International Women's Day 2025 Musings
I don't like to whinge and moan about the state of women in our society.
We have come so far and we have achieved so much. There is PLENTY more that needs to happen to increase our representation, but can we just recognise how far we have come. Women are leaders in all areas of our society and the limits placed on us are declining every year!
HOWEVER, the area that I do think we need to talk about where problems still exist is women's health and the systemic failure of the Western medical health care system that has traditionally ignored women's health issues. Even when we are included, it has been in limited and biased ways.
Let me share some significant landmarks in this story to highlight what I mean.
In 1977, a Food and Drug Administration policy recommended excluding women of childbearing potential from Phase I and early Phase II drug trials.
This decision reinforced the approach that women are not appropriate candidates for drug trials because of our fluctuating hormones and menstrual cycles. It also meant women were totally cut out of a critical area of health – research and drug trials. As a result, most mainstream drugs used today have never been specifically tested on women and dosages for women are given as a % of the standard male-tested dosage.
The impact of this was addressed in a 1985 report by the US Public Health Service Task Force on Women’s Health who warned that “the historical lack of research focus on women’s health concerns has compromised the quality of health information available to women as well as the health care they receive”. 1
Between 1989 and 1993, inclusion of women in clinical research was NIH (National Institute for Health) policy, but it was not law. Only in 1993 did that change when the US Congress wrote the NIH inclusion policy into Federal law entitled Women and Minorities as Subjects in Clinical Research.
The law included various requirements for NIH-funded research, including:
· NIH ensures that women and minorities are included in all clinical research.
· In trials including women and minorities, the trial should be designed and carried out so that it is possible to analyze whether the variables being studied affect women and minorities differently than other participants.
There is so much to say about this I don’t even know where to start. But let’s focus on two key areas. Firstly, it was only in 1993 that women being included in research became law (that is less than 35 years ago!) and secondly women didn’t get their own inclusion but came under the women AND minorities category.
Despite this move, it took another 20 years, until 2014, for the NIH to begin to acknowledge the problem of male bias in preclinical trials, and until 2016 for it to mandate that any research money it granted must include female animals in the process.
One more point about the 1993 legal inclusion.
Dr Aviva Romm states in her book “The Adrenal Solution” a commonly held belief that is takes approximately 17 years for research evidence to reach clinical practice. That means that from the date of release of research/drug trial findings patients have to wait on average 17 years to feel the practical impact in their health care. And that is assuming their Doctor is aware of the research findings, it is in a relevant field of medicine and there is enough impetus for the medical community to implement the findings and update existing protocols.
In November 2023 there was a significant landmark event when President Biden and First Lady Dr Jill Biden launched the White House Initiative on Women’s Health Research with a clear goal: to fundamentally change how the United States approaches and funds research on women’s health and a request of $12bn investment. In early 2024, the ARPA-H Sprint for Women’s Health Initiative, as part of the Bidens’ Initiative committed $100 million towards transformative research and development in women’s health.
How that money will be used and if things will change with the new US Administration is still unclear.
I know this review only focuses on the US but the same story is replicated in most Western countries.
And let’s not forget the most important piece of this conversation - the lived experiences of women themselves.
Women’s reproductive health issues are typically mis-understood and under-treated, usually with the first and most common line of treatment being The Pill. It can take anywhere between 5-11 years for women with endometriosis to be diagnosed.
The word “peri-menopause” has only started to be used in recent years, and most importantly medical training programs typical do not include any detailed training and modules about menopause, menopause symptoms, women’s experiences and treatment options. Most doctors have admitted that their training on menopause management is profoundly inadequate.
In May 2018 an article on the BBC website states:
“Women are less likely to have their pain treated, their symptoms taken seriously or to be given a diagnosis than men. Their bodies, and the conditions that primarily affect them, are less likely to have been studied in clinical trials (which make effective treatments difficult to find). Even medical products used only by women – like the oral contraceptive pill – are based on male bodies (in the case of the pill, male hormones).” 2
And research, polls and surveys consistently shows data that women themselves feel unheard or misunderstood after a conversation with their doctor or health care specialists.
The Women’s Center at the world renowned Mayo Clinic has done research on the gaps in the peri-menopause and menopause space and the findings make for sober reading.
“Some doctors are not equipped to discuss menopause and the range of associated symptoms because they were never trained on it in the first place, Dr. Faubion (director of Women’s Health at Mayo Clinic and the medical director of The North American Menopause Society.) says:
“Most trainees in internal medicine get at most 1 to 2 hours of education on the topic. It’s fallen out of the curriculum. Even gynecology training programs don’t offer significant education on menopause,” 3
The big kicker for me came around 2020 when the Mayo Clinic published a survey of 703 medical trainees at all postgraduate levels in family medicine, internal medicine and obstetrics at U.S. residency programs. Of 177 respondents, 20.3% reported not receiving any menopause lectures during residency, and only 6.8% said they felt prepared to manage women experiencing menopause.
This situation is exacerbated if you are a woman of colour or from an ethnic minority where a lack of cultural awareness among healthcare professionals and nuance about their health experiences can contribute to women feeling unheard or dismissed.
On this International Women’s Day I think we need to bring attention to this still silent struggle .
Women are still not being adequately seen, heard, taken seriously or given appropriate care and treatment in the healthcare system.
I will end with a caveat to this conversation:
It is NOT all doom and gloom.
Progress has been made in increasing the inclusion of women in medical research.
More medical training programs are including a deep dive into women’s health issues and especially menopause management.
Menopause Societies are active worldwide and engaged in training and educational programs.
Governments are allocating more money for women’s health research. For example in February 2025 the Australian Government announced $573.3 million to better health care for women with a specific focus on new funding for menopause health assessments, the development of national guidelines for menopause and perimenopause, and for new generation contraceptive pills to be listed on the Pharmaceutical Benefits Scheme.
Other examples like this exist, especially in the UK which has a very active Menopause Society and a very public and engaged menopause conversation.
Much still needs to be done, but my message for women on this International Women’s Day is that if you are not getting answers from your doctor, it’s usually not because of intentional malice. It is because historically the system has an inbuilt bias against supporting us!
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