It’s 2025, yet science and medicine are still downplaying women’s health concerns. That means women are being underdiagnosed and undertreated. Why are taboos around women’s bodies still interfering with healthcare? Caroline Zielinski investigates what needs to change for women’s health to flourish. This article first appeared in Cosmos Print Magazine, March 2025.
When Professor Bronwyn Graham was bitten by a dog while 12 weeks pregnant, she went straight to hospital. Worried about infection, she assumed she would be given the standard antibiotic treatment. However, her pregnancy proved to be a problem.
“They told me they would routinely give prophylactic antibiotics to dog bites, but because I was pregnant and the antibiotics weren’t listed as safe to use in pregnancy, they refused to give me anything unless the wound got infected,” says Graham, who is also the director for the Centre for Sex and Gender Equity in Health and Medicine at the George Institute for Global Health. It did get infected, and the hospital was forced to react by giving Graham penicillin and the antibiotics she would have otherwise been administered had she not been pregnant.
“So now both my offspring and I were exposed to antibiotics and an infection because of their hesitation to act,” Graham recalls. Thankfully, she and her baby were fine, but it is a story she often tells when speaking about the injustices women suffer at the hands of our medical and health systems.
The female cardiovascular system. Credit: Shubhangi Ganeshrao Kene / Science Photo Library / Getty Images.
Not taken seriously
It’s hard to believe that in 2025, women are disadvantaged at every stage of the medical journey. From preclinical trials all the way to pain management in hospitals, women (including female animals) are less likely to be recruited for clinical studies (unless it is a disease that uniquely or disproportionally affects them); to have their symptoms and pain taken seriously; or, if their symptoms are acknowledged, are more likely to be undertreated, misdiagnosed or given the wrong dosage of medication.
As Maya Dusenbery put it in her seminal book Doing Harm, “women’s symptoms are not taken seriously because medicine doesn’t know as much about their bodies and health problems; and medicine doesn’t know as much about their bodies and health problems because it doesn’t take their symptoms seriously.”
Broadly speaking, the way we understand and treat women’s health can be split into 3 categories: through health conditions that affect the female reproductive system uniquely, such as cervical cancer, menopause, pregnancy and endometriosis; through conditions which affect women disproportionately, such as autoimmune diseases, dementia, osteoporosis and mental health disorders; and conditions which affect them differently, such as heart disease, stroke and pain (to name a few).
Of the above, heart disease in women has become one of the better documented phenomena over the last few years. Despite being the leading cause of death among women in Australia – killing 3 times as many women as breast cancer – most don’t realise that more than a third of women have at least 3 risk factors, and that nearly 100,000 Australian women aged 18 to 44 have 5 or more risk factors.
Common (multiple) causes of death in women, 2022.
The problem, as Gabrielle Jackson writes in her book Pain and Prejudice: A Call to Arms for Women and their Bodies, is that almost “everything known about heart disease and its treatments has been learnt from studying men, so doctors have been trained to recognise the signs and symptoms of heart attacks, cardiovascular conditions and strokes in men”.
Professor Eric Morand, head of the School of Clinical Sciences at Monash Health and a clinical rheumatologist, says medical students get taught the primary risk factor for heart disease is being male. (Data shows that heart disease kills more men than any other disease, with death rates double in men than women.)
“Yes, [heart disease is] more common in men, but the ratio is not that large – there is an imbalance in the zeitgeist,” he says. “Women get heart disease, and because most trials are in men… there is insufficient evidence for some of the medicine [used to treat heart disease] and their effects on women.”
A 2022 Harvard University study that examined women’s participation in adult cardiovascular, psychiatric and cancer-related clinical trials found that among trials for therapeutics in these 3 areas, the percentage of women enrolled did not reflect the proportion of women affected by the disease. The researchers found this was particularly striking in psychiatric conditions, “where females make up 60 percent of the patient population, but just 42 percent of trial participants”.
When Dr Kate Young did her PhD on the quality provision of women’s reproductive healthcare, she was shocked at the way many doctors spoke about their female patients, especially when dealing with complicated conditions such as endometriosis.
“Literally a doctor said, ‘do mad people get endo, or do endo people end up going mad’?” Kate recalls.
“Doctors, even female ones, would describe other women as ‘girls’, infantilising them, but refer to male patients as men. It was always telling [how they spoke about women] they didn’t know what to do with. Instead of saying they didn’t have the knowledge to help, [the doctors] often fell on that psychosomatic explanation of women’s problems and her body”.
And while things are slowly changing (in the early 1960s, an NIH-supported pilot study from Rockefeller University that looked at how obesity affected breast and uterine cancer didn’t enrol a single woman, for example) all researchers interviewed for this article agreed that the medical system has a way to go before all women – including those who are pregnant – are adequately considered.
Pregnant women left behind
Despite pregnant women being adults, and therefore subject to the medical rules governing all adults, their exclusion from nearly all (if not all) pre-clinical and clinical drug trials is a hangover from a 1977 policy by America’s Food and Drug Administration (FDA), which recommended leaving out women of childbearing potential from phase 1 and early phase 2 drug trials. The policy was broad, and recommended excluding even women who used contraception, who were single, or whose husbands had had a vasectomy.
This ultra-cautious approach can be traced to the thalidomide tragedy – a drug prescribed to pregnant women during the 1950s and 60s to treat nausea – which led to more than 10,000 children being born with birth defects ranging from limb deformities to facial malformations. But, as Jackson compellingly argues, it’s also because medicine has always seen women first and foremost as reproductive bodies.
“Our reproductive organs were the greatest source of difference to men… The fallout of this difference is that for a long time, medicine assumed it was the only difference. Because women have reproductive organs they should reproduce, and all else about them was deemed uninteresting.”
As a result, women are subjected to medical advice designed to protect a potential foetus, whether they are pregnant or not. This view that women are walking wombs, combined with the horrific ramifications of thalidomide, have coloured almost all of medicine’s approach to women’s healthcare, inadvertently leaving pregnant women without information about treatments for almost all conditions (except infertility, but we’ll get to that).
Pregnant women need access to medication that is effective, safe and evidence based. The problem is that many drugs made today which may be safe are still not being tested on pregnant women – or women of reproductive age, which spans roughly from 15 to 45 – due to cost, ethical concerns and legal risk.
Treasure McGuire, Assistant Director of Pharmacy, Mater Health SEQ, argues in a recent piece for The Conversation, this leaves many “using drugs in ways that haven’t been approved – or not taking the medications they need out of fear they could cause harm”. This absence of pregnant women from clinical trials means we have no clear idea or solid data on how to treat them.
“There are broad underlying issues here, a majority of which is a paternalistic attitude towards pregnant women and a failure to treat them as the fully functioning adults that they are,” says Professor of obstetrics and head of women’s health at the University of New South Wales, Amanda Henry. “This is not confined to clinical trials. There is a tendency to undertreat, underdiagnose or manage poorly pregnant and breastfeeding women… as we tend to vastly overestimate the risks of various tests or medications on this population.”
She cites the example of an X-ray – which many health professionals are reluctant to perform on pregnant women due to radiation – as a prime example of this overestimation.
“The amount of radiation you get in an X-ray is less than you’d get on long-haul international flights,” Henry says. “And yet, we agonise about doing something like this when pregnant women are unwell.”
She also points to Australia’s sponsor-driven regulatory environment as a roadblock to introducing more safe medications and therapies for pregnant women. Following successful pre-clinical and medical trials (which usually take years), drug companies can choose to apply to the country’s regulatory body (in Australia, this is the Therapeutics Goods Administration, or TGA) to have their drug or vaccine prescribed on a wider scale.
The process of application is complex and requires many steps – and millions of dollars – before any new medicine can be prescribed. One application type, called a ‘new indication’, or additional therapeutic use, for an already approved medicine, means an already existing and safe drug can be reclassified for another use, and is the most relevant in cases of pregnant women.
“We have data that shows that medications we already use are safe and effective for use in pregnant women, but in Australia, it’s up to drug companies to make an application that will be used for this indication,” says Henry. And that’s expensive.
“Over time, we have got ourselves into a situation where we haven’t tested newer medication for safety and effectiveness in pregnancy, and medicines we do have are very vulnerable to disruptions and being withdrawn from the market altogether,” she adds. “This means that pregnant women have a lack of access to medical advances other parts of the population have enjoyed for years.”
Endocrinologist and director of Monash Centre for Health Research Implementation, Professor Helena Teede, also points out that with women having children later in life, more illnesses are occurring in pregnancy. “Therefore, it’s more important than ever to know how all these medications work,” she says.
The burden of infertility
We’ve already seen that medicine views women primarily through the tense of reproduction. This understanding of women, argues Dr Kate Young, goes all the way back to Plato.
“Because women can bear children, medical discourse associated women with the body and men with the mind… Comparatively little concern has been raised about men’s reproductive health, which is never advanced as a threat to men’s ability or right to participate in public life,” Young writes.
“In addition to restricting women’s public contribution, such beliefs provide medicine with an explanatory model of disease and illness in women: to deny one’s ‘biological destiny’ is to incite all manner of diseases, as Plato stated when theorising the wandering womb.”
Consequently, fertility is one area of research where women are overrepresented. Despite male infertility contributing to about half of all cases of infertility, the condition continues to be thought of as exclusively a woman’s problem – something that doctors are increasingly trying to change.
In October 2023, 26 researchers published a paper calling for a change in the default medical assisted reproduction strategy in most cases of male infertility, which “requires the woman to carry a large burden [which is] a stark example of gender inequity in medical treatment”.
A 2023 study analysing funding through the NIH found that female infertility research received significantly more funding compared to male infertility research, receiving more than US$436 million in funding compared to US$22 million between 2004 and 2022.
Other conditions which include more female participants than male (reflecting the diseases’ prevalence) include several autoimmune diseases, where more than 85% of sufferers are women, and which are the leading cause of death in women under the age of 65 in the Western world.
Professor Morand, a global leader in lupus research, says clinical trials have a ratio of 9 women to 1 man in lupus; 3 to 1 in rheumatoid arthritis trials; and about 2–3 women to 1 man in multiple sclerosis.
But centuries of disbelieving women, minimising their suffering, and cultural and moral shame around menstruation and other female body parts means we are also missing out on cutting-edge research in these areas that could be lifesaving.
Research undertaken in 2018 by Dr Jemma Evans, a former researcher at the Hudson Institute of Medical Research, on menstrual fluid found it contains proteins and bioactive materials that could help heal chronic wounds, which costs Australia $3.5 billion each year.
While the research is ground-breaking, Evans’s former colleague and head of the Endometrial Stem Cell Biology Research Group, Professor Caroline Gargett, told Cosmos she struggled to attract funding largely due to the “ick” factor that still surrounds female body parts. (Evans did not respond to multiple contact attempts.)
“Jemma was great, and her research was amazing, but she made the decision to leave after she couldn’t get funding to further the research,” Gargett says.
This is often the case with research that focuses on conditions more common or more impactful for women (with fertility a notable exception). Data disclosed by the National Health and Medical Research Council (NHRMC), Australia’s main health and medical research funding body, shows that between 2014 and 2023, endometriosis, which affects 1 in 7 Australian women, received $9.6 million in research funding; irritable bowel syndrome (IBS) which affects about 3 out of 10 people, with women twice as likely to be diagnosed, got $16.3m; chronic fatigue syndrome, of which about up to 80% of sufferers are women, received $4 million; chronic pelvic pain, which affects 1 in 5 women received $600,000; and vulvodynia, a condition where there is pain, burning and discomfort in the vulva that cannot be linked to a specific cause and which affects about 4 to 8% of women at any one time, and 10 to 20% in their lifetime, received… $0.
NHMRC medical research funding, 20214 to 2023.
Slow progress
But things are slowly changing. Teede, who also works as a doctor, urges people – especially women – to not lose faith in medical professionals. “We need to be careful to not constantly blame the challenges we have now solely on medical professionals,” she says.
“Absolutely change is well-overdue, and we have a lot to do. Our research and therefore our evidence, and therefore our education and practice has relied on a male paradigm of health, and that needs to be addressed.”
“But it’s a fine balance between holding the medical and healthcare establishment to account, expecting us to all do better… but also to acknowledge the context within which it’s occurred.” Teede says the Australian government is currently working on several different clinical quality registries, which includes all the data collected by hospitals being put into a national database and made accessible to researchers to study and analyse.
“It is unacceptable that in the current day and age the efforts that are expanded in data collection don’t result in a quality registry that is provided in a range of health conditions to improve quality care and outcomes,” she says. This is especially critical when it comes to pregnant women and their engagement with different treatments, vaccines and medicines.
In the clinical trials space, Graham (who was bitten by the dog while pregnant) says the NHRMC and the Medical Research Future Fund’s recent statement to researchers to consider sex, gender, variations of sex characteristics and sexual orientation at all stages of the research project is the biggest “game changer” in years.
“This document provides guidance to researchers on how they should be incorporating all those variables in their research, from the conception of the research questions, through to the reporting and analysing the results, and thinking about translating that,” she says. The problem, however, is that it’s not a mandate or policy like in Canada (since 1997) or Europe, where similar stipulations have existed for nearly a decade.
As for pregnant women? Henry says normalising testing on pregnant and breastfeeding women will take a multi-pronged approach, with several stakeholders, including the Royal Australian and New Zealand College of Obstetrics and Gynaecologists already working hard to change the status quo.
“We are not going to solve this overnight,” Henry says. “But we need to ensure that we don’t inappropriately exclude pregnant and breastfeeding women from research in vaccines and medications, and that the benefits and risks of medications is clear and well informed.”
Henry adds this doesn’t mean that pregnant women will necessarily be lining up to be in trials – “if given the choice, many women will still not do it” – but stresses we need to give them all the information and trust them to make the choice for themselves.
“We need to flip that blanket default answer of ‘no’, and really think about the cost of not including this population, and women more broadly, in clinical trials and beyond,” she says.
Young agrees. “We have a long way to go, but women do seem to be reporting more positive experiences in terms of being taken seriously,” she says.