Education Gap

A third of US women and people who menstruate leave symptoms unchecked because they’re worried they won’t be taken seriously

Did you know that US women and people who menstruate report the least positive health care experiences compared to 10 other high-income countries?¹ That’s why Flo has commissioned an important new study into female health.   

We asked over 10,000 people using the Flo app based in the United States how they understand, experience, and live with female health conditions at a time when female health continues to be significantly under-researched and underfunded. 



The results are compelling. A third of US women and people who menstruate leave their symptoms unchecked because they’re worried they won’t be taken seriously by a health care professional. In fact, fewer than 1 in 6 (14.9%) would go to a professional first, instead turning to internet searches, social media, or loved ones for advice and support. 



Flo’s comprehensive study aligns with our dedication to conducting research aimed at advancing the understanding of female health and supporting our members at every stage of their reproductive lives.

The study looked at:

• How specific educational sources shape the understanding that women and people who menstruate have of their bodies
• The journey women and people who have menstruate experience when seeking a diagnosis
• The magnitude of uncertainty women and people who menstruate face when recognizing and addressing symptoms

Let’s delve into the results in more detail.

Research overview

Our survey used the Flo app to ask 20 single- and multiple-choice questions to people using the app in the United States. Participants, who ranged in age from 18 to 54 years old, were asked about their awareness of female health conditions, seeking a diagnosis, education sources, and how symptoms have affected their lifestyle, communication, and relationships.

Flo research can reveal that:

• When communicating about female health conditions, 37% felt that doctors “might not fully understand their experience,” while 24% felt that they didn’t have the knowledge or vocabulary to explain their symptoms (from a group of 4,782).
• Similarly, 25% of women and people who menstruate in a group of 4,478 felt their partner would not understand their experience of these symptoms, while 20% worried about being a burden if they shared their experience. 
• 45% learned about female health conditions such as polycystic ovary syndrome (PCOS) and endometriosis online, 31% learned from health care professionals, and 23% said they never received education on female health conditions (from a group of 5,563). 
• When seeking a diagnosis, over 52% spent more than $100 (outside of insurance), while 12% spent between $1,001 and $5,000 (from a group of 4,885).
• Even once reaching a diagnosis, 21% of 4,387 women and people who menstruate sought out a second opinion.

How are women and people who have periods educated on their health? 

Education in the United States around sexual health varies widely from state to state, with many schools omitting it from the curriculum altogether. In 2015, the Centers for Disease Control and Prevention (CDC) identified that in most states, less than half of high schools (and only a fifth of middle schools) teach all 16 topics recommended by the CDC as essential components of sexual health education². This includes information around sexually transmitted infections (STIs) and pregnancy prevention. In fact, while sex and sexuality are covered varyingly across the country, many schools do not cover reproductive health within these programs. This leaves many women and people who menstruate with no choice but to turn to other sources to learn.

Positively, almost a third of women and people who menstruate (31%) said they had learned about female health conditions directly from a health care professional. However, a whopping 23.3% answered that they didn’t receive education on female health conditions at all, meaning almost a quarter of women and people who menstruate aren’t taught about the scope of these issues.

Our survey shows that almost half of women and people who menstruate learn about health conditions like endometriosis and PCOS through online sources (46% of 5,037 respondents). Furthermore, more than a quarter (27%) of those asked said social media was their source. Whether it’s to learn about symptoms or to seek help, women and people who menstruate, regardless of age, are seeking out information from sources on the internet. This is particularly true for younger people (26% of 18-to-24-year-olds say they do only this).

While looking online can be tempting due to its ease and ability to give instant answers, Dr. Tiffany Pham, obstetrician, gynecologist, and Flo medical advisor, US, says to make sure you’re looking in the right places. 

“Look to professional societies that focus on your particular condition to find a wealth of resources and information,” she explains. “An online search for professional societies in obstetrics and gynecology is a good starting point. Searching for a specific condition (such as PCOS) and the professional societies will usually result in several resources. Trusted sources include the National Institutes of Health, Centers for Disease Control and Prevention, American College of Obstetricians and Gynecologists, Society for Maternal Fetal Medicine, and American Society for Reproductive Medicine.”
 

When women and people who menstruate are uncertain about their symptoms, contrasting information from different sources doesn’t help. The survey delved into this, asking about which conditions respondents felt the most confident about, from their awareness and understanding to their ability to recognize symptoms. 

The results showed that many of the female health conditions asked about were understood by fewer than a quarter of those surveyed. Uterine fibroids, for instance, were only confidently understood by 8% of the 5,364 participants. That’s despite the fact that as many as 77% of women may eventually develop fibroids.³ Because of the lack of understanding of this health condition, many women and people who menstruate may not be aware of the possibility of developing fibroids during their lifetime nor the symptoms to look out for. 

More encouragingly, 45% of the 5,364 participants said they were confident in their understanding of premenstrual syndrome (PMS). This is perhaps not surprising considering an estimated 3 in 4 menstruating women experience PMS symptoms, making it far more likely to be discussed in everyday conversation.⁴

Breaking down the results even further, perceptions of conditions were found to vary widely between age groups and categories. PMS and premenstrual dysphoric disorder were understood better by older age groups, while STIs, PCOS, and endometriosis were all understood better by younger respondents. 

There is a growing awareness of these conditions in younger women and people who menstruate, possibly due to the growing impact of new social communities and online interaction (as the survey shows). Social media platforms like TikTok have become a place for storytelling, with real people at the heart of them — 75% of TikTok videos discussing endometriosis highlight personal experiences.⁵ 

The downside to this, of course, is that social media can have high levels of medically incorrect or misleading information. So although awareness around female health conditions might be on the rise, it still puts into question the true level of understanding. To ease this pressure of misinformation, many influencers and health professionals have embraced the trend of using social platforms to better educate women and people who menstruate, including Flo’s own series on debunking female health myths and fact-checking female health queries.

Challenges in communication

So far, our findings show a significant range in the understanding that women and people who menstruate have about their health. How does this wide spectrum influence how they communicate their concerns with others?

When asked about which symptoms participants would feel uncomfortable discussing with a doctor, the areas that seemed to be most challenging were:

• Vaginal odor (30% of 5,221 surveyed)
• Pain during sex (26.6%)
• Vaginal discharge (24.1%)

A similar pattern emerges when sharing these symptoms with family or partners. The most uncomfortable topics to talk about were:

• Vaginal odor (41% of 5,139 surveyed)
• Vaginal discharge (31%)
• Pain during sex (24.9%)

While the survey shows a level of discomfort in discussing sensitive symptoms generally, it’s clear that there’s slightly more anxiety when sharing issues with family or partners. This suggests that women and people who menstruate are more inclined to open up to a doctor, but is that the case? 

Dr. Pham says, “These topics, particularly vaginal odor, may have negative connotations, such as ‘being dirty or unhygienic’ as the cause of the odor; therefore, women may feel more embarrassed to talk about these symptoms.” 

“As for symptoms like painful intercourse, there could also be shame associated with this topic. Perhaps the patient feels like they are somehow defective or broken due to their symptoms of pain,” Dr. Pham adds. “Some people are uncomfortable discussing topics like sex with their doctor, or if they have a male doctor, they may be less willing to discuss these topics.”

This discomfort is even more common among younger people, where we see less confidence in their ability to communicate these common symptoms to a doctor. For instance, 17% of 18-to-24-year-olds said they felt uncomfortable talking about “vaginal odor” compared to only 10% of 45-to-54-year-olds who answered the same. There’s a similar pattern in the rest of the symptoms too, suggesting that perhaps older people typically have more confidence communicating with a doctor.

The survey also found that communicating with a partner about pain and other symptoms was commonly found to be challenging. The biggest reason was because women and people who menstruate felt that their partner would not understand, with a quarter (25%) of 4,478 respondents feeling this way.

This same stigma continues throughout the rest of the responses to this question. Other concerns around sharing health issues with a partner include:

• Worries about burdening partners with pain or symptoms (20%)
• Difficulty explaining how it might affect the relationship (19%)
• Feeling embarrassed (17%)

Dr. Pham says that keeping an eye on and writing down your symptoms can help to alleviate stress when struggling with communication, with either loved ones or a doctor. 

“Your doctor or health care professional will generally ask questions about duration, timing, intensity, or aggravating or alleviating factors. You should try to track your symptoms or write them down when they occur and with associating factors to give your provider better context around your symptoms,” she says.

How early should women and people who menstruate seek support? Dr. Pham says it depends on the symptoms, but a general rule is to consider severity and recurrence. 

“If the symptom is very severe (pain, heavy bleeding, etc.), seek help sooner rather than waiting,” she advises. “If the symptom is recurrent (pain with every cycle, skipping periods, spotting in between cycles, PMS symptoms with every cycle, heavy bleeding with every cycle, bleeding after intercourse, etc.), seek help if you notice the symptoms on more than one to two occasions.”

Leaving symptoms unchecked

We know women and people who menstruate face anxiety around communicating their symptoms to both health care professionals and loved ones, and Flo’s survey shows this might lead to a hesitancy to get these symptoms checked by a doctor, too. 

Staggeringly, over a third (35% of 5,563) admitted to leaving issues unchecked due to a fear of “not being taken seriously,” while 32% have been put off by long waits for an appointment, and 31% expressed concern about costs. 

Why are women and people who menstruate hesitant to follow up on symptoms with a health care professional? Dr. Pham explains, “There is a cultural belief that ‘women should just deal with it,’ and they are often told ‘this symptom is normal,’” she says, emphasizing the danger of “normalizing symptoms.” 

“The definition of ‘normal’ bleeding and pain is interpreted differently for every person, and no one tells you what ‘normal’ discharge, bleeding, and pain with periods should be like, so therefore, this may also stem from a lack of education on these topics,” she says. 

She continues, “Women may have had negative experiences with their health care provider in the past, so they feel they will not be taken seriously, or they have tried to discuss the symptom with a health care provider in the past and have been dismissed. In some cases, it could also be that people are in denial about their symptoms or are unaware of the severity of them, leading them to ignore them in the hope that the symptoms will resolve on their own.”

We strongly believe that by logging symptoms in an app like Flo, women and people who menstruate can better understand their bodies. 

Flo provides educational content and tools, cocreated with our team of 120+ medical experts, that can help our members learn when to seek advice from a health care professional. We can also support them at their appointments. With information about their symptoms on hand, they can more confidently advocate for their health. This is integral in breaking the cycle of neglect and ensuring that they receive the care they deserve.

And this approach is working. According to a recent study, 27% of people using the Flo app said it helped them improve their communication with their doctor and partner.

For those who have taken the step to seek help for their symptoms, they may not have gone to a doctor first. So where else do they choose to get advice before going to a professional?

The internet was the first source when it came to symptom checking, with 40% of 5,792 people saying they have scanned the web before talking to a doctor. 

In fact, fewer than 1 in 6 people would go to a professional first (14.9%), reinforcing the trend that women and people who menstruate are likely to pause before seeking advice from a doctor, instead relying on the internet and loved ones to guide them with these experiences.

Although turning to search engines or online forums for health advice can be tempting, Dr. Pham suggests that you should always opt to get a professional assessment. “If you experience pain or symptoms related to female health issues, you should always reach out to a doctor or health care professional for an evaluation,” she says. “Part of the evaluation process includes performing a thorough review of your symptoms as well as performing a physical exam (depending on the issue).”

Dr. Pham adds, “While these outside sources can certainly help provide supplemental information on your condition, it is best to consult with a health care professional so they can provide you with the appropriate context within which to better understand your condition and its treatment options.”

The reality of getting a diagnosis

It’s clear from the data that many women and people who menstruate feel reluctant to book a checkup, but relying on the internet and social media for answers comes with the risk of misinformation. Talking to a doctor about female health conditions and symptoms should always be the first place to turn, but as our survey results have established, this also comes with its own challenges.

Many of the people surveyed agreed it was difficult to communicate their concerns when explaining symptoms to doctors. In a group of 4,885 who were asked, 37% felt doctors “might not fully understand their experience,” while another 24% said they didn’t have the knowledge or vocabulary to explain their symptoms. 

This lack of understanding may feed into the gap in confidence among women and people who menstruate when it comes to advocating for themselves about their pain and symptoms. Again, Flo can be a helpful resource to make visits to the doctor easier, supporting people’s journeys to understand their health. Dr. Pham recommends giving as much context as you can around symptoms ​in order for the medical provider to better understand your experience. “Coming to the appointment prepared with the information you listed, including when the symptoms started, what makes it better or worse, and changes in lifestyle/stress levels, can give a better overview and help the doctor better understand and empathize with the patient,” she says. 

Flo’s Report for a Doctor feature is designed to help women and people who menstruate be prepared for appointments with health professionals. The survey found that 77% of 4,699 respondents felt the report was helpful, providing accurate information about their cycle length and symptom patterns. In fact, 99% of 5,299 respondents also said that tracking their cycle and symptoms with Flo made them more aware of their body and overall health. 

While just under half (45.8%) of those surveyed were able to get a relatively quick diagnosis from their doctor within just one to two appointments, sadly, this isn’t the truth for everybody. Some respondents weren’t as assured in the results of their diagnosis, with 11% of 4,513 saying they had not yet “received a diagnosis they were confident in.”

This lack of confidence often results in extra appointments, with 21% of 4,387 participants confirming they had sought out a second opinion even after reaching a diagnosis.

Further, the cost of these appointments can be an additional source of stress in the process. To find out how much women and people who menstruate are spending to reach these conclusions, Flo asked 4,885 participants the approximate amount they’ve spent (outside of insurance) on reaching a diagnosis for their most recent female health concern. The results were telling:

• Over half (52%) had spent over $100. 
• A quarter (24.3%) had spent between $100 to $500.
• 12% had spent between $1,001 and $5,000.
   

Breaking this down state by state, the average cost of diagnosis outside of insurance varied significantly, with some states hitting startlingly high expenses. For instance, 13% of diagnoses in Hawaii and Colorado cost $5,000 or more.

Seeking out a diagnosis for a health complaint is stressful for some women and people who menstruate, and it often affects mental health, meaning it can feel daunting to reach out to a health care professional. In these instances, Dr. Pham recommends doing your research and reading reviews.

“While this may seem time consuming, investing time up front when looking for a new doctor or health care professional can pay off in the long run when you find the right doctor that fits your needs. If your health care professional or doctor has a website, review the website to look at their credentials or what conditions they specialize in treating. This can help you determine if they are well suited to treat your condition or concerns.”

Conclusion

Our results expose a stark gap in the confidence and knowledge that women and people who menstruate have about their health in the US. Education about female health conditions is woefully inadequate, seeking help with health issues often induces anxiety, and diagnoses frequently come with considerable uncertainty. This creates a vicious cycle that perpetuates these challenges.

Feeling in control of your health should be a basic right, yet it remains a daunting task for women and people who menstruate in the United States. By making medically credible health information more accessible, we can transform the landscape for future generations. Additionally, we can bridge the education gap in female health by disseminating knowledge from healthcare professionals, fostering confident communication among providers and patients, and raising awareness about the severe consequences of neglecting symptoms. It's time to take action and ensure everyone can confidently manage their health.