Soaring Gynaecology Waiting Lists… Why?
Doctors’ routine dismissal of women’s debilitating health problems as “benign” has contributed to gynaecology waiting lists soaring by 60% to more than half a million patients, a senior health leader has said.
The Royal College of Obstetricians and Gynaecologists (RCOG) president, Dr Edward Morris, told the Guardian that waiting lists for conditions such as endometriosis, prolapse and heavy bleeding had increased by a bigger proportion than any other area of medicine in the past two years.
Many such conditions are defined as medically benign despite being life-limiting and progressive in some cases. In medicine, “benign” is traditionally used to indicate non-cancerous conditions, but Morris said institutionalised gender bias meant the term was used more widely in gynaecology, resulting in conditions being “normalised” by non-specialists and deprioritised within the NHS.
“We have to change the language. We have to call it what it is,” said Morris. “These conditions cause huge amounts of suffering to women. Being lumped in a topic called benign gynaecology downplays the importance and suffering.”
In practical terms, hospitals have regarded “benign gynaecology” surgery lists as being easy to cancel in an effort to tackle rising pandemic waiting lists, he said.
The intervention comes ahead of the launch of the government’s women’s health strategy for England, expected later this year, which ministers say will aim to redress “decades of gender health inequality”. The strategy is expected to include a focus on gynaecology problems, fertility and menopause.
Morris called for it to include the establishment of specialist gynaecology clinics across the UK – the equivalent of GP surgeries, but dedicated to women’s health.
He said biases within the NHS had contributed to unacceptable increases in waiting times for women. RCOG analysis revealed that gynaecology waiting lists across the UK reached a combined figure of more than 570,000 women as of December last year – just over a 60% increase on pre-pandemic levels and the biggest percentage increase of all elective specialties.
The number of women waiting more than a year for care in England increased from just 66 before the pandemic to nearly 25,000, and 1,300 have been waiting more than two years.
“There is a perception in many areas of the NHS that if there is a benign gynaecology surgery list, that’s a list that can be cancelled,” Morris said. “No one with cancer is going to suffer as a result.”
However, if left untreated, conditions such as endometriosis and prolapse can become worse, have a severe impact on quality of life and affect fertility. Endometriosis is a chronic condition that occurs when tissue similar to the womb lining starts to grow in other places, such as the ovaries and fallopian tubes. Pelvic organ prolapse is when one or more of the organs in the pelvis slip down from their normal position and bulge into the vagina.
Gynaecologists have raised concerns about an apparent increase in emergency admissions, including women with heavy menstrual bleeding requiring blood transfusions for severe anaemia, women with ruptured cysts, and those suffering acute pain. Some women, while waiting for surgery that needs to happen before fertility treatment, have gone past the age limit for IVF on the NHS.
Morris, a consultant gynaecologist at the Norfolk and Norwich University NHS hospital trust, said his own hospital no longer used the term “benign gynaecology” and instead organised teams according to the type of surgery performed, such as endometriosis surgery, laparoscopy and urogynaecology. He is urging other trusts to follow suit.
The government’s renewed focus on women’s health comes after a string of healthcare scandals primarily affecting women, including nearly 2,000 reported cases of avoidable harm and death in maternity services at Shrewsbury and Telford; more than 1,000 women operated on unnecessarily by the rogue breast surgeon Ian Paterson; thousands in the UK given faulty PIP breast implants; and many left with traumatic complications after vaginal mesh surgery.
In a 2020 review of vaginal mesh, hormonal pregnancy tests and an anti-epilepsy medicine that harmed unborn babies, Lady Julia Cumberlege identified an arrogant culture in which serious medical complications were dismissed as “women’s problems” for decades.
Dismissive attitudes or women having their problems minimised continued to be a concern, Morris said. “Women tolerate a lot more in the process of normalisation,” he said, adding that the approach to menopause symptoms or heavy bleeding is sometimes: “Your mum had it, so you’re going to have it – it’s not serious, live with it.”
To address this, and to make care more accessible, the RCOG wants the government to establish specialist gynaecology clinics across the UK that would offer cervical screening, contraceptive implants and advice on menopause and menstrual health.
At present, Morris said, women often found themselves shuttled back and forth between GP surgeries, sexual health clinics and hospitals due to the way treatments were commissioned. For instance, a woman who required a Mirena coil to address heavy bleeding in the perimenopause might be referred by her GP to a sexual health clinic and then find herself referred onwards to a hospital because the clinic was only commissioned to provide implants for contraceptive purposes.
“A seemingly simple thing has turned into a complicated journey and there are so many examples of this,” he said. “At the moment it’s fundamentally difficult to access care. The ideal situation is to have community gynaecology healthcare hubs that can address so many things really efficiently.”
Morris said there also needed to be more funding for research into women’s health issues, such as the biology underlying menopause symptoms. “There is a fundamental lack of research in women’s health,” he said. “Because there’s a bit of shame, stigma and silence on some gynaecological conditions, that spills over quite a bit into some of the research.”
Announcing the women’s health strategy for England in December, the women’s health minister Maria Caulfield said: “It is not right that over three-quarters of women feel the healthcare service has not listened. This must be addressed. Many of the issues raised require long-term, system-wide changes.”