Cutting corners on women’s healthcare is proving costly

Cutting corners on women’s healthcare is proving costly Kate Dion

What an expensive taboo can tell us about how far women’s healthcare has come

It affects half of the world’s population, can prematurely curtail women’s careers and is costing the US economy $26.6 billion a year,¹ but it is barely discussed in most workplaces around the world. What is it?

The menopause.

A recent study conducted by the Mayo Clinic has shown that menopause is wiping $1.8 billion in lost work time each year from the US economy. That figure jumps to $26.6 billion when medical expenses are accounted for. And the bill is likely to be even higher when the costs related to reduced hours of work, loss of employment, early retirement, or changing jobs are also included in the calculations.¹

Women spend more than a third of their lives in peri- or post-menopause and 1.2 billion women globally will experience these life stages by 2030, according to research conducted by the consultancy McKinsey.² Despite more than 1 million women in the US going through the menopause each year, the health effects are still not fully understood.³ Symptoms include hot flashes, night sweats, sleep disturbances, and cognitive impairment, but only 25% of women receive treatment, McKinsey found.²

Unfortunately, many of the issues experienced by women as they go through menopause are mirrored across all aspects of women’s health. This Women’s Health Month, we are taking stock of whether enough is being done to address the gaps in research funding as well as the challenges women face when it comes to receiving quality care and being able to access healthcare services.

Funding for women’s healthcare falling short of the mark

Research into women’s health has for decades been underfunded and still does not correspond to the burden of disease that women face, data show.

Both female animals and women have been excluded from clinical trials. This was partly due to concerns about the impact women’s hormonal cycles may have on study results.⁴ It is also the result of a guideline the FDA issued in the late 1970s, banning most women of “childbearing potential” from taking part in clinical studies after certain drugs were found to have caused serious birth defects.²

Since then efforts have been taken to address the research gap. The 1977 guideline was reversed in 1993 and by 2014 around 50% of all participants in clinical trials funded by the US National Institutes of Health (NIH) were women.⁵

But there still remains a disconnect between the proportions of women in clinical trials and the prevalence or burden of disease.

An analysis conducted by independent researcher Arthur Mirin based on data from the NIH and covered in a Nature article⁵ showed that disorders that disproportionately affect women, such as migraines, headaches, endometriosis, and anxiety disorders, attract less funding in proportion to the burden they exert on the US population. It also applies to oncology, immunology, and neurology.⁵

“Unfortunately [funding for women’s health] is really undervalued, understudied,” Neuroscientist Liisa Galea at the Centre for Addiction and Mental Health in Toronto, Canada was quoted as saying in the Nature article.⁵

When it comes to oncology, an analysis of cancer funding based on data from the US National Cancer Institute from 2007-2017 showed gynecological cancers had less financial backing than other cancers when accounting for how deadly they are, according to the Nature article⁵. Ovarian cancer, for example, is the fifth most deadly cancer, but twelfth in terms of its funding-to-lethality ratio, out of a list of 19 cancers. It’s a similar picture for cervical cancer, and for many gynecological cancers, the ratio of funding to mortality even fell during the 11-year study period.⁵

Yielding results

Yet increasing funding for women’s health research could pay dividends. An estimated $350 million investment into research focused on women could deliver a $14 billion economic return and lead to reduced healthcare costs, better quality of life as well as additional years of productivity, according to research conducted by Women’s Health Access Matters, a non-profit advocacy group, and the RAND Corporation, a non-profit research and policy organization. The study focused on Alzheimer’s disease, rheumatoid arthritis, and cardiovascular disease.⁶

Challenges in clinical practice remain

Gaining a better understanding in the biology of the female body, and conditions that specifically affect women as well as those that affect both men and women in different ways will play a crucial role in delivering better care for women at all stages of their lives.

A large body of evidence shows women are at a greater risk of mis and/or late diagnosis and suboptimal care across a range of conditions due to important gaps in knowledge. For example:

• Women are 50% more likely than men to get the wrong diagnosis after a heart attack, a study from the University of Leeds found.⁷
• One-third of women are more likely to be misdiagnosed following a stroke.⁸
• Women make up around 80% of those suffering from an autoimmune disease, and it takes an average of around five years to get a diagnosis.^9,10

The likelihood that women receive painkillers after surgery is 50% lower than for men,¹¹ while women with dementia have fewer visits to a General Practitioner, receive less monitoring, and take more potentially harmful medication, including antipsychotics or sedatives, according to research conducted by University of College London.¹²

Discrepancies in the delivery of care

“The disparity between allocations to healthcare in general compared with women’s health in particular is even more pronounced given that entire categories in female conditions are omitted from some health burden measures. For example, menopause and its associated symptoms are not captured in global disease burden databases, which look broadly at causes of death, diseases, injuries, and health risk factors,” McKinsey wrote in its analysis.²

Discrepancies in care are also leading to poorer outcomes for women with cancer and the Lancet Commission on Women and Cancer has said it will publish a report later in 2023 to “highlight the wide-range impacts of gender on cancer, emphasize the need for a gender-based approach to cancer research and policy development, and recommend policy changes to improve access to care and prevention services for women.”¹³

Breast cancer is the most commonly diagnosed cancer worldwide and is the type of cancer that is most likely to kill women. Cervical cancer is the fourth most commonly diagnosed. Women with both of these types of cancer can achieve good outcomes if they are diagnosed early enough – cervical cancer can be largely prevented thanks to new vaccinations – but deaths are still occurring due to a lack of prevention, early detection, and treatment services, particularly in low- and middle-income countries where 90% of deaths occur.¹³

Dr. Isabelle Soerjomataram, co-chair of The Lancet Commission on Women and Cancer, has also called for the discussion on women’s cancers to be widened, as women are often experiencing poor outcomes when diagnosed with cancers that affect both men and women, such as lung and colorectal cancers. For example, more women are dying from lung cancer than breast cancer in the US, data show.¹³

These challenges can be further compounded by not always being able to access the care that is needed in a timely manner.

Speaking up about suffering in silence

A number of barriers are still stopping women from seeking care, including gender discrimination, lack of education, and domestic violence.

“As a woman, I think there’s still a sense that suffering is part of what we do. Women come to me and ask, how much pain is normal? If there’s anything that’s impairing your ability to live your life, you should be able to seek help and advice.

“Women don’t necessarily want to be medicated, and their conditions often won’t fit into nicely pigeonholed clinical care pathways. But every woman deserves the chance to seek help, talk, get advice, and be listened to,” Professor Philippa Saunders FMedSci, Academy Registrar, was quoted as saying in an article that was published by the Academy of Medical Sciences.¹⁴

Many women do not feel heard when they speak to their healthcare providers – 84% of women responding to the Women’s Health Strategy for England survey said they had at times felt their clinicians were not listening to them.¹⁵

Often women report being dismissed as “chronic complainers”, while many women are even advised to see a psychiatrist in the early stages of an illness.⁸

As scientists seek to better understand the female body, economists’ calculations are showing that society can no longer afford not to listen to what women have to say about their health. It is becoming increasingly clear that women, societies, and economies will be a lot better off as soon as we start to invest in the research, clinical resources, and policy changes that women and their health deserve.

1. Mayo Clinic Proceedings. (2023). Article available from https://www.mayoclinicproceedings.org/pb-assets/Health%20Advance/journals/jmcp/JMCP4097_proof.pdf [Accessed May 2023]
2. McKinsey. (2022). Article available from https://www.mckinsey.com/industries/healthcare/our-insights/unlocking-opportunities-in-womens-healthcare [Accessed May 2023]
3. National Institute on Aging. (2022). Article available from https://www.nia.nih.gov/news/research-explores-impact-menopause-womens-health-and-aging [Accessed May 2023]
4. Weigard et al. (2021). Sci Rep 11, 20925.Article available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8536752/ [Accessed May 2023]
5. Nature. (2023). Article available from https://www.nature.com/immersive/d41586-023-01475-2/index.html [Accessed May 2023]
6. The Wham Report. Article available from https://thewhamreport.org/ [Accessed May 2023]
7. University of Leeds. (2016). Article available from https://www.leeds.ac.uk/news/article/3905/heart_attacks_in_women_more_likely_to_be_missed [Accessed May 2023]
8. Prevention. (2021). Article available from https://www.prevention.com/health/a26100121/misdiagnosed-women/  [Accessed May 2023]
9. Autoimmune Association. (2023). Article available from https://autoimmune.org/resource-center/about-autoimmunity/#1481574903922-68688035-6be6 [Accessed May 2023]
10. Benaroya Research Institute. (2017). Article available from https://www.benaroyaresearch.org/blog/post/diagnosing-autoimmune-diseases#:~:text=Being%20diagnosed%20with%20an%20autoimmune,typically%20has%20seen%20four%20doctors. [Accessed May 2023]
11. UK Parliament. (2021). Article available from https://lordslibrary.parliament.uk/womens-health-outcomes-is-there-a-gender-gap/ [Accessed May 2023]
12. UCL. (2016). Article available from  https://www.ucl.ac.uk/news/2016/dec/women-dementia-receive-less-medical-attention [Accessed May 2023]
13. UICC. (2023). Article available from https://www.uicc.org/news/addressing-gender-barriers-cancer-control [Accessed May 2023]
14. The Academy of Medical Sciences. (2021) Article available from  https://acmedsci.ac.uk/more/news/a-mans-world-how-healthcare-and-research-is-failing-women [Accessed May 2023]
15. National Institute for Health and Care Research. (2022). Article available from https://evidence.nihr.ac.uk/collection/womens-health-why-women-feel-unheard/ [Accessed May 2023]