In males, common heart attack symptoms include chest and shoulder pain, lightheadedness, and shortness of breath. Women can go through the same experiences during a heart attack, but their symptoms are typically more subtle, often going unnoticed by doctors for longer; numbness in the limbs, vomiting, sweating, and nausea could all be confused for the symptoms of other conditions before a doctor considers that it could be a heart attack. 

In fact, studies found that men experiencing chest pain were 2.5 times more likely to be referred to a cardiologist than women. This seems counterintuitive considering how female-specific conditions such as PCOS and pre-eclampsia increase cardiovascular risk, but these factors are often overlooked in assessments for heart disease. When women do see a doctor, those with cardiovascular disease are often misdiagnosed with something gastrointestinal-related, receiving less diagnostic tests and treatments. Many standard tests for heart attacks, such as the troponin blood test, are calibrated to detect levels typically found in men. These factors provide some insight into why women have a 20% higher risk of heart failure or death within five years of a heart attack compared to men, as reported by the American Heart Association.

Variation in symptoms is just one problem that doctors face when recognizing and diagnosing heart attacks in female patients. These higher mortality rates could be caused by unconscious bias: it was found that women were less likely to be prescribed medicine even when experiencing the same symptom severity as male patients. Another possible cause of women’s higher heart attack mortality rates is difficulties in reaching a diagnosis, resulting in female patients being treated once their disease has progressed further and the odds of success are lower. Finally, this disparity could be due to anatomical differences between the sexes; women generally have smaller hearts and narrower coronary arteries, so they have much lower chances of surviving life-saving procedures like coronary artery bypasses and angioplasties. Ultimately, the difference in the numbers is likely due to an unfortunate combination of all three factors. 

This effect is also seen outside of the doctor’s office, in the pill bottles that sit in many Americans’ medicine cabinets. Historically, clinical trials excluded women to avoid complications related to hormonal fluctuations, pregnancy, and other factors unique to female biology. This reasoning may have seemed practical at the time, but it is starkly outdated and has left a glaring gap in medical knowledge. For example, a drug called Zolpidem was first approved by the FDA in 1992, before regulations were passed that required that women be included in clinical trials. After the substance was deemed safe and effective in male test subjects, it was put on the market. Women who took Zolpidem began getting into more car accidents the night after taking it, prompting researchers to evaluate the effects of the medication on women compared to men. Scientists found that when men and women took the same dose of Zolpidem, the women had double the safe concentration of the medication in their blood. Subsequently, a separate recommended dose of Zolpidem for women was issued, half of the dose for men. 

Men and women metabolize both drugs and alcohol differently; males typically have more alcohol dehydrogenase, an enzyme that catalyzes the decomposition of ethanol. Thus, their systems can process and clear the alcohol from the body faster than women can. 

Healthcare should not be operated using a “guess and check” method for half of the population. Women shouldn’t have to cross their fingers and hope that whatever pills their doctor prescribes are suitable for their bodies. Nevertheless, Zolpidem is still the only drug on the market that has different recommended dosage levels for men and women. 

There is no shortage of horror stories where women struggle because the healthcare they received was not designed for their bodies. Women have a 29% higher chance of hip implant failure because the prosthetics are designed for the male anatomy. Medical devices like pacemakers and stents are also designed for male physiology, causing reduced efficacy and higher failure rates in women. The interaction between many drugs and women’s hormones have not been studied, so women are more likely to experience adverse side effects to medicine than men are. 

In women’s bodies, every organ has estrogen receptors; therefore, women’s reproductive systems are inherently intertwined with their cardiovascular, urinary, digestive, respiratory, and nervous systems. Anything researchers find out about the male body cannot be assumed as applicable to females, and vice versa. 

Since the science of medicine was created, the male body has been considered the universal standard by researchers and doctors alike. This sentiment has a fatal flaw—yes, we are all the same species, but men and women clearly experience disease differently. Therefore, women must have access to medical care that has been designed with their bodies in mind. However, many medical students are still taught a curriculum that predominantly focuses on male anatomy and physiology, perpetuating the notion of the male body as the standard for humans. This idea sustains a cycle of misdiagnosis and inadequate treatments for women. 

Lawmakers have recognized this dire situation for women, and tried to create legislation to mitigate this public health crisis. In 1993, the National Institutes of Health (NIH) passed the Revitalization Act, which required the inclusion of women and minorities in all their clinical trials. However, complete representation was still far away, as the mandate was poorly enforced and the data collected often was not separated by the gender of the test subjects. Later on in 1998, the Food and Drug Administration (FDA) created guidelines that urged pharmaceutical companies to test on female subjects. Once again, this policy fell short because it was a recommendation rather than a requirement. So far, out of all legislation on women in clinical trials, the NIH’s 2016 policy on Sex as a Biological Variable (SABV) has been the most impactful. The act has broadened the scope of research in both preclinical and clinical trials, pushed researchers to consider the difference between the sexes, and raised awareness on gender disparities in medicine.

Despite legislation aiming to foster gender-inclusivity in clinical trials, many studies still fail to include enough women to draw meaningful conclusions about how different treatments might affect them. When women are well-represented in a clinical trial, oftentimes researchers do not separate the test subjects’ results by sex; the lack of adequate, specific comparison means the impact of an experimental therapy on males versus females is usually overlooked.

Addressing disparities in women’s healthcare would involve a reworking of the research process and medical education. Making progress could involve passing robust legislation requiring meticulous clinical trials, pushing for an even split of male and female test subjects, and separating their data to examine differences. We need to raise awareness about conditions that predominantly or exclusively affect women, so that research focusing on them can be bolstered by grants and funding. Once we collect data to fill the gaps in our knowledge on women’s health, the curricula taught in medical school need to be updated with that information. The process of reworking education will inevitably be slow, but more action and attention will catalyze this revolution for the wellbeing of all women. 

These steps are vital to creating a better world, where our sisters, mothers, and daughters can all have access to the quality healthcare they need, whenever they may need it. It is going to be a long road to perfect equality, but it is a journey worth taking for the wellbeing of women across the globe.

Healthcare should not be operated using a “guess and check” method for half of the population. Women shouldn’t have to cross their fingers and hope that whatever pills their doctor prescribes are suitable for their bodies.