Women's Health: When the Evidence Doesn't Reflect the Patient
Women's health is often discussed through the lens of pregnancy, contraception, cervical screening and menstrual health. While these are all important aspects of healthcare, they represent only one part of the picture. Women's health is also cardiovascular health, bone health, immune function, mental health, healthy ageing, and every other body system that contributes to wellbeing throughout life. In many ways, women's health isn't a separate area of medicine at all. It is simply medicine viewed through the experiences and biology of half the population.
One of the things that makes women's health unique is that change is expected. Throughout life, women experience significant physiological changes that influence almost every organ system. Puberty, menstrual cycles, pregnancy, breastfeeding, perimenopause and menopause all bring normal hormonal shifts that can affect energy levels, mood, sleep, pain, metabolism and many other aspects of health. These changes are a normal part of life, but they can also make it difficult to recognise when something has changed in a way that deserves further attention.
Healthcare is not simply about identifying disease; it is also about recognising what is normal for you. A symptom that is expected for one woman may be unusual for another. Likewise, symptoms that gradually become part of everyday life, such as worsening period pain, increasing fatigue or changes in bowel habits, can sometimes be accepted as "normal" simply because they develop slowly or are commonly experienced by others.
Research suggests this uncertainty can have real consequences. Around one in ten women of reproductive age are living with endometriosis, yet diagnosis commonly takes seven to ten years.¹ Cardiovascular disease remains the leading cause of death among women globally, despite many women experiencing symptoms that differ from those traditionally associated with heart attacks.² Women also account for approximately 80% of people living with autoimmune diseases, many of which develop gradually and can present with symptoms that are easily attributed to the demands of everyday life.³
None of these examples suggest that women should become experts in medicine or worry that every symptom signals something serious. They do, however, highlight the importance of knowing your own body. The better we understand what is normal for us, the easier it becomes to recognise changes, ask informed questions, and seek healthcare when something doesn't feel quite right.
Because good healthcare is not only about the knowledge held by clinicians.
It is also about helping people understand their own health well enough to become active participants in their care.
Understanding your own normal.
One of the biggest misconceptions about healthcare is that patients are expected to arrive at an appointment knowing what is wrong.
They are not.
Healthcare professionals are trained to investigate symptoms, interpret clinical findings and make diagnoses. What they cannot know, however, is what feels normal for your body.
Has your menstrual cycle always been this heavy?
Is this pain different from what you've experienced before?
Has your energy changed over the last few months?
Are these headaches becoming more frequent?
Has this medication changed the way you feel?
These observations may seem small, but they often provide some of the most important clues in understanding what is happening. Becoming familiar with your own baseline doesn't mean becoming anxious about every symptom. Rather, it means recognising when something no longer feels like your normal.
When common doesn't always mean normal.
One of the challenges in women's health is that many conditions begin with symptoms that seem familiar.
Periods can be painful. Hormones fluctuate. Stress affects mood and energy. Fatigue is common, particularly when balancing work, study, whānau and the many other demands of everyday life.
The difficulty is that some health conditions begin in exactly the same way.
Around one in ten women of reproductive age are living with endometriosis, affecting an estimated 190 million women worldwide. Despite this, international studies consistently report delays of seven to ten years before diagnosis.¹ This isn't because there is one simple test that has been overlooked. Endometriosis can mimic many other conditions, symptoms vary considerably between individuals, and diagnosis often requires specialist assessment.
The same principle applies more broadly across women's health. Heavy menstrual bleeding, pelvic pain, persistent fatigue or changes in bowel habits may have many different causes, and often they are not serious. However, when symptoms persist, worsen, or begin affecting daily life, they deserve a conversation rather than an assumption.
A helpful question is not simply, "Is this normal?" but rather, "Is this normal for me?"
Women's health is whole-body health.
For a long time, a bungy jump felt physically out of reach for Awhina.
“I was in that mindset of being a bigger person and thinking, ‘That’s not going to be for me. It’s just going to be a dream.’”
But as she reached each new milestone, that lifelong goal began to feel possible.
“I thought, okay, this is becoming more and more attainable. I think I could actually do it.”
When she saw the Five Years of Fierce giveaway, she decided to back herself and enter. Now, with R&P helping make it happen as part of our fifth birthday celebrations, that “maybe one day” goal is about to become very real.
The bungy isn’t about proving anything to anyone else. It’s a celebration of the work Awhina has already done and the person she has found along the way.
Becoming an active participant in your healthcare.
Healthcare is increasingly recognised as a partnership.
Healthcare professionals bring clinical knowledge, experience and evidence. Patients bring something equally valuable, their lived experience.
Being an active participant in your healthcare does not mean arriving with a diagnosis or challenging every recommendation. It means feeling confident enough to ask questions, seek clarification and share the information that only you can provide.
Simple things can make a real difference. Keeping track of symptoms, particularly if they change throughout your menstrual cycle, can help identify patterns over time. Writing down questions before an appointment can make it easier to remember what you wanted to ask. Understanding why a test has been ordered, what a diagnosis means, what changes should be expected, and when to seek further review can all help you leave an appointment feeling informed rather than uncertain.
If something still doesn't feel right after an appointment, it is okay to go back. Symptoms change, new information emerges, and sometimes diagnoses become clearer over time. Seeking further review when something doesn't improve is not overreacting. It is part of looking after your health.
Looking ahead.
Women's health research has advanced enormously over recent decades. Women are now routinely included in clinical research, conditions that have historically received less attention are receiving greater investment, and our understanding of female biology continues to grow.
That progress is improving healthcare.
But knowledge should not remain confined to research papers or clinical guidelines.
Every woman deserves to understand her own body well enough to recognise when something has changed, feel confident asking questions, and participate meaningfully in decisions about her health.
Understanding your body will not prevent every illness, nor does it replace the expertise of healthcare professionals. What it does provide is confidence. Confidence to recognise when something feels different, confidence to seek help early, and confidence to know that your health is worth paying attention to.
Because knowing your body is not about having all the answers.
It's about knowing when it's time to start asking questions.
References
World Health Organization. Endometriosis. 2023. https://www.who.int/news-room/fact-sheets/detail/endometriosis
World Health Organization. Cardiovascular diseases (CVDs). 2021; World Heart Federation. Women and Cardiovascular Disease.
Fairweather D, Frisancho-Kiss S, Rose NR. Sex differences in autoimmune disease. American Journal of Pathology. 2008; NIH Office of Research on Women's Health.
