This article is written by Virginia Miller, Ph.D., Director of the Women’s Health Research Center at Mayo Clinic. Dr. Miller’s research for the last 25 years has focused on how sex steroids affect vascular function. She has authored over 200 original publications and reviews. She was the 2014 recipient of the Bernadine Healy Award for Visionary Leadership in Women’s Health from the Women’s Health Congress and a 2015 recipient of a Woman’s Day Magazine Red Dress Award for her work in research and advocacy for women’s health.
Your doctors and other health care providers pride themselves in providing treatments to their patients that are based on rigorous scientific proof. However, a closer look at the “scientific proof” indicates that such proof often does not account for the sex of the patient. Many commercials advertise ways to discover the DNA to define your ancestry. The DNA that is basic to defining whether you are male of female is located on the sex chromosomes: XX for females and XY for males. These chromosomes define biological sex, and the genes on these chromosomes direct the development of reproductive organs, such as the ovaries for women and testes for men, and secretion of hormones, estrogen and testosterone, that influence all aspects of health and disease.
In women, the amount of estrogen produced by the ovaries varies across a woman’s life. For example, production of estrogen increases at puberty, preparing a women’s body for reproduction. However, loss of ovarian function (and estrogen) before the age of 45 results in premature aging. Secretion of hormones during pregnancy allows a woman’s body to adapt to carry a baby to term. Pregnancy marks a dramatic change in how a woman’s body functions, from how much blood her heart pumps, how much fluid must be cleared by the kidneys, how the muscles and skeleton adjusts to excess weight, and brain behaviors needed to nurture the newborn baby.
Problems that arise during pregnancy such as high blood sugar (diabetes) or high blood pressure can set a woman on a path for other diseases after the baby is born. These changes, although remarkable, are often ignored by researchers and medical practitioners! A review of scientific studies indicates that most studies are conducted on male animals or men. When women are included, the results are not reported separately for men and women. Also, attention is not given to the hormonal status (e.g., premenopausal or postmenopausal) or a women’s pregnancy history. The absence of this information from studies and the medical history does not allow treatments to be individualized to the patient. One size, condition or treatment does not fit all!
New policies are being put into place that will change the way science is conducted and reported. More women will be included in studies, results of those studies will be reported by sex and a medical history will include information about hormonal status and pregnancy history beyond how many pregnancies or live births a woman has had but to include information about problems such as pre-term birth, diabetes and high blood pressure during the pregnancy.
In spite of these new policies, there are many forces at work that slow progress. First, there are political pressures: how money is spent for research, changes in medical insurance opportunities and the lack of understanding among law makers that women’s health is more than reproductive rights. Remember, the number one killer of women is heart disease, more women than men suffer from autoimmune diseases and more women than men die of some types of lung cancer, to name a few of the health issues women face that need more research and perhaps treatments that will work differently in women compared to men. Second, all of us have conscious and unconscious biases that influence how we interact with each other, including how health care providers interact with their patients and vice versa. These interactions can be improved with education and by patients becoming advocates for their own health. Third, the current structure of medical training does not consistently include topics of sex-differences. New educational materials are being developed to correct this problem.
So what does the future hold for medical practice? Researchers and medical practitioners need to see their work and patients through a sex and gender lens. While sex is biological, gender, on the other hand, is a psychosocial construct that reflects environments and behaviors that influence health, such as culture, type of job, income, living conditions (partner status, children, and extended family) that influence stress, nutrition, activity and attitudes and access to health care services. Science needs to provide the evidence; health care professionals need to develop and utilize the information in ways that keep the needs of their patients first.