Pediatricians are fond of saying that children are not just small adults – that their physiology and response to diseases are different. In the same way, women are not just men with different sex organs. Every cell in women is different than the corresponding cell in men, due to the difference in chromosomes.
Thus, women, as we have learned, often describe different symptoms when they are having a heart attack – and as a result, the diagnosis is often missed or delayed. Women have many more “auto-immune” diseases such as lupus and thyroiditis. Women obviously have unique diseases related to the menstrual cycle, such as endometriosis or polycystic ovary syndrome.
Women’s health issues are severely under-studied. Even though women make up 55% of patients hospitalized with acute coronary disease, they make up only 25% of participants in clinical trials of coronary disease.
Because women are considered at lower risk for coronary disease (even though as noted, they are over half the patients admitted with acute coronary symptoms), they are less likely to be prescribed statins, a proven life-saving therapy for patients with coronary disease.
Even though 70% of women take at least one prescription drug during pregnancy, only 5% of these drugs have been tested and shown safe during pregnancy.
Why this disparity? Throughout history, medical research and practices have primarily focused on men. This stems from outdated beliefs that women’s health issues were either insignificant or simply variations of men’s conditions. Many clinical trials specifically do not enroll women of child-bearing age, even those these same women may be given the treatments after the drugs are approved.
Women often complain of being “gas-lighted” (having their complaints ignored). Unconscious biases among healthcare providers can influence the quality of care provided to women. These biases may lead to symptoms being dismissed, pain being downplayed, or concerns being trivialized, all of which can result in delayed or inadequate treatment. For the same painful conditions, women are less likely than men to be prescribed pain medication.
Certain health issues specific to women, such as menstrual disorders or menopause-related symptoms, are dismissed as “normal.” This can lead to healthcare providers dismissing or minimizing these concerns, further perpetuating the cycle of inadequate care for women.
Addressing these issues requires a multifaceted approach that includes raising awareness, advocating for gender-inclusive research and healthcare policies, providing education and training on gender-sensitive care for healthcare providers and ensuring equitable access to healthcare services for all. By recognizing and actively working to dismantle these barriers, we can strive towards a healthcare system that provides equitable and compassionate care for everyone, regardless of gender.
Edward Hoffer MD is Associate Professor of Medicine, part-time, at Harvard.
What Does The Doctor Say?
By Dr. Edward Hoffer