As we come to the end of Women’s History Month and acknowledging their significant impact on society, we must also talk about women’s health. Women in the United States had the lowest life expectancy of 80 years, compared with women in other high-income countries. Women also had the highest rate of avoidable deaths.
I’ve written before in this column about why we need to make women’s health a priority, here and here. In honor of this year’s Women’s History Month, it’s important to understand the history of research around women’s health and acknowledge that not only must we not abandon the progress we’ve made but we must also continue to push for research and practice that enhances our knowledge about women’s health issues from pregnancy to menopause and beyond.
Continuing to prioritize a robust women’s health agenda is the scientifically, economically and ethically right thing to do.
The Scientific Reason.
When you look at a timeline of clinical and public health research, the focus on women’s health is relatively new. For example, while the National Institutes of Health were established in 1887, it wasn’t until 1990 that a dedicated office to women’s health research was created.
Women are biologically different than men. Women experience diseases differently. Cardiovascular disease is a prime example. Studies show that menopause notably increases a woman’s risk of heart disease, especially for those who enter menopause early. A statistic among younger women, 35 to 44 years of age, shows that coronary heart disease mortality rates have increased by 1.3% annually between 1997 and 2002.
Additionally, over the last two decades, there has been a significant change in the population demographics of pregnant women, resulting in a higher number of pregnant women with cardiovascular diseases. Guidelines to treat heart disease come from studies done in the 1990s and almost exclusively in men.
The burden of stroke plays out along a similar plane. Stroke is the third cause of death in women and kills more women than men. Women have unique risk factors for stroke, including high blood pressure during pregnancy, using certain types of birth control medicines and having higher rates of depression.
Before the enactment of the National Institutes of Health Revitalization Act of 1993, which mandated adequate representation of women in clinical trials, women were largely underrepresented in NIH-funded clinical research. Prior to that, the inclusion of women in trials was just a recommendation. Progress, however, has been made to close that large gap in gender representation in clinical trials. Today, women are said to make up close to half of clinical trials, yet, some studies place this number lower.
A study conducted in 2022 determined that across more than 1,400 trials, including roughly 302,000 participants, on average, 41.2% were female but with notable differences in female representation by trial. The study concluded that for each therapeutic area analyzed, the participation of females in clinical trials fell short of the benchmark derived from national prevalent data.
Inadequate involvement of women can negatively impact the value of a clinical trial, leading to unreliable data on how women will respond to a drug treatment.
The Economic Reason.
The number of women participating in the labor force has surpassed pre-pandemic levels, by about 2 million women, and sits at 79 million. And in 2022, female students made up 57.9% of all postsecondary enrollment, with the assumption that they are making up our future workforce. While women have been entering the workforce at historically higher rates, there are still gaps for many reasons. Of course, a leading cause is the lack of affordable childcare, but what about the lack of workplace accommodations and policies around women’s health needs? For example, there is very little research on menopausal impacts on women in the workplace, and even fewer laws and policies about menopause in the workplace.
The US Department of Labor shows a large proportion of women in the workforce are at the age when menopause starts, 45 to 54 (75.2%) and 55 to 64 (59.6%). A cost analysis of menopausal symptoms applied to the total population of working women in the US aged 45 to 60 years resulted in about $1.8 billion annually for lost work productivity. This did not include reduced hours of work, loss of employment, early retirement or changing jobs.
Real biological symptoms, including lack of sleep, brain fog, weight gain and mood fluctuations are often symptoms that are brushed aside but create a significant burden on women and their productivity.
It’s A Matter Of Ethics.
Simply put, women make up half of the country’s population.There is every scientific and biological reason why clinical researchers must approach women’s health with a different lens. While advances have been made towards accounting for sex as a biological variable, funding and resources must continue to be prioritized for women’s health. If half of the population suffers from debilitating, preventable chronic diseases and the therapeutic interventions being developed aren’t based on an accurate representation of the population, then I would expect that we would want to do better.
We shouldn’t just place importance on women’s history (and health) once a year, we should continually talk about this in the workplace, with our families, our elected officials, our public health practitioners and, most importantly, with each other.
Women’s health is not a taboo topic. We are the foundation of this country, and we need to be healthy to make this nation strong. The more we continue to have these conversations, advocate for new research and public health programs and make women’s health a funded and critical priority, the more progress we make towards a healthier, happier and more productive country.
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