Illustration by Matthieu Bourel
The Medical Gender Bias and Its Impact on Women
The Medical Gender Bias and Its Impact on Women
There’s a long history of women’s medical complaints—including PMS, horrible abdominal pain, and memory loss—being dismissed rather than examined as medical issues that deserve attention. And this gender bias in medicine still exists today, says neuroscientist Lisa Mosconi, PhD, who believes that women’s brain health, specifically, deserves far more research and care.
Two thirds of people affected by Alzheimer’s are women, and yet symptoms of cognitive decline in women are often brushed aside, overlooked, or understudied. In her latest book, The XX Brain: The Groundbreaking Science Empowering Women to Maximize Cognitive Health and Prevent Alzheimer’s Disease, Mosconi makes a compelling argument: Brain health is women’s health.
A Q&A with Lisa Mosconi, PhD
Women have been chronically understudied in medical science. The first major issue dates back to the 1960s, when a drug called thalidomide was given to women to treat a number of issues, including cancer, skin conditions, and morning sickness. It was later discovered that the drug had catastrophic effects when these women became pregnant, negatively affecting their babies and causing birth defects.
“We now have entire bodies of medical research from this time that have zero women in them.”
The FDA reacted to this with concern and decided that going forward, it would completely exclude women of maternal age from clinical trials to protect their health as well as their children’s. In retrospect, this wasn’t the wisest decision. All women from the age of puberty until menopause were excluded from research, and therefore women no longer informed research decisions.
We now have entire bodies of medical research from this time that have zero women in them. This is especially harmful in terms of drug trials: We have limited data on how certain drugs affect women. There has been an assumption that whatever findings there are in men should also apply to women. This has led to a fundamental bias in the medical community that women are just smaller men with different reproductive organs. I call this “bikini medicine.”
Using this biased research, doctors have diagnosed and treated both genders the exact same way. But it turns out that men and women are not the same, medically speaking. For example, women have a higher chance of being misdiagnosed in the middle of a heart attack and may not receive the proper treatment, leading to a poorer survival rate. In my field, neurology, we have also discovered differences in the brains of men and women that affect their susceptibility to different diseases and conditions.
Historically, women’s medical concerns have been dismissed instead of being considered real medical conditions that deserve attention and treatment.
Yes. In 1986, the National Institutes of Health established a policy encouraging scientists to involve women in studies along with the men. In 1993, the inclusion policy became a federal law, ensuring that women and minorities are included in clinical research. But the problem with this is that researchers rarely interpret their results in terms of men and women separately. They lump them together and remove the effect of gender using statistical procedures. In effect, this treats men and women indistinguishably in medical research.
There are a number of conditions that we know affect women more than men. These conditions primarily affect women’s brains. We don’t know much about these conditions to begin with and certainly don’t give them the attention they deserve in terms of prevention. Women are twice as likely as men to have anxiety and depression. Women are also more likely to suffer from headaches and migraines. Women are three times more likely than men to have an autoimmune disorder, including those that attack the brain, such as multiple sclerosis.
In terms of traumatic brain injuries, we know that women have a harder time recovering than men do and that their symptoms are generally worse than men’s. This is something that we never talk about because the focus is primarily on male professional athletes.
This is why I believe that brain health is women’s health. We need to shift the focus toward our brains and how important they are for every aspect of our health and functioning.
There is evidence that our reproductive organs and brain interact in crucial ways during our lives. Women’s brains age differently than men’s do, in part because we have different hormones. Men’s testosterone levels decline gradually over the course of their lives, which is largely a symptom-free process, while women’s estrogen levels decline rapidly during menopause.
“There are clear changes in women’s brains that occur during menopause.”
Menopause is an important time for women, during which many conditions can worsen. We tend to associate menopause with the ovaries, but the symptoms that women report—including hot flashes, night sweats, insomnia, depression, anxiety, brain fog, and memory lapses—all start in the brain. There are clear changes in women’s brains that occur during menopause. My lab discovered striking decreases in women’s brain activity during the transition to menopause—glucose metabolism declined 20 percent on average. The shape of the brain remains the same, but what’s happening inside is quite different. We also noticed the beginning of Alzheimer’s plaques in the brains of some women in their early fifties, which is earlier than when men start to show these signs of Alzheimer’s risk. And white matter lesions seem to be more of an issue for women during menopause. During menopause women are also more likely to develop meningiomas, which are the most common form of brain tumor, along with brain aneurysms.
Talking about menopause is still such a taboo, and we need more conversation around the medical issues that affect women during this time. The more that women demand information, the sooner we will be able to come out with solutions that work.
There’s so much confusion around this topic, and I think we now know at least what we should not be doing. For background: Doctors used to prescribe very high doses of hormones—estrogen, progesterone, or progestin—for women during menopause and leave them on these hormones for the rest of their lives. This was before hormones were studied in formal clinical trials.
In 1993, the government decided to launch an enormous clinical trial called the Women’s Health Initiative, to study the effects of hormonal therapy on menopausal symptoms as well as any negative outcomes on the risk of heart disease, dementia, and cancer. After almost ten years, the trial was shut down because the researchers found that hormonal therapy was doing much more harm than good for these women. They found that women taking estrogen and progesterone had a higher number of cardiovascular-related events, such as blood clots, strokes, and heart attacks. These women also had an increased risk of cancer and double the risk of dementia. The women taking only estrogen didn’t have such terrible side effects, but they still had some.
It took a long time to think about these trials in a critical way, and now most people agree that the women in the trials were too old—on average, they were sixty-five years old when the study began. We now know that if you give hormones to a woman so long after menopause, this isn’t good for their health. Now studies have begun to show that if you start taking hormones closer to menopause (within six years), you don’t get these negative side effects, but there may not be much benefit regardless. I believe that starting therapy six years after menopause may still be too late. Many of us are now studying whether hormonal therapy prior to menopause is beneficial.
Hormonal therapy does seem to be beneficial for women who have had a hysterectomy or an oophorectomy—the surgical removal of the uterus or ovaries. These women have a higher risk of dementia postsurgery, so taking these hormones for a few years may decrease their risk.
Women should get to know their numbers. It’s good to be tested at different stages of life so that you can get a good sense of how the body is changing. Doctors tend to go by reference values, so they’ll test your blood and say you’re fine compared to the average person. In reality, this number may be higher or lower than normal for you. If there’s a deviation from your normal numbers, that should be discussed and addressed.
The most important things to test for throughout your life are markers of metabolic health (thyroid function, insulin levels, hormones, and lipid profile) and cognitive function (memory, attention, and language). I also emphasize brain scans among my patients—particularly for conditions that may affect cognitive health—which are so important for women.
It’s important to start taking care of your health at a young age. We also need to empower women and support them through the bias and discrimination in the medical field. We need more awareness, and we need more female scientists to stand up.
Lisa Mosconi, PhD, is an associate professor of neuroscience in neurology and radiology at Weill Cornell Medicine and director of the Women’s Brain Initiative. She also serves as associate director of the Alzheimer’s Prevention Clinic. She is the author of The XX Brain and Brain Food.
This article is for informational purposes only, even if and regardless of whether it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The views expressed in this article are the views of the expert and do not necessarily represent the views of goop.
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