Gender bias in heart disease, and our usual roundup of women’s health news

On Tuesday I joined the British Heart Foundation (BHF) for a panel discussion on their upcoming campaign, Bias and Biology, exploring gender inequalities in women’s heart health. The panel, chaired by Women’s Health editor Claire Sanderson, featured cardiologist Dr Vijay Kunadian, Professor of Cardiovascular Medicine Chris Gale, and heart patient Esther Stanhope, who had a heart attack at the age of 45, but had no idea that was what had happened. They were joined by The Duchess of York Sarah Ferguson, former British Vogue editor Alexandra Shulman, and Stylist columnist Lucy Mangan.

Coronary heart disease is the biggest killer of women worldwide, killing more than twice as many women in the UK as breast cancer. But we just don’t hear about it as much, and we continue to think of heart attacks as something that only happen to overweight old men.

BHF research, authored by Professor Chris Gale, found that more than 8,000 women died over the last ten years as a result of gender bias in the treatment of heart disease. Their research suggested that 8,200 female heart attack patients could have been saved, if only they’d received the same standards of care as men. In fact, they found that women receive worse care than men at every stage, from diagnosis and treatment through to rehabilitation.

Women are 50 per cent more than likely than men to be misdiagnosed initially, leading to delays in accessing care, and eight per cent less likely than men to be recommended vital cardiac rehab after a heart attack. Of course, at the root of all this is a problem we’re all familiar with: women have been historically under-represented in research. Two thirds of clinical research into heart disease focuses on men and so key biological differences – like the fact women typically experience different heart attack symptoms from men – are still often overlooked.

In other news this week:

Research published in The Lancet raised hopes that the HPV vaccine could help to one day eradicate cervical cancer.

Another study, published by The British Medical Journalism, found that period pain causes women nine days a year of lost productivity. Also this week, Endometriosis UK launched its Endometriosis Friendly Employer scheme, aiming to drive positive change in the workplace for the 1 in 10 women with endometriosis (one symptom of which is severe period pain) and stamp out the culture of employers simply brushing women’s issues under the carpet.

And, in the US, a woman who miscarried after being shot in the abdomen has been charged with manslaughter – while her shooter faces no charges. You can contribute to her support fund using the details below:

Doctors shamed me for having ‘too much sex’ but my pelvic pain could be endometriosis

The Sun this week published the story of 27-year-old bride-to-be Sarah Rose McCann, who is spending £7,000 of her wedding fund on private treatment after doctors dismissed her chronic pelvic pain as caused by ‘too much sex’.

When she first experienced painful sex and recurrent cystitis at 18, Sarah was simply told her pain was ‘normal’, and she says the hardest thing was finding someone who would believe her. As Sarah told Belfast Live:

I was constantly going to doctors and going to consultants and they would say there’s nothing wrong with you. Up until the consultant I saw in January 2018, no one believed that I was in pain.

When I was 20, I went to see this one consultant and said ‘I have this pain all the time – I don’t know what to do, I have this pain in bladder, pain in my bowel’ and he just said ‘maybe you should stop having so much sex’.

Any time I saw them, the first thing they would ask is ‘have you had sex?’ and I’d say ‘yes’ and they would say it’s probably sex related, hormone related or something you’ve done.

I just felt like I was always getting nowhere – that my pain didn’t matter and I didn’t matter.

Older women can be equally susceptible to eating disorders

The Independent this week published a Washington Post piece exploring eating disorders in older women:

Though eating disorders are underdiagnosed across the board, they’re missed more frequently in midlife. Women 40 or older admitted for treatment at an eating disorder facility tend to have had their eating disorders longer than younger women who are admitted for treatment.

“Doctors still have trouble seeing eating disorders in anyone other than young patients,” Maine says. “Everyone who’s losing weight, they’re the star – they don’t ask you how you lost the weight. The emphasis on weight as a standard of health is absurd and it just encourages eating disorders.”

“Black women with PCOS are being failed by doctors – and it’s causing a loss of trust in the NHS”

Ore Ogunbiyi wrote for Stylist about the crisis of trust among black women with PCOS, who are being let down by their doctors. One of the women she spoke to, Courtney Boateng, describes being dismissed with ibuprofen when she went to her doctor in pain. “Looking back,” Ogunbiyi writes, “Boateng feels that the doctor underestimated her pain; a 2018 BBC report on racial and gender bias in healthcare affirms that this is a common story for black women. ‘I don’t normally come to the GP but if I’m telling you that something is not normal, I need you to react with some urgency,’ Boateng says.”

Another woman, Muoyowa Jemide, tells her she’s lost trust in GPs altogether: “They trivialised my pain,” she says. “They’re like, ‘I’m sure it’s nothing’ or, ‘we’ll call you if there’s anything.’ But they never call.” She hasn’t been back to the GP about her concerns since.

Breast implants ‘are causing anxiety, brain fog and forgetfulness’, watchdog reveals as 250 women prepare legal action over allegations they can also lead to cancer

The Daily Mail reported that 250 women are preparing to sue breast implant manufacturer Allergan over a whole host of side effects. According to The Mail, the Medicines and Healthcare products Regulatory Agency (MHRA) is also monitoring claims of symptoms of breast implant illness associated with breast implants.

Although BII is not a medically recognised condition in the UK or the US, there are growing calls for doctors to help women claiming to be suffering from its various effects.

[The MHRA] has received reports of 32 women suffering psychological symptoms of BII, according to The Sun, with the true number likely to be much higher.

Although BII cannot be tested for, women say their implants have left them with problems including forgetfulness, anxiety, sleep disturbances and depression.

Women told Channel 4’s Dispatches, which [aired on Monday] that they have found it difficult for doctors to take their breast implant illness seriously.

We need to do a better job of including black women in conversations about HIV and PrEP

Rianna Raymond Williams wrote for The Independent, highlighting how HIV public health campaigns – which often only feature white or gay men – exclude black women from the conversation, and from accessing PrEP to reduce their risk. She writes:

Data taken from, the Naz Project London reveals that 82 per cent of women living with HIV in the UK are from BAME communities, 75 per cent of women newly diagnosed with HIV are from BAME communities and 67 per cent of women living with HIV are Black African, all the above place black women at higher risk of sexual and reproductive health inequalities.

Unfortunately, as mainstream sexual health campaigns about HIV prevention often solely feature white or gay men, in addition to black women not knowing enough about PrEP to protect themselves, those who may be at risk tend to believe they are not.

The invisible woman? The challenge at the doctor’s office every woman needs to know about

This one wasn’t technically published this week, but I saw it shared on Twitter a few days ago and wanted to include it anyway. Back in May, Today explored the “pervasive gender bias in medicine [that] leads female patients to be misdiagnosed or dismissed as complainers… [and] the doctors fighting for change.”

Dr. Alyson McGregor, an emergency medicine physician, often treats young women who are having a heart attack, but she has to fight to convince other doctors to recognize what’s happening.

Women have different ways of having a heart attack than men, so when traditional tests — based on men’s bodies — show everything is “normal,” female heart patients are often told it must be reflux or anxiety: “Women are stigmatized as being anxious,” said McGregor, author of the upcoming book, “Sex Matters: How Male-Centric Medicine Endangers Women’s Health and What We Can Do About It.”

…

It’s not malice but a pervasive, implicit sex and gender bias in medicine that’s leading female patients to be misdiagnosed, neglected, dismissed as complainers, accused of being overanxious, mislabeled as depressed or told their symptoms are all in their heads, said physicians who are fighting to change the system. What will it take to improve how women, especially those with chronic health conditions, perceive they are treated by doctors?

And finally…

On Friday I shared this post on Instagram from Julian Van Horne about living with periods as a trans person. It’s an important read, so worth sharing here too.

 

View this post on Instagram

 

An important read, thanks for sharing, @thedisabledhippie ⬇️ #Repost @thedisabledhippie with @get_repost ・・・ PERIODS ARE FOR EVERYONE🎈 _ TW// possible gendered language, pregnancy, menstruation _ As pride month comes to a close, I debated for a while if I should even make this post. Then I realized all of my hesitation came from a negative place: fear stigma surrounding period talk. _ So, here I am. I decided I’m not going to be quiet about it. Because it’s NORMAL. _ Menstruation can and does occur in non-binary individuals. Hormone replacement therapy doesn’t always stop periods nor does every trans person want, need, or have access to HRT. This absolutely does NOT invalidate gender identity. Even though it might feel like it to the individual. _ I’ve never been candid about this, but today is a good day— I have a complex reproductive system. I have a condition called: Uterus Didelphys. It means I have two uteruses and cervixes. It also means that my period took forever to cease on T, and at some point I thought it never would. It also means that I started my period at 9 yrs old, and was told a few years later my chances of having children were slim. I didn’t really know how to grapple with that at such a young age. _ My periods growing up were HELL. With this condition you can have up to TWO periods a month. I found out because I needed an ultrasound after having a period last almost 3 months. _ Up until recently everything was quiet. And then it came back. A few weeks ago I experienced a period. Following that, I’ve had ovarian pain every day since. It’s sometimes debilitating. I was devastated. So many hateful and resentful thoughts filled my body. But I didn’t make this up in my mind. Societal standards did. I felt like I had to hide this or hate myself because of the stigma that surrounds period talk. Because of the exclusivity it includes. Or the subtle separations in society of who we can or can’t talk periods with. _ But I won’t hide for two reasons: 1.) Periods are not gross. Periods are a normal body process that should not be shamed. 2.) I want non-binary individuals to know that they aren’t alone. As well as, to not neglect reproductive health

A post shared by Sarah Graham (@sarahgraham7writer) on