Cry me a river

If you know a woman, you most likely know someone who experienced unexpected side effects from taking a Covid vaccine. Several women reported irregular menstrual cycles with heavier, more painful or delayed periods - claims that were initially dismissed by healthcare providers.

If you thought we'd moved past wandering wombs and hysterical women, you're wrong.

Anecdotal evidence about the shrugging off women's health concerns abounds - and it's not exclusive to Covid or its vaccine. One London woman suffered from excessive bleeding and irregular periods, only to find her doctor diagnosed her as a "weeping woman". A few months down the line, she found she had an 8 cm large fibroid and PCOS; she later had a miscarriage and then 20-day periods with debilitating pain, which affected her ability to carry out daily tasks, including going to work.

During the pandemic, many conditions affecting women - such as prolapse, endometriosis and heavy bleeding - were miscategorised as "benign" and put on the backburner to deal with Covid-related concerns. Before the pandemic, 66 women in England had been waiting over a year for medical attention. Now, that number stands at almost 25,000. Across the UK, gynaecology waiting lists have risen to an astounding 5,70,000 women - a 60% increase since pre-Covid times and a more significant percentage rise than in any other medical speciality.

Even when unrelated to sexual and reproductive health, issues women bring to professional healthcare providers aren't taken seriously. If you're a woman, many conditions, including Alzheimer's, lupus, coronary heart disease and rheumatoid arthritis, affect you differently and disproportionately compared to men. If you're a woman, you also receive some novel diagnoses. Across the world, women have been diagnosed with vague "women's problems", "that time of life", or just good old attention-seeking behaviour. In the US, 55% of women reported interacting with a healthcare provider who did not take their concerns seriously. The same study, commissioned by Athenahealth, also said that 54% of surveyed women had health concerns that they didn't talk to their doctors about because they feared appearing silly, dramatic or anxious. In LMICs, there isn't even enough data, anecdotal or otherwise, given how shrouded in secrecy and smoke "women's problems" are.

The sidelining of women reflects the underrepresentation of women - as participants, researchers and decision-makers - in clinical trials, industry and policy. The primary cause of death amongst American women? Cardiovascular disease. The proportion of women in relevant clinical trials? A third. 90% of lupus patients are women; with over a million and a half lupus patients, research remains underfunded. In fact, until 1993, the US government's National Institutes of Health (NIH) did not even require women to be a part of clinical trials, keeping them out of sample populations.

No prizes for guessing the state of research funding. In cases where a condition predominantly affects a particular gender, nearly 75% of the time, "men's diseases" are overfunded and "women's diseases" suffer from a dearth of funds. The (lack of) diversity in decision-making positions is telling: in North America, Europe and Australia, women comprise less than 30% of executive teams and approximately 20% of CEOs at biopharma companies. The proportion of women CEOs in healthcare is at an abysmal 1%; amongst early drug development investment partners, we have only 16% of women.

What decision-makers still need to address so far, however, is the enormous market potential for women's health services and products. RAND Corporation researchers ran simulations to determine the prospective return on investment in women's health issues. Even with conservative health improvement estimates of 0.01% and 0.1% for coronary artery disease and rheumatoid arthritis, respectively, the potential ROI is astounding. Doubling research funding for coronary artery disease in women can bring an ROI of 9,500%; for rheumatoid arthritis, the number stands at 174,000%.

However, policies governing women's health and their agency over their bodies play a sizeable role in the future of medical study, practice and research. In the US, a country already suffering from an OB/GYN shortage, the overturning of the Roe v Wade judgement has placed many healthcare professionals in precarious positions. Standard procedures like administering anaesthesia or chemotherapy to pregnant patients pose a possibility of harming the foetus; taking care of a pregnant woman's health puts doctors at risk of prosecution.

Such scientifically unsound and legally-complex legislation could deter medical students from pursuing this line of work. Further, medical residents in states with abortion bans would no longer have access to training mandated by the graduate medical accreditation council, leaving them with dangerous knowledge gaps that ultimately worsen the care that women will receive.

The dismissal of women's health concerns has resulted in dire effects not only for women but also for the economy and the legitimacy of medical interventions. For lupus alone, for instance, the US loses $33,223 on average in direct health care costs per patient; add to that the cost of lost productivity. Likewise, with infertility-related myths, we saw the dismissal of women's Covid vaccine-related concerns stoke the fires of misinformation and vaccine hesitancy. Disregarding the health of 50% of the world's population - whether wilful or subconscious - can erode the public's faith in the healthcare, medical and pharmaceutical industry.

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