The fundamental inequalities in women’s health

The latest NHS planning guidance was released last week. But that’s not what I’m going to write about today; I thought I’d bring to your attention to the decision to drop Women’s Health targets from the NHS plan.

It was mooted a week or so ago that this was because there was concern that the NHS gives in too easily to interest group lobbyists. I don’t see that 51 per cent of the population is an ‘interest group’ – they are actually pretty important if we want to reduce inequalities and reduce costs of long-term care through preventative medicine and appropriate treatments and interventions. But the reason, we are assured, is because the target for Women’s Health hubs in every system achieved 93 per cent (39 out of 42) in 2024/25 and therefore need not be repeated in this year’s guidance.

However, a recent poll shows that 18 per cent of women had reduced their working hours or left the workforce because of Women’s Health related issues. Of those, 39 per cent said they would definitely have been able to stay in work or maintain their hours if they had had better access to timely and effective healthcare. Half of the respondents said they had suffered dismissive, discriminatory or harmful treatment at the hands of the NHS.

So perhaps Women’s Health targets need to be reassessed and included in the NHS plan.

Inequalities in research matter

But planning guidance and women’s health hubs aside, there is still an alarming amount of inequality in Women’s Health. This is not just about health hubs and services – it’s much more fundamental than that.

I’m talking about scientific research, drugs, medical devices and lived experience. I would like to present the case for why biology is important because in the treatment of diseases; it’s the biological sex that counts – XX chromosomes, in the case of females.

Let me give one brief example of why the biological sex overrules the gender a person has chosen to identify with. 76 per cent of cell cultures used in lab research are male, i.e. XY chromosomes.  In the USA, a five-year cohort study into road traffic accidents involving a high proportion of women found the common factor that many were taking medication for insomnia. It was discovered that the female metabolism metabolises slower than the male metabolism. Yet still, in some cases it took more than two decades for sex-specific doses to be considered. How many more drugs out there are over-medicating women with doses continually optimised for men?

Previous studies on the benefits of aspirin for heart health were optimised for males. Yet, more women die from heart disease in the UK than men. And over a decade, 72 per cent of drugs were introduced to the market without data on pregnant or breastfeeding women, the default advice being to “ask your GP”, who often didn’t know any more than the patient. Women experience five times more side effects from drugs than men – is this because more than 60 per cent of clinical trials are on men? Even in animal testing, using males is the default.

Endometriosis has been cured twice in animals but in human trials it has failed, arguably because scientific discovery which is male based often does not work when translated into human females.

The are of course some amazing examples of funding, and rightly so, for research into horrific diseases such as cancer. Breast cancer research specifically gets 10 times more funding than research for female-specific heart disease. However, twice as many women die from heart disease than do from breast cancer.

Lack of suitable treatments

One thing that is a certainty for all women is menstruation, or problems with menstruation. One in eight women of working age took time off work last year because of symptoms, increasing economic burden through lost productivity.

10 per cent of women suffer adenomyosis where the endometrial cells invade the muscular cells of the uterus. This causes extreme pelvic pain. Often there are no diagnostics and no treatments, so patients are prescribed long-term pain medication or, in some cases, have a hysterectomy. Fibroids are another common occurrence in 70-80 per cent of women, although less than half are debilitated by them and 30 per cent end up having surgery to remove them, or a hysterectomy.

10 per cent of women suffer endometriosis, but again, there is no cure, so they are prescribed long-term painkillers, hormone treatments, surgery to cut away the affected areas, or a hysterectomy. Then there is the lesser discussed pelvic congestion syndrome causing chronic pelvic pain. 49 per cent of gynae appointments are because of pelvic pain and 30 per cent of these are likely pelvic congestion syndrome.  As it is difficult to diagnose because of similarity of symptoms to all of the above, the patient is usually given painkillers, hormone treatments or of course, the default hysterectomy. 20 per cent of women in the UK will end up having a hysterectomy at some point.

This is mainly because research does not invest enough in diagnostics, drugs, or devices specifically tailored to Women’s Health. Only 2 per cent of funded research is for pregnancy, childbirth and female reproductive health. Over half of the population suffer conditions specific only to them, yet only 2 per cent of research is dedicated to trying to find cures and treatments for women. The other half have 27 per cent of research dedicated to male-only health and the rest, we know, is optimised for men.

One shocking example of underfunding in research for medical devices for women, is vaginal stents for paediatric surgery, where little girls are operated on because of e.g. tumour removal, trauma or birth defects. There is no such thing as a paediatric vaginal stent. Surgical gloves are stuffed with gauze and inserted to maintain integrity. There have been amazing advancements in medicine and medical devices, yet something as simple as a paediatric vaginal stent is yet to be made readily available.

There is also the very real problem of medical gaslighting. Women tend to go to the doctor a lot more than men, because they are suffering extreme, sometimes chronic, pain, regular excessive and debilitating blood loss with associated fainting nausea and vomiting. But more often than not, they’re made to feel that they’re overreacting, just being oversensitive and there’s nothing really wrong, it’s just part of being a woman.

Among countless documented examples, I have also heard heart-breaking first-hand accounts from female clinicians, who in pregnancy, have voiced their concerns about their unborn child to both male and female doctors, only to be dismissed as overthinking due to their medical background—only to later suffer a stillbirth. They knew their bodies but were persuaded otherwise.

Another first-hand experience was told to me by a colleague, a senior nurse of many years’ experience, who suffered pelvic congestion syndrome. She was prescribed the usual treatments of long-term painkillers and hormones.  After being bedbound with pain and finally being offered a hysterectomy, she did her own research and ended up paying privately for scans and ultimately vein embolisation, a minimally invasive day case procedure that according to the private consultant, is frequently overlooked in the NHS. These were women who were trained in medicine. How the rest of the population can possibly feel they can speak up against such gaslighting or have the knowledge or confidence to research their options is worrying.

Inequalities impact the NHS

A consequence of underfunding of research into female-specific diseases in comparison to the burden of diseases, apart from the economic burden, is the cost to the NHS is in terms of long-term medication and preventable surgery. Not to mention mental health services, as some women who have lost a child or who are living with chronic pain, or who find it difficult to come to terms with hysterectomy, will require support through therapies.

And considering the number of hysterectomies being performed, studies show that the long-term consequences indicate potential associations with increased risk of cardiovascular disease, metabolic issues like diabetes and high cholesterol, osteoporosis, depression and even certain cancers and possibly even Alzheimer’s.  What is the downstream cost to the NHS for these potentially preventable co-morbidities?

So, if we’re really about reducing inequalities and looking at preventative medicine, better treatments and reducing costs, then maybe we need to start at the bottom, with the building blocks of medicine. By investing more in women’s health, the 39 out of 42 women’s health hubs can provide cutting edge, optimised care, reducing pressures on the system and vastly improving women’s health outcomes and experience.

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I would like to thank Brittany Barreto, Ph.D., author of of Unlocking Women’s Health, FemTech & the Quest for Gender Equity for inspiring me and sharing global research stats with me.