Show of hands, please: How many of you heard about endometriosis after 2017? Who knows about PMS but doesn't know exactly what PMDS is and that it often leads to the misdiagnosis of "bipolarity"? Is it news for you that anxiety and depression can be linked to your menstrual cycle and hormones? And did you know that hormonal contraception can lead to migraines with a loss of language comprehension? Our thesis: Until now, you probably didn't know any of these facts. And once again, our patriarchal system is to blame for this, more precisely the Gender Health Gap.
The problems of the phenomenon are complex: superficially, the gender health gap means that our health system is oriented towards the male part of the population. If you look a little deeper, you will notice that various aspects clash here:
Drugs are mainly tested on the male part of the population
On the one hand, most drugs are tested on men, even though the statistics on the corresponding disease suggest that women are more often affected by them. The problem is that, even though socially we don't like to talk about a binary world, hormone balance, metabolism and cardiovascular system are different in men and women. Accordingly, not all approved medicines work for women. A one-size-fits-all approach to medicine can be extremely dangerous: In the US, the same dosage for men and women was recommended for the sleeping pill zolpidem. However, women metabolise the drug more slowly than men. Thus, accidents often occurred the next day.
Women are often misdiagnosed
At the same time, many diseases are simply more likely to be diagnosed in men than in women, because the symptom catalogues that medical students have to learn by heart are oriented towards boys and men. Yet, women and men often show different symptoms of the same condition. For example, ADHD manifests itself in male patients in hyperactivity and mood swings, whereas in female patients it manifests itself in forgetfulness or low self-esteem.
Doctors often have personal bias
Another problem are the personal bias of doctors: Since women are perceived as more emotional than men, the same symptoms in women are often attributed to psychological causes – so some diseases are discovered much later in women than in men. The symptoms of a heart attack are often ascribed to psychological problems or the menopause by women themselves and their doctors. For six out of eleven types of cancer, a woman has to wait longer for her diagnosis than a man would. And the pain of women who go to the doctor with chronic problems tends to be labelled as emotional or imaginary by their doctors.
For women, it is not only the pain associated with illness that is underestimated, but also the pain associated with procedures. In Great Britain, for example, it has only been mandatory since 2021 to offer painkillers when IUDs, coil chains and the like are inserted. According to one survey, 43 per cent of those questioned said the pain of IUD insertion would be seven pain points on a scale of one to ten. Another study states that 70 per cent of those surveyed experienced mild to moderate pain and another 17 per cent experienced severe pain. In extreme cases, women even faint during the procedure or develop a form of vaginismus afterwards: In this case, the pelvic floor muscles cramp up so much that penetrative sex can cause extreme pain or is no longer possible.
"Women's diseases" are less researched
The so-called "women's diseases" are much less researched than most others. PMS, for example, has only been registered as a disease in its own right since 2000, yet it affects 90% of menstruating women. PMDS (premenstrual dysphoric disorder), on the other hand, which is colloquially referred to as the "worse PMS", affects about five to ten percent of menstruators. The symptoms of PMDS include depressive moods, anxiety, irritability, aggressiveness or exhaustion. PMDS can have such severe mental effects that it is often mistaken for bipolar disorder. A 2013 study even found that 20% of affected individuals considered suicide.
On the second most common gynaecological disease, endometriosis, the Robert Koch Institute writes: "Endometriosis shows very different progressions, according to estimations between five and 15% of women of childbearing age are affected." The average time until a diagnosis of the disease is made is seven to eight years, with 40 per cent of women going to ten or more gynaecologist appointments until they are referred to specialists. Not only do these women suffer unnecessarily long from extreme pain, they also have to expect impaired fertility. The longer endometriosis remains undiagnosed, the higher the risk of infertility.
Unfortunately, not much is known about both diseases, their causes, symptoms and treatment methods. The needed research is missing. The situation is similar for most other gynaecological diseases and syndromes. As recently as January 2022, French President Emmanuel Macron addressed the problem in a public video speech "Endometriosis is not a woman's problem, it is one of society." At the same time, he announced the implementation of a research and teaching roadmap for France.
Why mental illnesses are often not linked to our menstrual cycle
It is clear to us that PMS, PMDS and co. can have an impact on our psyche. The problem is that they are rarely recognised, they fall off the grid - right into the black hole between gynaecology and psychology. Gynaecologists are rarely trained in psychology and psychologists are rarely trained in gynaecology. So it is up to the doctors themselves to specialise. Another problem is that this field is wasteland for research funds and calls for proposals. It is not subsidised either by the gynaecological or the psychological side. Yet various mental problems, such as depression and anxiety, could possibly be solved with the right hormone treatments. A Danish study found that the likelihood of depression was 23 percent higher among users of the combined pill and 34 percent higher among users of the progestogen pill than among women who did not use hormonal contraception.
Guess my cycle
The gender health gap affects our lives on several levels. The sad result is that we are left alone with our bodies. In school, we are taking a driving licence for condoms and talked about hereditary diseases, but not about hormones or our cycle. We are never given a guide to the complexities of our bodies. Unfortunately, things are no different in adulthood: We have to discover, find out, google, try out and go from doctor to doctor. In the process, we are often confronted not only with ignorance and incompetence, but also with judgement. That's why we want to educate, stimulate discussions and bring the discourse into your heads, favourite restaurants and living rooms.