Chapter 18: Medicine’s Biggest Blind Spot is Still Women’s Bodies.

What Can Women Do To Protect Themselves?

Illustration Credit: Image_Jungle

If you have two X chromosomes, this chapter is for you.^[i] It’s no longer news that women patients are misdiagnosed, dismissed, ignored or gaslighted more often than men are. The receipts are everywhere. To protect ourselves from this barrier to better healthcare, we first need to understand the reasons before we can deploy the solutions.

So why are women’s bodies still medicine’s biggest blind spot? Two reasons:

1. Knowledge Gaps

   1. Missing Medical Research

   2. Missing Clinical Education and Training

2. Cognitive and Gender Bias

Knowledge Gaps

We don’t know what we don’t measure. We’re missing key data in published medical research and in clinical education and training. There’s a huge hole between what medical science knows about women’s bodies and about men’s.

Missing Medical Research:

Historically, medical researchers didn’t seek to learn the biological differences between the two major sexes. They didn’t study how symptoms of common diseases differ, how biochemical reactions to medications diverge, how healing rates or simple things like hormonal changes, menstruation, menopause or pregnancy affect those changes.

In truth, concerns that women’s bodies might react differently depending on the stage of their reproductive life cycle was the given reason why women were routinely excluded from study. Menstruation was seen as a problem that would muddy the results. And patriarchal attitudes meant heaven forbid pregnant women participated in the rigors of medication research. Which is why, way before the Tylenol controversy, pregnant women often went without medicine to reduce their pain, fever, cold symptoms, headaches, and anything else amiss.

Even now, fewer than 1 percent of medicines approved for use since 2010 have studied their impact on birth defects or asked the question, “How will this medication affect the pregnant mom-to-be?”

I recall the nightmare cold I had in my eighth month of pregnancy. Out of an excess of caution and lack of knowledge, my doctors denied me anything to help my sneezing, stuffy and runny nose, and deep bronchial cough. I coughed so hard I strained and tore the ligaments around my ribs and my back went out. For three weeks, I couldn’t take a full breath, sit, walk, bend or lie down comfortably. All to protect my pregnancy. It worked. I had a healthy baby (until he was misdiagnosed twice before he turned one), but I still panic when I feel a cold coming on.

Substandard care of women with heart disease and diabetes, are both so well documented
that study after study begin by stating it as accepted fact.

Most women are not pregnant, and they take the same medicines men take. However, women experience adverse drug reactions nearly twice as often as men, though the reasons are “poorly understood.” Most drugs currently in use were approved based on clinical trials conducted on men, so women’s reactions may lead to misdiagnosis and treatment errors. Is her experience a side effect or a new symptom? Is she overmedicated for her weight or is this a new condition? Perhaps she gets dismissed as just a “whiner.” Without data, how can doctors or nurses know?

The National Institutes of Health (NIH) and their Office of Research on Women’s Health (ORWH) have worked for decades to ensure that female patients are included in medical research and that the published results include breakouts by sex. Despite their valiant efforts, they can only influence the studies they fund. The same is true for every other governmental or nonprofit organization whose goals include diversifying research populations.

It’s personally maddening that the inclusion of female bodies is officially considered diversification. Women may outnumber men in the United States but you wouldn’t know it from their presence in published research papers.

Recent political events have made the situation worse by defunding many ongoing medical research projects and banning a long list of scientific terms –– including gender terms ––from future research projects.

Missing Clinical Education and Training:

The result of not studying women’s distinct biological systems is doctors can’t fully understand how female bodies differ from males for many common diseases and medicines. That means that over half of the population in the U.S. is experiencing a lower standard of health care than the rest. Diagnosis is a complex process involving many steps. Missing valuable information makes it harder.

Substandard care of women with heart disease and diabetes, two common conditions, are both so well documented that study after study, including one as recently as October 2025, begin by stating it as accepted fact.

There’s also a well-documented and “persistent gender gap” in identification and treatment of pain. Despite reporting similar pain levels, women’s pain is “underestimated, misdiagnosed, or undertreated.”

Many doctors still expect women and men to display the same symptoms for all conditions. That can cause delays in diagnosis in places where time is of the essence, like emergency departments (ED). Women reporting pain in the ED wait, on average, 30 minutes longer for treatment then male patients, and are less likely to have that issue even recorded in their charts. Comparing studies, it’s gotten worse since 2008. A 2020 study of women in the midst of heart attacks (myocardial infarction) also noted a delay in the arrival of an ambulance, pre-hospital diagnosis and treatment. EDs are also measurably slower to begin diagnostic testing for pulmonary embolism for women compared with men.

Women can experience many diseases differently than men do. Stroke is the third leading cause of death for women while for men it’s number five. According to the American Stroke Association, women have more risk factors for stroke and heart attack and neither present with all the same symptoms as men’s strokes and heart attacks. While some signs of a stroke are the same for men and women, women have additional easy-to-miss signs including fainting, general weakness, shortness of breath, nausea and agitation. Neurologists say that if a stroke isn’t recognized within the first three hours of the first symptoms, treatments are less effective. Delays due to gender may lead to a higher death rate from stroke.

Heart conditions are another classic example; 48 million American women are living with or at risk for heart disease. However, women’s heart attacks rarely arrive in the same dramatic way men’s do: clutching chest pain, pain shooting down the left arm, gasping for air. Ours are more subtle. Common treatments, like stents and angioplasty, were designed with male subjects. So, it’s not surprising that women have higher rates of complication or death after a heart surgery.

You’d expect that misdiagnosis rates might be better for diseases only women could get but it’s often not. Endometriosis is common for females of reproductive age though it can occur at any age; approximately 1 in 10 have this condition. But the average time to diagnosis is 10 years because research is grossly underfunded so even gynecologists tend to dismiss their patients’ symptoms. There’s also no cure and no understanding why endometriosis happens.

Over 81% of women have been pregnant and had at least one biological child. Yet, harm and death due to pregnancy, labor and delivery is higher for American women than any other developed nation. It’s much higher for women of color especially Black women. Over three-fourths can be prevented. Doctors and hospitals know the reasons why it happens, know what to do about it and talk about it a lot but the gap between knowledge and action is as wide as ever.

Generations of theories say women’s bodies are ruled by their emotional state.

Menopause isn’t a disease; it’s a stage of life every woman will experience. Primary care doctors often have outdated notions of what is and isn’t a menopause symptom and how to treat it. It’s diagnosed in a backwards fashion; you’re in menopause one year after your last menstrual period. There’s a lot of disinformation in both the medical and the supplement communities about how to treat menopause, when or if to start hormone treatments what type work or harm you, and more. I highly recommend reliable sources like Dr. Jen Gunter’s The Vajenda and The Menopause Society.

Cognitive and Gender Bias

Why do women commonly report feeling dismissed or ignored? Even when their physician is a woman?

Since the beginning of medicine, women patients have been considered untrustworthy reporters of their own symptoms. From the Greeks and Romans throughout the Victorian Age, many women’s health problems were blamed on wandering uteruses with intercourse and ejaculation as the only cure. I wish I was joking. Years later, when they realized that our wombs didn’t actually wander, they still believed that the womb was the source of many diseases in women. Centuries later, unrecognized diseases were blamed on women’s “tender and delicate Texture of the Nerves.”In her book Doing Harm, author Maya Dusenbery put a fine point on it when she wrote it was believed that “women were inherently prone to nervous disorders because their reproductive functions…took a great deal of energy away from their relatively small brains.”

While sexism is a factor, it’s not the root cause of the problem. It’s due to generations of theories that say women’s bodies are ruled by their emotional state. When doctors view women as emotional rather than rational and objective, it damages their respect for the patient’s ability to make decisions about their own care. They’ve been trained to think this way (though it’s purportedly changing.)

Many medical texts still used to train new doctors use the male pronouns (he, him) when they discuss physical illness and the female pronouns (she, her) when they discuss mental health illnesses. While it’s not the same as stating that women’s illnesses tend to be in their head, there is a cumulative effect that can impact overburdened doctors’ thinking.

As recently as July 20, 2018, there was a social media uproar over a practice question for medical students. It was titled “A 36-Year-Old Woman in Undetermined Pain” and wanted the students to answer, “Which of the following diagnoses characterizes her unexplained physical symptoms?” In the details of this woman’s case, it included the information that she was “quick to suggest treatment options and listens intently whenever any medical professionals are in the room.” To our ears, she sounds like an engaged patient who is knowledgeable and involved in her care.

The testing text disagreed. All the listed diagnoses suggested she was crazy. The “correct” answer was Munchausen Syndrome, a mental illness in which the patient pretends they’re ill when they know they’re not. Few medical students or doctors protested the question. It took a couple of days before the posted question reached the public and the reactions exploded on social media. The company who posted it quickly pulled the test question, apologized, and promised to review their whole question bank. They referred to it as an example of “medical misogyny, a huge problem women face when seeking treatment from medical professionals.”

In short, some gender bias is due to physicians’ growing frustration and irritation when healing efforts fail because research data is limited. Some of it’s due to the historical and current state of medical education. Some of is simply the doctor being a misogynist.

What You Can Do

When an issue is this common, it can feel overwhelming. While advocates for women’s health overall and reproductive health work to raise more funds for research and policy changes, you still need to get the best quality healthcare you can get.

1. Prepare before you see your doctor. Use the tips from Chapter 7.

2. Advocating for yourself is often necessary, although many find it daunting. Often you’ll get better attention and treatment when you bring someone with you to listen, take notes and ask questions. It saddens me to write this but bringing a man works best. Doesn’t matter if it’s a close friend, a husband, a brother or a male patient advocate.

3. Research your symptoms before your appointment and your diagnosis after. Check the pros and cons of online medical resources in Chapter 13.

4. Feeling your doctor isn’t taking your concerns seriously? Use the tips from Chapter 10.

5. Don’t stick with a primary care provider who doesn’t respect you. Get a second opinion. Chapter 11 explains why and how to do that.

6. New prescription? Ask if it’s been tested on women and if you can see a list of side effects by gender. If you take birth control pills, ask if it’s safe to take the new med with your birth control. Don’t be surprised if they don’t have the answer at their fingertips or if they haven’t even considered the question before. If we all do this routinely, eventually they will.

If you’re a woman, chances are you’ve been nodding or shaking your head throughout this chapter. You probably have your own story about a recent doctor’s visit. If so, please share it below. Together, we can help transform medicine’s blind spot into wisdom about women’s health.

Next up –– Chapter 19: Medical Racism Is Real. How The Color Of Your Skin Affects The Quality Of Your Diagnosis. And What You Can Do About It.

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^[i] That is how biomedical, clinical, patient safety and diagnostic quality research defines the female sex. (But I would hazard a guess that patients born with XY chromosomes but who have transitioned or who publicly present as female have the same type of real-life issues, magnified.)

© Helene M. Epstein 2025