Ovulation. Endometriosis. And especially: menopause. These once taboo words — among others — have become part of our daily vocabulary and conversations, a sign of greater interest in, and knowledge of, women’s health.
Yet even as women’s health has been receiving more attention than perhaps ever before, women remain poorly represented in clinical trials, and female health poorly understood compared to male health. Much of the attention remains focused on the reproductive aspects of women’s health.
This led the journal Science to plan a special issue dedicated to women’s health, published Thursday. “Biomedical science has come a long way over the years, and it has become increasingly clear that there are sex-dependent differences in many diseases that do not involve reproduction and that occur at all ages,” according to the introduction.
The issue was edited by an all-female team (Yevgeniya Nusinovich, Sacha Vignieri, Joana Osório, and Sarah Ross), which named political attacks on women’s rights and health care, as well as funding cuts affecting research in this area, as urgent motives behind their planning.
“The importance of doing clinical trials specifically in women has gained recognition over the years, and it’s something that should continue to be elevated, including as research funding cuts are targeted at this and other women-specific research, threatening the quality of women’s future healthcare,” they said.
Beyond reproductive health
The issue features reviews of research that aim to highlight recent findings on the impact of sex-dependent biological differences beyond reproduction, as well as deep dives into the latest discoveries about menopause and the pregnant body.
Women experience functional pain at about twice the rate of men, with persistent pain in the pelvic area often becoming a debilitating factor in their daily lives. The issue takes stock of recent research that identified sex-specific mechanisms of pain. The review highlights the impact of sex hormones, immune-neural interactions, the gut microbiome, and the role of ovarian hormones in pain, though it also highlights the deficit in efforts to understand female pain.
“Women are desperately waiting for concrete answers that might help eliminate the common ‘all in your head’ approach to their illnesses,” the authors of the review wrote.
Another review focuses on the impact of XX and XY chromosomes on aging and disease, making the argument that their impact is so significant that sex chromosomes should always be considered when developing precision medicine strategies.
Other contributions do take on issues of reproductive health. They call for a rethinking of menopause research and treatment, with an approach more tailored to the individual; investigating the immune system’s role in preparing for and carrying out a pregnancy; and considering the role of the ovary’s postmenopausal function.
Nusinovich, a senior editor at Science, said she considers research on post-reproductive health to be different from reproductive investigations “because the focus here is not on improving reproductive success but on considerations for a woman’s own health.” She said she considered including other medical conditions unrelated to reproduction in which sex differences play a role, such as cardiovascular and metabolic disease, “but it didn’t seem like there would be enough new biological insights (with mechanisms, not just clinical observations) for entire coherent review articles.”
The dearth of this research highlights the existing gaps. “We tend to focus on women in their reproductive years, and a lot of that I do think is driven by what institutions are willing to fund,” said Tiarney Ritchwood, a professor in the department of public health at Wake Forest University School of Medicine who focuses on health equity. “But I do think that the greater discussion on women outside of the reproductive years is really important.”
For other experts, however, including a strong focus on reproductive health is inevitable.
“There is still so much we don’t know about women’s health simply because sex is often considered an extraneous variable,” said Nicole Woitowich, executive director of the Northwestern University Clinical and Translational Sciences Institute who did not take part in the issue. “For many years, women’s health was synonymous with reproductive health. I’m glad we’ve broadened this perspective to consider the influence of sex across human physiology. Yet, pregnancy and menopause, for example, remain unique aspects of women’s health and we are just beginning to understand how these events can shape our long-term health and well-being.” Woitowich recently researched the reporting of sex differences in NIH-funded papers.
The attention to menopause is especially welcome, said Omisade Burney-Scott, a menopause justice advocate pushing to make menopause care inclusive through her platform, the Black Girl’s Guide to Surviving Menopause. Still, Burney-Scott said, the journal article is lacking some perspectives — including discussion of early menopause due to gender-affirming care, or a medical intervention — that shows the limitations of current research. “We must take into account the significant impact of environmental factors, such as systemic oppression (racism, classism, homophobia, transphobia, carcerality) on menopause health outcomes,” said Burney-Scott, who was not involved in the issue.
Women’s health needs funding, not just attention
For the editors, the value of the issue also resides in showing how much there is to learn about women’s health. “Out of all the special issues I’ve encountered, this one stood out to me as highlighting a ton of open questions and things that are just beginning to be studied, especially in the article on chronic pain, pointing to many opportunities for future productive research,” said Nusinovich.
The experts STAT spoke with agreed that a high-profile journal such as Science dedicating an issue to women’s health sends a strong signal to the scientific community. “It will contribute to increased awareness and even potentially increase research in this area, hopefully in the years beyond the reproductive ones,” said Ritchwood, “but none of this goes anywhere if there’s no funding dedicated to it.”
Unless there is a broader dissemination of these findings — and, just as importantly, a clear call to fund women’s health research — the impact will remain limited, she said. “The public is not reading Science, so it can’t just be something that we just communicate to ourselves. … Are we going to see it in Vogue, or something that the public is actually looking at?” she said.
Paula Schneider, the CEO of the Institute Advancing Women’s Health, a global nonprofit that focuses on improving women’s clinical care in midlife and after, noted that there is a lag in adopting new knowledge in clinical practice.
“Research is only half the equation. Even the evidence we already have on women’s midlife health too often doesn’t make it into clinical practice,” she said. “We need to close the gap between what’s known and what’s done, so that as discoveries like these arrive, women know what to ask, doctors know how to answer, and the system knows what to do next.”