Invisible Women: Pervasive Gender Bias Impacts Female Health

American women are responsible for most family healthcare decisions and are far more likely than men to be long-term caregivers for a sick or elderly spouse, family member, or friend. Yet they routinely face the effects of gender bias when it comes to their own health. Systemic inequities range from disproportionately less research into female health concerns to misdiagnoses and harmful stereotyping.

Growing awareness about health disparities of all kinds is creating opportunities to close the gaps in female healthcare. A galaxy of new technologies targeting women—collectively known as femtech—has emerged to help women better manage health conditions like fertility, pregnancy, and menopause. But the problem of inequity is ancient and much more needs to be done to achieve full healthcare parity for women.

Women are underrepresented in research

Gender bias in healthcare, as in society, is embedded, pervasive, and often unconscious. Many research studies historically have excluded or underrepresented females, with research data collected from males then generalized to females. Explanations for discounting half the population range from concerns about impacting fertility or pregnancy, to bias from male researchers to the assumption that males are most representative of the human species.

According to 1 study, women made up just 5.3% of gout medication trial participants, yet account for 30% of the gout disease population. Another report determined that although 60% of psychiatric patients are women, just 42% of clinical drug trial participants were female. Women likewise were underrepresented in cancer drug trials, participating at a rate of 41%, despite accounting for 51% of cancer patients.

Heart disease risk is higher in women

The consequences of excluding females from research can include delays in care, withheld treatments, or the application of inappropriate or ineffective care. Case in point: heart disease is responsible for 1 in 5 female deaths and is the leading killer of American women. Compared to men, women face a 20% higher risk of developing heart failure or dying within 5 years after their first severe heart attack. The increased mortality reflects, in large part, limited research and frequent misdiagnosis of heart disease symptoms in women.

Women also are less likely to receive appropriate treatment for blood clots and alarmingly, face a greater likelihood of failing to receive lifesaving interventions if they're 50 or older and critically ill.

Research shortcomings are compounded by common physician stereotypes regarding women. A 2018 study, for example, found that doctors typically view men with chronic pain as “brave" or “stoic," yet see their female counterparts as “emotional" or “hysterical." The study further determined that physicians were more inclined to believe a woman's pain was the result of a mental health condition as opposed to a physical ailment. As a result, women are more likely than men to be offered tranquilizers and antidepressants for pain instead of analgesic medications.

A taboo subject in the workplace

One area of women's health where the impact of gender bias is particularly pronounced is menopause—the transition women experience as their hormone levels change and their menstruation cycle ends.

Menopause typically begins between the ages of 45 and 55, lasts about 7 years, and can be accompanied by a range of often-debilitating symptoms. These may include loss of bladder control, palpitations, hair loss, hot flashes, sleep disorders, sweats, confusion, depression, irritability, and fatigue. Menopause can also increase the risk of developing osteoporosis, cardiovascular disease, diabetes, and dementia.

About 1.3 million women transition into menopause each year at the average age of 51 and at any given time, 27% of working women are experiencing the condition. Not surprisingly, nearly two-thirds say it negatively impacts their work life: menopause coincides with a woman's most productive employment years and comes as many advance into higher-level leadership roles.

The workplace challenges associated with menopause aren't just physical: a study found that menopausal women are viewed as less confident and less emotionally stable than non-menopausal women, and some report being ridiculed, harassed, or bullied over their condition.

It's little wonder, then, that many women are reluctant to acknowledge what they are experiencing and fear that being “outed" as menopausal could result in withheld promotions or being targeted during layoffs. According to 1 survey, nearly one-third of women had taken time off to manage their menopausal symptoms, but only a quarter informed their managers about the actual reason for their absence.

That wall of silence that surrounds menopause and the lack of available workplace policies to help women better manage the condition can lead to stress, anxiety, lower productivity, loss of job satisfaction, depression, and ultimately, a decision to leave the workforce.

Inadequate clinician training

The challenges of coping with menopause in the workplace may be exacerbated by inadequate care: more than a third of those with menopause symptoms are not diagnosed and don't know they're in the transition and another 20% wait a year or more before menopause is diagnosed. Missed diagnoses can reflect both ingrained taboos about discussing menopause as well as a lack of adequate clinician education.

A survey of post-graduate medical residents in family medicine, internal medicine, and obstetrics and gynecology found that most had only 1 or 2 hours of total education about menopause, and 20% said they'd had no training at all. Tellingly, just 7% said they felt prepared to treat menopausal women.

Treatments that can help address the underlying condition are scarce or non-existent. Testosterone deficiencies in women before and during menopause can trigger a range of symptoms beyond the loss of libido, including: weight gain, mood disorders, and cognitive impairment. Yet few, if any, FDA-approved testosterone products are available for women. Conversely, the market for male testosterone replacement therapy is nearly $2 billion worldwide.

Femtech solutions

For women grappling with menopause—as well as a host of other female health or biological conditions—the good news is that a range of consumer-centric applications are coming to market to help improve quality of life and health. These include a bracelet that can instantly alleviate hot flashes, as well as data-driven wearables that note the frequency and severity of menopause symptoms and use an artificial intelligence-based solution to recommend user-specific treatments.

Other personal trackers monitor women's periods to help determine optimal fertility. One of these, called Clue, blinds and aggregates data from its 12 million monthly users to support scientific research. Still, other wearables help women optimally manage pregnancy care.

An English company, Elvie, has developed a wearable breast pump as well as a pelvic exercise trainer app. An Israeli company called MobileODT relies on a small imaging device, smartphones, the cloud, and artificial intelligence to enable women to screen themselves for cervical cancer.

In the clinical environment, DotLab has developed a first-of-its-kind blood test that can accelerate the diagnosis of active endometriosis, an often-painful condition that may impact the bowel and bladder and traditionally can take up to 10 years to diagnose.

Eliminating gender bias in healthcare

As important as consumer-directed solutions are, erasing female health disparities will require a major commitment by both providers and the institutions that teach them. Strategies include:

• Increasing the representation of women in medical research
• Increasing the number of women in the highest levels of healthcare to bring a greater understanding of women's health needs
• Redesigning clinical training to support more evidence-based, gender-specific care
• Developing practical strategies for clinicians, including checklists and patient interviews, to help identify and eliminate gender bias in healthcare

In the workplace, a woman's willingness to openly acknowledge their menopausal challenges can, paradoxically, help take the air out of gender bias. A study published in the Harvard Business Review found that bias was reduced when women talked openly about what it's like to go through menopause.

“Our analysis suggests that the act of disclosing your own menopausal status conveys confidence and stability, essentially cancelling out the negative bias that people would otherwise hold," the authors noted.

Eliminating healthcare gender bias ultimately will depend on a similar willingness of women to speak up whenever they encounter disparities. Just as important, if not more so, men must acknowledge the existence of gender bias in healthcare and elsewhere. They should understand that they may be subconsciously helping perpetuate it, and that they therefore have a special duty to work to make the world a fairer, more just, and equitable place.

Look to RTI Health Advance

RTI Health Advance works with healthcare organizations navigating health equity gender bias issues and forming a person- and population-centric approach to erasing female health disparities. We evaluate the status quo, identify a tailored menu of options that are appropriate and achievable, and work with organizations to implement evidence-based, best-practice approaches.