MANY HEROIN CATEGORIES ” PERSONAL EXPERIENCE ” , to share the story of rare diseases, told how their complaints for a long time did not pay attention: their malaise blamed on hormonal processes of the menstrual cycle, and some have not been advised as soon as possible to get pregnant and give birth to “get healthy.” It is women’s complaints that doctors often do not take seriously – we understand how gender inequality worsens our health.
For centuries, women’s ailments were considered semi-far-fetched, and poor health was attributed to “hysteria” or “uterine fury.” It would seem that with the development of science, such an attitude should have become a thing of the past, but even now many problems are “explained” by hormones or premenstrual syndrome, or even psychosomatics – without going too deep into the question, of course. One gets the impression that a woman is too sensitive a creature who takes everything to heart, who needs to “pull herself together” so as not to get sick. Hormonal fluctuations or painful menstruation are suggested simply to endure – “you’re a woman.”
This attitude is the result of, among other things, a lack of knowledge; women’s health has not been studied for a long time, and it is not as well studied as men’s. As a result, women are more likely to experience conditions that modern medicine is unable to explain: there is simply not enough scientific data. We are talking about such poorly understood processes as, for example, fibromyalgia and chronic fatigue syndrome – they are much more common in women, and historically no one wanted to invest effort and money in trying to understand their essence. Research decisions and funding were predominantly made by men; back in 1990 it was said that only 13% of the total research budget goes to researching risks to women’s health. “They finance what they themselves fear, ” said Pat Schroeder of the US House of Representatives at the time.
The difference in the study of male and female problems encourages confidence that women are characterized by hypochondria, and all unpleasant symptoms are “in the head”. Many of us have gone to doctors with complaints that did not have an obvious physical cause – but few realize that doctors’ vigilance towards patients and patients differs. Chronic fatigue can be the result of an autoimmune disease , but women are more likely to go undiagnosed because fatigue will be attributed to stress, lack of sleep and hormones. It is known that the diagnosis of autoimmune diseases takes on average almost five years and requires visits to five doctors, while 75% of patients with these diseases are women.
Women who seek help
with signs of heart failure have fewer chances of a full examination – this phenomenon is called Yentl syndrome.
Research shows that gender inequality is not limited to rare diseases or conditions with vague symptoms. Of people seeking emergency care with acute myocardial ischemia (a developing heart attack), women younger than fifty-five were more likely to be mistakenly sent home. In 2015, a meta-analysis of 43 studies was conducted on the experience of women with heart disease – the publication was titled “Does anyone see me? Can anyone hear me? ” Women noted that their symptoms were simply not taken as seriously as the complaints of men; some were denied the necessary diagnostics (ECG or blood test for cholesterol), explaining that “such a young woman cannot have heart problems.”
Women who seek help with signs of heart failure are less likely to undergo a full examination. This phenomenon is called Yentl’s syndrome – after the heroine of the story, and then of the film about a Jewish girl disguised as a man in order to get an education. Interestingly, women who did receive the necessary examinations received the same intensive treatment as men – and this further emphasizes the essence of Yentl syndrome: in order to be treated appropriately, you need to show yourself as a man. By the way, it is in women that a heart attack is more often accompanied by manifestations that are unlike the classic pain behind the breastbone – such as stomach discomfort, nausea and pain in the lower jaw.
Another important aspect is the attitude to health as to something that a person creates by his way of life and for which he is responsible. At the same time, it is easy to forget that avoiding stress (the most important risk factor for many diseases) is not always possible, and women are more prone to it simply because of the way society works: how to recuperate when you do most of the housework, control family logistics, you run into a glass ceiling at work, and the world expects emotional service from you ? The recommendation to “get more rest” is difficult to fulfill if the conditions do not imply the need for such rest for women. Taking responsibility for your health is good, but not everyone has the same opportunities to take care of themselves.
The authors of the meta-analysis mentioned above say that women with heart disease faced a lack of understanding and lack of support from loved ones – and at the same time felt a sense of guilt for not being able to care for others due to illness. “Mom cannot be sick, she must always be there” – these are the words of one of the patients of the study , where it turned out that women themselves often do not go to the doctor right away, but only after fulfilling all their “obligations” towards the family. Feeling bad is not just not enough to quit and rest or go to the doctor – women also hide it from loved ones so as not to seem like “hypochondriacs” or “whiners”.
Yentl syndrome manifests itself in a variety of situations: for example, women are less likely to get good pain relief for abdominal pain. Brain tumors in women are diagnosed later than in men – and at the first visit to the doctor, the symptoms of these dangerous diseases are attributed to fatigue or even a desire to attract attention. It is in women that doctors often miss the signs of an impending stroke , and diagnosis of lymphoma, cancer of the bladder, stomach and other organs in patients takes longer than in men.
Another important issue is the study of how drugs work in the body of men and women . Until recently, few women were included in clinical trials ; from 1977 to 1993, the FDA prohibited women of reproductive age from participating in early-phase trials that study the safety of new drugs in healthy people. Given that the participants in the first phase of clinical trials are paid for the time spent, women were also deprived of the opportunity to earn money here; the ban was covered by paternalistic concern for the “future offspring” – naturally, no one asked specific women who would like to take part if they were planning to have children at all.
It is in women that doctors often miss the signs of an impending stroke,
and the diagnosis of lymphoma, cancer of the bladder, stomach and other organs
in patients takes longer than in men.
Of course, to some extent, it is simply more convenient to conduct drug research in men: it is a more homogeneous population, without hormonal fluctuations, menstrual cycles and the risk of getting pregnant while taking a dangerous drug. But all this should only emphasize the need to study how drugs work in the female body, with all its features. Otherwise, we are faced with the fact that the next complaints will be attributed to stress or fatigue – and they may be just an unforeseen effect of a drug that has not been studied on women.
In 1993, the US Congress ordered the National Institutes of Health (NIH) to include more women in their research. However, as of 2015, progress was still insufficient: the number of women in studies of the same cardiovascular diseases did not even allow making specific treatment recommendations. In a 2010 publication , it was noted that the percentage of women in studies of certain diseases is lower than the percentage of women with these diseases in the population: for example, in studies of hyperlipidemia or heart failure, 28 and 29% of participants were women, although in fact they share the incidence with men. in half.
Moreover, if we talk about research carried out by government organizations (and here again we are talking about the US NIH), an imbalance is noted in preclinical studies – those that are carried out on animals. The course of diseases such as multiple sclerosis (which is more common in women) is critically important to study in female animals. The choice in favor of male rats or mice is made due to the fact that females allegedly will not have stable indicators – after all, they have an estrous cycle (analogous to the menstrual cycle of women) and associated fluctuations in hormone levels. In fact, this is not the case, and the results obtained in female mice do not vary more than in males.
In commercial studies, that is, carried out by pharmaceutical companies, they still strive to include more women, so that the proportion of patients and patients with the disease being studied reflects their share in real life. When studying completely new drugs, when the risks to the fetus and pregnancy are unknown, women are simply asked to use highly effective contraception – and before the situation looked as if no one was able to regulate their own ability to become pregnant. If we are talking about a substance that can penetrate the semen, then the requirements for contraception are also imposed on male participants. Efforts are being made to include people of different ethnic origins and older people among the participants, because the metabolism of drugs can depend on these factors. After taking the same dose of the drug, its concentration in the blood can suddenly be different in people of different sexes or origins. It is safer, of course, to study the medicine that older people will take in young people with relatively stable health, but it is hardly advisable.
The issues of gender inequality in medicine began to be raised by feminists almost fifty years ago – then it was first said that women’s complaints, even if they do not differ from men’s, are much more often labeled as psychosomatic. Almost everyone is now aware of the problem: regulatory agencies are trying to track and encourage women’s participation in clinical trials, and substantial grants are being made to study biological differences between the sexes . European experts advise researchers to change their attitude towards women, considering them not as a “subgroup”, but as half of the population.