International Women’s Day of Health 2021
Today is International Women’s Health Day and women's health is making its way onto the political agenda as more evidence emerges to demonstrate the inequalities that women face in healthcare. The data shows that whilst women in the UK have a longer life expectancy than men, they spend less of their lives in good health. There are many theories as to why this happens and there are studies that suggest there are gender biases in clinical trials which contribute to the inequality, but it is also accepted that there is less known about female specific conditions. Sadly, there are many stories which highlight the struggle for equal care - from 8th March 2021, the Women's Health Strategy is going to spend 12 weeks talking to female patients. the findings will then be published for discussion in Parliament.
Women and Pain
Firstly let’s talk about pain and women! Why? Because many studies show that there is an inequality in how women are treated for pain, despite women suffering with almost all chronic pain conditions to a much greater extent than men.
Our network members reached out with their stories:
“I once spoke to a training Reg who said to me, 'women [patients] cry all the time but it's no big deal, but when a man cries its pain'. This statement felt quite invalidating, and I wonder what we can do - without attacking or pushing people into a corner - to help people realise that pain is pain regardless of gender/race/medical history/age/sexuality etc.” (Anonymous Women’s and BAME network member)
“I had unresolved severe pelvic pain that was being investigated. I was at one point hospitalised for the pain and was pregnancy tested multiple times across the 5 days I was an in-patient despite the fact I knew and stated numerous times there was no way I was pregnant. When I asked one of the nurses administering one of these tests about it, I was told this was likely because young women often lie about their sexual activity – this really upset me and I felt judged. In an examination with a Consultant I was also told that others would not have rated their pain as highly as I did for the same issue. This comment made me feel like I was being labelled a liar and ‘wasting NHS time’ despite the fact that I knew something was wrong with my body. I was later diagnosed with an issue that got missed because it is not usually seen in my age group – I genuinely feel like had this been a male of the same age it would have been picked up sooner... Whilst I knew both the pregnancy test comment and comment about my pain were wrong and made out of sexism, I was too afraid (and unwell) to speak up as I worried it would prevent me from getting the proper treatment I knew I needed. I was 20 years old at the time and this was my first real interaction with healthcare as an adult and the first time I had required hospital treatment in my lifetime. I was unsure what the process was for making complaints and don’t think I would have had the confidence to do so at the time (if I am honest I don’t know how confident I would be now 6 years later). I would like to stress that I eventually had some amazing care but it was a struggle to get to a point where someone firstly, made me feel listened to, and secondly for that person to be in a senior enough position to do anything about it.” (Anonymous women’s network member)
The UHP staff survey shows a slight increase in well men are feeling from a wellbeing perspective and a decrease in women’s mental health across the trust, reflecting what many of the national studies are showing. The reasons are multifactorial but are thought to be attributed to gender imbalance in household duties, including childcare during lockdown and trying to balance this with full time work. Research shows that more women have lost their jobs compared to men during the initial lockdowns, and they are also finding it harder to stay positive – not forgetting the rise in domestic violence against women during COVID times, which I spoke about in my last blog.
“The statistics still stand that men are more likely to die from suicide whereas women are more likely to attempt - these stats are grim, and I do not seek to invalidate the death rates for either gender. I have noticed over the past 10 years that there has been a lot of emphasis of helping men to become more open and reduce the stigma around psychological health which is so needed and life changing. Not much investigating has been done into why women are more likely to attempt and why, if they are more likely to attempt, are they viewed through an attention-seeking looking-glass?”
If you need any help and support, please visit the UHP staff Support Hub here or the Devon Wellbeing Hub who are available to help with any issues you may be facing.
Many women fight for years (the average wait is 8 years) to get a diagnosis of Endometriosis and even after the diagnosis they are let down by the level of care available, even though 1 in 10 women suffer from this debilitating illness.
"I failed most of my GCSEs because I was in bed, in crippling pain. I've lost nearly every job I've ever had because of my poor attendance...GPs ask me to explain to them what endometriosis is, because they don't know. They're the ones who are meant to help." There are also women in their early 20's told to get pregnant to treat endometriosis.
“Women are often, and especially in the workplace, viewed as 'irrational' or 'hormonal.' We are largely (biologically) ruled by our Infraradian cycle, which is why at particular times of the month, we are more social, focused, have higher energy levels and other times we are more thoughtful and pensive, at times vulnerable to hormonal imbalances that can affect our immune system and emotional regulation. In the same boat - men also have their own hormonal cycles of change that affect all of the above-mentioned things in different ways. How do we change the culture to help people understand that everyone has good days and bad days and if a woman doesn't understand something as quickly, she is not irrational however could benefit from more guidance/training?” (Women’s and BAME Network member).
Pre-Mentrual Dysphoric Dysfunction (PMDD)
Premenstrual Dysphoric Disorder (PMDD) is a cyclical, hormone-based mood disorder with symptoms arising during the premenstrual, or luteal phase of the menstrual cycle and subsiding within a few days of menstruation. It affects an estimated 5.5% of women and AFAB individuals of reproductive age. While PMDD is directly connected to the menstrual cycle, it is not a hormone imbalance. PMDD is a severe negative reaction in the brain to the natural rise and fall of oestrogen and progesterone. It is a suspected cellular disorder in the brain. Symptoms can worsen over time and or around reproductive events such as menarche (the first menstrual cycle), pregnancy, birth, miscarriage, and perimenopause (International Association for Premenstrual Disorders).
“My periods are a curse; I have to organise my life around them. I know that for half the month I am going to be hyper anxious, paranoid and depressed and to me this is much much worse than the physical side effects. I get brain fog, sweats, hot flushes and second guess every decision or interaction I make. One to two days before my period I can feel suicidal, just so the anxiety and paranoia will end! Once I get my period I’m back to my normal happy functioning self although spend the next few weeks dreading the onslaught of it all again, it’s not a life. There is very little understanding of this by GPs or even specialists – I have felt belittled and invalidated in my experiences. The stigma on it also means that other women, those who don’t get any form of PMS, believe I am exaggerating or making it up – “have I tried a different diet, exercise or talking therapies” (CBT is also a recommended treatment for this condition). For clarity I tried all the above – I was, at one point, running up to seven miles a day just to take the edge off the anxiety. My only option now after trying various treatments, is a hysterectomy, which is not without its own risks and issues. My wish is that awareness and funding for research around this increases and at some point we have a cure.” (Anonymous Women’s Network Member)
For Support: International Association for Premenstrual Disorders
Hyperemesis Gravidarum (HG) is a condition at the extreme end of the pregnancy sickness spectrum. It affects 1% of women with pregnancy sickness and is very debilitating for sufferers. The range of knowledge within healthcare and society is variable across the country. Women who suffer with HG experience, loss of earnings or employment, changes to family plans, sense of dying, suicidal ideation or termination, depression, anxiety, guilt and loss of self, Inability to care for self and others, social isolation. The charity Pregnancy Sickness Support receives thousands of calls a year from suffering women, supporting women who are being ignored and abandoned, Caitlin Dean, Chair of PSS says that ‘whilst there has been improvement in recent years there is still far to go, women are still being devalidated for what is a very serious medical condition’.
Michelle Owen, Sky Sports Presenter and Pregnancy Sickness Support Charity Ambassador suffered from severe HG and explains ‘the battle aside from the horrendous sickness and constant nausea was the ignorance of medical professionals offering me ginger not offering treatment or rehydration. On reflection it was truly shocking. Our NHS is wonderful, but something needs to be done to help women. One nurse told me a story of a lady who at 20 weeks couldn’t even lift her head off the pillow and had a termination. That same nurse ignored me when I said people eating food in the bed next to me was making me sick.’
For Support: Pregnancy Sickness Support
Perimenopause is the stage from the beginning of menopausal changes to the post menopause, the time following the last period. Post menopause is usually defined as more than 12 months with no periods.
From age 40 years onwards, there is a rapid decline in the number of egg cells within the ovaries. During the perimenopause, the ovaries are still working and producing hormones but are not producing the correct balance of hormones. In the early stages, the levels of oestrogen and progesterone fluctuate markedly and symptoms and period patterns may change from month to month. The fluctuating and gradually falling level of oestrogen taking place during the perimenopause, can lead to early signs of the symptoms more often associated with the menopause such as hot flushes, night sweats, mood changes, disturbed sleep, joint aches and change in weight and distribution of fat? more fat tends to be deposited around the waist rather than the hips leading to a change to the "apple" shape rather than "pear" shape. Symptoms affecting the vagina and bladder such as vaginal dryness, irritation and itch, discomfort during sex, passing urine often and at night and discomfort when passing urine, are thought to be later symptoms of the menopause, but some women may notice them in the perimenopause
Management of the oestrogen deficiency symptoms of the perimenopause should start with review of diet and lifestyle? the early changes should alert us to put in place whatever changes are needed, such as improving diet, losing weight, increasing exercise, stopping smoking, reducing alcohol and caffeine, to reduce not only early symptoms but also long-term effects of oestrogen deficiency such as osteoporosis and cardiovascular disease. Specific treatments such as Hormone Replacement Therapy should be considered and would aim to "top up" the declining oestrogen levels, while providing progestogen for protection of the womb lining.
Seek help from your doctor and don’t suffer in silence.
‘It’s so odd that when you go to request a scan for a female patient and you answered that you know that the woman is not pregnant by clarifying that they’ve gone through “the change (menopause)”. What do they think we’ve changed into, reptiles? I’d like to see this terminology changed’ (Anonymous – junior doctor).
Other sources of help and support are:
- Pausitivity Know Your Menopause which is good for bite sized informative and helpful YouTube videos on the menopause
- The Vivup Wellbeing Platform, who provide our Employee Assistance Programme (EAP), which has a menopause section on it. Visit: Vivup.co.uk. For the EAP, call 03303 800658 for free confidential help and support available any time, 24/7, 365 days a year.
- Health Passport (attached), a living document to enable a conversation with your manager about your wellbeing, any support you may need including reasonable adjustments to help you carry out your role which can then be taken with you as you move between teams or departments throughout your NHS career.
Anyone can develop Fibromyalgia, although it affects around 7 times as many women as me. The condition typically develops between the ages of 30 – 50 but can occur in people of any age. Some estimates suggest 1 in 20 people may be affected to some degree; however it is not clear as it can be difficult to diagnose.
Symptoms vary from individuals including Chronic Pain, extreme tiredness, muscle cramps and stiffness, sleeping issues, Brain-Fog, headaches, IBS and many more.
“I was diagnosed in 2016 after 18 months of tests, involving the worst period of sickness from work along with the stress of the beginnings of going through the sickness process with now clear diagnosis to what was wrong with me. I ended up leaving my job, applying for PIP and having to appeal all the way to Court! This was an extremely stressful time and I spent a large part of my life in bed or on crutches, being scared as I didn’t know what was happening to my body. Once I received my PIP, got a place on a Pain Management Course and found understanding of my condition I finally got back to work. I have to manage my condition closely, but I can start living again albeit very differently than before.”
Fibromyalgia Action UK is a charity the offers information and support to people with Fibromyalgia. It is also currently Fibromyalgia Awareness Month, contact our Staff Network DAWN plh-tr.DAWN@nhs.net who can help with information and support.