Women’s health has been described as a “patchwork quilt with gaps”, an analogy which describes how multidisciplinary it is, and also how much further scientific research is still needed. U.S. Congress only wrote the NIH inclusion policy into federal law in 1993, a move that established guidelines for the inclusion of women in medical trials where there were none before.
An important distinction must be made between assigned sex (whether or not you are born female) and gender (the social construction). As a field of healthcare, women’s health tries to encompass preserving wellness and preventing illness in those assigned female at birth, while considering how gender impacts those who identify as women.
This article considers the medical necessities of female assigned sex as an important benchmark in women’s health, but also how societal constructions of gender are also important in disease prevention. While there are limitations to taking an approach that focuses on gender, it can highlight important ways women can be marginalized in a system that doesn’t consider their specific needs and concerns regarding their health.
Why is Women’s Health Important?
Gender can have a remarkable effect on how an individual experiences the world, both how you express yourself or self-identify and, importantly in the context of healthcare, how the world receives you. This can lead to lived consequences socioeconomically, such as discrimination and the gender pay gap. Therefore, it creates different physical and emotional needs shaped by gender.
These perspectives on women’s health have shifted from a previously biomedical point of view to a biopsychosocial model (say that three times, fast), extending well beyond the scope of gynecology alone. However, first and foremost, it covers the female reproductive systems to include:
- Pregnancy and pre/postnatal care
- Sexual Health
- HIV/AIDS awareness
While this represents an important baseline in women’s health by covering the medical necessities of assigned sex, the construction of gender has more of an influential role in diagnosing and preventing disease. Knowledge of clinically significant gender differences in screening, risk factors, treatment, and prognosis is emerging across a broad range of diseases.
In compiling this information, it is important to note few studies adequately look into the role of gender in diagnosing and preventing diseases. Frequently, the focus is on cisgender women, where gender and sex are conflated. Better information exists when it comes to mental health and gender, than how physical health is affected by gender. Below are some of the serious conditions affecting physical health where womanhood has been shown to influence diagnosis and treatment of diseases that affect females.
The leading cause of adult mortality is heart disease, regardless of gender or sex. However, significant research shows that, on average, women are diagnosed with cardiovascular disease seven to ten years later than men. This is largely due to less self-awareness in women and lower representation in medical trials. They may also not present the typical symptoms associated with heart attacks; instead, they experience subtler symptoms like lightheadedness, upper-back pressure, and nausea, which can be mistaken or misdiagnosed.
The endocrine system is crucial to health and wellness, consisting of glands across the body that secrete hormones that act as chemical messengers for the processes in the body. These processes tend to be interconnected, so a problem in one area can lead to problems in another, for example, Polycystic Ovarian Syndrome (PCOS) can be linked to insulin resistance. This variation in expression and symptoms can sometimes cause delays in discovery, but a lack of research into issues that affect females and gender stereotypes in addressing women’s concerns is also a factor. An estimated 1 in 10 women have endometriosis; it can take them anything from three to eleven years to get diagnosed.
Cancer remains one of the greatest barriers to increasing life expectancy in the twenty-first century. Certain cancers are obviously influenced by sex, such as cancers of the female anatomy (cervical, ovarian, vulva etc.). While breast cancer does affect males as well it is much more common in women and is the most commonly diagnosed cancer as of 2021.
The most robust evidence highlights the links between gender and the prevalence of anxiety and depression. Twice as many women are affected when compared with men. Furthermore, being a transgender woman is an increased risk factor, as many as half of the transgender women in this study experienced depressive symptoms. It is also clear that gender impacts how people experience these conditions and how they access help and support. Therefore, it needs consideration when coming up with a treatment plan.
Of the 8.5 million people with an autoimmune disease in the U.S., a staggering 80% of them are women. Though the exact reasons for this are not proven, ideas have mainly been based on hormonal or genetic factors of female assigned sex. However, gender affects immune response and has the potential to be a factor in the development of autoimmune disease.
Can this inform our approach to health?
Knowledge of how female sex can impact our exposure to certain diseases and how womanhood can impact their diagnoses and treatment can be a powerful tool to safeguard our personal wellness. Some of the most important aspects in terms of wellness facilitation within women’s health are female nutrition and hormones. In regards to gender, the most convincing evidence and actionable advice covers mental health aspects such as stress management and awareness of gender bias.
DIET AND NUTRITION
Nutrition is the cornerstone that wellness is built upon, giving our bodies everything they need to stay healthy. Fundamentally, gender doesn’t alter the type of nutrients the body needs. Assigned sex accounts for minor differences depending on life stage (for example during pregnancy). In sum, a diet high in fresh fruits and vegetables is still best for optimal health.
Our diet has the power to influence the expression of our genes and so the development of disease. Currently, there is no clear methodology for how this might be utilized to prevent disease onset, other than to continue to nourish the body with healthy foods.
Gut health may play a role in overall wellness: a healthy gastrointestinal system has been shown to influence immunity and even brain health. Anatomical and endocrinological factors account for how female sex can impact digestion; the uterus influences the pathway of the colon, and female hormones can affect the GI tract, making digestion slower.
The menstrual cycle also has the ability to affect bowel habits. However, a healthy diet, drinking plenty of water, and eating adequate amounts of fiber are ways to manage these symptoms. For most, these disturbances will not impact their regular daily routine.
The two dominant hormones in the female body are estrogen and progesterone. These govern many of the female-associated characteristics, such as the shape of the body and fat storage and play a key role in the regulation of the menstrual cycle and fertility. Fluctuations in the delicate balance of these hormones can drastically influence the quality of life, affecting mood, appearance, libido, and causing unpleasant symptoms. Many females can empathize with PMS symptoms, menstrual cramps or the potentially debilitating morning sickness and fatigue that accompanies early pregnancy.
Taking care of our hormonal health revolves mostly around thinking about what we ingest, the food that we eat, what we put on our skin, and the environment we are surrounded by. Healthy fats are essential for synthesizing hormones from plant-based sources like nuts, avocado, olive oil, or animal products like full-fat dairy and oily fish.
In the modern world, we are frequently exposed to chemicals that could disrupt the balance of our hormones found in food and the environment. For example, modern pesticides and soy products have both been shown to have the potential to mimic estrogen’s effect in the body. Stress also has a detrimental impact on our hormonal health, increasing cortisol in the bloodstream and affecting the wider system.
Recent years have seen the beginnings of research that acknowledges the links between gender and mental health. However, the correlation between these two variables is deep-rooted and complex. While mental health issues occur in all genders, women, both cisgender and trans, are indeed more vulnerable to certain external factors such as gender-based violence that can impact their physical and mental health.
Collectively, this all amounts to unique stressors that women experience. In our increasingly fast-paced world, stress management is a crucial element of wellbeing. This can take many different formats: daily steps in personal self-care such as walking, meditation, journaling, or outsider support in the form of counseling and therapy can support your mental health. Taking responsibility for our mental health and prioritizing it in the same way we would our physical health can be really beneficial for our overall wellness.
Social, environmental, and economic factors can also have an impact on wellness. For example, gender bias in the labor market influences the experience and opportunities for women in the workplace and can significantly impact overall health. Women are more likely to take on the burden of unpaid care, both for children and relatives, which can quickly lead to a full plate in the climate of “doing it all,” where women are also expected to have full-time jobs.
When accounting for some of the differences between the diagnosis and treatment of the same diseases, a factor is often gender bias in medical care. Women are more likely to have their concerns ignored by their doctor, especially if they relate to women’s health, as researched in the book ‘Doing Harm’ by Maya Dusenbury. Knowing how to advocate for yourself and getting access to the correct information is a key skill that we should teach young girls in how to take care of themselves.
What is abundantly clear is that stereotypes relating to gender and assumptions based on a person’s sex can harm those involved and can have detrimental effect on mental and physical health. Care has to be taken to meet people on an individual level regarding what’s best for their health and wellness.