We’re struggling with a medical research gender gap. Women have more adverse side effects to medications and receive sub-optimal care for some conditions because clinical studies historically excluded women of child-bearing age. We can’t follow popular health and fitness advice because those studies are usually conducted on young, healthy males. We need to learn to listen to our bodies and do what is right for us.
In my 20’s, I realized every time I stopped working out and started eating what I wanted, I’d lose weight. It didn’t make sense to me. I worked out hard about five days a week and ate small, healthy meals every 3-4 hours. I did what I was supposed to do.
Health magazines said I was doing everything right. But as soon as I started listening to my body, took the rest I wanted, and ate the foods I craved, I’d lose weight.
Looking back at it, I was overstressing my body and not eating enough fat. I believed low-fat anything was healthier. The chocolate my body craved was probably exactly what I needed.
What does this have to do with medical advice? A lot of studies don’t put women into consideration. We may be following advice from research, but the research is about young, healthy men. And we’re NOT equivalent to smaller men. Our hormonal differences change how we react to stress in our environment and how we metabolize food and drugs.
Women in Medical Studies: A History
Imagine running the National Institute of Health in the 1970s. A drug trial has gone terribly wrong, and babies are being born with deformities. Are you panicking? Thinking you need to do anything you can to stop this from happening again? I would be.
In 1977, in response, all women of childbearing age were excluded from all drug trials. It doesn’t matter if you’re not sexually active, your partner has had a vasectomy, or you’re confident in the birth control method you’re using. No woman was allowed into drug trials anymore! It sounds a little crazy to me, but I can understand how the medical research gender gap began.
After over a decade, including women in drug trials started back up around 1989. But until 1993, it was only practice, not law. The National Institutes of Health Revitalization Act of 1993 requires that clinical research includes women and minorities. About time!
Why Studying Women is More Difficult Than Men
Besides the issue of making sure unborn babies are safe, women have fluctuating hormones through our cycles. At certain times of the month, we feel better than at other times. Some women have PMS and other symptoms that happen cyclically. How can researchers account for these subjective feelings?
If you begin a drug and a week later you start getting brain fog, feel a little depressed, and get a migraine, is it from the new drug, or could it be a nasty bout of PMS? When women aren’t in tune with their cycle, it gets a little fuzzy when determining cause and effect.
And we’re all different! How do we account for differences in research when one woman might feel terrible the week before her period while another gets tired around ovulation? And a third woman might not be as sensitive to hormone fluctuations and feels fine all month.
These differences make it a lot more challenging to study women, so we’re often not included in the research. Or if we are, only post-menopausal women or women on birth control are included. It’s a lot easier to study women whose hormones fluctuate on a 24-hour cycle, the same as men.
But honestly, it blows my mind that we study women on birth control, and assume the findings relate exactly the same to menstruating women. Our hormones are different! Why would they not take us into account?
Why Does It Matter?
As the director of the Office of Research on Women’s Health (ORWH) at the NIH said:
“Because we have studied women less, we know less about them. The result is that women may not have always received the most optimal care.”Duke Health
What an excellent summary. We need to study women so women can get treatments that are relevant for us. Our hormonal differences can cause Alzheimer’s, certain lung cancers, and depression, and yet we’re not well represented in studies for these diseases. If a woman gets a condition because of her hormones, the treatments studied on men will not be optimal!
One of the most well-known examples is heart attacks. Researchers studied men only around heart attacks from the beginning. Now, women are more likely to die of a heart attack because we are less likely to get care as quickly. When you think of a heart attack, you think of chest pain. Women are far less likely to get that symptom and so we don’t go to the hospital as quickly.
Science hasn’t caught up to the fact that women and men metabolize drugs differently. Because of higher body fat composition, lower body weight, and other differences, men and women can have different side effects when taking the same drug. But studies don’t call out these differences.
If a study has 10% of participants with a particular side effect, it could mean 40% of the women and no men had that side effect. We should be calling out these differences. As recently as 2005, the market pulled eight prescription drugs because of women’s health issues. And women are almost twice as likely as men to have an adverse reaction to medications.
How does this happen? Even though women are included in more studies, women usually join in the later research stages. The earlier stages determine the dosage, so the dosage isn’t optimized for women. Instead, the studies tend to determine whether women can tolerate a dose optimized for men.
What Can We Do?
We need to know our own body. Understanding our natural ebb and flow through the month and listening to what feels good to us is important. If we’re following fasting advice, for example, and we feel like fainting, we should stop. We can try again in a week or so, when our hormones are at different levels.
Not all popular advice applies to us, and we might be healthier if we workout less at certain times of the month. We need to find what works for us and not follow the studies that don’t take women into consideration. The medical research gender gap can improve. We can put our health back into our own hands. We need to listen to our bodies and do what is best for us. And we’re the only ones who know what that is.
Now I eat chocolate when I feel my body truly wants it. (Extra magnesium required. Happy to help!) And I don’t feel bad when my body tells me to take it easy with exercise. I may not be winning any races, but at least I have enough energy to stay awake past my son’s bedtime.
For some help with cycle syncing, grab the cycle syncing cheat sheets! They will help guide you to the best way to live with YOUR hormones and understand what your cycle is telling you.