What Did Medicine Get Wrong About Women?
How decades of research gaps, overlooked symptoms, and assumptions about women's bodies became embedded in modern medicine.
She was 49 when she started experiencing chest discomfort.
It wasn't the dramatic, crushing pain she had seen in medical dramas. She felt exhausted, occasionally nauseated, and unusually anxious. Sometimes the discomfort traveled into her back. She assumed it was stress. She had a demanding job, family responsibilities, and plenty of reasons to feel overwhelmed.
Eventually, she saw her doctor. They discussed her symptoms and anxiety. She was encouraged to manage her stress, improve her sleep, and watch her diet.
Nobody initially recognized what was happening to her heart.
This fictional composite illustrates a documented problem: women's cardiovascular symptoms have historically been underrecognized, sometimes contributing to delayed diagnosis and treatment.
Medicine is complicated. Diagnoses are missed, research evolves, and treatments change. But what happens when generations of research rely disproportionately on male bodies, women's pain is interpreted differently, and medications are prescribed without adequately investigating how women process them? For much of modern medical history, women were expected to benefit from research that hadn't adequately included them.
We are still dealing with the consequences.
The Male Body as the Medical Standard
For decades, medical research frequently treated men as the default research population. Women, particularly those who might become pregnant, were often excluded because researchers worried about hormonal fluctuations and reproductive risks.
In 1977, the FDA recommended excluding women of childbearing potential from early drug trials, even when pregnancy was unlikely. The intention was partly protective, but medications would eventually be prescribed to patients who hadn't been adequately represented in safety studies. In 1993, Congress established requirements for including women and minorities in NIH-funded clinical research, subject to appropriate exceptions. In 2016, the NIH implemented its policy requiring researchers to account for sex as a biological variable in applicable studies.
Women now represent roughly half of participants in NIH-supported clinical research, but historical gaps remain, particularly in laboratory studies relying heavily on male animals and cells. That matters because research becomes the foundation of medical education, diagnostic criteria, treatment recommendations, and pharmaceutical development.
When the evidence is incomplete, the consequences can follow patients for generations.
When Women's Pain - and Hearts - Are Treated Differently
Ask women about their experiences seeking medical care, and familiar stories emerge. Their symptoms are attributed to stress. Painful periods are considered normal. Chronic pelvic pain becomes something they should learn to manage. Unexplained symptoms may be dismissed as anxiety.
Not every experience reflects medical bias. But research demonstrates differences in how women's pain is assessed and treated. A 2024 study published in Proceedings of the National Academy of Sciences found evidence that female emergency department patients were less likely to receive pain medication than male patients presenting with comparable complaints.
Consider endometriosis. It can cause debilitating pelvic pain, painful menstruation, gastrointestinal symptoms and difficulties affecting employment and relationships. Yet diagnosis has historically taken years. Despite affecting approximately one in ten reproductive-aged women worldwide, it has received relatively limited research funding.
Imagine how differently health care might develop if severe pelvic pain were routinely investigated rather than considered something women should endure.
Cardiovascular medicine reveals another historical gap. For much of the twentieth century, heart disease was treated primarily as a male problem, and research reflected that assumption. We now know that cardiovascular disease is a leading cause of death among women. Chest discomfort remains the most common heart attack symptom in both women and men, but women may also experience nausea, shortness of breath, back or jaw pain, and unusual fatigue.
Problems arise when clinicians or patients expect symptoms to fit an overly narrow picture of a heart attack.
Research indicates that women with suspected coronary heart disease may experience diagnostic delays and receive fewer referrals or treatments. A 2019 experimental study involving 225 medical students found that when psychological symptoms accompanied possible coronary heart disease, the female patient was perceived as having the lowest cardiovascular risk and was less likely to receive certain treatment recommendations.
The study doesn't establish that every clinician behaves this way. It illustrates how assumptions can influence medical judgment before a diagnosis is made.
How much of what we consider normal female suffering is actually suffering medicine hasn't adequately investigated?
Prescription Drugs and the Male Standard
One revealing example of the research gap involves prescription medications. Historically, biomedical research often relied on a hypothetical standard patient: a man weighing approximately 154 pounds. Yet women generally differ from men in average body size and composition, and certain medications are absorbed, metabolized, or eliminated differently.
Many adult medications are prescribed at standard doses rather than according to individual body weight. A drug studied primarily in men may therefore produce different blood concentrations or side effects in women. But weight isn't the entire explanation. Biological differences can affect medication processing independently of body size.
Consider zolpidem, commonly known as Ambien. In 2013, the FDA announced lower recommended starting doses for women after evidence showed they eliminated the medication more slowly than men. Higher morning blood concentrations increased the risk of impaired alertness, including impaired driving. The recommended starting dose of immediate-release zolpidem for women was reduced from 10 milligrams to 5 milligrams.
A 2020 analysis published in Biology of Sex Differences examined 86 drugs with documented differences in how men and women processed them. For 76, women experienced greater drug exposure or slower elimination. Where adverse-reaction data were available, these differences frequently corresponded with higher rates of side effects.
Researchers emphasized that body weight alone couldn't explain their findings.
This doesn't mean women should automatically receive smaller doses of every medication. Some drugs require weight-based dosing, others need individualized adjustments, and some have no meaningful sex-related differences. It means we need adequate evidence rather than assuming the same dose is appropriate for everyone.
A woman's body should not become the final testing ground for a medication that was inadequately studied before reaching the pharmacy.
Reproductive Health and Mental Health
Research gaps become particularly visible during pregnancy, postpartum recovery, and menopause.
Pregnancy changes cardiovascular function, metabolism, and medication processing. Mental health conditions may also emerge or intensify during pregnancy and after childbirth. Yet research has historically struggled to include pregnant patients while appropriately managing potential risks. Excluding pregnant women can protect study participants from poorly understood risks. But routine exclusion leaves clinicians with less reliable evidence when those patients eventually need treatment.
The solution requires carefully designed research, appropriate safeguards, and informed consent.
The CDC's analysis of pregnancy-related deaths from 2017 through 2019 found that mental health conditions, including deaths related to suicide and substance-use disorders, were the leading underlying cause among the deaths reviewed. More than 80% of pregnancy-related deaths in that dataset were estimated to be preventable.
Mental health deserves serious attention throughout women's lives. Depression, anxiety and other psychiatric conditions require appropriate treatment. But a psychiatric diagnosis should never become an excuse to overlook physical symptoms. Depression can coexist with cardiovascular disease, hormonal changes, chronic pain and other medical conditions. Treating one diagnosis shouldn't prevent clinicians from investigating another.
Women deserve comprehensive medical assessments, not a choice between having their physical symptoms believed and receiving mental health care.
Who Pays the Price for Incomplete Research?
At SWOP Behind Bars, these questions extend beyond the examination room. We work with people whose access to health care is complicated by poverty, incarceration, unstable housing, stigma, and previous experiences with institutions that haven't always treated them with dignity.
Consider a woman entering a correctional facility with an undiagnosed chronic condition. Someone whose symptoms have repeatedly been dismissed. A survivor whose physical symptoms are interpreted primarily through the lens of trauma, substance use, or her history in the sex trade. Medical research gaps don't disappear when someone becomes incarcerated. Neither do medication side effects, cardiovascular disease, endometriosis, menopause symptoms, or psychiatric conditions. The consequences are particularly difficult for patients who cannot choose their physicians, obtain specialist referrals, afford medications, or seek second opinions.
Women aren't one uniform population. Biological differences matter, but so do age, race, disability, income, geography and living conditions. Research must account for those differences without reducing patients to stereotypes.
Medicine has made important progress. Women are better represented in clinical research, scientists increasingly recognize sex-related differences, and previously neglected conditions are receiving attention. But including women in studies is only the beginning. Researchers must analyze outcomes, report meaningful differences, and ensure discoveries change clinical practice. Medical education must reflect what we know about cardiovascular disease, pain, reproductive health, medication safety, and mental illness.
And health care must remain accessible to people who cannot afford specialists or navigate complicated insurance systems.
At SWOP Behind Bars, we repeatedly encounter a fundamental problem: people cannot benefit from treatments they cannot access, diagnoses they never receive, or research findings that never reach their physicians.
This series began by asking why women's health so often becomes urgent only after something terrible happens.
The history of medical research raises another question: How many women experienced unnecessary suffering while medicine was still learning to study them?
We cannot recover the years lost to missed diagnoses, inadequate treatment, or preventable complications. But we can examine the assumptions that led to those failures and ensure that future research takes women's health seriously throughout their lives.
Because women's bodies were never simply smaller versions of men's bodies. And women should never have to prove they belong in the research that determines their medical care.
