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It’s no secret that women are more likely than men to be misdiagnosed by a medical professional. In fact, as many as 57 per cent of women have reported being wrongly diagnosed by a doctor. In 2016, a study found that women have a 50 per cent higher chance than men of receiving a misdiagnosis after a heart attack, while researchers found in 2014 that 33 per cent of women are more likely than men to be misdiagnosed after a stroke. When it comes to women’s health, an explicit gender bias in medicine can lead to serious and sometimes life-threatening results. That’s why Dr Erin Nance, an orthopaedic hand and wrist surgeon located in New York City, has dedicated the month of October to sharing the most commonly misdiagnosed health conditions that affect women. Her series has since gone viral on TikTok, as she discussed how symptoms of rare autoimmune disorders or infertility can present differently in women, leading to a misdiagnosis. For the first video of the series, Dr Nance revealed how postural orthostatic tachycardia syndrome - also known as POTS - affects more than one million people, but is present in mostly women aged 20 to 50. However, Dr Nance explained that POTS is so difficult to diagnose because “we can’t see it”. “This is the group of women that get written off by doctors because they look healthy. There doesn’t seem to be anything wrong with them,” she said. According to the National Institute of Neurological Disorders and Stroke, POTS is a condition in which a reduced volume of blood returns to the heart after someone stands up from a lying down position. As a result, patients with POTS may experience an increased heart rate, dizziness, or fatigue when they stand up after lying down. @littlemissdiagnosed Day 1: It’s me, POTS, I’m the the problem it’s me #littlemissdiagnosed #31for31lmd #pots ♬ original sound - Dr. Erin Nance ?? Dr Nance explained that some other symptoms of POTS include “chronic fatigue, brain fog, total body chronic pain, GI [gastrointestinal] stomach issues, anxiety, headaches, and it can affect any part of your body”. Another difficulty about POTS is that there’s “no specific treatment” to help the condition, Dr Nance said. “We can’t do a biopsy, we can’t do any imaging, there’s no blood test for it,” she added. Instead, doctors may recommend drinking more fluid, exercising regularly, or wearing compression stockings to keep blood flow in the centre of the body. For the 14th day of her video series, Dr Nance received 1.4m views when she spoke about the commonly misdiagnosed symptoms of stroke in women. “Stroke is the third leading cause of death in women,” she began the clip. “Yet, women are over 33 per cent more likely to be misdiagnosed when having an acute stroke.” Dr Nance admitted that most women who experience a stroke are often told by doctors that they simply have anxiety or a migraine. When it comes to the “unique” symptoms of stroke that are present in women, some may experience loss of consciousness or fainting; general weakness; shortness of breath; confusion, unresponsiveness, or disorientation; sudden behavioural change; agitation; hallucination; nausea or vomiting; seizures or even just hiccups. @littlemissdiagnosed Day 14: Stroke is no joke #littlemissdiagnosed #31for31lmd #stroke ♬ original sound - Dr. Erin Nance ?? “These unique symptoms are often the ones that are overlooked,” Dr Nance said, before detailing the individual risk factors that can put women at a greater chance of having a stroke. The first on the list of risk factors was taking birth control pills, followed by pregnancy, hormone replacement therapy, and history of suffering from migraines. “The reason why this is so important for everyone - every normal, everyday person - to know this is because the best outcomes are when women are evaluated and treated within three hours of having this symptom,” Dr Nance added. On day 16, the orthopedic surgeon explained how symptoms of a heart attack can also be wrongfully overlooked by doctors. “More women than men die of heart disease every year, yet women have a 59 per cent increased risk of being misdiagnosed with acid reflux, stress, or anxiety,” Dr Nance said. Besides chest pain, a woman may exhibit signs of a heart attack when she experiences unusual fatigue for several days; sleep disturbances; shortness of breath; lightheadedness; nausea or cold sweats; indigestion or gas-like pain; and pain in the arm, neck, jaw, or back. @littlemissdiagnosed Day 16: It’s not always Big on the Peloton #littlemissdiagnosed #31for31lmd #heartattack #womensheart ♬ original sound - Dr. Erin Nance ?? When it comes to multiple sclerosis (MS), Dr Nance revealed on day 19 of her video series that women are 83 per cent more likely to be misdiagnosed for MS by a doctor. MS is a disease that affects the “myelin” - the protective sheath covering the brain, nerves, and the spinal cord. According to Dr Nance, some of the often-missed signs of MS include extreme fatigue, confusion, forgetfulness, and mood swings. @littlemissdiagnosed Day 19: You’re gonna be okay #littlemissdiagnosed #31for31lmd #ms #multiplesclerosis ♬ original sound - Dr. Erin Nance ?? As for lupus - an autoimmune disease in which the immune system attacks its own tissues, causing inflammation in the body - Dr Nance shared in the 20th video of her series that women between the ages of 15 and 45 are most likely to develop the disorder. “The average time from when you first develop your symptoms to diagnosis is six years,” Dr Nance revealed. @littlemissdiagnosed Day 20: Sneaky little ? #littlemissdiagnosed #31for31lmd #lupus ♬ original sound - Dr. Erin Nance ?? She claimed that 46 per cent of patients report being misdiagnosed with something other than lupus, while “54 per cent of them were told that either nothing was wrong with them or that their symptoms were psychological.” “The main problem with lupus is that the longer you go undiagnosed and untreated, then the greater risk for end organ damages,” she added. The Independent has contacted Dr Nance for comment. 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‘SPF cocktailing’ is the latest beauty trend to make waves on TikTok. It’s all about mixing your favourite SPF with another product – such as concealer or highlighter – and applying that as a ‘cocktail’ onto skin. In theory, the idea sounds good – the aim is to reduce the white cast some SPFs leave, and mean less steps slathering products onto your skin in the morning – but dermatologists and skin experts have started pointing out the potential dangers of this new trend. “SPF cocktailing is a recipe for disaster in so many ways,” says Dr Ross Perry, medical director of Cosmedics skin clinics. “By mixing SPF with products such as concealer or highlighter you are leaving the skin entirely exposed to the dangerous UV rays, which will very likely burn the skin and potentially lead to skin cancer down the line, not to mention leaving you more prone to premature ageing.” Dr Paris Acharya, leading aesthetic doctor and face surgeon agrees, saying: “When you mix an SPF with your other make-up products, such as foundation or concealer, you are changing the overall properties of the SPF and diluting the strength of the product. “This will therefore reduce the protection that you will be getting from the SPF. There may also be certain products within your make-up products that may interfere with the way that your SPF is meant to work.” However, Perry understands why people might be looking for ways to make their SPF look better. “Sunscreens are notoriously cosmetically unattractive purely in part to the ingredients. The reason for this is that’s how they prevent the sun’s rays penetrating into the skin. The suncream companies already try to dilute this down as much as possible in order to make it cosmetically acceptable, however I appreciate in some instances this does not quite go far enough.” So for Perry, it is a “balance between having someone wearing something that will protect your skin, versus not wearing it”. He adds: “I don’t advocate mixing the ingredients together, as it may reduce efficacy. I do believe though that if this is the only way people will wear sunscreen, then some sunblock is absolutely better than no sunblock.” But make no mistake: the best option is wearing SPF that hasn’t been mixed with any other products. “It only takes one sunburn in a lifetime to lead to skin cancer. [Skipping sunscreen] isn’t something you should be doing at all, and in no way should be encouraged,” says Perry. If you do want to reduce the white cast of sunscreen, Perry’s advice is to “apply a good moisturising cream prior to using a sunscreen – this will help the sunscreen absorb into the skin and reduce the tint”. While Perry doesn’t recommend mixing your products together, he does suggest that layering is fine: “If you apply them all separately and give them a chance to absorb first.” Acharya has some other recommendations for best practice when it comes to sunscreen. “My ultimate top tip is to always use a broad spectrum SPF. Broad spectrum protects you from both UVA and UVB rays which helps the skin to stay youthful and will help to reduce premature ageing and sunspots,” she advises. “Another important tip for using an SPF is to always apply it to the face and neck to ensure full coverage and protection of all exposed areas. The skin on your face and neck is some of the first to age on your body so it’s vital that we care for these areas properly.” Acharya recommends an SPF30 or above for your face, and adds: “It is always recommended to reapply your SPF throughout the day at least twice to maintain maximum protection.” 5 of our favourite SPFs… These sunscreens are so good, you’ll want to apply them solo. 1. Collistar Protective Sun Cream SPF 50+, £35, LookFantastic 2. Caudalie Vinosun Protect Very High Protection Lightweight Cream SPF50+, £23 3. Paula’s Choice Advanced Sun Protection Daily Moisturiser SPF 50, £33.15 (was £39) 4. Biore UV Aqua Water Essence Sunscreen SPF50, £15.99, Superdrug 5. PCA Skin Daily Defense Broad Spectrum SPF 50+, £42

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