This post is written by Milena Bacalja Perianes, managing partner of strategy at Madami and founder of the Menstrual Health Hub and Odette Hekster, managing director at Population Services International (PSI)-Europe.

  • The problem: The invisibility, normalisation, and minimisation of women’s pain is endemic in our society.

  • Why it matters: Women make up 50% of the global population yet they disproportionately bear the burden of inadequate healthcare systems.

  • The solution: An integrated solution to women's diverse health challenges across the life cycle: from menarche to menopause.

"It is not a problem of women. It is a problem of society," French President Emmanuel Macron said while announcing the launch of a national strategy to combat endometriosis. This call for action on health conditions affecting women was recently echoed by Professor Annemiek Nap, head of the department of obstetrics & gynaecology at Radboud University Medical Centre in the Netherlands, who stated that “this is not only a French problem, yet a global problem”.

From the margins to the mainstream

Globally, one in ten women suffers from endometriosis, a chronic and progressive condition in which tissues similar to the lining of the uterus grow outside of it. However, endometriosis is just one of many common menstrual discomforts, conditions and disorders that 190 million women around the world struggle to manage on a daily basis. This campaign, and similarly the Women’s Health Strategy for England (released in December 2021), demonstrate that women’s pain and experiences are increasingly moving from the margins to the mainstream in political discourse.

Women make up 50% of the population, therefore it makes sense that conditions and disorders which affect them should receive the funding and support needed to ensure that better research, testing, diagnosis and treatment can be offered. However, globally there is a funding (and commitment) gap when it comes to women-focused research and solutions.

In the case of endometriosis, Professor Nap states that funders and governments are insufficiently aware of what gains can be made for women when addressing such issues as endometriosis. Addressing women’s menstrual discomforts, conditions and disorders not only leads to less pain for women but has benefits for society as a whole - think fewer health care costs and women’s increased ability to contribute to societies and economies. A healthy population is a productive one, therefore investing in women’s health is smart economics.

We are excited to see these important commitments by the French and UK governments come at a time when the world is increasingly aware of unconscious gender and racial bias, and how these lead to the marginalisation or invisibility of certain groups. In her book Invisible Women, Caroline Criado Perez provides a variety of examples from smartphone design to urban planning where women are disadvantaged as a result of a male-centric viewpoint.

"we are here to tell you that period or pelvic pain is not normal and it’s time we start talking about it. "

Politicised bodies?

Women’s bodies are often a political weapon to be mobilised or repressed when politically convenient. It is important to remember that when it comes to global health, there is extensive evidence to suggest that women disproportionately bear the burden of poorly designed and inadequate healthcare systems. We saw this clearly during the global COVID-19 pandemic, which significantly disrupted essential health services mainly in middle- and low-income countries with limited accessibility and availability of services. During this time, we witnessed the deprioritisation of services that overwhelmingly impacted the health, wellbeing and participation of women including their ability to access antenatal and safe birthing services, sexual health clinics, (post)abortion care and family planning services.

The invisibility, normalisation, and minimisation of women’s pain is endemic in our society, with women’s pain taken less seriously than men’s. Historically, women’s pain has routinely been ignored with a number of studies showing that women in pain are much more likely than men to be misdiagnosed and less likely to be prescribed pain medication.

These experiences are exacerbated ten-fold when women walk into their doctor’s office and begin to describe some form of period, pelvic or vaginal-related pain. Over the centuries, we have normalised the idea that periods are just painful and vaginas are too mysterious to be fully understood by our healthcare systems.

But we are here to tell you that period or pelvic pain is not normal and it’s time we start talking about it.

Endometriosis is just one of many menstrual disorders or conditions from which a woman who experiences severe pain or pelvic discomfort may be suffering from.

The World Health Organization (WHO) estimates that there are 116 million women worldwide who suffer from polycystic ovary syndrome (PCOS), a hormonal disorder that causes an assortment of health problems, such as irregular menstrual periods, excessive hair growth, and the development of cysts on their ovaries. It can also cause infertility.

The other most notable menstrual disorder is uterine fibroids, with 4.5% (UK) to 17% (Italy) of the population experiencing this disorder. Uterine fibroids are non-cancerous growths of the uterus or womb that can cause anything from heavy menstrual bleeding, abdominal, pelvic or leg pain, or specific pain during intercourse. The Fibroid Foundation Africa states that countless women suffer miscarriages because of fibroids.

Women are not one group: who is seen and heard - and who is not?

In addition to menstrual disorders being seen as ‘women’s issues’, therefore less likely to receive attention or funding, we know that women of colour are statistically more likely to experience some of these conditions (such as fibroids) and receive sub-par care and treatment than their caucasian counterparts. In the US, African-American women disproportionately make up the number of hysterectomies (surgical removal of (part of) the uterus) than any other group. Why is this?

Health disparities are not just about gender equity but also racial equity. We cannot achieve universal health coverage without thinking about health equity and by looking at social inequality. We have to be honest with ourselves about which groups are seen and heard in healthcare settings, and which are not. National health campaigns and global health strategies must be cognizant of how different social identities such as gender, race, sexuality or disability status affect not only the disease burden but the quality of care that is received.

"Equitable healthcare systems must recognise the diverse needs of all its citizens in the diverse bodies in which they live."

With a global rollback of women’s rights, women’s bodies (particularly their vaginas) are in constant threat of politicisation by the left or right. In the US this has manifested in the global gag rule and a state by state fight for abortion rights for American women. We can see similar threats to women’s sexual and reproductive health across the globe such as in Ethiopia, Kenya and even countries in Europe including Poland. This is about a woman's fundamental right to decide over her own body, and that this right is protected. And about her right to be seen and heard by a healthcare system that recognises her pain and experience as real and worthy of treatment.

As the French and UK governments roll out these critical health strategies at home and overseas as part of global health policies, seeking to improve the health of populations and prosperity of nations, it's important that we continue to put women’s unique bodies and interconnected experiences front and centre. As Macron said, “it’s time we make these women’s fights visible”.

Let’s move towards integrated solutions to diverse needs

While there is a dire need for targeted investments in research on illnesses related to specific women’s health concerns, political agenda-setting for health issues should go beyond 'one-condition' campaigns and instead focus on integrated solutions to women's health challenges across the life cycle: from menarche to contraceptive needs; from pelvic pain to menopause; from pleasurable and painless sex to healthy women, mothers and thriving babies. Not every woman with period or pelvic pain has a condition, but menstrual health could just be the key to unlocking half the world’s wellbeing.

Equitable healthcare systems must recognise the diverse needs of all its citizens in the diverse bodies in which they live.

While the UK and France are beginning this important shift toward the prioritisation of women’s unique health needs through implementable health policy, there is much to be done. Where can other European countries and even the European Union step up to actively pursue a commitment to universal health coverage which recognises that diverse bodies have diverse needs?

The time is now to ensure our healthcare systems are inclusive, equitable and responsive to the real lives and experiences of the people they seek to serve.

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