options available for reproductive health conditions, and that patients understand their options.
On training, the report called on the Department of Health and Social Care (DHSC) to set out plans to improve the accessibility and take up of professional development in women's reproductive health conditions among practitioners in primary care, adding those plans should include increased funding for training on reproductive health conditions and protected time for GPs to undertake that training. The Government should also consider how to better incentivise healthcare professionals to specialise in women's reproductive health, including making obstetrics and gynaecology a mandatory rotation in training.
MPs on the cross-party committee chaired by Labour MP Sarah Owen raised concerns that the teaching of the menstrual health element of relationships, sex and health education (RSHE) is “insufficient and inconsistent”, often delivered too late to be of use. It found that girls are leaving school not knowing what constitutes a ‘normal’ period, unequipped to spot the symptoms of reproductive health conditions. The report called on the Government to ensure teachers tasked with the menstrual and gynaecological health element of RSHE receive the training necessary to deliver it effectively and that information should be taught around the time most girls first experience menstruation. Statutory guidance, it added, should specify that boys be taught about female reproductive health conditions and include intersectional differences.
Many women and girls, the report cautioned, are using online spaces to seek help. It is therefore imperative, the report concluded, that the NHS and trusted sources become a first port-of-call to prevent misinformation and that the NHS website, app and social media presence must be comprehensive, accessible, inclusive, and highly-visible.
The report cited the severe pain experienced by some women undergoing routine healthcare procedures such as hysteroscopy, IUD fitting and cervical screening. It called on the NHS to do more to monitor and enforce protocols governing such procedures and ensure they are underpinned by informed consent, are trauma-informed and take account of a patient’s medical history and related experience. The NHS, it added, should collect data on whether guidelines for potentially painful gynaecological procedures are being adhered to, including patients’ experiences.
The expansion of the women's health hub model has the potential to be a positive step towards providing the joined-up care and commissioning needed to effectively support women experiencing reproductive health conditions, the report said, adding the Government must now allocate long-term, ring-fenced funding and resource to embed and develop the hub model, including increased provision of ultrasound facilities that can aid diagnosis. In calling for more funding the Committee notes studies which have shown that increases in funding for gynaecology provide a significant return on investment.
On research, WEC recommended the Government should allocate a greater share of research funding to support research into the causes, diagnosis and treatment of women's reproductive health conditions. While increased funding will in itself attract more researchers to this area, NHS England and research bodies should also consider what steps they can take to increase interest among clinical academia, it added. The report recommended the Government commits to reducing waiting times for an endometriosis diagnosis to less than two years by the end of this Parliament and to improved understanding and treatment of heavy menstrual bleeding over the same period.
Chair of the Women and Equalities Committee and Labour MP Sarah Owen said: “Our inquiry has shown misogyny in medicine is leaving women in pain and their conditions undiagnosed. 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
“Up to one in three women live with heavy menstrual bleeding, one in ten have a condition such as endometriosis or adenomyosis. It cannot be right that despite the prevalence of these conditions, that such a lack of understanding and awareness persists.
“WEC heard compelling testimonies during the inquiry from high profile women including Naga Munchetty and Vicky Pattison about their experiences over years in seeking effective help. This issue is impacting so many women across the country from their teens through to their retirement.
“This report must act as a wake-up call and the NHS must urgently implement a training programme to improve the experience of treatment and diagnosis of reproductive health conditions.
“Improving early diagnosis, including follow-up appointments, should be a key performance indicator for the Women’s Health Strategy for England. Individuals with a suspected or diagnosed reproductive health condition should be offered specialist mental health support.
“The Committee calls on the Government to recognise the financial benefits of increased investment in early diagnosis and treatment of women's reproductive health conditions and provide the additional funding necessary to truly transform the support available to the millions of women affected by reproductive ill health in this country.”
