From pain to heart disease, studies show doctors have often written off women’s physical health issues as psychological problems – as being “all in their heads.”
It’s an endemic issue, due in part to the way the health care system has built its institutional knowledge on studies and clinical trials on men, not women. The result: misdiagnosed patients or delayed diagnosis for many conditions, which can lead to prolonged pain, worse health outcomes and unaddressed issues that ripple across women’s lives.
For women seeking care, it’s important to know how to be an advocate for their health – and to understand the ways the health care system is working to change for the better.
Medical knowledge built on men
Several decades ago, “women’s health” meant anything related to the unique parts of the female body – breast and ovarian cancer, pregnancy and conditions related to menstrual cycles. Yet there’s so much more to women’s health. Men and women are different in many more ways than just their anatomy: they experience different symptoms for the same disease, they respond to pain differently, they have different rates of specific diseases, and respond to medications differently.
As women seek health care – even for issues with their hearts, kidneys and brain – they are walking into an institution where most health practices, tests and treatments are largely based on research on men. The U.S. Food and Drug Administration recommended excluding women of childbearing age from clinical trials in 1977, due to concerns about drugs causing potential birth defects. The FDA reversed this recommendation in 1993. And it wasn’t until 2016 that the National Institutes of Health (NIH) instituted a new policy requiring sex to be considered as a biological variable in both human and animal studies.
“More often than not, basic and preclinical biomedical research has focused on male animals and cells. An over-reliance on male animals and cells may obscure understanding of key sex influences on health processes and outcomes,” the NIH policy states.
As a result, doctors have less institutional knowledge to draw from when treating women – and must rely on emerging research to guide their treatment decisions.
For example, women respond differently to some drugs than men. In 2014, the FDA lowered the recommended dosage for women for the sleep aid zolpidem – sold under the brand name Ambien. It cut the recommended dose in half for women – which means for the 20 years prior, women were taking twice the needed dose. During that time, women were more susceptible to being mentally impaired the morning after taking the drug.
Women and pain
Women experience pain differently from men – and yet, it’s hardly been studied, even with mice. A survey of mouse and rat studies published from 1995 to 2006 found 79% used only male mice.
Recent research is beginning to show the impacts of this issue on women:
- Doctors and nurses prescribe less pain medication to women than men after surgery, even though women report higher levels of pain.
- A study of emergency room visits indicated women were 13% to 25% less likely to receive opioid painkillers than men for acute abdominal pain. Women also waited 16 minutes longer, on average, to receive a painkiller.
- A 2022 survey of more than 2,400 women conducted by the National Pain Report found 65% of respondents said they feel doctors take their pain less seriously because they are female.
A significant source of pain for women are conditions and treatments related to their menstrual cycle. More than 11% of women in the U.S. between the ages of 15 and 44 have endometriosis – a painful condition in which endometrial tissue grows outside of the uterus. As the tissue continues to grow and expand, it can bind organs together – leading to a risk of infertility – and causing significant pain.
And yet, 40% of patients who reported endometriosis symptoms to health care providers found their discussions to be not or rarely open or productive; and one in four patients said they don’t feel heard, believed or supported, according to a survey by the Alliance for Endometriosis.
Health conditions affecting women
Heart disease is the primary killer of women in the U.S. – but symptoms in women may be hard to recognize. Women’s most common heart attack symptom is chest pain or discomfort – which is the same for men.
But women may experience other symptoms that are typically less associated with heart attack, such as shortness of breath, nausea/vomiting and back or jaw pain, according to the American Heart Association. Early signs of a heart attack in women can easily be confused with acid reflux, influenza or just a part of aging – like pain or discomfort in the arms, back, neck, jaw or stomach, as well as dizziness, cold sweats, lightheadedness and fainting.
Even with these known differences in how women experience a heart attack, there is a disparity in treatment. A national survey of emergency room treatment found women ages 18 to 55 who reported chest pain waited longer and received a less thorough evaluation for a heart attack than men, according to a 2022 report in the Journal of the American Heart Association.
Increasingly, adult women are being diagnosed with attention-deficit hyperactivity disorder, or ADHD
Women’s symptoms have often been mislabeled as depression or anxiety as they dealt with feelings of restlessness or difficulty concentrating, and instead were left with untreated ADHD. As more is becoming known about this issue, diagnosis and treatments are evolving.
For every two women with an autoimmune disease in the U.S., one man has a condition. Autoimmune disorders occur in which the body’s immune system attacks itself – often causing inflammation, fatigue and pain.
These conditions predominantly affect women. Autoimmune diseases include rheumatoid arthritis, Sjogren’s syndrome and lupus. But these diseases can be hard to diagnose at first, as signs and symptoms can slowly emerge over years – which can take a toll on patients, especially with repeated tests and unresolved symptoms.
Advice for women
For women, regularly seeing a health care provider for health maintenance evaluations and preventive screenings is an important part of staying healthy. Talking with your doctor about your questions and concerns is a key part of these regular visits to ensure your whole health is taken into consideration. Choose a doctor that you feel comfortable with and that you feel listens to your concerns.
If you have an ongoing health concern, make sure you feel heard by your doctor and care team. It is important for you to always advocate for yourself. A doctor’s role is to listen to your concerns, and along with you, to come up with a plan of care that you both feel comfortable with based on your symptoms and the medical literature available. Even when you feel comfortable with your care team, it is always okay to seek a second opinion so that you are aware of all options for your care.
Dr. Marti Walsh, MD, is a senior medical director and associate chief medical officer at Blue Cross Blue Shield of Michigan.