What Does The Women's Health Strategy Mean For PCOS & Endometriosis?
In July the government published its first ever Women’s Health Strategy for England (https://www.gov.uk/government/publications/womens-health-strategy-for-england/womens-health-strategy-for-england), following a public consultation that attracted more than 100,000 responses. This was a landmark moment in itself – an acknowledgement that women’s health has long been neglected, and a first step towards changing that. But what does the strategy actually mean for women with PCOS and other reproductive health issues?
Firstly, the scale of the response demonstrates an enormous public appetite for change. Of the 100,000 women who responded, 84% felt they had not been listened to by a healthcare professional, with many saying their symptoms had been dismissed, and more than 90% saying they didn’t have enough information about women’s health issues. Perhaps unsurprisingly, the five key areas respondents wanted the government to prioritise were gynaecological conditions; fertility, pregnancy, pregnancy loss and postnatal support; the menopause; menstrual health; and mental health.
The Women’s Health Strategy is a ten-year plan, which lays out a series of ambitions to be achieved over the next decade, and details various steps towards those aims. That means we’re not going to see change overnight, but that’s to be expected – the biases and inequalities in women’s healthcare are complex and deeply rooted, requiring seismic cultural and practical shifts to take place.
Key commitments include measures to improve medical students’ training and assessment on women’s health issues, and greater investment in women’s health research. The General Medical Council (GMC) is introducing a new assessment process for all new medical students from the 2024/25 academic year onwards, covering a range of women’s health issues, including menstrual problems and endometriosis – although PCOS isn’t on the list of conditions covered (https://www.gmc-uk.org/-/media/documents/mla-content-map-_pdf-85707770.pdf).
Meanwhile, the government will commission a new policy unit dedicated to reproductive health, as part of the National Institute for Health and Care Research (NIHR), which will carry out research to inform policy on menstrual health, gynaecological conditions and the menopause. The strategy also pledges to “encourage” research into suggested areas, including the links between PCOS and metabolic syndrome – although it’s not entirely clear what form this encouragement will take.
If implemented well, both of these could have a huge impact on women and people affected by gynaecological and reproductive health conditions. Like so many conditions that primarily affect women, these have long been under-researched and poorly understood by the medical community. While awareness of issues like PCOS and endometriosis has begun to improve in recent years, it’s clear there’s still plenty of work to be done on improving diagnosis times and support – not to mention developing more effective treatments and even cures.
The strategy also states that NHS England is updating the service specification for severe endometriosis. This, it says, will ensure specialist endometriosis services have access to the most up to date evidence and advice, and help to improve standards of care. Meanwhile, NICE (the National Institute for Health and Care Excellence, which publishes treatment guidelines for the NHS) is reviewing whether to update its guidance on endometriosis, and “will also consider the development of a guideline on polycystic ovary syndrome (PCOS) through the established processes for identifying and prioritising guidelines” – which, frankly, sounds a bit vague and non-committal at this stage.
There are similarly vague commitments on reducing endometriosis diagnosis times – something Endometriosis UK and patient advocates have long been calling for. As part of its ten-year plan on menstrual and gynaecological health, the strategy pledges that: “women and girls with severe endometriosis [will] experience better care, where diagnosis time is reduced on the journey from initial GP appointment through to final diagnosis”. But with no clear target for when or how much the diagnosis time should be reduced by, it’s difficult to see how the success of this ambition will be measured.
The government has already introduced mandatory relationships, sex and health education (RHSE) to the school curriculum, covering topics like menstrual health and the menopause, and the Women’s Health Strategy reiterates that this will be an important part of educating girls and young women about their bodies and monthly cycles.
Over the next ten years, the strategy aims for women and girls to “have an awareness of the different gynaecological conditions such as endometriosis and PCOS.” However, these conditions are not yet specifically included in the health curriculum, which raises questions about how this ambition will actually be achieved. We’d like to see the government go further, so we’re calling on them to include PCOS and endometriosis in the health education curriculum. You can sign our petition here to support the campaign.
Finally, women’s health charities, healthcare professionals and professional bodies – including the Royal College of Obstetricians and Gynaecologists (ROCG) – have raised concerns about the apparent lack of dedicated funding to put the strategy into practice, and highlighted the need for a workforce plan to further support its implementation. The radical change that is so desperately needed will be difficult to truly achieve without both the money and the staff to put the strategy into practice.
None of this is to say that it isn’t a hugely positive first step. The fact that such a strategy now exists is fantastic progress, even if it is long overdue. This ten-year plan covers a lot of ground, and so much of what it commits to is really very promising. But, with so many of the finer details still unclear, the true impact of the Women’s Health Strategy remains to be seen.