Why do doctors underdiagnose these 3 conditions in women?

International Women's Day prompts us to celebrate women and womanhood. However, recent research suggests that women may face more than their fair share of challenges, including in receiving appropriate medical care. What are some of these challenges, and why do they occur?

Women have played a vital role in the improvement of medical care across clinical fields.

Figures such as Dorothea Dix, who helped change the face of mental health care, Rosalind Franklin, who contributed to the discovery of human DNA structure, and Dr. Virginia Apgar, who put together the evaluation criteria assessing the health status of newborn infants, have revolutionized medicine.

Despite this, women and girls across the world still face challenges and discrimination in medical settings.

Only last year, for instance, senior staff from the Tokyo Medical School, as well as from Juntendo and Kitasato Universities in Japan, admitted to manipulating entrance exam scores so that fewer women candidates would qualify for their courses.

These admissions spurred endless debates about the degree to which women who choose medical care as a profession keep on facing waves of discrimination.

Such problems, however, do not stop at women trying to build a career in medical sciences. According to some reports, women also face discrimination as patients. Sometimes, their doctors fail to diagnose conditions they are struggling with, or offer them the wrong diagnosis and consequently, the wrong kind of therapy.

In this Spotlight feature, we will look at some of the conditions that doctors underdiagnosed in women and explore some of the possible reasons behind these lacks in medical care.

One of the chronic conditions that many women struggle with for a long time before they manage to receive a correct diagnosis — if they ever do — is endometriosis.

woman in pain holding her abdomen

Women have to wait to get their endometriosis diagnosed for 'a disturbingly long time.'

Endometriosis is a progressive gynecological condition, which doctors currently consider incurable. Endometriosis occurs when the type of tissue that usually only lines the uterus grows in other parts of the body. This can include the ovaries, fallopian tubes, urethra, but also the bowel, kidneys, and other organs.

Symptoms of this condition include debilitating pain in the pelvic area, as well other parts of the body, heavy and persistent menstrual bleeding, spotting between periods, pain during sex with vaginal penetration, nausea and vomiting, severe headaches, and persistent fatigue.

These symptoms can often have a severe impact on an individual's quality of life, affecting their productivity, other aspects of their physical and mental health, and their relationships.

Estimates in the journal Fertility and Sterility indicate that 10–15 percent of women of reproductive age live with this condition, and 70 percent of women who experience chronic pelvic pain actually have endometriosis.

Researchers from the Endometriosis Association, which is an international research and advocacy organization, write, "The time from the onset of symptoms to diagnosis is disturbingly long." Two-thirds of the people they spoke to begin to experience symptoms of endometriosis during adolescence. However, most of these people do not seek medical attention immediately, and once they do, it can take doctors 10–12 years to make a correct diagnosis.

Typically, doctors can only diagnose endometriosis by conducting a laparoscopy. This is a minor surgical procedure in which a doctor inserts a tiny camera into the abdomen to look for lesions and abnormalities.

A doctor may prescribe pain relief medication or hormonal therapy for the management of endometriosis, but since this condition is progressive, many people require multiple and regular surgeries to remove the abnormal tissue growth.

 

'So validating to know I wasn't weak or crazy'

One woman, aged 25, who spoke to Medical News Today, explained that she lived with severe endometriosis symptoms for years before she received a correct diagnosis.

Primarily, this was because both she, her family, and the doctors that she consulted, thought that her disabling symptoms were nothing more than "bad period pains," or else they mistook them for other health problems.

"I thought it was totally normal to have excruciating pain and 10-day-long heavy periods," she told us. "My mom, aunt, and grandmother all had the same experience, so I was always told 'that's just how it is for women in our family,'" she added.

"I thought maybe I was weak and not able to handle the pain as well as other girls. Last year I was diagnosed with deep infiltrating endometriosis and finally had an explanation and, most importantly, a treatment plan. It was so validating to know I wasn't weak or crazy, just dealing with a chronic condition."

She also told us that her journey towards a diagnosis was difficult and long-winded. "I've gone through three [general practitioners] and two gynecologists in 2 years," she explained. She added that because her condition affected several organs, she received many different — and incorrect — diagnoses before the doctors eventually identified the real issue.

"I have endometriosis on my bladder, urethra, kidneys, and bowel, so I wound up with many doctors saying 'you have [irritable bowel syndrome]' and 'you have [pelvic inflammatory disease],' when I knew this wasn't the case."

Another health problem that doctors often fail to spot in women is coronary (or ischemic) heart disease (CHD). This disease occurs when the arteries that deliver oxygenated blood into the heart, so that the heart can pump it out to the other organs, become unable to "service" the heart effectively.

Since researchers conduct most clinical trials in men, we still lack a clear idea of how heart disease manifests in women.

The symptoms of CHD vary from person to person, which can make the condition challenging for doctors to spot. However, more generally, symptoms also differ between men and women, and more women thus go undiagnosed until the condition becomes exacerbated.

The National Heart, Lung, and Blood Institute explain that symptoms can also vary between different types of CHD, and some people do not experience any symptoms at all. However, some common symptoms include angina (pressure in the chest area, especially during physical activity), neck pain, and fatigue.

They also state that "[h]eart disease is the leading cause of death for women," and that women are more at risk than men of developing non-obstructive CHD. This condition can occur when the arteries that go into the heart abnormally tighten or are "squeezed" by the surrounding tissue.