The Gender Health Gap: How Women’s Bodies Have Been Sidelined in Scientific Research
By Dr Tosin Sotubo-Ajayi
Why Women Have Been Sidelined in Science
Historically, scientific research has centred on men as the default study participants. Researchers claimed that the hormonal fluctuations women experience made their bodies unpredictable and too complex, leading to a preference for studying men. In 1977, the FDA (the US Food and Drug Administration) issued guidelines excluding women of childbearing potential from certain phases of clinical trials, fearing the unknown effects of drugs on pregnancy outcomes. While it sounds protective, this essentially blocked women of reproductive age from most clinical studies, which meant that women’s health was consistently left out of the scientific equation.
The tide started to shift in 1993, with the National Institutes of Health Revitalization Act, which required government funded studies to include both women and minorities. However, by that time, decades of male-centred research had already laid the groundwork for medical treatments, drugs, and clinical guidelines that often overlooked women’s unique physiology. Although this area is improving, women’s health remains largely understudied, and women are still left with healthcare built on data that doesn’t fully reflect their needs.
The Impact of the Gender Health Gap
The lack of research on women’s health isn’t just a gap in knowledge, it affects multiple areas of everyday healthcare and real women globally. Here are a few examples:
1. Medications
As we are now aware, many drugs we use today were developed and tested primarily on men, without accounting for the significant physiological differences between male and female bodies. For example the oestrogen and progesterone hormone fluctuations experienced by women during the menstrual cycle can affect how drugs are processed by the body, their effectiveness and possible side effects. These fluctuations aren’t minor details; they can determine how well a drug works, how quickly it’s processed, or what side effects an individual might experience. This knowledge gap unfortunately continues to affect women’s healthcare today.
2. Reproductive health conditions
The lack of dedicated research into women’s health has left us with significant gaps in understanding and treating common conditions like endometriosis and polycystic ovary syndrome (PCOS). Affecting millions of women globally, these conditions are often misunderstood, misdiagnosed, or mistreated causing physical and emotional pain and impacting daily life.
Let’s take a look at endometriosis as an example. Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, which can lead to intense pain, abnormal bleeding, and, in some cases, infertility. Despite affecting an estimated 10% of women of reproductive age globally, research on endometriosis remains limited. Many women endure years of symptoms before finally receiving a diagnosis, with the average time to diagnosis between 7 to 11 years.
While some progress has been made, we still don’t fully understand why endometriosis occurs and these unknowns continue to hold back advancements in preventive care and precise treatment approaches.
3. Mental Health
Women are diagnosed with anxiety and depression more frequently than men, but their experiences with these conditions can vary significantly. Hormonal factors including menstrual cycles, pregnancy, and menopause play essential roles in women’s mental health, influencing mood and energy levels. However, dedicated research exploring these connections remains limited. Take Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) for example. Premenstrual syndrome (PMS) is a combination of physical and emotional symptoms that many women experience in the days before their period. PMDD is a much more severe form of PMS that impacts mood and can lead to debilitating emotional symptoms. Yet few studies have focused on understanding its underlying causes. The need for research that acknowledges and explores these hormonal influences is critical to improving mental health care for women.
Bridging the Gender Health Gap
Closing the gender health gap will require a multi-faceted approach. Here are just a few ideas:
1. Inclusion in Research
While inclusion in research has made significant strides, particularly with studies exploring the impact of hormones such as oestrogen and progesterone in women, there is still a long way to go. It’s crucial that women are included in clinical trials at all stages of testing, ensuring that their unique physiological needs are accounted for.
Additionally, research should incorporate a gender-based analysis, investigating how different treatments affect men and women differently, particularly in relation to hormonal fluctuations. For example, tracking changes throughout the menstrual cycle provides more answers and data on how treatments affect women at different points in their cycle.
2. Technological Innovation:
The rise of FemTech (technology designed to address women’s health) has opened doors for invaluable menstrual cycle research. Through innovative devices and apps that track hormonal changes, menstrual symptoms, and fertility patterns, we now have access to valuable data that sheds light on how the menstrual cycle influences both physical and mental health. By investing in FemTech, we can use these tools to improve diagnoses, treatment plans, and overall healthcare for women.
3. Education and Training:
If we’re going to make real progress, medical education has to evolve right from the beginning. Training our future healthcare practitioners to recognise the breadth of gender-specific differences including symptoms, risk factors, and treatment responses will be instrumental in closing the gender health gap. By doing this we can ensure that women receive better, faster, and more accurate care that addresses their health needs.
Conclusion
The gender health gap is an ongoing issue that demands our attention. For far too long, women’s health has been sidelined in research, leading to significant gaps in our understanding of how various conditions, treatments, and medications uniquely affect women. This oversight has real consequences, affecting everything from how women’s bodies respond to medications to the quality and effectiveness of their treatment and care.
But the tide is turning. With a growing emphasis on inclusion in research, the rise of innovative solutions, and with this improving medical education, we have the opportunity to make meaningful progress. It’s essential to recognise that women’s health is not just an offshoot of men’s health; the two are uniquely different and therefore women’s health requires dedicated focus and tailored approaches.
References:
Schiebinger L. Women's health and clinical trials. J Clin Invest. 2003 Oct;112(7):973-7. doi: 10.1172/JCI19993. PMID: 14523031; PMCID: PMC198535.
Steinberg JR, Turner BE, Weeks BT, et al. Analysis of female enrollment and participant sex by burden of disease in US clinical trials between 2000 and 2020. JAMA Netw Open. 2021;4(6)
. doi:10.1001/jamanetworkopen.2021.13749.
Romanescu M, Buda V, Lombrea A, Andor M, Ledeti I, Suciu M, Danciu C, Dehelean CA, Dehelean L. Sex-related differences in pharmacological response to CNS drugs: A narrative review. J Pers Med. 2022 May 31;12(6):907. doi: 10.3390/jpm12060907. PMID: 35743692; PMCID: PMC9224918.
Dantkale KS, Agrawal M. A Comprehensive Review of the Diagnostic Landscape of Endometriosis: Assessing Tools, Uncovering Strengths, and Acknowledging Limitations. Cureus. 2024 Mar 26;16(3):e56978. doi: 10.7759/cureus.56978. PMID: 38665720; PMCID: PMC11045176.
Office of Research on Women’s Health. History of women in clinical research. National Institutes of Health. [cited 2024 Oct 27]. Available from: https://orwh.od.nih.gov/toolkit/recruitment/history#1.
Mishra S, Elliott H, Marwaha R. Premenstrual Dysphoric Disorder. [Updated 2023 Feb 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532307/