Benign Gynaecological Conditions and the burden of global disease: something needs to be done!

According to the National Institute for Health and Care Excellence (NICE), around 1.5 million women in the UK suffer with endometriosis, a similar number to those affected by Diabetes. However, unlike those with Diabetes, it takes on average 7.5 years for women to get a diagnosis of endometriosis.

In light of Endometriosis month this March, at Learna | Diploma MSc we want to ensure that healthcare professionals are equipped with the knowledge and skills required to provide women with the proper care, diagnosis and treatment for endometriosis, and a number of other Benign Gynaecological Conditions (BGCs).

Prof. Alison Fiander, joint Programme Leader for our Women’s Health courses, has recently undertaken research with a study group from the Royal College of Obstetrics and Gynaecologists (RCOG), UK, drawing attention to the huge burden of morbidity due to Benign Gynaecological Conditions globally.

The RCOG group collated data from the Global Burden of Disease database, measured as years lived with disability (YLD) and weighted for impact. [Wijeratne D, Gibson JFE, Fiander A, Rafil-Tabar E, Thakar R. The global burden of disease due to benign gynaecological conditions: A call to action. Int J Gynaecol Obstet Feb 12, 2024, DOI: 10.1002/ijgo.15411].

It is important to note in relation to endometriosis research that while the research showed endometriosis recorded separately as the second most frequent BGC, ‘other gynaecological conditions’ accounted for the highest number of all YLDs across all countries. This figure realistically will also include cases of endometriosis - due to the huge delay in diagnosis time in High Income Countries, and the lack of access to diagnostic facilities and lack of healthcare professionals with specialist education in Low-and middle-income countries.

Hear from Prof Alison Fiander herself about the latest endometriosis research:

“The last 30 years have seen significant progress in global women’s health with much of the focus on maternal health and cervical cancer. Although there is still progress to be made in these areas, the lack of political priority given to BGC results in a large burden of unrecognised morbidity, enormous preventable suffering, and poor quality of life.

Whilst the Sustainable Development Goals (SDGs) have broadened the scope of women’s health priorities to include issues such as child marriage and gender-based violence, there remains a serious neglect of BGC, even though they contribute more to morbidity amongst women and girls than many other conditions considered major global health priorities.

Imagine living with heavy menstrual bleeding as a teenage girl, excluded from school due to stigma, lack of sanitary provision or a safe place to change. Or years of heavy bleeding resulting in iron deficiency anaemia and an inability to carry on with daily tasks anymore.

Imagine the irritation of chronic or recurrent ‘thrush’ (vulvovaginal candidiasis) or continuous aching and incontinence due to urogenital prolapse and nowhere to access help. What about years of pain, having to have time away from education or work, struggling with subfertility only to eventually be diagnosed with endometriosis?

In High Income Countries (HIC) almost 4% (3.94%) of years lived with disability were due to BGC in women aged 15+ years. In Low- and Middle-Income countries (LMIC) BGC accounted for an even higher percentage of morbidity, 5.35% of all YLD, and in Low Income Countries (LIC) this rose to 8.11% of YLD being due to BGC.

For specific gynaecological conditions, the leading cause of morbidity varies between age and income classification. Access the full paper here for greater detail.

Due to lack of access to gynaecological health services, diagnostic facilities as well as stigma in many areas of the world, the true morbidity of BGC could be many magnitudes higher than captured by the Global Burden of Disease database.

The GBD due to BGC was compared in the paper to the combined morbidity of
malaria/tuberculosis and HIV/AIDS as these conditions have much higher political and global health priority than BGC. The global YLD resulting from BGC (5.06%) were greater than combined morbidity of these well publicised conditions (1.08%), yet little priority is given to BGC.

To address the huge burden of disease due to BGC, and their enormous socioeconomic consequences, a sustained focus is required to make BGC a global priority. This involves funding for prevention, early identification, and the prioritisation of management of BGC by policy makers, governments, and non–governmental organisations.

Healthcare professionals and policymakers can address several areas to improve the care of women with BGC including access to evidence-based conservative treatments, improved decision-making, and safe surgical intervention.

For example, many BGC can be managed conservatively using established treatments, such as contraception for menstrual conditions, fibroid symptoms, and pelvic pain. Improving access to newer, long-acting agents such as the levonogestrel Intrauterine System (IUS) also has potential to manage symptoms and reduce surgical intervention. Training sufficient providers and using task-shifting where appropriate is crucial. The workforce for BGC is clearly insufficient at present.

In conclusion, BGC are a hugely under-reported and under-resourced area of global
women’s health; this is a marker of continuing gender inequality and highlights an urgent need to prioritise holistic healthcare for women.”

Study Women's Health Postgraduate Courses with Learna

For healthcare professionals looking to improve the poor quality of life currently suffered by many women and girls, our women’s health programmes offer an opportunity to make a real difference.

Study online, part-time to obtain a Postgraduate Diploma in Women’s Health in one year, or an MSc in just 2 years, during which time you will be supported by our exemplary faculty of world-leading experts in women’s health, including Prof. Alison Fiander.

Our master’s in women’s health offers the opportunity to undertake valuable research in women’s health in a topic of your choosing, with the chance of your research being published in reputable academic journals. The programmes are designed to fit seamlessly around existing professional and personal commitments, offering ultimate flexibility for healthcare professionals.

This endometriosis month, you can play your part in improving the quality of healthcare for women with better diagnosis, treatment and management of endometriosis and other Benign Gynaecological Conditions. Develop your career in obstetrics and gynaecology when you apply today to study our women’s health courses for nurses, doctors and other healthcare professionals this September.

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