For over a century, a critical flaw has permeated the fabric of modern medicine, significantly impacting women’s health outcomes. In the late 19th century, Sir William Osler, often lauded as the father of modern medicine, famously mischaracterized severe cardiac pain in women as “pseudo-angina” – a condition he reassured his aspiring doctors did not lead to death, attributing it instead to a “nervous” disposition. Astoundingly, in 2025, over 120 years later, women presenting with chest pain are still frequently misdiagnosed with anxiety, often denied life-saving treatment, even as cardiovascular disease remains the leading cause of death in women globally.
This persistent misconception is just one glaring example of a pervasive gender health gap. The male body has historically been the default in medical understanding, leading to a dangerous short-sightedness that fails to acknowledge fundamental biological differences between sexes – differences that manifest in varying symptoms, disease presentations, and responses to treatment. Women, for instance, process pain differently, exhibit distinct immune responses, and have varied drug metabolisms.
Where does this enduring health gap originate? And what can be done to dismantle these deeply ingrained myths? Here are five critical areas where current approaches to women’s healthcare are falling short, and what we must do to correct them.
1. The Research Blind Spot: A Male-Centric Foundation
The very bedrock of our medical knowledge is overwhelmingly male-centric. For decades, women were systematically under-recruited or entirely excluded from clinical trials, ostensibly to “protect their childbearing potential,” as a 1977 FDA report highlighted. This legacy continues to haunt contemporary medicine.
Even today, research funding disproportionately favors diseases more common in men, like hepatitis or AIDS, at the expense of conditions predominantly affecting women, such as endometriosis or anorexia. A 2021 study revealed that 75% of cases where a disease affects predominantly one sex saw funding skewed towards male-prevalent conditions in the US.
Despite recent efforts to increase female recruitment in trials, women are often still outnumbered by men, and crucial sex-specific outcomes are frequently ignored. This underrepresentation is particularly stark in stroke and cardiac disease trials, and even more so within minority groups. The problem is so foundational that, shockingly, even the test mice used in studies are predominantly male. The erroneous assumption that female mice’s reproductive cycles make them “more variable” participants, coupled with a refuted belief that including both sexes doubles research costs, has led to a wealth of data that may not accurately translate to women, impacting everything from drug dosages to diagnostic criteria.
2. One Dose Does Not Fit All: Tailoring Treatment to Biology
Assuming that a “one-size-fits-all” approach works for drug types and doses is a dangerous fallacy. Women’s bodies differ significantly from men’s in ways that impact drug processing. They have slower gastric transit times, affecting drug absorption, and altered drug metabolism due to higher body fat, lower plasma volume, smaller organ sizes, and reduced organ blood flow.
Both pharmacodynamics (what a drug does to the body) and pharmacokinetics (how the body uses a drug) vary between sexes. The alarming lack of trial data on these differences means we are largely unaware of the full scope of this problem in clinical care. However, a crucial clue exists: a study analyzing reactions to dozens of medications (including cardiovascular drugs, antidepressants, and anti-seizure drugs) found that “standard” doses in women led to higher blood concentrations and longer drug elimination times than in men. This outcome was tightly linked to a near doubling of negative drug reactions.
What effectively becomes an “overdose” for women does not improve prognosis. In fact, a study in The Lancet showed that women receiving just half the internationally recommended doses for heart failure drugs had better survival rates and fewer hospitalizations than those on higher doses. Conversely, men achieved the best outcomes at 100% of the target dose. Clearly, what’s right for men is not necessarily what’s right for women.
3. The Diagnosis Dilemma: When Tests Look for the Wrong Thing
Receiving the right diagnosis is paramount, but for women, diagnostic tests often fail to identify the correct issue. Take heart attacks, for instance. Doctors typically use coronary angiograms to detect blocked blood vessels (obstructive coronary artery disease), which usually leads to definitive treatment like stent insertion.
Yet, women are significantly more likely to have “normal” angiograms (10.5% of women vs. 3.4% of men), even when other tests confirm reduced blood flow to their heart. This is because women are more prone to non-obstructive causes of heart problems, such as artery tears (dissections) or coronary artery spasms, which angiograms often miss. Consequently, many women are mistakenly sent away with a clean bill of health.
Furthermore, risk prediction models for conditions like cardiovascular disease often omit female-specific risk factors such as polycystic ovary syndrome, premature menopause, pre-eclampsia, and preterm birth. If we cannot predict, we cannot prevent. This diagnostic disparity extends beyond heart health; women with renal cancer, stroke, and multiple sclerosis face higher rates of misdiagnosis and delayed diagnosis. Studies show women are consistently more likely than men to be perceived as exaggerating or fabricating their symptoms, even when reporting equivalent pain scores. This inherent medical bias, sadly echoing Osler’s 19th-century error, can profoundly impact diagnosis.
Signs of a Heart Attack (For Everyone): Contrary to persistent myths, recent research shows that women do not inevitably develop “atypical” heart attack symptoms. Men and women should both be vigilant for common symptoms (chest pain or pressure, and pain radiating to both arms, particularly the left), alongside other indicators like: anxiety, coughing, shortness of breath, unusual fatigue, dizziness or feeling faint, sweating, nausea, and pain in the shoulder, neck, back, tummy or jaw. If you experience any of these symptoms, regardless of your sex, seek immediate medical assistance.
4. Invisible Patients: The Plight of Unheard Women
At the core of the gender health gap is the undeniable reality that women are often unheard in healthcare settings. A 2022 UK Government survey found that 84% of women felt they had not been listened to by healthcare professionals. A recent House of Commons committee report highlighted that women suffering from debilitating pain and bleeding due to endometriosis and adenomyosis are frequently told their symptoms are “normal.”
The average diagnosis time for endometriosis is a staggering 8-10 years, during which women endure immense suffering that impacts their relationships, careers, and overall well-being. Stigma surrounding menstruation and sex further compounds this issue; a recent survey found over half of women with symptoms of pelvic floor dysfunction did not seek help, with many feeling embarrassed or believing their symptoms were “normal.”
Disturbingly, the more women speak up about their personal experiences, the less likely they are to be believed. The podcast series ‘The Retrievals’ chillingly documented how a dozen women undergoing fertility procedures at the Yale Fertility Center were dismissed and disbelieved about their excruciating pain, only for it to be revealed months later that a nurse had been stealing their pain medication and replacing it with saline. As the podcast host noted, women patients face a delicate balance: complaining just enough to be taken seriously, but not so much as to appear “shrill.”
5. Unequal Ground: Beyond Simple Misogyny
While medical bias is a significant factor, the gender health gap is complex and multi-faceted. For example, women are less likely to receive clot-busting treatments (thrombolysis) for stroke. While one might immediately cry “discrimination,” a deeper look reveals that thrombolysis must be given within a narrow 4.5-hour window. A higher prevalence of stroke in women living alone often delays their arrival at the hospital, meaning the optimal treatment window is missed. Furthermore, women with stroke tend to be older and experience more severe strokes, leading to worse outcomes.
These examples highlight that factors beyond simple medical misogyny are at play, intersecting with age, social support, and wider systemic issues. Funding for medical training often prioritizes long-term conditions, leading to shortfalls in critical areas for women’s health. For instance, a 2020 survey of US pediatricians found only a third were aware of national guidance regarding medical evaluation for periods not starting by age 15.
Globally, women often face fewer employment rights, educational opportunities, less financial independence, and greater caring responsibilities – all impacting their ability or willingness to access medical care. These factors intertwine with variables like race, ethnicity, and income, further exacerbating health disparities. A recent NHS report (late 2024) found that areas with higher deprivation levels report worse health outcomes for women.
It’s crucial to acknowledge that the gender health gap is not an argument that men have it better or women have it worse across the board. Worldwide, female mortality is lower than male mortality, and the gap is growing due to factors like war, conflict, homicide, suicide, occupational hazards, and behavioral factors affecting men’s lifespans. However, women frequently miss out on life-changing medical care, leading to a paradox: while women live an average of four years longer than men, they spend a higher proportion and more years of their lives in poor health.
Your Health, Your Voice: Empowering Yourself
While it is not a patient’s responsibility to cure systemic bias or misogyny, empowering oneself in healthcare settings is vital. Doctors must also reflect on their own biases and listening practices, approaching each patient with curiosity and openness, and acknowledging the validity of a patient’s concerns even if they don’t immediately agree.
For individuals, here are practical steps to empower yourself at clinic appointments:
- Document Symptoms Thoroughly: If you feel well enough, write down your symptoms beforehand. When did they start? What makes them better or worse? Be as detailed as possible.
- Bring a Companion: Another pair of ears can be incredibly helpful for remembering information and advocating for your needs.
- Prepare Questions: The NHS and various healthcare charities (like the British Heart Foundation and Macmillan Cancer Support) offer online lists of questions you can ask your doctor, whether general or condition-specific.
- Bring Official Information: If you feel your doctor should be more concerned about your symptoms, Cancer Research UK suggests bringing along a copy of official symptom lists or guidelines.
- Maintain a Symptom Diary: A pain and symptom diary can provide valuable insights for your appointment.
More than anything, you deserve to be heard. Dismantling the deeply entrenched myths about women’s health requires a fundamental shift in medical education, research, and practice. By listening to those who are living through illness and understanding the unique complexities of women’s bodies, society as a whole will undoubtedly benefit.
