“Women's health is still a white space... I am optimistic and we all have a role to play.” This is one of the quotes that came up during the panel discussion at the HBA Zurich Zug event back in March 2022. This October, HBA Europe hosted a conversation in Reuters Events Pharma on how to raise muscle and stop feeling awkward having conversations about menstruation, hormones, and menopause. Another HBA event is planned on the 6th of December in Basel, aiming to put women’s health in the spotlight. Huge progress has been made in the last decades regarding women’s health, but continuing to raise awareness is critical as the inequality has not been fully eliminated.
When the Beijing Declaration and Platform for Action was signed in 1995, women’s health was all about procreation. On the BMJ podcast, Cara Tannenbaum, Scientific Director of the Institute of Gender and Health at the Canadian Institute of Health Research describes that at the beginning of her career she was excited to start a medical center for women through their life course in a new hospital. Asking approval from the head of the gynecologist department, Cara got the response that women can have kids by the age of 50, best case 60 and he could not see why they had to treat them through their whole life course.
A few decades later, many people still connect women’s health with contraceptive pills and abortion. How many times do we hear about young women being on the pill to “control” issues from acne to irregular cycles instead of having access to healthcare to identify the cause? However, this solution is nothing more than temporary. In the Hormonal Genius podcast, Jamie and Teresa mention how the pill is used often as “band-aid” and encourage women to search for good healthcare and get to know their bodies instead of resorting to the pill. On 28 September 2022, BBC posted an article about how women’s symptoms are ignored by GPs and are often misdiagnosed. It is a fact that women who were experiencing heart attacks were told it was a panic attack. During the HBA ZZ discussion panel event “The Business of Women’s Health: It’s Much More Than you Think”, Petronela Sandulache, Founder of Cordifio Health, mentions that 50 percent of women even following a heart attack, get misdiagnosed with anxiety or depression — as everything that we know on cardiovascular disease has been studied on white men. And a timely diagnosis is key to keeping the heart beating. If this is not a wake-up call and the main reason to raise awareness and have events like the above, then what can be?
There are many factors that restrict more dialogue about women’s health. Perhaps the term is too broad for many to grasp, or the absence of personal empathy or contextual relevance is lost to many — for example, the workplace is ultimately measured by productivity, not belonging. Instead of tackling each psychographic barrier one by one, could we jettison the past ‘baggage’, rephrase and reframe women’s health in a way that galvanizes them?
In this article, we aim to explain what women’s health care is about. Kara Saunders, one of the fittest humans on the planet, who in August 2022 participated for the 10th time in the Crossfit Games explains how she realizes that the common nutrition for athletes, mostly designed for a male body, is not what she needs to feel healthy and strong. She is aware that a man can recover in 24 hours and has the same day every day of the month, while every week for a woman can be different. And yes, women’s health differs from that of men in various ways. Sex matters when it comes to metabolism, bone density, heart, and immune system. Therefore, we need to develop a branch of medicine that focuses on the treatment and diagnosis of diseases and conditions that affect a woman's physical and emotional well-being1. We need to highlight the part of physical and emotional well-being at this point. This involves a woman trying to understand how her hormones work and manage to take advantage of them. There are days of the month before ovulation when women feel that they can conquer the world, multi-task, get the big picture, and be extravagant and creative. However, there are ten to fourteen days after, when the estrogen and progesterone levels are low and productivity cannot be that high. During this period, women feel weak, sometimes even depressed. But what if a woman understands her cycle and works proactively to complete tasks on the days when her body gives her all the energy and the rest of the time focuses on completing smaller, “silent” tasks or even just takes time to re-energize with a good night’s sleep. What if each female employee felt comfortable mentioning to their male colleagues that they have menstrual pain and they need to step back that day? Pushing themselves to perform at maximum capacity when their body resists can only worsen the pain and deteriorate the negative feeling — and negativity is contagious. This situation is not only bad for the woman who goes through the struggle but impacts the productivity of the other people in the workplace. Fortunately, it seems that there is some serious action being taken. In May 2022, Spain’s Cabinet approved a bill that grants paid medical leave for women who suffer from severe period pain. Another positive corporate progress comes from Diageo, who made the Balance+ smartphone app available to employees. This app allows employees to diagnose and manage their symptoms of menopause. These may be signs that there is a wind of change and the dark times when women’s health was a taboo are behind us.
The next question we look to answer is if progress is also being made in research. Unfortunately, historically there have not been enough females enrolling in clinical trials, so they were made mostly on males. As a result, most of the clinical trials’ hypotheses were approved or rejected based on the male body reaction, which negatively impacts drug efficacy for women. In 1992, the U.S. FDA approved Ambien, a medication to help people sleep. Only in 2013, 21 years later, the FDA set the drug dosage for women at half of the initial dose as the likelihood to have a considerable amount of drug still in their blood more than 8 hours later was high and this resulted in a high risk of car accidents. Based on a biotechnology article written by Sandeep Ravindran2, 8 out of 10 drugs that were pulled from the market between 1997 to 2011 were showing greater risk for females. According to the same article, even preclinical studies were executed mainly on males — meaning drugs were approved taking into consideration only one sex. Sixty years ago, there was a strong excuse for this. Before the time that contraception methods got established and pregnancy tests got more accurate, there was a high risk of unknown pregnancy. This is not an excuse anymore and women are not excluded but they are still underrepresented. Thus, awareness needs to be raised about the need of having a diverse population but also about the safety of the trials so that more women are encouraged to enroll as Dr. Rice, Gynecologist Oncologist and Chair of UW-Madison Department of Obstetrics and Gynecology, is describing at the Women’s Healthcast in 2019. The challenge with executing the clinical studies is not only having a sufficiently diverse population but also the high cost of them. To convince governments and institutions to invest in research for women’s health, we need to prove that the ROI is high. In the same interview, Dr. Rice mentions that gynecological cancer is underfunded compared to other kinds of cancer and there is tremendous room for improvement. Based on the statement published in May 2022 by the Founder and CEO of Women’s Health Access Matters, Carolee Lee, “The Women's Health Access Matters report shows that women’s health is not just good science, it’s a good investment. Doubling the current research focused on women in just three disease areas, adding $300 million, will yield over $13 billion in economic returns through a greater quality of life, economic gains, and reduced healthcare costs. In order to truly celebrate women’s health, we must first invest in it.” Maybe the numbers are accurate, maybe not, but the message remains strong, the health and well-being of women can strengthen the global economy3.
Fortunately, the progress made on women’s health is significant, but we are not where we should be. Women’s health on a societal level remains a taboo subject, niched among those who are actively seeking solutions and minimized or avoided by those who do not experience them. Until we create open channels on either side, such as creating safe spaces to both express and learn, it will remain unheard. It is time to make women’s health a priority and to move the gender equality needle towards improving health equity and this is why HBA Zurich Zug dedicated this article to this important topic. To close, we would like to quote Sean Yap, Co-Chair HBA Europe Impact Committee, “We should no longer be backwards in coming forwards when talking about women’s health”.
2 The quest to show that biological sex matters in the immune system, Sandeep Ravindran, MIT Technology Review