Why do doctors underdiagnose these 3 conditions in women?

blonde woman facing man

Maria Cohut 
checked by Paula Field
International Women’s Day
prompts us to celebrate women and womanhood. However, recent research suggests
that women may face more than their fair share of challenges, including in
receiving appropriate medical care. What are some of these challenges, and why
do they occur?

Women have played a vital role
in the improvement of medical care across clinical fields.
Figures such as Dorothea Dix,
who helped change the face of mental health care, Rosalind Franklin, who
contributed to the discovery of human DNA structure, and Dr. Virginia Apgar,
who put together the evaluation criteria assessing the health status of newborn
infants, have revolutionized medicine.
Despite this, women and girls
across the world still face challenges and discrimination in medical settings.
Only last year, for instance,
senior staff from the Tokyo Medical School, as well as from Juntendo and
Kitasato Universities in Japan, admitted to manipulating entrance exam scores
so that fewer women candidates would qualify for their courses.
These admissions spurred
endless debates about the degree to which women who choose medical care as a
profession keep on facing waves of discrimination.
Such problems, however, do not
stop at women trying to build a career in medical sciences. According to some
reports, women also face discrimination as patients. Sometimes, their doctors
fail to diagnose conditions they are struggling with, or offer them the wrong
diagnosis and consequently, the wrong kind of therapy.
In this Spotlight feature, we
will look at some of the conditions that doctors underdiagnosed in women and
explore some of the possible reasons behind these lacks in medical care.
One of the chronic conditions
that many women struggle with for a long time before they manage to receive a
correct diagnosis — if they ever do — is endometriosis.
Endometriosis is a progressive
gynecological condition, which doctors currently consider incurable.
Endometriosis occurs when the type of tissue that usually only lines the uterus
grows in other parts of the body. This can include the ovaries, fallopian
tubes, urethra, but also the bowel, kidneys, and other organs.
Symptoms of this condition
include debilitating pain in the pelvic area, as well as other parts of the
body, heavy and persistent menstrual bleeding, spotting between periods, pain
during sex with vaginal penetration, nausea and vomiting, severe headaches, and
persistent fatigue.
These symptoms can often have
a severe impact on an individual’s quality of life, affecting their
productivity, other aspects of their physical and mental health, and their
Estimates in the journal
Fertility and Sterility indicate that 10–15 percent of women of reproductive
age live with this condition, and 70 percent of women who experience chronic
pelvic pain actually have endometriosis.
As the authors of that study
paper write, “The time from the onset of symptoms to diagnosis is
disturbingly long.” Two-thirds of the people they spoke to begin to
experience symptoms of endometriosis during adolescence. However, most of these
people do not seek medical attention immediately, and once they do, it can take
doctors 10–12 years to make a correct diagnosis.
Typically, doctors can only
diagnose endometriosis by conducting a laparoscopy. This is a minor surgical
procedure in which a doctor inserts a tiny camera into the abdomen to look for
lesions and abnormalities.
A doctor may prescribe pain
relief medication or hormonal therapy for the management of endometriosis, but
since this condition is progressive, many people require multiple and regular
surgeries to remove the abnormal tissue growth.
‘So validating to know I
wasn’t weak or crazy’

One woman, aged 25, who spoke
to Medical News Today, explained that she lived with severe endometriosis
symptoms for years before she received a correct diagnosis.
Primarily, this was because
both she, her family, and the doctors that she consulted, thought that her
disabling symptoms were nothing more than “bad period pains,” or else
they mistook them for other health problems.
“I thought it was totally
normal to have excruciating pain and 10-day-long heavy periods,” she told
us. “My mom, aunt, and grandmother all had the same experience, so I was
always told ‘that’s just how it is for women in our family,'” she added.
“I thought maybe I was
weak and not able to handle the pain as well as other girls. Last year I was
diagnosed with deep infiltrating endometriosis and finally had an explanation
and, most importantly, a treatment plan. It was so validating to know I wasn’t
weak or crazy, just dealing with a chronic condition.”
She also told us that her
journey towards a diagnosis was difficult and long-winded. “I’ve gone
through three [general practitioners] and two gynecologists in 2 years,”
she explained. She added that because her condition affected several organs,
she received many different — and incorrect — diagnoses before the doctors
eventually identified the real issue.
“I have endometriosis on
my bladder, urethra, kidneys, and bowel, so I wound up with many doctors saying
‘you have [irritable bowel syndrome]’ and ‘you have [pelvic inflammatory
disease],’ when I knew this wasn’t the case.”

2. Coronary heart disease

Another health problem that
doctors often fail to spot in women is coronary (or ischemic) heart disease
(CHD). This disease occurs when the arteries that deliver oxygenated blood into
the heart, so that the heart can pump it out to the other organs, become unable
to “service” the heart effectively.
The symptoms of CHD vary from
person to person, which can make the condition challenging for doctors to spot.
However, more generally, symptoms also differ between men and women, and more
women thus go undiagnosed until the condition becomes exacerbated.
The National Heart, Lung, and
Blood Institute explain that symptoms can also vary between different types of
CHD, and some people do not experience any symptoms at all. However, some
common symptoms include angina (pressure in the chest area, especially during
physical activity), neck pain, and fatigue.
They also state that
“[h]eart disease is the leading cause of death for women,” and that
women are more at risk than men of developing non-obstructive CHD. This
condition can occur when the arteries that go into the heart abnormally tighten
or are “squeezed” by the surrounding tissue.
Unlike obstructive CHD, which
is more likely to be characterized by tell-tale chest pain, non-obstructive CHD
is often “silent” and may go unnoticed for a long time.
Past research published in the
BMJ has argued that doctors often miss CHD in women because of the different
set of symptoms and because women themselves do not seek medical attention
early on.
“Women may have more
atypical symptoms than men — such as back pain, burning in the chest, abdominal
discomfort, nausea, or fatigue — which makes the diagnosis more
difficult,” the researchers write.
Moreover, they add that:
“Women are less likely to seek medical help and tend to present late in
the process of their disease. They are also less likely to have appropriate
investigations, such as coronary angiography and, together with late
presentation to hospital, this can delay the start of effective

‘Research has focused
primarily on men’

Specialists have been trying
to find better ways of assessing and diagnosing women with heart problems, but
they acknowledge there is still a long way to go in this respect.
One review, which appears in
the journal Circulation Research, notes, “For the past 3 decades, dramatic
declines in heart disease mortality for both men and women have been observed,
especially in the [over] 65 years age group.”
“However,” its
authors add, “recent data suggest stagnation in the improvements in
incidence and mortality of coronary heart disease, specifically among younger
But why is this the case? The
study authors argue that it may all be down to the underrepresentation of
female populations in clinical studies for heart and vascular problems. They
“For many decades,
[cardiovascular disease] research has focused primarily on men, thus leading to
an underappreciation of sex differences from an etiologic, diagnostic, and
therapeutic perspective. As long as women are underrepresented in clinical
trials, we will continue to lack data to make accurate clinical decisions on 51
[percent] of the world’s population.”

3. Attention
deficit/hyperactivity disorder

Women do not just miss out on
physical health diagnoses; this problem also extends to other conditions, such
as behavioral conditions, and more specifically, attention
deficit/hyperactivity disorder (ADHD).
The National Institute of
Mental Health define ADHD as “a brain disorder marked by an ongoing
pattern of inattention and/or hyperactivity-impulsivity that interferes with
functioning or development.”
Typically, doctors see ADHD as
a problem specific to childhood, and the Centers for Disease Control and
Prevention (CDC) note that in 2016 — the latest year for which data are
available — around 6.1 million children in the United States had received an
ADHD diagnosis.
Furthermore, according to the
Anxiety and Depression Association of America, while approximately 60 percent
of children with ADHD in the U.S. continue to experience the symptoms of this
condition as adults, less than 20 percent of adults with ADHD receive the
correct diagnosis.
If adults, in general,
struggle to receive a diagnosis, the situation is even worse in the case of
women. Research has shown that both families and healthcare professionals are
biased towards believing that boys and men are more likely to have ADHD, and
they are more likely to ignore similar symptoms in girls and women.
In fact, some sources indicate
that up to three-quarters of all women with ADHD never receive a diagnosis, and
in the case of children, doctors diagnose fewer girls than boys with ADHD.
Moreover, girls have to wait
longer than boys to receive a diagnosis of ADHD. While boys, on average,
receive a diagnosis at age 7, girls have to wait until they reach the age of 12
to get the same clinical attention.

Some women think ‘it is too

In a review published in The
Primary Care Companion for Central Nervous System Disorders, researchers
explain that in boys and men, ADHD manifests as hyperactivity and
impulsiveness; in girls and women, this condition takes a different guise. In
women and girls, the primary symptom of ADHD is inattentiveness, which doctors
may struggle to spot. Often doctors take this less seriously.
The same source also suggests
that girls and women with ADHD may develop ways of masking their symptoms. Some
may appear to have better coping strategies than boys and men with the same
Also, because people with ADHD
sometimes have other mental health problems, such as anxiety, depression, and
obsessive-compulsive disorder, the review authors point out that existing evidence
indicates that doctors will much more eagerly diagnose women as living with a
mental health condition, but deny them an ADHD diagnosis.
One woman — now in her 50s —
who spoke to MNT told us that although she fits ADHD criteria and has lived
with ADHD symptoms for a long time, she still has not received an official
“Therapists are pretty
sure I have ADHD, the [national health services] still do not diagnose ADHD in
adults and in particular women, and [only] direct you to do online tests,”
she explained, adding:
“[After] reading an
article by a man in the United Kingdom that [said] it took years for him to get
a diagnosis, I stopped worrying about it. It is too late to take medication for
it at my age; as they say, [it would be like] shutting the stable door after
the horse has bolted.”
Although medical systems
across the globe have come a long way in terms of providing better quality care
at an appropriate time, such accounts make one issue very apparent, namely that
discrimination is still present in clinical research and health care. To fight
it, we must all learn how to listen — really listen.
Kayode Ojo
Kayode Emmanuel Ojo is the Co-Founder and Managing Director at SHEFFA Limited. He is presently studying Computer Science at the National Open University, Victoria Island, Lagos.