Long Reads

Yentl syndrome: how this little-known gender bias could be costing women their lives

More than 8,000 women in 10 years needlessly died from a heart attack. When are we going to close the gender gap in healthcare?

When you hear the words ‘heart attack’, you probably picture a middle-aged man clutching at his chest, before falling dramatically to the ground.

For us women, this is a problem. A new report from the British Heart Foundation (BHF) has highlighted an alarming ‘heart attack gender gap’, and it’s costing women our lives. BHF-funded research estimates that more than 8,200 women needlessly died over a 10-year period because the treatment they received was worse than that given to men.

It’s just yet another example of how dangerous everyday sexism can be when it comes to our health.

heart attack in women
Heart attack in women: over 8,000 women have needlessly died from a heart attack

As a freelance health journalist, and founder of feminist health blog Hysterical Women, I see evidence of this danger all the time. There’s a growing body of research into the ‘gender pain gap’, showing that women’s health concerns are less likely to be taken seriously than men’s across a huge range of conditions. Gender bias in healthcare is complex, and deeply ingrained – ranging from the subtle and insidious, through to downright medical misogyny – but it’s time we urgently started addressing it.

Heart attacks in women are not rare. Coronary heart disease – which causes most heart attacks – kills twice as many women in the UK as breast cancer. Despite this, the misconception that only men are affected prevails. Sometimes, of course, it’s as simple as a lack of awareness leading to symptoms being missed in those who don’t fit that mould.

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Marie was just 35 years old – a young and fit woman – when she had a heart attack. “I had this shocking pain in my chest, which then went down my arm, and I went really, really hot, and dizzy,” she says. These are the classic symptoms of a heart attack, yet she says: “it never occurred to me that it could be anything of that nature.”

heart attack women
Heart attack in women: Marie was 35 when she had a heart attack

When paramedics arrived, an electrocardiogram (ECG) showed no abnormal heart activity, and Marie was told it wasn’t mandatory for her to attend hospital. Luckily, the paramedics suggested that she did. “I was in a lot of pain, so I wanted to get checked out, but I noticed the ambulance didn’t have its lights on and I was still assuming I’d be back at work in time for lunch,” she says.

It wasn’t until Marie had been admitted to A&E and undergone further ECGs and blood tests that someone realised she was, in fact, suffering from a heart attack. An angiogram revealed this was caused by a spontaneous coronary artery dissection (SCAD) – a rare but devastating condition that predominantly affects young, healthy women.

Fortunately, in Marie’s case, the story has a happy ending, and she received excellent care. But would paramedics, or even Marie herself, have been quicker to recognise the urgency of her situation if she’d been a middle-aged man presenting with the same symptoms? It’s impossible to know for sure, but research shows that women having heart attacks attend hospital later than men, and are 50% more likely to receive a wrong initial diagnosis. Another study found that women are seven times more likely than men to be misdiagnosed and discharged in the middle of having a heart attack.

That’s before you even get as far as treatment, where research shows women consistently receiving worse care than men. A plethora of studies – not just about heart attacks – show that women are less likely to be taken seriously than men, are kept waiting longer in A&E, and are more likely to be prescribed sedatives for pain, instead of painkillers. They are also more likely to have their pain dismissed as a psychiatric problem

This phenomenon is so widespread it even has its own name, Yentl Syndrome – a phrase originally coined in 1991 by cardiologist Dr Bernadine Healy to describe the different ways men and women are treated after heart attacks.

plant in hospital
Heart attack in women: women are less likely to be taken seriously than men in hospital

Anecdotally, too, you probably know at least one woman who’s felt dismissed or not been taken seriously by her doctor. You might have even experienced this yourself. I’ve heard many of these stories – including, most recently, a woman who was dismissed with “stress”, only to later be diagnosed with a tumour on her pituitary gland. By the time it was discovered, the tumour was so large that within just six months it would have caused irreversible blindness.

But, while it’s easy to find statistics and examples of how frequently this happens, it’s harder to pinpoint exactly why. With heart attacks, it was once believed that men and women experienced different symptoms – that ‘male symptoms’ were seen as the default, while women’s symptoms were ‘atypical’ and therefore often missed. But newer research has shown this to be a myth.

So what exactly is going on? Medicine’s history of sexism and ‘hysteria’ certainly has a lot to answer for when it comes to persistent, and often unconscious, gender biases across the medical community. While doctors might not say, or even consciously think, a patient is ‘hysterical’, women’s pain and suffering is still too often dismissed as either ‘all in her head’, exaggerated, or – in the case of sexual and reproductive issues like endometriosis – a normal and inevitable part of being a woman.

Women have also historically been more likely to be excluded from medical research – meaning less is known about how women respond to certain medications and treatments, and even less is known about conditions that primarily affect women. A 2017 study found that even just including women as researchers improved the likelihood of medical research taking sex and gender differences into account – and that failing to do so could have “potentially life-threatening and costly consequences”.

As so many of these cases show, it’s vital that we empower women to know our own bodies and fight our own corners – whether that’s knowing the symptoms of a heart attack, or calling out doctors who don’t take you seriously. But the onus shouldn’t be on women to make doctors believe us. Improving women’s participation in research – both as subjects and researchers – is one tangible step we can take towards closing this gender gap, along with educating doctors and medical institutions to be aware of their own unconscious biases.

More than 8,000 women’s lives could have been saved if they’d been treated equally to men. Just remember that the next time someone tells you feminism has done its job.

The NHS lists the following symptoms as signs of  a heart attack:

  • chest pain – the chest can feel like it’s being pressed or squeezed by a heavy object, and pain can radiate from the chest to the jaw, neck, arms and back
  • shortness of breath
  • feeling weak or lightheaded, or both
  • an overwhelming feeling of anxiety

The NHS adds that “it’s important to stress that not everyone experiences severe chest pain. The pain can often be mild and mistaken for indigestion.

“It’s the combination of symptoms that’s important in determining whether a person is having a heart attack, and not the severity of chest pain.”

For more information, please visit the NHS website here.

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Images: Getty, Unsplash, courtesy of author

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