Women left in pain as gynaecologists prioritise suspected cancer

Kiwi women are being left in debilitating pain because some GPs are being told not to refer patients to gynaecology clinics unless it’s suspected they have cancer. This means never even reaching the waiting list to see a specialist. Instead they are being left to pay for their own scans or treatments privately, or miss out on care. Georgina Campbell reports.

Wellingtonian Catherine Kohler has been experiencing debilitating migraines and getting her period every two weeks, sometimes even more regularly, for months now.

She is exhausted, and was exasperated when her GP said she couldn’t be referred for specialist care.

“I can’t keep doing this, something has to happen, I just want some answers,” she told the Herald.

Catherine Kohler has been unable to see a specialist despite experiencing irregular periods and debilitating migraines for months. Photo / Mark Mitchell.

GPs say the situation is upsetting for women who can’t afford to pay for private care but don’t qualify for a community services card.

Health New Zealand Te Whatu Ora confirmed the gynaecology service at Christchurch Women’s Hospital could not accept referrals unless cancer is suspected.

And only urgent or semi-urgent referrals are being accepted at the women’s clinic at Wellington Regional Hospital.

Both services are under significant pressure due to sustained high levels of acute demand and workforce shortages.

The women’s health service in Auckland continues to accept referrals, regardless of urgency.

‘I didn’t feel like I was being taken seriously’

In mid-2022, Kohler was burnt out and suffering from both depression and chronic migraines. She was doing postgraduate study, working at a food bank, and had been a volunteer counsellor throughout the Covid-19 pandemic.

She moved from Wellington to Auckland to be closer to her family while recuperating.

Kohler was referred to a neurologist, and given antidepressants and migraine medication that made her feel like a “zombie”.

Within a few months, she was getting her period constantly.

Kohler went to her GP and was told to focus on controlling her stress, she said.

“Being a woman, I didn’t feel like I was being taken seriously.”

Catherine Kohler says she just wants to know what's causing her debilitating migraines and irregular periods. Photo / Mark Mitchell.

She took matters into her own hands and called several women’s health services, including Family Planning where she said there was a four-month wait.

Kohler’s GP finally decided she should be referred to a gynaecologist just as she was preparing to move home to Wellington last year.

By the time a specialist in Auckland was available to see her, Kohler was already living back in the capital.

Kohler couldn’t afford to fly up to Auckland for one day and the referral could not be transferred.

Her new Wellington GP told her she couldn’t get a referral unless it was cancer and asked whether she could afford to go private. That was before Christmas.

“Lately I feel a little bit scared because it’s not stopping, I’m still bleeding,” Kohler said.

Her GP has ordered blood tests, STI checks, and a smear test.

High demand for services and workplace shortages

Te Whatu Ora hospital and specialist services national director Fionnagh Dougan acknowledged the distress current waiting times are having on women who are awaiting treatment across the country.

“Our health services continue to experience significant pressures due to sustained high levels of acute demand and workforce shortages, and this is having an impact on planned care.

“Our immediate focus is on urgent patients and those who have been waiting the longest for treatment. We continue to work hard to put in place systems and processes so improvements to waiting times are made.”

Te Whatu Ora understood the stress of not having a referral accepted, Dougan said.

“We encourage anyone with concerns or changes in their condition to reach out to their GP or referring team.”

Conditions considered urgent enough for a referral to the women’s clinic at Wellington Regional Hospital include persistent new abnormal bleeding from the uterus on most days, endometrial cells present on a smear, or suspected cancer due to an abnormal mass.

Non-urgent conditions include heavy periods from fibroids without causing amenia or a persistent ovarian cyst that’s considered low-risk.

The gynaecology service at Christchurch Women’s Hospital is unable to accept referrals unless there is a suspicion of possible cancer, due to capacity constraints.

Colposcopy referrals are continuing to be accepted in line with the National Cervical Screening Guidelines, and hysteroscopy referrals for abnormal bleeding.

GPs are also being supported with specialist advice on gynaecological issues.

In Auckland the women’s health service continues to accept referrals that meet the usual clinical criteria for specialist gynaecological care, regardless of urgency.

Call for women to speak up

Wellington GP and president of the Royal New Zealand College of General Practitioners Dr Samantha Murton said when the hospital pushed back on a referral, she was being asked for scans and other procedures to be done before referring the patient again.

This meant having to refer women for paid services, like ultrasounds, that they wouldn’t have to pay for if they were able to be referred to the hospital.

It created inequity between those who could afford to get a scan done and those who could not, she said.

“It is the squeezed middle,” Murton said.

Only urgent or semi-urgent referrals are being accepted at the women’s clinic at Wellington Regional Hospital. Photo / Mark Mitchell

“The people who aren’t Community Services Card holders but the affordability of an ultrasound scan is out of reach for them. They’d have to save up for it and they couldn’t possibly afford to go and see someone privately so, there’s a group in the middle that really misses out.”

It was upsetting telling patients they may have to wait for several months to be seen by a specialist, if at all, Murton said.

It also added to the workload of GPs trying to care for those patients, she said.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists NZ vice-president Dr Sue Fleming said these long waiting times affected women’s quality of life.

“The thing about women is that often they do put up with symptoms for quite a long time before finally presenting to their primary care doctor.

“Then to be faced with a long wait or an inability of access means those conditions - be they heavy menstrual bleeding or pelvic pain or urinary symptoms or incontinence which are some of the common problems - they really have an impact on women’s general wellbeing.

“Their ability to get out in the workplace and contribute, fulfilling their family responsibilities, and mental challenges can be exacerbated.”

Fleming said women who were concerned about long waits for specialist care should keep their GPs in the loop in case different treatments may be available in the meantime to help them manage.

She also advocated for women to speak up.

“The system is under pressure, there’s no doubt about it, but if those who are missing out on care aren’t vocal, change won’t happen at the pace we need it to.”

Georgina Campbell is a Wellington-based reporter who has a particular interest in women’s health, local government, transport, and seismic issues. She joined the Herald in 2019 after working as a broadcast journalist.