The unique health risks of the female body

When it comes to healthcare, science has come a long way in helping treat and diagnose a wide range of conditions. The patient experience for menstruating people, however, is a systemic issue that has been slower to progress. Pollie’s focus is expanding access to quality care to people with polycystic ovarian syndrome (PCOS), but we recognize that quality care can be hard to find, especially as a female.

With the recently-coined term “medical gaslighting,” females are sharing their stories to bring attention to the gender biases they have experienced firsthand (1). Although the term medical gaslighting is relatively new, the gap in equal care has existed for decades, largely due to the sex-specific differences that have been overlooked in research.

How exactly did we get here? In this article, we’re going to dive into gender biases, how biological differences affect different areas of healthcare, and ultimately how you can advocate for yourself to obtain the care you deserve.

A quick history on female health research

Female health has historically been underfunded, underdiscussed, and under-researched.

Clinical trials and diagnoses have been historically focused on males. In fact, it wasn’t until 1990 until the National Institutes of Health (NIH) addressed the need for more inclusive studies to support findings that could also be applicable to females (2). Although this was a step in the right direction, hormonal fluctuations and menstrual cycles could still be used as a variable to exclude females from studies.

It took fifteen years for the NIH to state that sex be considered a biological factor in research and required studies to include both sexes (or provide a valid reason for exclusion) in order to receive grant funding. Despite these changes, advancements in research have still been slow: female-specific diseases, and the female body in general, continue to be underfunded areas despite studies that show that repurposing a conservative amount of dollars could see a significant return on investment.

Inadequate research has trickled down to gaps in patient care

Fast forward to today, what are the implications of decades-worth of male-centric research? 

While it is a convoluted topic that’s rooted in gender norms, stereotypes, and biases, it cannot be debated that as a result of medical research’s historic focus on the male body, female health issues have been largely dismissed. There have been numerous studies and surveys conducted that reveal the stark differences in patient care. Below are a few examples that highlight the contrasting experiences between sexes.

• Females have a 33% longer wait in the emergency room compared to males with severe abdominal pain (3)
• When surveyed, 26% of females indicated they have felt dismissed while 18% of males felt dismissed (4)
• Females are less likely to be prescribed pain medication due to the pain being psychosomatic (5, 6)
• Studies show females tend to have an overall negative experience and a sense of mistrust in healthcare professionals (4, 5, 6)

This dragged out back and forth between female patients and healthcare professionals leads to a long wait for the right diagnosis, a process that can take years. During this period, symptoms can worsen, drastically impact quality of life, and increase risk for poor health outcomes. Like with many conditions, identifying the problem early to find a treatment plan is critical to reducing risks to long-term health.

Let’s take a closer look at specific areas where female health has been impacted due to lack of research.

Heart health in females: under-recognized and underestimated.

There are many underfunded areas in female health, but one of the most poignant examples is cardiovascular health, largely due to the biological differences (7). 

Heart disease is the major cause of death in females over 65, yet only 13% of females surveyed indicated heart health as their greatest personal risk. The survey also revealed that the topic of cardiovascular risk and specific symptoms pertinent to females was never brought up by their physicians (8). 

Let’s dive deeper into the biological differences in relation to heart health.

Studies show as females go through menopause, the complex hormone changes can affect cardiovascular health  (6, 7). Estrogen helps increase HDL (the good cholesterol), so with the decline of this hormone in peri-menopausal years, the risk for high cholesterol, hypertension, and heart disease rises (8). 

Additionally, compared to males, females have smaller hearts and narrower blood vessels which cause heart disease to progress differently in females. Rather than having plaque buildup in large arteries, females are more likely than males to develop this buildup in the heart’s smaller blood vessels (9). 

There are decades-worth of research studying plaque buildup in the large blood vessels of the heart, but there is less understanding on how to treat buildup and inflammation in the small vessels, which reiterates the point that the female body is often under-discussed and under-researched. 

What are heart health symptoms to look out for?  

Although there are overlapping heart attack symptoms that both sexes share, females have unique symptoms of cardiovascular issues that are often overlooked. 

These symptoms include indigestion, unusual fatigue, shortness of breath, back pain, nausea, sleep disturbances, and more (8, 10). These symptoms can all occur even in the absence of chest pain, which can make heart attacks and other heart diseases difficult to identify, especially if one is not aware of these lesser known markers.

Varying symptoms and biology should equal a different diagnostic criteria and treatment plan, yet the same tests, procedures, and medications have been used universally.

While major strides are being taken in bringing awareness to female cardiovascular health by countless organizations, like Go Red for Women, research has been (once again) slow to catch up. 

The two standard tests for diagnosing heart attacks (a cardiac troponin and a cardiac catheterization) can effectively detect heart attacks for the male body, but may not be the best measurement for females: 

• A cardiac troponin: Measures the levels of troponin in the blood, a protein that’s released when there is damage to the heart. However, a female could be having a heart attack and still fall below the level of detection. 
• A cardiac catheterization: Detects blockages in the large arteries, but female heart attacks can often happen in smaller arteries, as mentioned earlier. What results is a greater likelihood that a heart attack will be missed for menstruating people who undergo this standard testing. 

Although this information is not new, there still is no gold standard on how to effectively diagnose and treat blockage in the small arteries, a female specific symptom. More research and funding is necessary to gain a deeper understanding in the sex-specific factors that contribute to heart disease. Intricate reproductive systems, hormonal differences, and gynecological conditions (like PCOS) are a major part of female bodies that make them different from male bodies. 

Our reproductive systems also leave room for conditions that do not even apply to male bodies.

Because of the stark anatomical distinction between the male and female body, health issues manifest in various ways. How cardiovascular health affects menstruating people is just one out of countless examples of the complex differences that occur between the two sexes. 

One major driving factor for this is the reproductive system and the ever-fluctuating hormones involved. The reproductive system (and all that is required to help it function) is extremely complex and has its own set of conditions that can occur when there is even the slightest imbalance. This puts females, AKA just about half the population, at risk of an entirely different category that does not apply to males. And as we previously discussed, the female body has been historically understudied and the lack of research has been especially apparent in the field that affects only females: gynecological conditions.

Gynecological conditions can take years to diagnose and people who menstruate are often told their symptoms are psychosomatic or just a “bad period.” With no diagnosis, individuals who have gynecological conditions suffer for years without the proper resources and support they need to treat or manage symptoms. 

Even when a diagnosis is made, treatment options and educational tools to manage symptoms can be minimal. There are endless gynecological conditions to discuss, but we will be focusing on two of the most common in the next sections: endometriosis and PCOS.

Endometriosis

First, let’s talk about endometriosis. You have probably heard of endometriosis at some point, but what exactly is it? 

Endometriosis is a gynecological condition that affects 10% of menstruating people globally. When you have endometriosis, endometrial tissue (the tissue that typically lines the uterus) grows outside of the uterus. It can grow on the ovaries, fallopian tubes, and even the pelvis lining. As your hormone changes during the menstrual cycle, this tissue can become inflamed and painful (10). 

The symptoms of endometriosis vary from person to person. For instance, some people experience no symptoms, while others experience a variety of symptoms (11). 

Common symptoms of endometriosis include: 

• Painful periods
• Heavy menstrual bleeding
• Pain with bowel movements and urination
• Pain during intercourse
• Infertility
• Back pain

Some of these can be easily dismissed as PMS (premenstrual syndrome) symptoms, which may be why it takes an average of seven years to diagnose a person with endometriosis (11). Yes you read that right, seven years. If you have endometriosis, the pain can be debilitating, which leads to decreased quality of life and decline in mental health.

Unfortunately, this experience is not uncommon. 

A survey of 1817 people diagnosed with endometriosis, or have discussed endometriosis symptoms to a healthcare professional, shows that 90% of participants reported feeling unheard and disbelieved (12). 

And even if a medical provider does think you may have endometriosis, to make an accurate diagnosis, a laparoscopic surgery is needed. This procedure can be costly and invasive, which can be a major deterrence to obtaining a proper treatment.

Even after a diagnosis is made, patients are not provided with many resources to learn how to improve symptoms. Lifestyle changes can play a huge role in helping symptoms, yet this information is not widely discussed or included in a treatment plan (13).

To learn more about endometriosis and how you can manage symptoms, click here.

Polycystic ovarian syndrome (PCOS)

At Pollie, our core focus is PCOS. We are passionate about  spreading awareness that PCOS is more than just a fertility issue: it is a whole-body chronic condition.

PCOS is a hormonal disorder that affects 10% of menstruating people during their reproductive years. It accounts for nearly 70% of infertility cases, making it the leading cause of conceiving struggles (14). 

In addition to infertility, people with PCOS are more prone to develop other chronic medical conditions such as diabetes, heart disease, endometrial cancer, mental health issues - and endometriosis. 

Like with all conditions, symptoms may vary. Below are the most common PCOS symptoms.

• Irregular periods
• Acne 
• Weight gain
• Hirsutism
• Hair thinning
• Infertility 
• Pelvic pain

‍PCOS and endometriosis may have a couple of overlapping symptoms, but they are two completely different conditions. Read more about how PCOS and endometriosis differ here. 

Although PCOS has a huge impact on people who are trying to conceive, understanding the increased risks for other chronic conditions are not at the forefront of discussion, which can ultimately affect long-term health. Below are some stats on long-term PCOS health risks:

• 50% chance risk of developing diabetes by the age of 40
• 4x — 7x higher risk of heart disease, as discussed above
• 3x higher risk of developing endometrial and other estrogen-related cancers
• 3x higher risk of developing a mental health condition like anxiety or depression

While these statistics are quite alarming, having this knowledge can empower you to make the necessary lifestyle changes to manage symptoms and reduce long-term health risks. Nutrition, movement, stress management, and sleep are all factors that can significantly improve symptoms.

Just a small problem: not many people with PCOS are made aware of the heightened risks and various ways they can improve symptoms.

In an anonymous survey conducted by Pollie, only 11% of the 95% of people were satisfied with conventional healthcare resources. Another study shows over half of participants reported not receiving adequate information and long-term lifestyle tools for managing PCOS. Rather than obtaining resources from providers, participants disclosed they find a majority of educational tools through their own research on the internet. Overall, the study shows an overall poor patient experience (15). 

PCOS is often seen as just a fertility disorder, and countless people (our co-founder, Jane, included) have been prescribed birth control and told to revisit when they are trying to conceive. However, PCOS is a chronic condition that affects the whole body and should be treated as such. While birth control can certainly be a tool to help symptoms, it is often the only option offered to patients when discussing treatment plans even though research shows an interdisciplinary approach works best.

What does this mean for me?

It is clear that the female body needs to be part of the conversation in all areas of research, but there is a glaring disconnect that cannot be ignored when it comes to reproductive health and gynecological conditions. Although this may all sound discouraging, there has been more awareness surrounding gender biases and medical gaslighting in recent years.  

Individuals, doctors, and organizations are speaking out and taking strides to make progress in bridging the gap. This article touched base on gender gaps, but we also recognize that gender is one of many biases that exist. Race, age, socioeconomic status, weight, geographic location, and more can all factor into implicit biases. These biases can be even more amplified for people who are transgender or nonbinary.

Knowing these biases exist can prepare you to be a better advocate for yourself and be on the lookout for signs that you may be experiencing medical gaslighting. Below are a few examples of what that could look like (16).

• Your problems are dismissed or criticized as psychological
• Symptoms are trivialized and categorized as “normal” 
• Further tests deemed unnecessary until symptoms “worsen” 
• Your gender, race, sexuality, age, or weight is used to justify your symptoms

You understand your body best so if something does not feel right, trust your intuition and find another provider. It can be intimidating to advocate for yourself, particularly in a medical setting, so we’ve put together a few tips to help you navigate the visit.

• Put together documentation of your symptoms (date, time, and a description of symptoms)
• Make a list of questions and concerns before your appointment
• Bring a support person (you can ask them to leave if a sensitive topic is brought up)
• Practice what you want to say beforehand
• Explain the previous treatments that you have tried and what has worked or not worked for you in the past
• Get a second opinion

For more tips on how to advocate for yourself, reach out to your Pollie care team!

References

‍

1. Moyer, M. W. (2022, March 28). Women are calling out 'medical gaslighting'. The New York Times. Retrieved April 21, 2022, from https://www.nytimes.com/2022/03/28/well/live/gaslighting-doctors-patients-health.html 
2. Faden, R., & Federmen, D. (Eds.). (1994). Women and Health Research: Ethical and Legal Issues of Including Women in Clinical Studies: Volume 1. Institute of Medicine (US) Committee on Ethical and Legal Issues Relating to the Inclusion of Women in Clinical Studies. https://www.ncbi.nlm.nih.gov/books/NBK236535/ 
3. Chen, E. H., Shofer, F.S., Dean, A. J., Hollander, J. E., Baxt, W. G., Robey, J. L., Sease, K. L., & Mills, A. M. (2008). Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain. Academic Emergency Medicine, 15(5), 414-418. https://doi.org/10.1111/j.1553-2712.2008.00100.x
4. Pawlowski, A. (2019, May 13). Dismissed: The health risk of being a woman. today.com. Retrieved March 30, 2022, from https://www.today.com/health/dismissed-health-risk-being-woman-t153804 
5. Samulowitz, A., Gremyr, I., Eriksson, E., & Hensing, G. (2018). "Brave men" and "emotional women": A Theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain. Pain research & management, 2018, 6358624. https://doi.org/10.1155/2018/6358624
6. UPI. (1989, March 11). Researcher says women less likely to get painkillers. Upi Archives. https://www.upi.com/Archives/1989/03/11/Researcher-says-women-less-likely-to-get-painkillers/2047605595600/
7. Maas, A. H., & Appelman, Y. E. (2010). Gender differences in coronary heart disease. Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation, 18(12), 598–602. https://doi.org/10.1007/s12471-010-0841-y
8. Gender matters: Heart disease risk in women. Harvard Health. (2017, March 25). Retrieved April 21, 2022, from https://www.health.harvard.edu/heart-health/gender-matters-heart-disease-risk-in-women 
9. Harvard Medical School Teaching Hospital. (n.d.). Heart disease: 7 differences between men and women. Brigham and Women's Hospital. Retrieved April 21, 2022, from https://give.brighamandwomens.org/7-differences-between-men-and-women/ 
10. Mohamed, Abdul Wadood. “Endometriosis: Causes, Complications, and Treatment.” Healthline, 15 Dec. 2021, https://www.healthline.com/health/endometriosis#symptoms. 
11. Obstet Gynaecol. 2020. Jan;40(1):83-89. doi: 10.1080/01443615.2019.1603217. Epub 2019 Jul 22.
12. Charlton-Dailey, R. (2021, December 10). 90% of people with endometriosis report being dismissed by doctors and family. Verywell Health. Retrieved April 21, 2022, from https://www.verywellhealth.com/endometriosis-survey-disbelieved-5211872 
13. Vennberg Karlsson, J., Patel, H., & Premberg, A. (2020). Experiences of health after dietary changes in endometriosis: a qualitative interview study. BMJ open, 10(2), e032321. https://doi.org/10.1136/bmjopen-2019-032321
14. U.S. Department of Health & Human Services. (2019, April 1). Polycystic ovary syndrome. Polycystic ovary syndrome | Office on Women's Health. Retrieved April 21, 2022, from https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome 
15. Gibson-Helm, M., Teede, H., Dunaif, A., & Dokras, A. (2017). Delayed Diagnosis and a Lack of Information Associated With Dissatisfaction in Women With Polycystic Ovary Syndrome. The Journal of clinical endocrinology and metabolism, 102(2), 604–612. https://doi.org/10.1210/jc.2016-2963
16. Are you a victim of medical gaslighting? Hampton & King. (2021, August 14). Retrieved April 21, 2022, from https://www.hamptonking.com/blog/are-you-a-victim-of-medical-gaslighting/#:~:text=Medical%20gaslighting%20is%20when%20a,issues%20and%20sentiments%2C%20for%20example. 

‍