Diagnosing Gender Injustice: Endometriosis and Women’s Healthcare Experiences in Scotland

This blog is the fourth in our series, “Gender (in)justice: Views from Scotland”, featuring pieces authored by legal academics at Glasgow Caledonian University. GCU Law has a strong socio-legal research culture, and this blog series draws on our research across diverse legal contexts. This blog series will explore recent legal developments and emerging legal challenges at the intersection of gender and justice in the law of Scotland. By publishing pieces exploring gender justice issues from a Scots Law perspective, we hope to inspire discussion and invite critical perspectives not only among researchers working in the Scottish context, but from our colleagues in the rest of the UK and beyond.  

By Rachel Bond

Keywords: endometriosis; women’s health; medical misogyny; pain

Quotes taken from my PhD interviews with women aged 18 or over in Scotland who have been diagnosed with endometriosis.

Labelled ‘the missed disease’, endometriosis affects 1 in 10 women and those assigned female at birth. It takes on average 8 years and 10 months to diagnose. Endometriosis is often found in areas around the womb, causing symptoms when patches of endometriosis break down and bleed but cannot leave the body. Symptoms include severe pain, heavy periods and extreme fatigue affecting every aspect of daily life, including education, careers, relationships and mental wellbeing.

A gendered condition, endometriosis raises questions about how practices of ignorance are entwined with practices of prejudice, which could explain why women wait years for action to be taken in response to their symptoms.

 

Medical Misogyny

Medical misogyny begins with how we think about the human body: there is ‘anatomy’ and there is ‘female anatomy’. Historically, the study of anatomy has privileged a male ‘norm’, placing anything that deviates from the standard as ‘atypical’ or ‘abnormal’. Women are represented as a variation to the standard human anatomy, defined and distinguished primarily by their reproductive function.

This reductive understanding has had profound consequences. Women’s bodies have long been misunderstood, mislabelled or mishandled because of a lack of understanding beyond what deviates from the standard. The failure to identify fundamental differences between men and women’s bodies beyond reproductive function has contributed to gender stereotypes and health inequalities. These structural biases result in women struggling to access high-quality and timely care, treatment and support for conditions that disproportionately affect them. 

Growing evidence tells us that many women have concerns regarding trust and feel disbelieved and ignored by their healthcare provider(s). Accounts of women being ‘gaslighted’- having their symptoms minimised or invalidated - are common, particularly in relation to the suffering of pain. The 2024 Gender Pain Gap Index Report found that, despite a narrowing gender pain gap, 62% of women felt like their pain had been dismissed or ignored, up from 49% in 2023. Over a quarter of respondents admitted to questioning the legitimacy of their own pain; believing their pain was not real or serious after being dismissed. Gendered assumptions persist, framing women as ‘emotional’ and ‘hysterical’, which result in two conflicting beliefs about women’s pain: (1) that women suffer pain simply because they are women and (2) that women’s pain is imagined or exaggerated.

In light of a lack of research and awareness of endometriosis, associating the condition with socio-historical constructions of women, menstruation and pain has informed ignorance. Medical discourse has historically theorised endometriosis as a product of ‘disorderly female biology, behaviour and personality’, commonly misattributing many of the symptoms as evidence of hysteria, mental illness, a lack of self-care and a lack of reproductive activity.

Women’s endometriosis-like symptoms are being ignored or mishandled, not only as a result of a lack of understanding and awareness of the condition, but because of entrenched medical misogyny. This is represented in a lack of medical research, treatment options, inadequate specialist care and growing gynaecology waiting lists.

https://www.gov.scot/publications/endometriosis-lived-experience-insight-report-2023/documents/

Policy Developments for Women’s Health

Concerns about the quality of women’s healthcare have been spotlighted through a number of public inquiries, campaigns and scandals.

In the face of widespread attention, the Scottish Government has responded. In 2021 the Scottish Government published the Women’s Health Plan to reduce avoidable health inequalities for women and girls. The initiative focused on six priority domains of women’s health: menopause, menstrual health (including endometriosis), abortion and contraception, postnatal contraception, and cardiovascular health. The Final Report was published in November 2024.

One of the central objectives of the Women’s Health Plan was to prioritise the reduction of diagnostic delays in endometriosis and to enhance the quality of treatment available for the condition. To deliver on these actions, the Scottish Government interviewed 20 women about their lived experience of the systems and healthcare pathways for endometriosis in Scotland. The findings highlighted the importance of clear treatment pathways and endometriosis specialist centres across Scotland, which participants identified as markers of a good care experience.

In response, the Endometriosis Pathway for Scotland has been published. Adapted from NICE guidance, the pathway integrates primary, secondary, and tertiary care to provide a streamlined care pathway for those diagnosed with endometriosis and with endometriosis-like symptoms. This mars a progressive step in improving health care experiences of endometriosis for women from symptoms to diagnosis, treatment and aftercare. However, significant challenges remain - particularly in service capacity, specialist provision and cultural attitudes that undermine trust between women and their healthcare provider(s) as a result of embedded medical misogyny. 

In September 2025, NHS England adopted Jess’s Rule. This patient safety initiative introduces a ‘three strikes and rethink’ approach whereby if a patient presents three times with the same symptoms or concerns without a clear diagnosis, the GP must review and reconsider the case. The rule has been welcomed by campaign group Endometriosis UK as a positive development for those living with endometriosis symptoms. A 2024 report by Endometriosis UK found that 47% of respondents reported seeing a GP 10 or more times before receiving a diagnosis. To date, the Scottish Government has not implemented Jess’s Rule, and its future approval remains unclear.

Concluding Thoughts 

Embedded medical misogyny is leaving women in prolonged and unnecessary pain, with symptoms often remaining undiagnosed for years. Gendered conditions such as endometriosis represent how structural biases within medicine perpetuate diagnostic delays and inadequate care, shaping women’s experiences of Scotland’s healthcare system.

Policy developments, including Scotland’s Women’s Health Plan 2021-2024, have been widely welcomed. The introduction of Scotland’s Endometriosis Care Pathway represents progress in creating structured, evidence-based approaches to diagnosis, treatment and aftercare for those living with endometriosis symptoms. While this represents progress, rebuilding women’s trust and confidence in the doctor–patient relationship remains an urgent priority.

Despite some progress, a recent report has indicated that women’s health across the UK is on a decline, with some inequalities widening. There is a pressing need to move beyond a narrow focus on reproduction and reproductive services and recognise women’s health as a holistic service requiring comprehensive gender-specific care. Without dismantling the epistemic and institutional practices that sustain gendered ignorance, initiatives risk being incremental rather than transformative. The challenge ahead lies in embedding gender-specific care as a normative standard - ensuring that women’s pain is neither dismissed nor delayed but recognised as legitimate and urgent.