The hidden toll of female-specific health conditions on mental health

A new study has found that women living with female-specific health conditions, such as endometriosis, experience higher rates of psychological distress than women with conditions that affect both sexes.

Samantha Banton's journey to diagnosis was a long and arduous one, spanning nearly two decades. Her symptoms began as a teenager, with severe cramping, pain, and headaches in the days leading up to her period. "The few days leading up to my period were really awful, lots of cramping, lots of pain, headaches," she said. "Then when my period would actually start it would be excruciatingly painful."

Despite visiting multiple GPs in her hometown of Geraldton, 400km north of Perth, Ms Banton was told she was being "dramatic" and that her symptoms were "normal" due to her 28-day cycle. It wasn't until she underwent a laparoscopy that she received a diagnosis of severe endometriosis.

The years of uncertainty took a significant toll on her mental health. "The amount of searching up symptoms and also gaslighting yourself," she said. "You do start to fall into rabbit holes where you just re-evaluate your entire life and try to work out what you're not doing enough of because you still have these symptoms."

Link between mind and body

The Beyond the Surface report by Women's Mental Health Australia found that women with female-specific physical conditions experience greater psychological distress than women with conditions that impact both sexes. Neuroscientist and report co-author Bronwyn Graham said that under-diagnosis of these conditions was a major factor in the connection. "I think the biggest issue is that these conditions are under-diagnosed … so women are spending many years with undiagnosed discomfort, pain, other symptoms," Professor Graham said. "The symptoms themselves are going to be causing mental health distress, but then the way that they are received within the health system causes secondary distress … which elevates those symptoms."

Regional women face added challenges

The report found that women living outside metropolitan areas had significantly higher rates of mental health issues, including depression, anxiety, and post-traumatic stress disorder. Isolation, limited service providers, and long appointment waiting times are just some of the challenges regional women face. Ms Banton, who now lives over 1,000km from Perth, said the cost of medical treatment was an added burden. "You don't like to count costs, but sometimes you keep a running total in your head about what you have spent in order to get answers," she said.

Dee Van Beek, founder of Karratha Women's Place, a not-for-profit organisation providing free health programs and activities, said that social isolation and lack of services exacerbated the issue. Her daughter, Fern, a provisional psychologist at the centre, added that getting help to deal with physical health conditions could add to the mental health strain for women living in the regions. "Being away from family and friends, support networks, you also have that social isolation," Fern said. "Then the lack of services and options for support here … also creates additional stress and anxiety."

More integrated health care

The report recommends improved "wrap-around" care, with mental health support integrated into routine health care. Professor Graham said that fragmented service delivery failed to reflect the complex requirements of modern health care. "People may be going to get their symptoms of pelvic pain treated," she said. "But actually the thing that's most bothering them is the mental health side effects of that, and there aren't clear referral pathways." She urged women to advocate for their own health care and treatment needs. "You know your body, you know when something is not normal."

For Ms Banton, receiving her diagnosis was a mixed emotional experience. "Euphoric and really saddening because it was nice to have an answer, but it was sad at the same time," she said. "It meant that it hadn't all been in my head for many years; there was actually a reason."