Minimal presentation

women's health

and medical gaslighting

women's health

women's health

and medical gaslighting

72%

...of women have experienced medical gaslighting

"Everyone feels tired sometimes"

"Let's see if it's a problem in six weeks"

"Have you tried more/less exercise?"

"That's probably just anxiety"

"Did you google that?"

"It's not worth doing any tests"

"That's normal for your age"

Medical gaslighting

"It's all in your head"

• Hysteria was the first mental disorder "discovered" in women (around 2nd century BC)
• Hippocrates himself believed that the womb travelled around the body, spreading hysteria
• For a long time it was treated as a form of witchcraft and cured with herbs, sex (and later abstinence) and fire
• Hysteria was still officially a mental diagnosis until 1980
• It popularised the idea that mental health can cause physical symptoms, but in a way that belittled women's actual experiences and allowed them to be ignored

history

Why does this happen?

• Men's bodies have always been considered to be the norm (even in the Bible - Adam is created first, and Eve is a variation on him)
• In 1977, after the thalidomide crisis, the FDA made a policy to exclude "women of reproductive potential" from phase 1 and 2 clinical trials (unless they were pretty much dying anyway)
• For the next decade, this meant that the bodies and hormones of these women wer completely ignored when developing drugs and treatments
• In 2019, women accounted for only 40% of participants in clinical trials for cardiovascular disease, cancer, and psychological disorders, the three conditions which affect women the most
• Many clinical trials do not separate their findings by sex, or other factors such as race, leading to a lack of knowledge about particular groups that could be at risk

research

Why does this happen?

• Diseases which primarily affect women generally have more of a burden on their lives than those that affect men
• However, they are also underfunded in comparison
• Ovarian cancer is the 5th most lethal form of cancer, but the 12 most funded
• The NHS spends 50 times more on legal claims relating to pregnancy than it does on pregnancy related research
• Pregnant women were excluded from 80% of covid clinical trials, leading to them being more vulnerable and unable to get vaccinated

research

Why does this happen?

• Doctors are not taught enough about women's health issues, partly due to lack of research
• This leads to underdiagnosis, as symptoms don't point to a particular condition
• Doctors often assume that if they don't know what is wrong with a (usually female) patient, there must be nothing wrong
• They then assume that women presenting with the same symptoms must be fine

education

Why does this happen?

• Present very differently in women, but doctors are only educated in male heart attacks
• Women are more likely to die after being admitted to hostpital with a severe heart attack but also less likely to be given treatment to prevent them in the future
• Women are 50% more likely than men to have a heart attack misdiagnosed

heart attacks

Case studies

• About 80% of people with ME/CFS are women
• Women also report much worse symptoms
• Some of this bias could be due to men underreporting symptoms

me/cfs

• Women account for 80% of people with autoimmune diseases
• Average diagnosis takes 5 years

autoimmune conditions (e.g. lupus, rheumatoid arthritis, coeliac disease)

• Affects around 10% of women, but only 2/10 cases are diagnosed
• Average diagnosis time is around 8 years

endometriosis

Case studies

chronically ill women

Selena Gomez has lupus and released her documentary 'My Mind and Me' in 2022.

Sarah Hyland had kidney dysplasia, and had multiple surgeries leaving her chronically ill while filming Modern Family.

Miranda Hart has ME after contracting lyme disease as a teenager. She has talked a lot in the past week about being ignored by doctors for years.

https://www.nature.com/immersive/d41586-023-01475-2/index.html