A Historic Double Standard

by Mim Senft

“You seem really stressed. Do you think some of these symptoms are related to what is going on in your life?”

Many women with difficult-to-diagnose medical issues sometimes find their symptoms marginalized or ignored by medical professionals. What’s implied is that what you are feeling may just be “all in your head.” For women who have been in this situation, it can be extremely difficult to get the care they need. It can be frightening and demoralizing. Unfortunately, there is still a legacy of “female hysteria” as a catchall for hard-to-diagnose women’s health issues.

An All-Male Model

Female physiology has been a stumbling block for decades, when it comes to women’s health equity. Historically, all health research was done on men and male animals. That means symptoms for diseases and their corresponding treatment are based on research that never took into consideration the differences between male and female physiology.

Why were only men included? From puberty through our childbearing years, women’s physiology cycles on a monthly basis. Hormonally, our bodies go through a shift as we move through menopause. It was so much easier for researchers to just focus on men, with fewer hormonal variables to deal with and what was viewed as “cleaner” research. And we need to keep in mind that those reviewing the research were also almost always men.

The result has been that women, going back decades, have not had health equity. For many years, the standard symptoms for heart attacks were thought to be chest pain and pain down the left arm. But chest pain is often not a symptom of a heart attack for women. Jaw pain is more common. Extreme fatigue and indigestion are more common. But if a physician or medical professional still focuses on the more traditional list of symptoms for a heart attack because of the way they were trained, using those based on male physiology, women can be misdiagnosed.

According to the Go Red For Women website, cardiovascular disease is the No. 1 killer of women, causing one in three deaths each year. It is important to note that women of color can be at an even higher risk. And it isn’t just about heart attacks. Not being diagnosed or treated properly applies to strokes, cancer treatments and mental health therapies.

Women are Different

We all know that women metabolize alcohol differently than men. If we are given doses of medication that aren’t designed for our bodies, then we don’t have health equity. We may not get the same positive outcome as our male counterparts. That can be dangerous. Several years ago a sleep medication was approved by the FDA. Data started to emerge, once it was being widely prescribed, about women staying drowsy for many hours after waking up, much longer than men taking the same dosage. It was presenting real risks, particularly if they were driving. The research, prior to bringing it to market, hadn’t included women. The company did finally adjust recommended dosages based on gender.

These differences in symptoms of disease and the impact of treatment of female versus male physiology only came to light over the past few decades. That means older doctors and health professionals may have been trained based on older research. It should make us wonder how many women, our mothers and grandmothers, were sent home from an emergency room because the doctors didn’t recognize what the patient was experiencing as life-threatening.

Gender Differences and COVID

In the United States, between 1989 and 1993, the National Institutes of Health (NIH) encouraged the inclusion of women in clinical research, but it was not the law. The NIH Revitalization Act of 1993 was a step in the right direction, but only applies to NIH-funded research.

Fast forward to today, when there was little discussion about the gender differences in how women contract COVID, if we have any different symptoms, if women respond differently to treatment protocols and if the health outcomes, over time, are different by gender. Johns Hopkins University recognized the need for gender specific data and is currently working on gathering global data on COVID and whether or not treatment protocols need to be adjusted for women. We will also need to know if some of the long-haul COVID symptoms are gender specific so there can be more targeted treatment.

There is still, unfortunately, health research underway that doesn’t adequately address physiological gender differences. Women may be included in the study, but the study doesn’t break out the data by gender. In some parts of the world, women are still excluded from health research, which skews global health data.

Until the science catches up, there are ways that women can better protect their own health and well-being.

Listen to your body. It can be intimidating when doctors tell you that what you are feeling may not be a real symptom. No one knows your body better than you. Don’t ignore things like the sudden onset of a severe headache, persistent indigestion, or a change in sleep that goes on for more than a few nights. These may all be signs of a health issue that needs to be addressed. Write down your symptoms. If you need support when talking to the doctor, particularly if you feel he or she is not listening to you, consider bringing a friend or family member who can be an advocate. You deserve to be heard.

If you are struggling to get diagnosed, consider working with qualified, experienced functional medicine professionals, preferable those who are also MDs. One of the best training grounds for medical professionals is the Andrew Weil Center for Integrative Medicine at University of Arizona. See if your functional medicine provider was trained there. The website for the program at University of Arizona also includes a search function to find a trained practitioner in your area. Many people have found that including a functional medicine approach when dealing with a hard-to-diagnose or persistent health problem has gotten them back to a place of optimal health and given them a way to better protect it going forward.

Let other women know about the need for more gender specific health research and talk to your health partners about this issue. Start educating younger women in your life early about protecting their health and well-being, learning how to listen to their bodies and not being shy about speaking up. This is their health investment strategy, their 401(K) for a healthier future. The more they invest in protecting their health and their well-being early in life, the more years of good health they will have.

No matter what your age, getting better at listening to your body is a gift you can give yourself starting today. It will give you the opportunity to not only be healthier, but to thrive. Your health partners should be listening to you. You should always feel that your voice is being heard so that you are getting the equitable health support you need. You deserve no less. You deserve health equity.

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