Dallas Bollmann is mortified. Her hands are clammy, and the room suddenly feels 10 times smaller.
An hour ago, she was sitting in a maths class and now a doctor is telling her getting pregnant could cure her severe abdominal pain and heavy vaginal bleeding.
Maybe, she thinks, she misheard him. She's only 15.
Surely bringing a baby into the world isn't the answer to treating her unknown health condition?
But Bollmann heard right.
She left that appointment in tears and never returned.
She didn't follow that doctor's advice and instead suffered in silence.
Nearly a decade later, she got the correct diagnosis for her symptoms: endometriosis, a crippling condition affecting at least one in 10 women.
Her story is far from isolated.
Follow women's personal stories of poor healthcare in our interactive grid below. Click on a face to go to the full story.
The Herald is launching a new campaign called In Her Head, revealing how our health system is failing women, often making them feel like their illness is a figment of their imagination or "just part of being female".
It follows our earlier reporting which last year revealed how systematic gender bias in our medical workforce is ruining women's health.
The campaign follows stories of women suffering conditions such as endometriosis, surgical mesh complications, birth injuries, postnatal depression and gynaecological cancers.
It aims to empower more wāhine to feel heard, and to provoke discussion about how we are treating women in our health system.
We also interviewed doctors, advocates, researchers and politicians to understand what's going wrong and how we can better healthcare services for women.
International studies show women suffer from greater rates of misdiagnosis and longer delays for treatment. In Sweden, women in a hospital emergency department waited significantly longer to see a doctor and were less often classified as an urgent case. In the US, women were more likely to receive anti-anxiety medications than men when they came to hospital with pain – and were more often misdiagnosed as psychiatric patients.
Women are more likely than men to be misdiagnosed for stroke, face longer waits to be diagnosed with cancer and heart disease and are treated less aggressively for traumatic brain injury, the New York Times reported on March 28.
Similar research is not available for New Zealand, but the Herald found thousands of Kiwi women have received large taxpayer-funded payouts after being let down by our country's health system. ACC has paid nearly $27 million in the past five years to women who have been harmed by treatment.
This is likely the tip of the iceberg, as many women and advocates the Herald spoke to said they weren't aware they had a right to lodge a claim or they weren't eligible.
Separate data the Herald obtained from the Health and Disability Commission (HDC) showed women complain significantly more often about their healthcare than men.
Between 2017 and September 2021 the HDC received 5812 complaints about treatment provided to women, compared to 3266 for men. The agency said it didn't have data showing how often complaints were upheld.
The most common grievances from women were:
• Inappropriate treatment.
• Missed, incorrect or delayed diagnosis.
• Failure to communicate effectively with the woman.
• Disrespectful manner or attitude.
• Inadequate, inappropriate examination or assessment.
• Lack of access to services.
• Delay in treatment.
• Unexpected treatment outcome.
When the Herald asked commissioner Morag McDowell why the HDC received more complaints about women's healthcare than men's, she said the reasons weren't fully known but there were probably many factors.
"For example, the number of complaints can be driven by the amount of contact time with healthcare providers, awareness among [patients] of their rights and willingness to complain, and communication and quality of care issues."
One of the underlying problems in our record of poor healthcare for women remains informed consent. It has been 33 years since the Cartwright Inquiry into mistreatment of cervical cancer at National Women's Hospital in Auckland addressed a serious lack of informed consent for women in health services, resulting in the Code of Health and Disability Services Rights under the Health and Disability Commissioner Act 1994.
The Code means that by law, New Zealand's healthcare system is meant to treat everyone with respect, dignity and appropriate standard of care. Yet progress has been painfully slow.
As former Commissioner Anthony Hill noted in the 2019 HDC annual report: "The issue of informed consent… continues to be raised in complaints to HDC."
Every day, women leave medical appointments feeling like they haven't been listened to.
Some are sent home from emergency departments after being accused of being a 'drug seeker' or 'mentally unstable'.
Many are told there's nothing wrong with them and they are made to feel like their suffering is "just a part of being a woman".
Some are misdiagnosed, some wait decades to be diagnosed and many slip through the cracks, ultimately left to suffer in silence.
The consequence can be deadly and is nearly always soul-destroying.
"I kept thinking maybe I'm just being weak, maybe I just need to harden up. For years that made me think I was going crazy but I wasn't crazy," 31-year-old Bollmann says about her endometriosis, that wasn't believed by health professionals for nearly a decade.
"You feel like you are being suffocated," says 26-year-old Whaiora Patrick, whose postnatal depression was deemed "not critical enough" to qualify for maternal mental health support.
"My sister was misdiagnosed and tested for an STD. She had a cancerous tumour in her ovary and it killed her," Matt says about his 36-year-old sister Amy Meyer, who died in May last year.
Why are there so many unknowns about the female body?
For centuries it's been assumed that women's bodies function similarly to men's but this is wrong on many levels, University of Auckland senior bioengineering researcher Kelly Burrowes says.
As a result, she says, women suffer higher rates of some of the most challenging medical conditions.
Autoimmune disease, for example, affects about 8 per cent of the global population, but 78 per cent of patients are women.
Females are three times more likely than males to develop rheumatoid arthritis and four times more likely to be diagnosed with multiple sclerosis (MS), an autoimmune disease that attacks the central nervous system.
Women make up two-thirds of people with Alzheimer's disease, and are three times more likely to have a fatal heart attack than men. They are also at least twice as likely to suffer chronic pain conditions such as fibromyalgia, chronic fatigue syndrome and chronic Lyme disease.
Why? Burrowes, and many other researchers across the globe, say it's partly because medical research has excluded women.
"Women's menstrual cycles and the variation of her hormones were thought to complicate results, which meant more subjects were needed in clinical trials and that meant increasing costs," Burrowes said.
The US Food and Drug Administration (FDA) recommended women of "childbearing age" be excluded from clinical research studies in 1977, to protect the unborn children, even if they weren't pregnant.
Male-only studies were justified by a preconceived belief that findings would apply to women also, Burrowes said.
Eight out of 10 of the drugs removed from the US market between 1997 and 2000 were withdrawn because of side effects that occurred mainly or exclusively to women.
In New Zealand, MedSafe - our medicines and medical device safety authority - does not require an equal number of women and men to be included in clinical trials affecting both genders.
The Herald put this to MedSafe and received this response: "Medsafe has involvement in clinical trials for new medicines only. It does not mandate how trials are conducted but expects them to be carried out according to best practice."
Oversight by male researchers of how women's bodies function differently to men's is still prevalent today, Burrowes says.
Once she was in a room of male researchers discussing the development of a Covid ventilator. She pointed out that measurements would need to be changed so it wasn't directly under the nipples - "women have breasts, that would be painful".
"As previous examples show, we know women respond to diseases and medications differently because every cell in a person's body has a sex," Burrowes says.
She adds that getting investment for women's health research can also be really challenging because a lot of investors are male and do not relate to health problems females face.
A Harvard Business School study, published in June last year, found women were more likely to invent medical treatments for endometriosis, cervical cancer, and other female conditions, but the lack of women scientists limited the potential for these life-saving innovations. The study showed women represented only about 13 per cent of patent holders in the US.
Some key issues: Surgical mesh
Politicians have promised to improve women's healthcare for years but advocates say the talk has not been matched with action.
In April 2017, Prime Minister Jacinda Ardern said Labour would push for urgent action to help people suffering from complications caused by surgical mesh, which is often used to repair pelvic organ prolapse (POP) - a common childbirth injury.
More than 600 people, mainly women, injured by surgical mesh shared their story in a report to the Ministry of Health in December 2019. Many suffered chronic debilitating pain, erosion, infection and were left unable to walk without aid, have sex or exercise. Some tried to take their own life as a result, the report said.
While Scotland and England put a pause on the use of pelvic surgical mesh in 2018 - which remained as providers couldn't supply evidence the products were safe - New Zealand has not followed suit.
Instead, DHBs were told by the Ministry of Health in December 2017 to take urgent action to minimise the risks from surgical mesh to patients.
Yet there remains no specific qualification for specialists to perform the procedure or off-shore training to teach surgeons how to insert and remove surgical mesh correctly – something one specialist told the Herald was desperately needed.
Charlotte Korte, who was injured by surgical mesh and has been advocating for other women whose lives have been destroyed by the device, said it wasn't only surgeons working at DHBs but also those in private practice who weren't being monitored.
"We've been debating surgical mesh for over a decade and still women continue to be harmed by it," Korte said.
Another advocate, Renate Schutte, said she would like to see a pause on the use of pelvic surgical mesh similar to those used overseas because it was still not being inserted safely.
Endometriosis
One in 10 women suffer from endometriosis, a crippling but little-discussed condition in which tissue normally lining the uterus grows either on the ovaries, fallopian tubes or intestines.
On average, women in New Zealand wait 8.7 years from onset symptoms to be formally diagnosed. During that time, the average number of doctors they see is five, research by the Medical Research Institute of New Zealand revealed in March.
In September 2020 Ardern said "women shouldn't exist in a life of pain" and more research was needed on the condition.
"I do think that there's often poor diagnosis, that leads to poor treatment, that leads to a huge amount of suffering," Ardern said.
Health minister Andrew Little also fronted the media in late 2020, saying "we must do better" for those with endometriosis.
Endometriosis New Zealand (ENZ) co-founder Deborah Bush says she finds these comments "patronising" and "disturbing" as treatment is still not being made a DHB priority.
"Referrals are rejected due to the number of referrals being greater than the resources allow," Bush says.
"The reasons cited are usually capacity issues... this makes a mockery of the ministers' statements."
ENZ chief executive Tanya Cooke echoes Bush's comments, saying they often have girls and women contacting them after repeatedly presenting to ED and being sent home on opioids without answers.
Maternity services
Maternity care continues to be operating at "dangerous" levels, with frequent reports of women sent home from hospitals just hours after giving birth with no support, Mothers Matter advocacy group founder Chloe Wright says.
According to a 2017 Ministry of Health report, 11 primary birthing facilities around the country closed between 2008 and 2017. Since then a further unit, Lumsden, has been downgraded to a "hub", forcing local women to travel to Southland or Dunedin hospitals.
And in September, the Te Awakairangi Birthing Centre in Lower Hutt closed, despite desperate attempts from the community to save it. Women giving birth now have to go to Hutt Hospital where the maternity unit last year went into code red, with just one midwife on duty, and code black, where women are flown to other parts of the country because there is no space.
The Wright Family Foundation poured more than $5 million into the centre over the past three years but the investment was not enough to keep the facility afloat. Wright said at the time it was "absolutely devastating".
"Giving birth happens once and you relive it thousands of times, so how it happens is critical.
"If women are not being cared for, if they're feeling like they have to hide their injuries or their anxieties, that will impact their children for the rest of their lives."
A 2021 ACC report found women were less likely to make ACC claims and more likely to be declined when they did. They also received far less compensation than men.
In response to that report, the Government took steps to introduce cover for some birth injuries.
Advocates said this demonstrated what could be done to improve women's health but again it was the "Band-Aid approach" and little was being done to prevent these injuries.
In February, submissions closed on the bill to widen ACC cover for birth injuries. However, the Green Party, doctors and injured women say many wouldn't get the help they needed because its scope was too narrow.
Green Party ACC spokesperson Jan Logie told RNZ the bill didn't include all birth injuries.
"It doesn't include broken bones or fractures, it doesn't include muscle ligament tears or ruptures, it's unclear about other forms of prolapse or scarring injuries, nerve damage - so that's quite a long list of things that aren't included, and it doesn't include injuries to the baby".
Six painful diseases affecting women
Endometriosis
Endometriosis is a condition in which tissue normally lining the uterus grows either on the ovaries, fallopian tubes or intestines.
Women with the illness can be left in severe pain and experience heavy bleeding. In some cases they can become infertile.
At least one in 10 women live with the condition but many wait years, if not decades, to be diagnosed because it's often dismissed as "part of being a woman". The longer it's left untreated the worse it gets.
Surgery is the only way to diagnose endometriosis. Depending on the severity of the disease, it can be removed during that operation and managed with birth control pills. Removing the ovaries or uterus is sometimes recommended where symptoms have significantly affected the women's quality of life.
Adenomyosis
Adenomyosis is a condition of the female reproductive system which causes the uterus to thicken and enlarge. Often women with adenomyosis also have endometriosis.
It can cause heavy and prolonged menstrual bleeding, severe cramping, pain during sex and blood clots that pass during a period.
Medication can help relieve pain and lessen heavy bleeding but removing the uterus (hysterectomy) is sometimes recommended in severe cases.
Fibroids
Fibroids are abnormal growths that develop in or on a woman's uterus. Sometimes these tumours become quite large and cause severe abdominal pain and heavy periods. In other cases, they cause no signs or symptoms at all.
The growths are typically non-cancerous. The cause of fibroids is unknown.
Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is a hormonal disorder causing elevated levels of insulin and testosterone which enlarge ovaries with small cysts on the outer edges.
Symptoms include menstrual irregularity, excess hair growth, acne and weight gain.
PCOS can't be cured but it can be managed. Treatments include birth control pills to regularise periods, medication to prevent diabetes, statins to control high cholesterol, hormones to increase fertility and changes to diet to manage weight gain.
Postnatal depression
It's normal for mothers to experience a brief low mood shortly after the birth of a baby (pēpi). People call this the "baby blues". Postnatal depression is different because it lasts longer and can be more severe.
Symptoms included insomnia, loss of appetite, intense irritability and difficulty bonding with the baby. Left untreated, the condition may last several months or longer. Treatment can include counselling, antidepressants or hormone therapy.
Pelvic organ prolapse
Pelvic organ prolapse (POP) is a condition caused by a weakening of the pelvic floor muscles, often from childbirth, where the organs in your pelvis (womb, bladder and rectum) slip down from their usual position into your vagina.
Symptoms include urine incontinence, lower back pain, bulging in the vagina, bladder infections, difficulty with bowel movement and problems with sexual intercourse.
It can be prevented with physio and if caught early can also be treated with physio. Surgical mesh is often used to treat POP but the insertion of the device has caused harm to hundreds of women in New Zealand.
