By the Letters: Opportunities in Women’s Health
An Overview of Spaces for Improvement, Innovation & Investment — from A to Z
On International Women’s Day in 2021, we published “By the Numbers: Investments in Women and Women’s Health”. For this year’s International Women’s Day post, our focus remains on current gaps and potential solutions in women’s health — this time though, we’re breaking down those opportunities by the letter.
Autoimmune disorders: 80% of patients with autoimmune disorders are women. Autoimmunity can lead to bloating, fatigue, muscle weakness and lack of coordination, and fertility and pregnancy complications.
Despite these disorders’ prevalence in and effects on women, female-specific research received only 4% of total NIH immune disorder research funding in 2019.
Birth control: Women bear most of the mental and emotional work of preventing pregnancy. They also endure the physical aspects — such as daily pills, insertion of intrauterine devices, injections — and the subsequent side effects: depression, hair loss, headaches, micronutrient deficiencies, mood swings, nausea, suicide, heavier periods, lighter periods, early periods, late periods, shorter periods, longer periods, or no periods — among others.
Even in 1956, during the first large-scale trial of the pill — one of the most common contraceptives — women noted side effects like blood clots, headaches, and nausea, but they were considered “unreliable historians”, and their concerns were dismissed.
According to one study, 91% of women believe that no available contraception method meets their three most important criteria: affordability, effectiveness, and lack of side effects.
Bonus Fact: A promising two-shot hormone-based birth control option for men caused participants to experience acne, depression, mood swings, and suicide. Although women experience similar side effects, their contraceptive options remain available while the trials for the men’s shots were discontinued due to “too many side effects”.
Cardiovascular disease: Cardiovascular disease is the top killer of women, causing one in every three deaths. Yet only 38% of participants in cardiovascular clinical trials are women.
For heart attacks specifically, the most recognized symptoms — chest pain, shortness of breath, and lightheadedness — are usually typical for men. Since women’s symptoms can include chest pain but also back pain, nausea, and stomach pain, they are 50% more likely to receive the wrong diagnosis following a heart attack and 50% more likely to die within the year after their heart attack than men are.
Depression: Women are 2–3x more likely to develop depression and 2x more likely to have anxiety than men are. As a result, they are the major consumers of the $87.5 billion spent annually in the U.S on mental healthcare.
Endometriosis: Globally, endometriosis affects about 10% (190 million) girls and women of reproductive age and totals almost $21,000 per person per year in direct and indirect costs. But endometriosis still takes seven years on average to diagnose, and there is currently no cure.
Facebook ads: Facebook has banned ads from 60 different women’s health startups — which address issues such as bladder control, endometriosis, fertility, menopause, pregnancy and postpartum care, and sexual wellness— and suspended the accounts of half those companies.
The controversy around ads is not new. Facebook and Instagram (now Meta) have banned ads that included words like “vaginal”, “vaginal health”, “menopause” and even “OB/GYN” because they seemingly represented “adult content” or advertised “sexual pleasure”. Meanwhile, since companies with condom, erectile dysfunction, and premature ejaculation ads apparently focus on “family planning”, they meet Meta’s advertising policy and are allowed to run.
Bonus Fact: In 2021, Dame, a women’s sexual wellness company, won its lawsuit against the Metropolitan Transportation Authority and could run (modified) ads. Previously, men’s health companies like Roman could run subway ads containing words like “erectile dysfunction” while ads from Thinx, the period-proof underwear company, weren’t allowed because they included the word “period”.
Gross Domestic Product (GDP): In 2020, U.S. healthcare spending saw a 9.7% growth year-over-year, accounted for 19.7% of the U.S’ Gross Domestic Product, and reached $4.1 trillion ($12,530 per person).
Women are the dominant spenders: they make 80% of household healthcare decisions, and they live longer, are more likely to have chronic healthcare conditions, and see healthcare providers more regularly than men.
Hormone Replacement Therapies (HRTs): HRTs can replace estrogen, especially for menopausal and postmenopausal women. While they can decrease the risk of certain health conditions (including heart disease and osteoporosis) and the symptoms of menopause (including hot flashes, night sweats, and trouble sleeping), they come with their own side effects, including increased risks of blood clots, heart attacks, strokes, and breast cancer.
Infertility: 10 to 15% of heterosexual couples struggle with infertility. Although infertility is often 40% due to the woman, 30–40% due to the man, and 20–30% due to a combination, women receive the brunt of the social burden. A literature review found that only one article — of 157 on gender and reproductive health — targeted men, and a 2016 study found that 81% of federally-funded US clinics with family-planning services provided preconception care and education to women. Only 38% provided the same to men.
Joint health: More than 60% of individuals who experience joint pain are female, and rheumatoid arthritis is two to three times more common and osteoporosis is four times more common in women than men. Factors behind this difference include women’s increased joint and ligament mobility, women’s decrease of estrogen and, consequently, cartilage protecting their joints, and obesity, which is more common in women than men.
Kidney Disease: Women are more likely to be diagnosed with Chronic Kidney Disease (CKD) than men are. CKD can lead to adverse pregnancy outcomes, increased cardiovascular risks, and death: in fact, it is among the top 20 causes of death worldwide. Despite these sex-based differences, the data and reasons behind them remain lacking.
Bonus Fact: Women are more likely to be kidney donors and less likely to receive a donated kidney than men are.
Language: The phrase “women’s health” is used to describe health issues affecting women. That term can be misleading, though, since the health of women affects not only women but also their parents, children, and all others who depend on them for care.
Note: We’ve been using the term “women” to describe individuals who are biologically female to be consistent with past trials and research.
Menopause: Despite the number of women experiencing menopause and the direct and indirect costs of women with symptoms, recent studies have found that only 20% of OB/GYN programs in the country offer menopause training and only 6.8% of postgraduate medical residents felt “adequately prepared” to help women experience menopause.
NIH Revitalization Act: In 1977, the FDA guidelines for clinical trials excluded women of child-bearing potential from participating in almost all early-phase clinical research. Fewer than 30 years ago, in 1993, the FDA reversed that ban with the NIH Revitalization Act.
In 2016, the NIH passed the Sex as a Biological Variable policy, stating that NIH-funded research must include female cells and tissues. But since NIH-funded research accounts for only 6% of all clinical trials, participation remain around 86% white and usually male.
Ovarian cancer: Ovarian cancer accounts for more death than any other cancer of the female reproductive health system. When detected early, 70 to 90% of ovarian cancer patients live more than five years after their diagnosis — but only 20% of ovarian cancers are found early.
Prescription Drugs: The FDA withdrew 10 prescription drugs from the market between 1997 and 2000, eight of which caused greater health risks in women than men. Due to “serious male biases in basic, preclinical, and clinical research”, the drugs’ effects on women weren’t revealed until after they were commercially available.
Despite these withdrawals, sex biases still continue in clinical trials, leading women to experience adverse drug reactions and overmedication.
Bonus Fact: In 2015, female Viagra — advertised as the “pink pill” to emphasize its focus on women — had a 25-person clinical trial. Only 2 were women.
Quantity: Women make up half the population. Despite the estimated $500B in annual medical expenses attributed to them, only 4% of all healthcare research and development targets their health specifically.
Reference Man: Life science research and medical practice remains based on men, specifically a 70-kilogram (154-pound) white “Reference Man”. Besides their reproductive capabilities, women were considered to be only small men.
Bonus Fact: In 2022, the most advanced female model was built in entirety; anatomy lessons no longer have to swap female features in and out of a standard male model.
Sexually Transmitted Infections (STIs): Women are more likely to contract STIs and to have more serious symptoms than men are, but they are also less likely than men to recognize their symptoms as those of an STI (and not another health condition). Untreated STIs in women can lead to cancer, infertility, pregnancy complications, and adverse health conditions in the babies of infected mothers.
Teaching of gender medicine concepts: Women and men differ in how they experience certain health conditions and treatments for those conditions. Yet 70% of post-graduate physician trainees indicated that gender medicine concepts are never or only sometimes discussed/presented in their training program.
Urinary Tract Infections (UTIs): UTIs are the second most common infection (behind the common cold) in the U.S. Women, though, are more affected than men, both because of their likelihood of having a UTI once in their lifetime (50%-60% vs. 12% respectively) and of the stigma around women’s sexual intercourse, which can lead to UTIs. UTIs, though, can also be affected by stress, swimming in a lake or ocean, and the inability to take bathroom breaks as needed.
Vagina: As one male venture capitalist said, “I don’t want to talk about vaginas every Monday morning in my partner meeting.” Despite the innovation possible in vaginal health, the word “vagina” itself is enough to make many male investors — who are more than 85% of all decision-making venture capitalists — uncomfortable, unwilling, or uninterested.
The result is a lack of funding for women: female founders received only 2% of all venture capital funding in 2021 and that percent only shrinks for female founders of women’s health companies.
Bonus Fact: Contraceptives, sexual intercourse, pregnancy, labor and delivery, perimenopause, menopause, and post-menopause all change the vagina.
Weight: Adult women are more likely to be obese and, thus, be at increased risk for health conditions including diabetes, cancers, cardiovascular disease, musculoskeletal disorders, and mortality than men are. As a 2021 study noted, “The gender difference in weight control is definitely observed. Nevertheless, heterogeneity resource of gender difference related to weight control was still unclear[…and] few studies compared 2 gender groups to explore the potential difference in predictors associated with weight loss.”
Bonus Fact: Women are more likely than men to perceive themselves accurately as overweight or obese.
(e)Xaminations: Women are more likely than men to see a doctor (93% of women compared to 88% of men as of 2020).
Regular health examinations and screenings are beneficial, but they aren’t always accessible to women due to cost and/or access to health insurance, work issues or other conflicts, or distrust in the medical establishment; women are more likely than men to say that a healthcare provider dismissed their concerns (21% vs. 12% respectively) or didn’t believe them (10% vs. 7% respectively). 20% of women who had a negative experience with a healthcare provider believed it was due to their gender.
Women of color face additional biases: 33% of surveyed Black women reported experiencing racial discrimination by a doctor or at a health clinic, and 21% said the concern of facing racial discrimination has caused them to avoid going to a doctor or seeking healthcare.
Bonus Fact: Gender bias in medicine dates back to Ancient Greece and persists today: a 2021 study found that observers perceived female patients to be in less pain than male ones, though both groups were reporting and exhibiting the same pain intensity.
Yeast Infections: 75% of women will have at least one yeast infection in their life. Yeast infections can be caused by sexual activity but also by antibiotic medication, birth control, diabetes, immune conditions, and pregnancy. While men can get yeast infections too, the rate of infections is so uncommon that the number of men affected remains unclear.
Zinc (and other micronutrient) deficiencies: Because of hormonal changes, women of or past child-bearing age — especially pregnant, breastfeeding, and menopausal women — are more at risk than men for micronutrient deficiencies, such as calcium, vitamins B6 and D, iodine, and iron. The result of those deficiencies include adverse pregnancy outcomes, osteoporosis, nervous system disorders, and cancers.
Zinc deficiencies specifically can increase susceptibility to anemia, the common cold, and neuropsychiatric condition, stunt growth, limit recovery time, and heighten the risk of morbidity in mothers and infants.
This A-to-Z list is not meant to be all-encompassing but to be an overview of spaces in which men’s and women’s health differs and in which investment and innovation for women has been historically lacking. Which health conditions would you add? Let us know — and follow Avestria on this blog and on our website, LinkedIn, and Twitter to hear more from us.
