A committee appointed by Health Ministry Director-General Moshe Bar Siman-Tov has submitted its recommendations for fundamentally shifting Israel’s national approach to women’s health, moving from isolated solutions towards a policy that addresses women’s health throughout their lives, beyond pregnancy, childbirth, and gynecology, the Health Ministry announced on Thursday.
The committee, chaired by Mali Kusha and supported by eight teams of experts, based its approach on medical and scientific research demonstrating how biological, gender-related, social, and cultural differences affect health, prevention, diagnosis, treatment, and health outcomes. It also recognizes differences among women and their changing healthcare needs throughout their lives.
Israel is among the many countries in which women’s healthcare suffers in comparison to men. According to the Briah Foundation, a foundation dedicated to reducing the Israeli gender gap in health, women are more likely to wait longer to be seen in emergency rooms, to have their pain dismissed as insignificant, and to be perceived as incapable of making their own decisions regarding their bodies and the medical treatments they want.
Additionally, most medical research is based on the male body, with far-reaching consequences, from women taking medications that have been tested exclusively on men to heart disease being underdiagnosed in women because their symptoms may differ from those experienced by men.
The committee’s key recommendations to the Health Ministry address a range of women’s health issues from childhood to old age.
Comittee urges early prevention, detection of mental health issues, anemia, and endometriosis
For children, adolescents, and young women, the committee recommends strengthening prevention and early detection of mental health issues, eating disorders, anemia, and endometriosis, alongside promoting proactive healthcare services.
Endometriosis, a chronic progressive gynecological disease, may take years to be diagnosed in Israel and can be severely undertreated, despite affecting between 10% and 12% of women and girls of reproductive age. It occurs when cells resembling the uterine lining grow outside the uterus, creating lesions, cysts, and adhesions that may cause pain, fertility difficulties, and functional impairments, among other complications.
A study of almost 2,000 Israeli women and girls diagnosed with endometriosis between the ages of 13 and 66 found that 50% of women reported suffering from 11 to 15 symptoms involving different bodily systems simultaneously.
In addition to menstrual pain (85%), chronic pelvic pain, and bleeding, other common symptoms were found to cause suffering of very high intensity, including fatigue and exhaustion (80%), digestive problems (72%), pain during or after sexual intercourse (60%), and abdominal bloating (76%).
The study also found that the average delay in diagnosing endometriosis is 11.2 years. There is typically a 4.6-year delay between the onset of symptoms and the time that women first report them to a medical professional.
The study, conducted by Endo Israel, a non-profit organization that promotes the awareness, research, and treatment rights around endometriosis, suggests that the delay may stem from the low level of public awareness of the disease or even that extreme pain is abnormal.
Women have reported extreme pain that regularly impacted their day-to-day life while menstruating, which they believed to be standard.
Researchers also suggested that women and girls may take time before reporting their pain due to experiencing past pain being belittled or distrust of the medical system resulting from previous experiences in which medical conditions were minimized and dismissed.
The fear that doctors may dismiss endometriosis symptoms is not unfounded – from the time that a woman reports her symptoms to a medical professional, typically a gynecology or family medicine doctor, an average of 6.6 years will pass before she receives a diagnosis.
These findings highlight the low level of medical awareness of the disease as well as a lack of clinical guidelines for treating the disease in community healthcare.
Further compounding the delay may also be due to gender discrimination in the medical system’s treatment of women experiencing pain.
Diagnosis delay costs patients, medical system
The delay can also be extremely costly, both for the patients and the medical system.
An online survey including almost 900 diagnosed women found that before being diagnosed, 45% of patients were referred to gastroenterology specialists, 40% to gastroenterology institutes, 20% to orthopedic specialists, 16% to urologists, nearly 16% to psychiatrists, and nearly 9% to psychiatric clinics at medical centers.
Approximately 31% of patients underwent gastroscopy, approximately 30% underwent colonoscopy, and 19% underwent hysterosalpingography (an imaging examination of the uterus and fallopian tubes).
Once diagnosed, endometriosis is most commonly treated with over-the-counter painkillers and combined oral contraceptive pills or progesterone pills, according to Endo Israel’s study.
The effectiveness of these treatments was found to be “moderate,” while cannabis treatment was found to be the most effective, although it was tried only by a relatively small proportion of women.
While 40% of women underwent surgery as a result of the disease, some of the women had to undergo more than one operation, and 10% of those who underwent surgery had more than three operations.
Twelve percent reported no improvement whatsoever following surgery, and only 20% of women experienced significant improvement that lasted for a period of up to three years.
Nearly 64% of women reported feeling that the medical system had no solution whatsoever for them.
Committee urges healthcare system to meet mental healthcare needs, trauma, violence, and hormonal changes, including menopause
In addition to the recommendations for childhood and adolescence, the committee established by the Health Ministry recommended that mental healthcare should continue into adulthood with tailored services for women at various stages of life, addressing trauma, violence, pregnancy and childbirth, hormonal changes, and social risk factors.
Menopause should be incorporated into the standard continuum of healthcare services through raising awareness, training medical professionals, and improving access to diagnosis and treatment.
Menopause, the cessation of menstruation, typically occurs between the ages of 40 and 50 and is actually a single stage in a three-stage process: premenopause (also called perimenopause), menopause, and postmenopause, according to the National Council for Women’s Health of the Health Ministry.
Most women will experience at least one symptom out of approximately 30 that may affect their quality of life, including hot and cold flashes, sleep disturbances, emotional and cognitive changes, vaginal dryness, and joint pain, among others.
The council emphasized that these symptoms are not inevitable. They can be treated with professional guidance to reduce frequency and intensity and, in some cases, be eliminated entirely. However, the council found that there is insufficient awareness of the possible symptoms, even among physicians.
According to the council’s report, the vast majority of Israeli women who reported experiencing menopausal symptoms were not offered treatment to alleviate their symptoms by healthcare professionals.
There is currently no officially recognized medical specialty in menopause.
Committee calls for more treatment for chronic diseases and elder care
The Health Ministry’s committee also called on the ministry to address older women’s health, prevention, diagnosis, and treatment, and to adapt to address chronic diseases, cardiovascular and bone health, cognitive function, pain, and physical functioning.
According to the Briah Foundation, women are the primary sufferers of diseases characterized by chronic pain which fall under the category of ‘invisible diseases,’ diseases difficult to diagnose through a single specific medical test or imaging procedure.
This includes fibromyalgia (characterized by widespread muscle pain) and chronic fatigue; endometriosis (characterized by sharp pain in the pelvis and abdominal cavity); vulvodynia (pain in the vulvar and vaginal area); painful bladder syndrome (IC); and hypermobility syndromes.
Endometriosis is not the only disease in which there is a significant delay in diagnosis. The average delay between the onset of symptoms and diagnosis is over two years, while for painful bladder syndrome the average time is seven years.
The lack of awareness of these diseases among many physicians forces women to move between several healthcare providers before receiving a diagnosis.
Additionally, there is a shortage of specialist physicians and dedicated clinics for treating diseases that primarily or exclusively affect women in Israel.
Aside from practice, the Health Ministry’s committee stated that research and medical data collection accounting for sex and gender differences must be strengthened to improve the quality of diagnosis and treatment and reduce healthcare disparities.
Health Ministry reviewing recommendations
The Health Ministry said it is currently reviewing the recommendations as it develops a multiyear action plan.
“Women’s health is an integral part of [our] vision of excellence. The committee’s work provides a significant professional foundation for advancing a broad national policy that connects research, prevention, diagnosis, treatment, and system-wide management,” Bar Siman-Tov said.
“Our responsibility now is to examine how to translate the recommendations into practical steps, with clear objectives and measures of success, so that we can continue to improve women’s health in Israel throughout every stage of life.”
