Women’s health on film: how Mike Leigh changed the game

Cinematic representations of women’s health conditions have a history of gesturing towards the abject and horrific. Mike Leigh’s Secrets and Lies (1996) reminds us that horror doesn’t need to be the only way. 

Mike Leigh’s award-winning Secrets and Lies (1996) turns twenty years old this year and it remains a film about big ideas. The English writer-director’s examination of a series of interconnected lives in London covers issues of class, race, guilt, and envy, and it sears with pathos from its opening scene. The film follows Hortense Cumberbatch, an optometrist who sets out to find her birth-mother after her adoptive mother dies. She is successful in her quest, but the relationship she forges with her birth-mother, factory worker Cynthia Purley, is complicated from the outset. The interactions between Hortense, Cynthia, and Cynthia’s family are tense and often painful to observe, but underscoring each character is a sense of warmth and empathy, through which Leigh demonstrates his skill as a character writer.

Leigh launches some hefty moments of emotional intensity at his audience in Secrets and Lies. In particular, sequences involving Hortense and Cynthia are often rife with misunderstanding, desperation, and remorse. Yet Leigh is also a master of small moments; the moments that, at first glance, might seem almost insignificant, but prove to be crucial as his intertwined narratives evolve. Complexity in Leigh’s films often comes through in brief scenes, snippets of dialogue, or minimal body movements from the actors. Cinematography is also crucial to Leigh’s character developments, as the mise-en-scène of a setting, the composition of a shot, or the navigation of space provides viewers with subtle clues to inform our understanding of character dynamics. His rich use of language, both verbal and non-verbal, explicit and implicit, brings into focus small human moments that resonate just as strongly now as they did twenty years ago.

Consequently, it is not the mammoth themes or obvious moments, nor even the principal characters of Hortense and Cynthia, that I wish to emphasise here. Instead, I seek to draw attention to the support character of Monica, Cynthia’s sister-in-law, who receives a small, but significant, amount of screen time. I propose that Leigh’s complex portrayal of Monica represents an important moment in cinema’s discussion and depiction of women’s health, specifically gynaecological issues. Far from the menstruation horror of The Exorcist (1973) and Carrie (1976, 2013), or the surgical violence of Dead Ringers (1988), in which women’s bodies are figured as abject, Leigh sketches a portrait of women’s health concerns – namely endometriosis and infertility – with subtlety and compassion. He does so, too, at a time when these matters are rarely explored onscreen within the style of cinematic realism, and let alone so deftly.

With Monica, Leigh sets up a situation whereby initial looks are deceptive. In her first appearance, Monica is seen vigorously vacuuming her home and shouting at her husband Maurice when he opens the front door and stumbles into her. Dressed nicely in a shift dress, but with her styled bob somewhat disheveled, Monica is frustrated. Each time Maurice asks her a question – would she like a drink; what would she like to eat – she yells her answers and criticises him. All of her limbs are alert with agitation as she slams doors and cupboards, barely containing her anger. Monica’s house is so tidily kept that her uninhibited behaviour seems incongruous with the neat space around her. This is a confronting introduction to a character and, at this point, the source of Monica’s bad mood has not yet been broached. She comes across, then, as unreasonable and unlikeable, especially given her treatment of a well-meaning husband.

Secrets and Lies screengrab

It is not until two scenes later that Leigh gives us our first clue as to Monica’s distress. A tight mid shot in a bathroom shows Monica sitting on the toilet, her trousers at her knees and her underwear visible, taking a tampon from a drawstring bag. Suddenly she hunches forward and grips the bathtub next to her with one hand and, as the camera cuts to a close-up shot of her face, she closes her eyes and exhales in agony. This short sequence is startlingly intimate, but the camera’s presence does not feel voyeuristic or predatory. Rather, it is Leigh engaging in observation of an acute but understated nature. He provides us with sufficient information in fragments; cutting away to the next scene before the image of Monica on the toilet becomes exploitative.

Secrets and Lies screen grab

In the following sequence, the camera returns to the same bathroom, but this time Maurice is in there filling up a hot water bottle. He then moves into their bedroom, where Monica lies beneath mounds of white linen on their four-poster bed. She looks like a queen, yet she is anything but rested. As Maurice goes to sit at the end of the bed, there is considerable distance between the two characters; staging that enhances the stunted conversation between a worried husband and a suffering wife. When Maurice comments that Monica’s pain is “unpredictable”, she laments that, “No, it’s not unpredictable…I wish it was unpredictable”, closing her eyes and surrendering to her bed as Maurice watches on helplessly. This scene, again short, is significant in confirming Monica’s battle with her menstrual cycle. Her periods are heavy, rife with dysmenorrhoea (painful cramps), and, worst of all, reliably so. The regularity of this situation means that she is frequently bed-ridden with pain; defenceless against her own body.

Secrets and Lies screen grab

Although the culprit for these symptoms remains nameless throughout the film, the small pieces of information that Leigh provides – both verbal and visual – sketch a vivid profile of endometriosis. This disease affects millions of women around the world, but can be difficult to diagnose and complex to manage. The condition occurs when tissue from a woman’s uterus grows outside of the uterus, often causing significant pelvic pain, problems with menstruation, associated bladder and bowel issues, and in some cases infertility1. Recently endometriosis has received attention due to celebrities such as Padma Lakshmi, Lena Dunham, and Jaime King going public with their struggles – and urging other women to as well2. At the time of Secrets and Lies, however, the condition was seldom spoken about in the media and often misunderstood outside of the medical world.

In some ways endometriosis is still considered a ‘hidden’ epidemic3, given many women are reluctant to tell people about their symptoms and, if they do seek treatment, the process can be long, confusing, and distressing. Sometimes women’s symptoms are missed and other times they are dismissed. Some women keep their suffering quiet due to embarrassment or the belief that their pain and bleeding is a ‘normal’ part of being female and something to be ‘put up with’. One cannot forget also that, in the days of psychoanalysis, women’s reproductive issues were perceived as ‘hysteria’. While this line of thinking is medically discredited, it occasionally lingers in the popular imaginary. Secrecy is thus often involved in a woman’s endometriosis journey and it is secrets that fascinate Leigh, as is evident by his film’s title. For Monica and Maurice, their greatest burden is the secret that, as a result of Monica’s condition, they have been unable to have children.

Infertility is the major effect of endometriosis that plagues the couple to the extent that, in earlier parts of the film, they are not even able to verbalise their secret. They call it “that” and Monica urges Maurice to never tell his family about it. Maurice is filled with disappointment, while Monica is filled with shame.

Monica adopts a preoccupation with cleanliness and order as a way to regain some form of control over her life, given that she has so little power over her body. Upholding external appearances thus becomes crucial to Monica as she strives to impress a sense of harmony and organisation upon those she meets. Leigh juxtaposes a shot of her lying on top of her bed in an old nightie, with unwashed hair, pain killers, and a hot water bottle with a shot of her wearing a shapely dress, with perfectly styled hair as she sets a table with painstaking attention to detail. This latter shot is taken through a window looking out onto the backyard, framing Monica within patterned, scalloped curtains to align her with decoration and neatness. The private disarray of the previous shot is replaced by a public façade of order.

Secrets and Lies screen grab
Secrets and Lies screen grab

Monica is not intrinsically harsh, but her frustration and humiliation at what she perceives as her body’s failures harden her. She acts uncomfortably around Cynthia but has genuine warmth for her niece Roxanne, whom she greets with affection when Maurice’s family come to their house for a barbecue. For Monica and Maurice, Roxanne represents the closest thing they have to a child, so their mantelpiece is topped with a framed photograph of Roxanne in primary school. This barbecue is a traumatic event for all involved, as it is the moment when Hortense is revealed as Cynthia’s long-lost daughter, creating the dramatic climax of the film. Significantly, it is also the moment when, for the first time, Monica’s infertility becomes known. When Cynthia accuses Monica of being “selfish” for “not wanting children”, Maurice is forced to tell the truth: that Monica is “physically incapable” of having children and that they have endured fifteen years of tests, operations, and trials with no success. Maurice’s voice breaks as he explains this and Monica finally allows herself to be publicly vulnerable. She ends the scene crying in Cynthia’s lap, letting out years of grief in a single moment; her secret no longer repressed.

Secrets and Lies screen grab

In Monica’s final sequence of the film, Leigh frames her and Maurice in an overhead shot as they lie in bed together. It is a tight shot, focusing on little else but their bodies. Monica rolls over to nuzzle Maurice as she professes her love for him. They whisper that they have each other and, for now, that is enough. With their secret finally exorcised, they can begin to cope properly with their heartbreak and forge a new chapter for themselves. In spite of so much sadness, disappointment, and physical distress, Leigh suggests that there is hope for this couple. He does not attempt to neatly resolve what is an ongoing situation of acceptance and adjustment, nor does he contrive an ending that diminishes the enormity of Monica’s health conditions. Leigh stays within the realm of recognisable life experiences, creating a small moment of beauty within previously bleak circumstances.

Secrets and Lies screen grab

With Secrets and Lies, Leigh demonstrates that women’s health issues can be explored realistically and sensitively in the cinema, rather than only being depicted as abject, horrific, or in metaphorical terms. His film suggests that health conditions such as endometriosis take immense emotional and physical tolls on women and their families, but that love can persist through chronic illness, and that even relationships at near-breaking point have the capacity to strengthen.

In an interview in 1997, a year after the film’s release, Leigh stated:

“I think if you read Monica right, she suffers not only from her infertility but also from menstrual cramps, so she’s filled with anxiety. But in the film’s final sequence you see her capable of behaving in a warm and sympathetic way. I want her to be seen as a multifaceted character”4.

Leigh has certainly achieved this goal, contributing to productive discussion of women’s health on screen and rendering Secrets and Lies an illuminating film twenty years on.


1. “Endometriosis Fact Sheet”, Jean Hailes Medical Centre, 2014, https://jeanhailes.org.au/contents/

2. Lola Pellegrino, “Padma Lakshmi: Endometriosis is Real, and It’s Staggering”, Lenny Letter, November 17, 2015, http://www.lennyletter.com/health/interviews/a161/padma-lakshmi- endometriosis-is-real-and-its-staggering/.

3. Sarah Boseley, Jessica Glenza and Helen Davidson, “Endometriosis: the hidden suffering of millions of women revealed”, The Guardian, September 28, 2015, https://www.theguardian.com/ society/2015/sep/28/endometriosis-hidden-suffering-millions-women.

4. Leonard Quart, “Raising Questions and Positing Possibilities: An Interview with Mike Leigh, 1997”, in Mike Leigh: Interviews, ed. Howie Movshovitz, Jackson, Mississippi: University Press of Mississippi, 2000, p. 133.


Emma Sutherland is a PhD student at the University of Melbourne. Her academic research interests include theories of empathy, creative collaboration, social histories of cinema, and art/independent film aesthetics. She also likes to write about health in the context of visual and literary cultures.