As it's revealed gynaecological waitlists have doubled in the UK, we ask - why are female health diagnoses taking so long?

In news today, new BBC research has revealed that gynaecology appointment waitlists in the UK have more than doubled since February 2020.

According to the research, a staggering three-quarters of a million (755,046) women's health appointments are still waiting to happen. This is up from 360,400 prior to the pandemic in 2020.

This indicates that 630,000 women - not including those that haven't been diagnosed and so aren't yet on a waitlist yet - are still waiting to be seen for painful and debilitating conditions including fibroids, incontinence, menopause care and endometriosis.

To put this into perspective, pre-pandemic (Feb 2020), gynaecology departments had 66 UK waitlists of more than a year. This month, there are more than 22,000.

While health ministers maintain that they are working tirelessly to improve the situation, many experts say the research is yet more evidence that women aren't being looked after.

"Women are being let down," Dr Ranee Thakar, president of the Royal College of Obstetricians and Gynaecologists (RCOG) shared with the BBC.

"Gynaecology is the only elective speciality that solely treats women and has one of the worst waiting lists across the UK. This reflects the persistent lack of priority given to women and women’s health."

Bottom line? "Women are suffering. We know it is affecting their mental health. They are not able to go to work, they are not able to socialise."

There are a whole host of gynaecological female health conditions affecting women across the country, many of which are woefully under-researched. However, one condition that can often take the longest to diagnose is endometriosis, with the average current diagnosis time sitting at seven years. Pair that with the seemingly ever-lengthening wait times for treatment, and you're looking at issues affecting you for decades of your life.

Back in 2022, we reported on the sad loss of Aubrion Rogers was just 30 years old when she passed away following a long wait for endometriosis surgery. Many endometriosis sufferers came forward at the time to share their opinion that if Rogers had been given an endometriosis diagnosis and in turn treatment sooner, her life could have been saved.

"It is tragic that a young woman has lost her life from what appears to be complications from endometriosis," shares doctor Nitu Bajekal, a senior consultant obstetrician and gynaecologist and author of Living PCOS Free.

Below, Bajekal explores why endometriosis diagnosis in the UK takes an average of around seven years, plus deep dives into the ongoing issue that is female gynaecological care.

Why does endometriosis diagnosis take so long? An expert explains

First things first - according to Bajekal, Rogers' tragic passing isn't a regular occurrence. "In my 35 years of experience as an ob-gyn with a specialist interest in endometriosis, this scenario is extremely rare," she shares. That being said, more does need to be done to ensure women don't wait years of their lives just to get a diagnosis and treatment for the chronic pain the condition causes.

Not entirely sure what endometriosis actually is? As in our guide to the many endometriosis symptoms, Bajekal explains that endometriosis is a chronic inflammatory oestrogen-dependent condition. "Endometriosis affects up to at least one in ten women and those AFAB (assigned female at birth) from teenage years through to the menopause and can be debilitating for many, presenting a significant health burden."

Endometriosis describes tissue similar to the endometrial lining of the uterus - which sheds as your period every month - and finds its way into the pelvis through a number of mechanisms, sticking itself to the back of the uterus and ovaries, which are the commonest sites.

Wondering what living with endometriosis is like? According to the 1.5 million women in the UK thought to have the condition, extremely painful - even more so because endometriosis diagnosis takes so long.

"Symptoms of endometriosis get overlooked very often, leaving women suffering from debilitating chronic pelvic pain, painful and heavy periods, painful sex, backache, bladder and bowel symptoms for years before a diagnosis of endometriosis is even considered," explains the doctor.

When does endometriosis diagnosis normally occur? 

Interestingly, it's often during investigations for fertility that it is first picked up, Bajekal shares.

"It takes an average of 6.7 years to be diagnosed with endometriosis," she goes on. So, why? "Painful periods are often not taken seriously and may be normalised both by health professionals and the general public."

Endometriosis can be misdiagnosed as:

• Irritable Bowel Syndrome (IBS)
• Pelvic Inflammatory Disease (PID)
• Painful periods.

How do I get an endometriosis diagnosis? 

Good question. Ultrasound and nowadays an MRI scan can be useful in helping to diagnose endometriosis, shares the doctor. That's because ovarian chocolate cysts (endometrioma) may be seen on a pelvic ultrasound and an MRI can sometimes pick up deposits of endometriosis. "An MRI pelvic scan can also pick up some cases of adenomyosis (deep internal endometriosis within the muscle of the womb), which can cause new symptoms of painful periods," she continues.

However, a keyhole operative procedure called a laparoscopy is the gold standard diagnostic test for endometriosis. "While this is an invasive procedure, done under a general anaesthetic, it not only confirms the diagnosis, it also allows a thorough assessment of the pelvis," she explains. That way, biopsies can be taken to analyse the tissue and treatment to excise ovarian cysts and release scar tissue can be all done at the same time by an experienced surgeon and a plan can be made regarding further management, especially regarding fertility options and pain management.

Medical treatment for mild cases or after surgery include:

• Hormonal medications such as the combined hormonal pill
• Progesterone
• Fertility drugs.

Endometriosis treatment: 3 steps to easing your endo pain

If you suffer from chronic pain and fear you may have endometriosis, PCOS, PMDD or any other common female health condition - or have been diagnosed - know this: you are not alone, and there is support out there.

If you have any of the following symptoms, do not hesitate to see a doctor, she shares:

• Painful periods
• Heavy periods
• Pain on vaginal intercourse
• Bowel or bladder symptoms
• Pain or blood while opening bowels or passing urine
• Issues falling pregnant.

Once you've been diagnosed, there is plenty of medical help available. Bajekal suggests asking to be referred to an endo specialist if you suspect you may have it. "There is medical help available post-diagnosis," she reassures. "And early diagnosis and acknowledging your condition allows for effective treatment, pain relief and overall improvement in mental and physical wellbeing, improving your overall quality of life," she shares.

The following tips might help, too.

1. Be aware of your own body

That is, always make a note of any changes. "Seek medical advice if over the counter painkillers do not settle your period pains or your day-to-day life is being affected by pelvic pain," the doctor advises.

2. Keep a pain and menstrual calendar

Top tip: track your menstrual cycle phases so when you meet your doctor, you have all the information ready.

3. Adopt a healthy lifestyle

And finally, work towards adopting a lifestyle with adequate sleep, reduced stress levels, and a balanced diet, she shares. Why? Preliminary research is showing that all of these factors can help ease symptoms.

When referencing "women," Bajekal wishes to be inclusive. People assigned female at birth (AFAB) may now belong to groups other than women, such as non-binary, intersex, and transgender people and often menstruate.