Despite progress and scientific advancements to improve health outcomes over the years, women’s health still isn’t being taken seriously. Women’s concerns about their health are often ignored, misdiagnosed or diagnosed late.
This is a systemic problem in our healthcare system, affecting clinical studies and medical research, interactions with healthcare providers and outcomes, and societal education and awareness on women’s health.
Gender Inequality In Medical Research
Historically, clinical trials and diagnostic criteria focused on data from men. In the US, it was only 1990 when the National Institutes of Health (NIH) created The Office Of Research On Women’s Health to address how a ‘lack of systemic and consistent inclusion of women in NIH-supported clinical research could result in clinical decisions being made about health care for women based solely on findings from studies of men - without any evidence that they were applicable to women'.
Historically, the difference in male and female hormone levels, particularly the normal hormonal fluctuations women have throughout the menstrual cycle, have been used as a reason to exclude women from clinical studies on the basis that this introduces more variables. It was only 2015 when the NIH required medical investigators to consider sex as a biological variable. They also required that to receive grant funding, both sexes must be included in the research, or provide a valid reason for why one sex is excluded. Unfortunately despite measures to reduce the data gap between sexes in clinical research, this issue still exists.
There are many consequences of this. It means that diagnostic criterion and disease pathologies are often informed by data from men, despite the fact that women may present with a disease differently. Excluding or under-representing women in drug trials also has damaging effects.
Females have a 1.5-1.7 greater risk of having an adverse drug reaction compared to male patients. A reason for this is that females may biologically metabolise and react to drugs differently. It may also mean that some drug doses should be different for men and women. This was found to be true in an American sleep medication zolpidem (also known as Ambien), where the recommended dose was found to be double as much as women should consume.
Women And Reproductive Health
A Public Health England survey found that 31% of women reported experiencing severe reproductive health symptoms in the last 12 months, such as heavy periods, infertility, menopause, and incontinence. Unfortunately this survey also reports that over 50% of women who experience mild or severe reproductive health symptoms do not seek assistance.
Sadly, women may feel uncomfortable or afraid to talk to healthcare professionals about symptoms they are experiencing, which may prevent them from accessing the care they need. In a small study, of the 75% of women in the UK that reported experiencing menopause symptoms, only 36% visited their doctor, while 50% did not seek treatment and 26% sought treatment elsewhere. In 2015, Ovarian Cancer Research found that in the UK, if a woman suspected a sexual health or gynaecological problem, only 17% of 18-24 year olds and 68% of 55-65 year olds would seek medical attention.
Despite reproductive health problems being so common, the 2018 UK Health Research Analysis Report found that of the 21 distinct health categories, the reproductive health and childbirth category only received 2.1% of the total awards and expenditure for all direct awards submitted to the analysis.
Endometriosis is one of the reproductive conditions that has received national and global attention for slow and unacceptable diagnosis times. In the UK, it takes on average 7.5 years to be diagnosed. Endometriosis is incredibly common and affects 1 in 10 women, the same number of people that have diabetes. However, endometriosis research is woefully underfunded. For every $1 of research funding invested in endometriosis, there is $200 invested in diabetes research. The combination of long waits for a diagnosis, and inadequate treatments can leave women with pain, infertility, low self-esteem, difficulty maintaining work, and too many or unnecessary medical appointments and treatments.
In ovarian cancer, 45% of women wait 3 months from their first GP visit to receive a correct diagnosis. This delay may mean that the cancer becomes harder to treat. A report by Target Ovarian Cancer highlights some of the difficulties women and GPs have at identifying symptoms of ovarian cancer, which may cause delays in seeking help, and make a proper diagnosis more difficult. For example, only 20% of women in the UK can list bloating as one of the main symptoms of ovarian cancer. The charity also reports that 44% of GPs think that symptoms only present in later stages, when they can appear early. This is one of the many examples where both more education for doctors and the general public is needed to help raise women’s health outcomes.
Women And Heart Health
It’s not only symptoms and conditions involving women’s reproductive health that are overlooked. This problem happens in illnesses that affect both men and women. The British Heart Foundation reported that more than 35,000 women are admitted to hospital with a heart attack every year, but women are 50% more likely than men to receive an incorrect initial diagnosis after a heart attack.
The British Heart Foundation also found that women who had a final diagnosis of a total blockage of the artery, also known as STEMI, were 59% more likely to be misdiagnosed compared to men. Women with a final diagnosis of a partial blockage, or NSTEMI, were 41% more likely to be misdiagnosed than men.
One of the reasons why heart attacks are misdiagnosed in women, is that the protein troponin, which is released when a person has a heart attack, is lower in women than men. The levels used to diagnose a heart attack are often based on men’s levels of this protein. However research has found that peak troponin levels in females are 4x lower than males in hospital patients. In the last few years, this has led to the development of new testing that can detect lower troponin levels.
Additionally, men and women may experience heart attack symptoms differently. Although The American Heart Association finds that most women report chest pain or discomfort, women are also more likely to experience symptoms such as shortness of breath, back pain, jaw pain, nausea, or vomiting.
The British Heart Foundation also notes that women report experiencing some less common symptoms such as anxiety brought on very suddenly that may feel like a panic attack, or excessive coughing or wheezing. More awareness is needed to help people identify that women may experience different symptoms of a heart attack to men, in order to improve health outcomes.
Women And Pain Management
Men and women’s pain is often treated differently. In addition to medical research often not focusing on women, and gender biases that women may encounter in the healthcare system, some research suggests that there are biological reasons for why males and females experience pain differently.
This remains an evolving area of research, but implicates hormonal differences in males and females, such as oestrogen, progesterone, and testosterone, in why pain may be experienced differently. Some research also suggests that men and women’s cerebral cortex, the main communications network in the central nervous system, processes pain differently and may also be linked to the role of sex hormones.
Research also suggests more women than men have a chronic pain condition. Some of these conditions include migraines, fibromyalgia, IBS, and chronic tension type headaches, TMJ, and interstitial cystitis. A study in Sweden reported that for all of the 10 different anatomical regions, more women than men reported pain in the last 7 days, and were also much more likely to report experiencing chronic widespread pain.
Similarly, women have a higher prevalence of autoimmune conditions than men. Autoimmune disease is when the body launches an immune response by lymphocytes or antibodies on its own cells - or when the body attacks itself. Autoimmune conditions include rheumatoid arthritis, irritable bowel disease, type 1 diabetes, multiple sclerosis, myasthenia gravis, and systemic lupus erythematosus.
This again highlights the importance of women being adequately represented in medical research to understand both why they have higher rates of autoimmune diseases, and also if there is a need for different approaches to manage specific autoimmune conditions between males and females.
Women And Weight Management
Weight management is another area of healthcare where men and women face inequalities.
Although generally, weight can be managed through exercise and nutrition, there are some differences between the sexes. Due to higher levels of testosterone, men tend to have lower fat mass and more muscle mass than women. As a result, men often need to consume more calories than women, because muscle will burn more calories than fat. In the context of weight management, typically, both men and women lose muscle with age and this affects weight loss.
Beyond this, female sex hormones may make it more difficult to lose weight. For example, one of oestrogen’s many functions is to influence glucose and fat metabolism. As a result, lower oestrogen levels may lead to weight gain. This steep decline in oestrogen levels may also be a reason why during menopause, some women may gain weight.
While high stress levels can contribute to weight gain in both men and women, this may be exacerbated in females due to the fact that oestrogen is released by fat cells. Conversely, when oestrogen levels are too high weight gain can also occur.
Beyond sex hormones, other hormones such as cortisol, insulin and thyroid hormones can influence weight. Being overweight or underweight may indicate other health issues. It’s important that women feel comfortable speaking with their doctors about this, and also that their healthcare providers can look beyond diet and exercise to other underlying mechanisms and conditions.
In the UK and throughout the world, inequality in healthcare between men and women persists. This systemic problem touches all levels of the healthcare system - from how research is conducted and funded, the testing and diagnostic criteria, and interactions and medical interventions with healthcare providers and outcomes.
Increased medical research with a greater number of female participants is crucial. There needs to be more resources and guidance to improve diagnostic criteria and time, understanding of disease pathologies, and medical outcomes. We have to build awareness and trust, to empower women to talk to their doctor when they feel something isn’t quite right. GPs also need to receive greater training on female specific problems, so women are diagnosed earlier, and their health concerns are taken seriously and not dismissed or marginalised.
While focusing on the inequalities in healthcare between men and women, we must also acknowledge that even amongst women inequalities exist that also need addressing. There are inequalities in women’s health outcomes varying by race, ethnicity, religion, sexual orientation, and gender identity.
At Forth, we want to break down the barriers that women face in healthcare by giving them a greater understanding of their own health. We want to empower women, so they feel more in control over their own health and have the confidence to seek medical help if problems arise.
We support all the work being done by healthcare professionals, researchers, scientists, and the growing number of female founded healthcare businesses who are passionate about raising awareness around the taboos surrounding women’s health needs, and like us want to be part of a growing movement which are intent on driving equality in female health.