When a link to this study, which found that the higher a patient’s BMI, the lower their physician’s respect for them, showed up in my Twitter feed yesterday (thanks, Michelle), I started connecting some dots.
Women delay seeking treatment for menstrual pain due in part to taboos about menstruation and concealment, often waiting and suffering for years. As I learned recently (and reported here), research estimates an average delay between onset of pain and diagnosis of endometriosis of 8 years in the UK and 11 years in the US.
Women (and men) who are considered “overweight” are frequently treated badly by health care practitioners, who tend to focus on the weight as the Cause Of All Illness and Ailments. Regardless of the reason for seeking treatment, fat patients are advised to lose weight. Given this reality, many fat people avoid seeing health care providers altogether, and those who do are less likely to be screened for breast, cervical, and colorectal cancers. Even fat people with college educations and health insurance avoid doctors.
So what happens when fat women have menstrual problems? (Please note that I am following the practice of other advocates of fat acceptance and Health At Every Size (HAES) in using the term fat as a descriptive adjective, not a pejorative.)
Xanthine sought care from a respected gynecologist in her community for her uncomfortably heavy periods. The doctor could not stop talking about her gut: “Cut out the refined starches. Lose some of that gut, yes, at least twenty pounds you could stand to lose. Ha ha! Goodbye!” Xanthine reminded him again of the reason for her pelvic exam, and he changed her prescription for birth control pills.
Gina, a 16-year-old with a history of irregular menstruation who stopped having periods altogether, was advised to join Weight Watchers and to get lap-band surgery.
Because of a career-related relocation, Susanne was unable to receive treatment from the same doctor who diagnosed her Polycystic Ovarian Syndrome (PCOS). Her new gynecologist told her, “PCOS isn’t a real disease, it’s been made up by fat women.” This doctor went on to disparage the test results from her previous physician as well as Susanne’s intelligence.
There are more stories, of course. These are just some of the most egregious examples from the collection at First, Do No Harm: Real Stories of Fat Prejudice in Health Care.
I’m left wondering how many women of all sizes suffer in silence. How do any of us even know what counts as “normal” or “abnormal” menstruation??
