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Don’t Be Dramatic: The Severe Underdevelopment of Women’s Health

Medical research is not as objective as you might think. Despite the substantial advancements in biomedical science over the past century, the development of women’s health research tells a more complicated story. Across multiple specialties, conditions that affect primarily women have been underfunded, underresearched, and, at times, clinically minimized. The effects of this are measurable, with women consistently struggling to get the help they need in a medical setting.


For much of the twentieth century, women, particularly those of reproductive age, were routinely excluded from clinical trials in the United States (U.S. Government Accountability Office [GAO], 1992). This only formally changed with the NIH Revitalization Act of 1993, which mandated the inclusion of women in NIH-funded research (National Institutes of Health [NIH], 2023). While this has improved representation, it has not automatically corrected the long standing gaps in scientific research. In 2020, only 5% of global research and development funding was allocated to women’s health research, and only 1% for all women-specific health conditions outside of cancer. (Nature, 2024). Meanwhile, the McKinsey Health Institute estimated in 2022 that closing the women’s health gap could contribute approximately $1 trillion annually to the global economy by 2040, reflecting that women’s health still currently remains greatly underprioritized (McKinsey Health Institute, 2022).


Few conditions illustrate this more clearly than endometriosis.


Endometriosis: A Common Disease with an Uncommon Delay

Endometriosis is a chronic inflammatory disease in which tissue similar to the uterine lining grows outside the uterus, often affecting the ovaries, fallopian tubes, and pelvic peritoneum (World Health Organization [WHO], 2023). It affects approximately 10% of reproductive-age women and girls worldwide; an estimated 190 million individuals (WHO, 2023). Despite its prevalence, the average delay from symptom onset to diagnosis ranges from seven to ten years (Nnoaham et al., 2011; WHO, 2023). This delay is particularly striking given the severity of symptoms, which may include chronic pelvic pain, dysmenorrhea, dyspareunia, fatigue, and infertility (WHO, 2023).


In a large multicenter study spanning ten countries, Nnoaham et al. (2011) found that endometriosis significantly impairs quality of life and work productivity, bringing with it substantial economic costs. Yet diagnosis typically requires laparoscopic surgery, which is invasive and can have a painful recovery (ESHRE Guideline Group on Endometriosis, 2022). Although updated guidelines increasingly support clinical and imaging based diagnosis, non-invasive diagnostic procedures still remain limited, and there is currently no cure (ESHRE Guideline Group on Endometriosis, 2022; WHO, 2023). Treatment options, including hormonal suppression, analgesics, and surgical excision, only focus on symptom management. Recurrence after surgery is common, and many patients require long-term therapy (ESHRE Guideline Group on Endometriosis, 2022).


Importantly, a comprehensive assessment of research gaps concluded that endometriosis research funding does not proportionately reflect the condition’s prevalence or burden relative to other chronic diseases (As-Sanie et al., 2019). In other words, a disease affecting one in ten reproductive age women remains comparatively under researched. An eye-opening demonstration of this is current existing research surrounding endometriosis. A small 2013 study found that sildenafil citrate, commonly known as Viagra, provided hours of pain relief from painful menstrual cramps associated with endometriosis. The lead researcher applied for additional funding to do a larger clinical trial, but his grants were rejected, with comments the researcher received questioning whether painful periods were a “priority public health issue.” (Cunningham, 2019) That same year, funding was approved for a study assessing the attractiveness of women with endometriosis. The study’s conclusion was: “Women with rectovaginal endometriosis were judged to be more attractive than those in the two control groups. Moreover, they had a leaner silhouette, larger breasts, and an earlier coitarche.” Coitarche is the age at first sexual intercourse. This study has been described by many researchers and activists in the medical community as “heartbreaking” and “disgusting.” (Jackson, 2020)


The delay in diagnosis is not solely scientific. Qualitative research demonstrates that individuals with endometriosis frequently report having their symptoms minimized or attributed to psychological causes during early clinical encounters (Ballard et al., 2006). Severe menstrual pain is often normalized, contributing to prolonged referral times and delayed evaluation.


A Pattern of Treatment

Endometriosis is not an isolated case. Cardiovascular disease is the leading cause of death among women globally. However, women are more likely than men to present with atypical symptoms during a myocardial infarction and are at increased risk of misdiagnosis (Harvard Health, 2016). Similarly, women account for nearly 80% of individuals affected by autoimmune diseases, yet this discrepancy between sexes remains incompletely understood (Fairweather et al., 2008).


Pain research reveals documented sex differences in pain perception and response to pain medication (Mogil, 2012). Nonetheless, evidence suggests that women reporting pain are more likely to receive sedatives rather than medication and to have their symptoms attributed to psychological factors (Hoffmann & Tarzian, 2001).

These examples reflect a broader structural pattern: women’s health conditions often receive attention only after the patient’s prolonged advocacy or mounting evidence of harm. Otherwise, their symptoms are written off as “dramatic.”


Future Directions

Historically, medicine provided psychological explanations for women’s physical symptoms, including diagnoses such as hysteria (Tasca et al., 2012). Although modern medicine has moved beyond such terminology, implicit biases may still influence clinical interpretation, particularly in conditions characterized primarily by pain.


To meaningfully address the underdevelopment of women’s health, three changes are necessary:


  • Equitable research funding proportional to the burden of disease.

  • Mandatory sex-specific data analysis in clinical trials.

  • Medical education reform that integrates sex and gender based medicine across specialties.


The WHO identifies endometriosis as a public health issue requiring improved awareness, earlier diagnosis, and expanded research efforts (WHO, 2023). The NIH Office of Research on Women’s Health continues to advocate for the systematic consideration of sex as a biological variable in biomedical research (NIH, 2023). These initiatives show that there is progress, but the persistence of multi-year diagnostic delays and limited innovation in treatment suggests that these gaps remain. Endometriosis serves as a case study in how oversight in research leads to consequences in the lives of millions. When half the population frequently have their pain dismissed, wait years for diagnosis, and hardly see progress in treatment options, change is clearly long overdue.


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