Health

Feminist health: the gender gap exposed

What you can do to empower yourself
Photography: David Lineton. Hair and make-up: Lindsey Poole

Get this: the simple fluke of being born a woman could affect everything from your chances of getting the correct diagnosis when you’re unwell to how your pain is treated. Dubbed ‘the gender health gap’, this discrepancy between the sexes has been found to show up in the misdiagnosis or dismissal of women’s symptoms, particularly in cardiovascular and gynaecological matters, meaning their concerns can be taken less seriously than men’s. However, the good news is, things are starting to change, as medical experts fight to redress the balance.

But how did the gap come about? First up: the historical reasons. Derived from the Greek word ‘hystera’ (meaning uterus) a little more than 100 years ago, ‘hysteria’ was the go-to diagnosis for any unexplained illness experienced by a woman – and only a woman – with connotations of melodrama, of course. And stereotypes stick. For instance, there’s a belief by some experts that women’s pain isn’t taken as seriously as men’s. Plus, the fact that fewer women work in research and as senior medics may be a factor.

Notably, there’s also been a dearth of women involved in medical trials. In 1977, the US Food and Drug Administration (FDA) excluded any women of ‘childbearing potential’ from taking part. While this was done with safety in mind (researchers were concerned about the potential for drugs to cause birth defects in unborn children), it produced skewed US research and was overturned 17 years later.

Fortunately, more changes have taken effect. In 2017, the UK’s National Institute for Health and Care Excellence (NICE) issued guidelines telling GPs to listen more carefully to their female patients in relation to suspected endometriosis diagnoses.

And doctors themselves are leading the charge. Dr Jane Leonard, a London-based GP, believes it’s key to empower women to ask more questions. ‘Every woman – every person, actually – should feel unashamed about asking their GP for a second or third opinion if they feel it’s needed,’ says Dr Leonard. ‘As doctors, we also need to ensure that we’re asking all the right questions.’

It’s about working with your GP to empower yourself. Read on for how to bridge some of the biggest gender gaps in health today…

Gender gap: HEART ATTACKS
Despite more than 35,000 women being admitted to hospital each year with heart attacks, a 2016 study by the University of Leeds showed they had a 50% higher chance than men of receiving the wrong initial diagnosis.

To further complicate things, in a US study, ‘typical’ symptoms of a heart attack – such as chest pain and shortness of breath – were shown to not always apply to women. In fact, 42% of US men report chest pain with a heart attack, compared with 30.7% of women. And the younger a woman is, the less likely she’ll feel chest pain with a heart attack. That’s possibly why twice the number of British women die in the 30 days after a heart attack, in comparison with men.

Bridge the gap: It’s essential that women understand the potential differences in symptoms so you know when to seek help. Women may experience fatigue, anxiety, light-headedness and sleep disturbances over a period of more than a month, rather than the sudden classic ‘heart attack’ pain, and they often report feeling cardiac pain to the rear of the chest in the upper back, neck, jaw or around the shoulder. Dr Leonard says that if you have any of these symptoms, plus sweating or nausea, don’t delay. Go to your local A&E, where simple tests, including an ECG, can aid diagnosis.And if you find yourself in this situation, don’t be afraid to ask doctors about a troponin blood test (a protein produced when the heart’s in trouble), which improves heart attack detection rates in women.

If you’re aged between 40 and 74, you’re eligible for a free NHS health check in England. It can help you understand your chances of developing cardiovascular disease (CVD) over the next 10 years, and what you can do to reduce risk and help keep your heart healthy. To find out more, go to healthcheck.nhs.uk.

Gender gap: DEMENTIA
Around two-thirds of the 850,000 people living with dementia in the UK are female.

‘Male and female brains are different,’ says Professor Tara Spires-Jones, an expert in Alzheimer’s disease at the University of Edinburgh. ‘While both have around 100 billion nerve cells wired up with more than 100 trillion connections, these are particularly affectedby hormones such as oestrogen, levels of which change during the menstrual cycle and the menopause.’

However, a study by the University of Illinois found that women with early-stage dementia were able to do better in memory tests than men with the same condition, meaning their illnesses went undiagnosed for longer.

Bridge the gap: Dr Leonard says that family members or friends can often be helpful in noticing the early signs of dementia. ‘Look out for people forgetting key pieces of information they’d normally store in their short-term memory (long-term memory isn’t usually affected early on). Other things, like deviating from routine or suddenly becoming forgetful around things related to personal safety, such as leaving the oven or hob on, can indicate that something’s wrong.’

The Alzheimer’s Society has produced a downloadable booklet, Worried About Your Memory? while the NHS has a guide to what’s involved with the condition. In Boots stores in Great Britain, there’s at least one colleague who’s a Dementia Friend. They’ll have an understanding of what it can be like to live with dementia and can be a friendly face for those affected by it. Look out for Boots colleagues wearing Dementia Friends badges.

Gender gap: PAIN
In an oft-quoted 2008 US study of nearly 1,000 patients who went to A&E with similar stomach complaints, women were 13-25% less likely to receive painkillers than men. And a study in 2001 by the University of Maryland, ‘The Girl Who Cried Pain’, found women in pain were more likely to have their symptoms written off as ‘emotional’ or ‘not real’.

Experts cite various reasons for these differences – from ‘implicit bias’ (the stereotype that men are tougher) to the fact that women who present to the Emergency Department with abdominal pain are often assumed to have a gynaecological problem.

‘Gynaecological pain is subjective,’ explains Dr Leonard. ‘Whether there’s an acute or chronic problem, or it’s a standard period pain, it can sometimes be difficult for doctors to diagnose. But as GPs, it’s our responsibility to ask patients open questions, such as “What’s happened to make you come here today?”, or “How has this changed over time?” Maybe the painkillers they take are no longer effective, or perhaps it’s having an impact on their quality of life. All of these things need investigating.’

Bridge the gap: Don’t feel bad about going to the GP when you’re suffering. If you get repeated bouts of abdominal pain, keep a diary noting where you are in your cycle and what you’ve eaten. This may help your GP work out if it’s a hormonal or dietary issue. Doctor isn’t able to give you a diagnosis? Request a referral to a gastroenterologist, or a gynaecologist (at the GP’s discretion). The NHS website is a good place to start for more information (see below).

Bookmark now…

Feel empowered and educate yourself more on women’s health with these websites:

NHS.uk: the go-to resource for official health info, with a specialist section devoted to women.

Nice.org.uk: The National Institute for Health and Care Excellence has a huge database of evidence-based research.

This feature has largely used US studies. In the UK, women should seek advice from a health professional when they have concerns.
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