The Problem with Women's Healthcare

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Growing up in the 1980s, and coming of age in the 1990s in Dublin, one of my greatest fears was getting pregnant in my teens. But it was an anxiety that lasted well into my twenties. Our mothers had fought for the right for us to work, earn, travel, get our own places, for the freedom to wait to have families. Getting pregnant too young seemed like an end to all that. Yet, being a girl in an era where religion controlled our education and our health meant our heads were filled with an extraordinary amount of misinformation and paranoia.

From the latent notion that you could just practically look at someone and nine months later give birth (full gestation is actually ten months, just another bit of ignorance that abounds), to horror stories of broken condoms and failed morning-after pills, followed by undertaking the health risks and stigma of travelling to England for an abortion. As a result, I went on the pill soon as I was sexually active, still having little or no education about how my body worked.

By the time we got to repealing the eighth last year, while it felt incredibly important and vital, it also felt at least thirty years late. It was monumental and essential, but it was simply a first step in dismantling what has historically been a deeply sexist, ignorant and prejudicial systematic bias towards women’s health. Repealing the eight underscored that the only time other people really take an interest in women’s health is when women are pregnant. And even then the focus was, and still greatly is, on the health of the baby. The hangover from an attitude that women are a kind of incubator, filling their function, permeating still.

For the rest of your reproductive life as a woman, the incredibly complex area of our health and the influence of our hormones just gets parcelled off to the odd GP visit if needed. There is little care, research and next to no funding given to an extraordinary amount of change and fluctuation that having a whole set of extra organs that produce life results in. And in that regard, it can feel little has moved on since Victorian times in terms of the kind of support and education made available.

For many, dealing with difficult periods means decades of suffering a kind of disability. Whether it be from pain, intense bleeding, extreme emotions – depression, anxiety just some of the lovely ones – all fuelled by the fact that we have a bunch of chemicals interacting with our brain in a very unique way. Many women for so long have been conditioned to just accept this as a fait accompli. We are mostly in the dark about what to do about it and the options out there can be both practically and financially prohibitive. Doctors are not expert enough in it, and with about 30% of GPs women, there are not enough female doctors to engage with on it.

Men’s health tends to be a more static picture. Women’s is not. Yet the same approach is taken to both.

I remember when I came off the pill in my early twenties, I noticed some big hormonal changes which really worried me. I went to talk to the GP at the time, who was beyond disinterested. I went back on the pill at various points in my twenties, still vaguely terrified of having an unplanned pregnancy. When circumstances changed in my thirties, the whole process reversed and the struggle to conceive became all-consuming. Throughout that whole experience, at every step, only private healthcare provided any options.

In the meantime, after suffering severe pain for years, I was diagnosed with endometriosis, and so had surgery. It wasn’t a fix. Now in my forties, things have changed again. After only experiencing mild hormonal-induced emotional ups and downs in my thirties, I began to suffer from a complete loss of emotional regulation. This was in addition to severe cramping with frequent migraines. I essentially feel like I am going mad for at least a week out of every month.

So I went back on the pill, which could only be a single hormone version because of the lack of success combination pills have on migraines. I put on weight, after working really hard to lose it. That regularised, but after nine months I was having long bouts of intermittent, sometimes really heavy bleeding accompanied by intense pain. Not to mention that several of my cupboard doors were now stuck together with bits of gaffa tape after I karate kicked the hell out of them on a particularly bad hormonal surge. All through this time I have not felt like anyone had my back. I have questioned my sanity, my very ability to function and I have been countless times directed to NHS webpages by health professionals because evidently Irish medicine doesn’t do female health information. I have been told there is either a hysterectomy or more contraceptive treatment.

For so long dealing with women’s health and hormonal changes has been seen as some kind of dark art. And so we try everything. Diet, exercise, acupuncture, hormones, no hormones, herbs, wine, no wine – many of us get so desperate we’d be willing to pay some member of the occult for a quick fix. All the while we are never really told what’s going on. Hormones are part of the neurological system, the health of your ovaries are linked to the health of your brain. And the other way round. Oestrogen is deeply involved in brain function and is really key for our energy production. When your oestrogen is low your brain function slows down. When you go through menopause, it is actually your brain that is going through a transition.

So this week I embark on another chapter. After paying through the nose for a private pelvic scan I am going to have the Mirena coil inserted. It is another form of contraception which I am taking for completely other reasons. At almost €400, I can’t afford it, but I can’t afford not to either. I don’t want to feel like I’m losing my mind anymore. I don’t want to be in so much pain. I don’t want to feel like those are my only options. They shouldn’t be. But it’s time we stopped treating women’s health always in the frame of getting pregnant, or not getting pregnant, and that our extraordinary, unique biology is given the respect, support and lifelong care it deserves.

Jessie Collins, July 2020.

What is your experience of health care in midlife?
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