Doctors keep misdiagnosing women, with lethal consequences
BY Susan Carleton
27th Jan 2024 Health Conditions
7 min read
Women face an epidemic of missed diagnoses in the UK, but knowing the signs of the most common overlooked diseases can help you take charge of your health
At 26, Jolene Stockton was already well on her way to a
brilliant career as a professional golfer. Rounding out her good
fortune, she and her husband were
expecting their first child, and the
pregnancy was going well.
Everything changed six months
after the birth of her daughter, when
Jolene's energy began to wane.
"Walking a short distance was difficult," she recalls, "and I wanted to
sleep all the time."
Jolene started losing weight, despite her almost constant hunger—and
constant eating. Her heart raced,
and she frequently felt overheated.
Then her left eye began to protrude.
Only when she applied for life
insurance and was rejected because
of an abnormal blood test did she
learn the cause: a malfunctioning
thyroid gland.
Thyroid disorders are one of several
diseases commonly misdiagnosed—
or missed altogether—in women.
Delays in treatment from faulty diagnoses can put affected women at
risk of major complications—some
even fatal.
What makes a disease hard to
detect? One reason is vague symptoms, that come on gradually and
are difficult for the patient to describe. That is why women should
know about commonly missed diseases. The following are six of the
most frequently misdiagnosed:
Thyroid disease
Jolene Stockton's weakness, weight loss and eye
trouble were caused by Graves' disease. This disorder prompts the
thyroid gland—which produces hormones that help regulate the body's
use of energy—to become overactive and pump out far more thyroid
hormone than normal.
The result
is hyperthyroidism, a condition that
speeds up bodily processes, including
heartbeat, digestion and metabolism.
Thyroid disorders affect around
1.1 million Britons, 90 per cent of
them women. The groups at highest
risk include women in their twenties
and those over 50.
"Thyroid irregularity such as Graves' disease often
goes unspotted because the signs on
examination are not that obvious,"
says Sir Richard Bayliss, chairman
and medical trustee of the British
Thyroid Foundation.
"Graves' disease often goes unspotted because the signs on examination are not that obvious"
"That's why it
is essential that patients describe the
symptoms they have experienced as
precisely as possible."
Jolene's doctor prescribed anti-thyroid drugs, which controlled her
symptoms until her third child was
born. When the disease flared again,
Jolene received radioactive iodine,
which destroys overactive thyroid
tissue.
This treatment usually brings
a permanent remission but may
require lifelong use of thyroid hormone replacement therapy.
Although not yet playing professional golf, Jolene eventually hopes
to make a comeback. "For now," she
says, "I'm happy just to be able to
take care of my family."
Endometriosis
If untreated, endometriosis can cause scarring and even infertility
By the time she
was 22, Lam Lenaghan had learnt to
live with painful menstrual periods.
But one month the pain was particularly severe, involving the lower back
as well as the abdomen.
Her doctor
thought she had a urinary tract infection and prescribed antibiotics. But
her discomfort persisted, accompanied by bloating, painful intercourse
and severe constipation.
After visiting six doctors, Lam
finally saw one who diagnosed endometriosis, a disease that affects an
estimated 1.5 million women in the
UK.
With endometriosis, tissue that
normally lines the uterus is found in
other areas of the pelvic cavity and
abdomen, sometimes causing debilitating pain, particularly during menstruation.
Untreated, it can lead to
scarring and formation of adhesions.
It is also suspected to be a cause of
infertility.
"It can lead to scarring and formation of adhesions. It is also suspected to be a cause of infertility"
Says Keith Edmonds, consultant
obstetrician and gynaecologist at
Queen Charlotte's and Chelsea Hospital, London: "Because endometriosis produces many of the same
symptoms as other gynaecological
conditions, it can easily be misdiagnosed at first."
A recent survey by
The National Endometriosis Society
revealed that more than a quarter of
its 2,000 members had suffered for
ten years or more before a correct
diagnosis was given.
Accurate diagnosis of this requires
a special viewing device called a laparoscope, which is inserted through
an incision to view the linings and
organs of the abdomen and pelvis.
During Lara Lenaghan's treatment,
the doctor used a laser to vaporise
several areas of endometriosis on her
large intestine and uterus. Now 25,
she had her first child in February.
After surgery, doctors often rely
on medication to keep endometriosis
from returning.
Treatments include
oral contraceptives and drugs such as
danazol and zoladex. In less severe cases, aspirin and non-steroidal
anti-inflammatory drugs (NsAins) are
used to control pain.
Pelvic inflammatory disease
A
19-year-old secretary went to her GP,
complaining of a persistent vaginal
discharge. The doctor told her she
had a yeast infection and sent her
home with anti-fungal suppositories.
A week later, she was in a hospital
casualty department with high fever
and excruciating abdominal pain.
There a pelvic infection was diagnosed, and she was given antibiotics.
Although her doctors didn't know
it at the time, the secretary was actually suffering from pelvic inflammatory disease (PH)), an infection of the
reproductive organs.
In 1992 some
6,500 women were treated for PID
at genitourinary clinics in England
and Wales. Yet many are unaware of
their condition because doctors may
not recognise the symptoms. And
sometimes there are none.
PID usually develops when infections, most
often sexually transmitted, are not
treated promptly and aggressively
enough with antibiotics to be totally
wiped out. Frequent changes of sexual partner and unprotected intercourse increase the risk of infection.
"This near-fatal complication was a direct result of PID"
Fifteen years after her first casualty department episode, the former
secretary was happily married and
expecting a baby.
Two months into
the pregnancy, she developed an agonising pain in her left side and was
rushed to hospital. There she underwent emergency surgery for a ruptured tubal pregnancy.
This near-fatal complication was
a direct result of PID. The disease
had caused scarring of her fallopian
tubes, which made it impossible for
the fertilised egg to pass through
and become implanted in the uterus.
Approximately half of the 4,000 cases
of tubal pregnancy that occur in England and Wales each year are thought
to have been linked to PID.
PID may also result in the complete blockage of the fallopian tubes,
which must be open for a woman to
conceive. As a result, each episode
of PID doubles a woman's chance of
infertility. The scarring or blockage
can sometimes be reversed with
microsurgery.
Systemic lupus erythematosus
Fever and fatigue are both signs of lupus, which can cause serious kidney damage
Michelle Housum was 15 when she
developed a persistent ache in her
chest and swelling in her fingers and
ankles. Her paediatrician diagnosed
pneumonia, which improved with
antibiotics. The joint problems were
growing pains, the doctor said.
Within a few months, however, the
teenager's elbows, knees and wrists
had become painful and enlarged,
and she was also plagued by rashes,
fever and fatigue.
Finally she entered
the hospital, weighing a skeletal four
stone nine and feeling so weak she
could barely lift her head.
Tests revealed Michelle had systemic lupus
erythematosus, an autoimmune disorder in which the immune system
attacks normal tissue.
An estimated 40,000 Britons suffer from lupus. The disease affects
nine times as many women as men.
Although it can occur at any age,
adult women make up the majority of
patients. Those of African or Asian
descent are at particular risk.
"Without treatment, kidney failure, seizures or debilitating arthritis may develop"
Lupus is difficult to diagnose because its many symptoms can vary
between patients. Says Brian Harmer,
director of the charity Lupus UK,
"Lupus can mimic other diseases such
as multiple sclerosis and rheumatoid
arthritis. There is currently no single
test to give a definite diagnosis."
The illness frequently starts with
fatigue, low-grade fever, hair loss,
sun sensitivity, and sores in the nose,
mouth and throat. A facial rash on
both cheeks and over the bridge of
the nose is another common sign.
Lupus can affect every organ system in the body, causing heart, lung
and kidney problems, as well as headaches.
Without treatment, kidney
failure, seizures or debilitating arthritis may develop. No cure is available.
But if the patient is treated early
enough, the immune system can be
suppressed and the disease arrested
before significant damage is done.
Michelle Housum controls her illness now with corticosteroids, which
suppress the immune system overactivity, and an anti-malarial drug,
which controls the rashes, fever and
muscle aches. Milder cases may be
treated with low-dose corticosteroids,
aspirin and NSAIDs.
Interstitial cystitis
In 1981, 32-year-old Marie Grimes experienced
symptoms of a bladder infection,
which her doctor treated with antibiotics even though her urine tested
negative for bacteria.
But day after
day she felt an ache in the lower
abdomen, accompanied by shooting,
burning urethral pains that came and
went without warning. Her frequent
need to urinate made her virtually
housebound.
Five doctors Marie saw could offer no help. "Some of them told me
it was all in my head," she says.
Finally, after four years, a urologist
diagnosed her condition as interstitial
cystitis (IC), a puzzling bladder disorder that's rare in men but affects
thousands of women.
"Her frequent need to urinate made her virtually housebound"
"Interstitial cystitis is hard to diagnose because the symptoms resemble
many other bladder conditions," says
Simon Hill, Research Fellow in Uro-Gynaecology, King's College Hospital, London.
"Strictly accurate
diagnosis requires a cystoscopy."
This
test involves hospitalisation and a
general anaesthetic; otherwise the
doctor must rule out all other possible reasons for bladder symptoms,
including common cystitis, kidney problems, certain sexually transmitted diseases and cancer.
The treatment Marie Grimes was
given—heparin, most often used as
an anti-coagulant, infused directly
into the bladder, along with another
medication taken orally—allayed her
symptoms.
A variety of treatments is
available to IC patients, but none
is effective for everyone.
Coronary heart disease
Signs of a heart attack in women can feel like minor conditions like heartburn
Furniture shop owner Jackie Landreth,
49, awoke one night with a crushing
chest pain that radiated down her left
arm. She braved the pain until morning, then saw a GP who told her she
looked healthy and sent her home
with antacids for indigestion.
Seven hours later, Jackie's friend
found her collapsed in her living room. She was rushed to hospital,
where doctors determined she'd had
a major heart attack. Tests showed
that one of her coronary arteries was
completely blocked.
Coronary heart disease (CHD) is
the number one killer of women,
claiming some 78,000 lives in the
UK each year.
Britain has the highest heart disease rate among women
in the world. And yet women with
CHD symptoms are less likely than
men with similar complaints to receive intensive evaluation and treatment.
"Britain has the highest heart disease rate among women in the world"
"Until five years ago, doctors
associated heart problems mainly
with men, and didn't recognise that
women are prone to the same risk
factors—smoking, obesity and diabetes," says Dr Diana Holdbright,
cardiology research registrar at the
London Chest Hospital.
Women typically have heart attacks later in life than men. The
elderly in general are less likely to
experience chest pressure or pain
radiating to the left side and may
have only "heartburn" or shortness of
breath.
This makes it difficult for
women and doctors to recognise coronary problems.
Jackie Landreth underwent angioplasty, the procedure that uses an
inflated balloon-tipped catheter to
widen clogged arteries.
Now, after
completing cardiac rehabilitation, she
has found ways to lessen stress and
reduce fat in her diet.
In addition to
beginning an exercise programme,
she takes daily drugs and has regular
evaluations by her cardiologist.
This article is part of our archival collection and was originally published in August 1994. While we strive to present historical content accurately, please note that circumstances and information may have changed since the article's original publication. Some individuals mentioned in the article may no longer be alive, and events or details may have evolved. We encourage readers to consider the context of the original publication and to verify any current information independently
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