In the last four years we have seen women take to the streets, unified by experiences such as the #MeToo movement. As further disparities regarding gender and race gain global attention, we ask how science is playing their part in reinventing social structures. In particular, the research needed to improve women’s health.
51% of our global population menstruate. Therefore, tracking devices such as inne provide women with powerful tools to understand their hormonal health. Science recognises how sliding levels of estrogen and progesterone impact mental, physical, and reproductive health. However, with those changes seems to come challenges. Throughout history, hormonal fluctuations have been an excuse to exclude women from medical studies. In the US, where a large proportion of research is carried out, it wasn’t until 1993 that a ruling was passed for the National Institute of Health to include women in clinical trials (1). Yet, research focusing specifically on women’s health is still largely ignored. From chronic pain to racial inequality, we take a closer look at the facts and figures.
Link between the Menstrual cycle and mental health
Scientific studies have dispelled the myth that women’s mood swings are unjustified. Research shows that PMS impacts up to 80% of women worldwide, presenting an array of symptoms (2). However, 40% of females do not respond to treatments available (3). Another 5 - 8% of women wait up to eight years to be diagnosed with Premenstrual Dysphoric Disorder, a hormone-based mood disorder often misdiagnosed as bipolar (4). It is common practise that healthcare professionals prescribe women struggling with PMS or PMDD with the contraceptive pill or antidepressants (5). However, with over 150 reported symptoms, including physical pain, sleep disorder, suicidal thoughts, and mood fluctuations, there is an obvious gap in options available.
Menopause is another pathway of women’s health which science is slowly understanding. Studies show that 50 - 60% of postmenopausal women suffer from vaginal atrophy (dryness), causing physical and mental distress. This has adverse effects on women’s sexual pleasure, yet only 25% will seek medical help (6). These figures reflect the disproportionate lack of support regarding female sexual health compared to conditions such as erectile dysfunction, something which affects 19% of the male population (7). As more women vocalise the importance of their sexual satisfaction, we wait for scientific studies to do the same.
Racial Disparities within Women’s Health
Seeing women participate in clinical trials is a huge step towards gender equality. However, Black, Asian and historically marginalised ethnic women are still the least likely to be included in these studies. Racial discrimination has a damaging affect on physical and mental health, and studies show how science is only adding to the problem (8). Studies show that preconceptions about certain ethnic groups continually lead to underestimated pain by medical professionals and a delay in diagnosis (9). In the U.K alone, Black and historically marginalised ethnic women will experience barriers in accessing antenatal and maternity service. This results in them being three times more likely to experience adverse birth outcomes and five times more at risk of dying in pregnancy or postpartum (10,11). These are not the only shocking figures found within the healthcare system.
Every year, there are over half a million new cases of cervical cancer and 50% result in mortality. Africa accounts for a quarter of those deaths, with Sub-Saharan Africa reporting the highest rate of diagnosis in the world (12, 13). Racial disparities are also present in regards to uterine fibroids. These are benign lumps growing on the wall of the uterus, and are more prevalent in Black women than any other ethnic group (14). Uterine fibroids are often considered to be symptomless but increased pelvic pain and abnormal bleeding are also common. Because Black women are a minority within clinical trials, and knowing that their pain is commonly underestimated, a void appears regarding the accuracy of this condition’s severity.
Physical Wellbeing in relation to Menstrual Health
The need for more research becomes a pressing matter when looking at how much the menstrual cycle can disrupt daily routine and physical wellbeing. For many women, the ability to function throughout the day is dictated by monthly cycles of severe discomfort. In the US alone, 50 million women suffer from symptoms such as irritable bowel syndrome, chronic fatigue, vulvodynia and lower back pain (15). When looking at the entire female population, 10% have endometriosis (16). This is a disease that's cause and cure is still unresolved, resulting in women being misdiagnosed. On average, it takes 8-12 years between the onset of pain to the point of recognising endometriosis. Similarly, PCOS is a condition with no found cure. Symptoms include ovulation pain, hair loss, acne and weight gain. Witnessing the ever growing list of problems highlights how solutions to aid women’s health fail to catch up.
The diversity of each woman’s menstrual cycle continually evolves throughout her lifetime. Female health tracking helps recognise how day to day physical functions impact those changes. From the amount of sleep we have to the level of stress we're under, lifestyle choices play a pivotal role in our wellbeing. Growing attention on women in sports has been matched by a parallel awareness in relation to exercise and menstruation. Recognising how intense training and restrictive diets can lead to secondary amenorrhea has shined a light on ways to workout in sync with your cycle. Removing social pressure to perform at a consistent level is one way women can nurture their reproductive health.
Science recognises that a woman's reproductive health goes through many stages, from her first period, to potential pregnancy, leading her through to menopause. However, there is a severe lack of funding and a number of outdated stigmas attached to women’s health. inne is amongst a number of leading projects advocating for change. Through individual female health tracking, overarching similarities amongst women can be found. Building an ethnically inclusive, global body of data that will improve medical research. With this progress, we believe in the potential to attract interest from further medical professionals, and funding bodies.
1. Liu KA, Mager NA. Women's involvement in clinical trials: historical perspective and future implications. Pharm Pract (Granada). 2016, 14(1), pages 708.
2. Gillings MR. Were there evolutionary advantages to premenstrual syndrome?. Evol Appl. 2014,7(8), pages 897-904.
3. Freeman, Ellen, Therapeutic management of premenstrual syndrome, Expert opinion on pharmacotherapy, 2010
4. Sanskriti Mishra, Raman Marwah, Premenstrual Dysphoric Disorder, 2020, article consulted on October 22nd, 2020.
5. McKinlay, J The worldwide prevalence and epidemiology of erectile dysfunction. International journal of impotence research, 2000
6. Naumova I, Castelo-Branco C. Current treatment options for postmenopausal vaginal atrophy. Int J Womens Health. 2018, 10, pages 387-395. Published 2018 Jul 31.
7. Marjoribanks J, Brown J, O'Brien PMS, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database of Systematic Reviews 2013, Issue 6.
8. Williams DR. Racial/ethnic variations in women's health: the social embeddedness of health. Am J Public Health. 2002,92(4), pages 588-597.
9. Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A. 2016, 113(16), pages 4296-4301.
10. Garcia R, Ali N, Papadopoulos C, Randhawa G. Specific antenatal interventions for Black, Asian and Minority Ethnic (BAME) pregnant women at high risk of poor birth outcomes in the United Kingdom: a scoping review. BMC Pregnancy Childbirth. 2015, 15, page 226. Published 2015 Sep 24.
11. RCOG Position Statement: Racial disparities in women’s healthcare, 6 March 2020
12. De Vuyst H, Alemany L, Lacey C, et al. The burden of human papillomavirus infections and related diseases in sub-saharan Africa. Vaccine. 2013, 31(suppl 5) F32–F46
13. Pinder, Leeya F., Brett D. Nelson, Melody Eckardt, and Annekathryn Goodman. 2016. A Public Health Priority: Disparities in Gynecologic Cancer Research for African-Born Women in the United States. Clinical Medicine Insights. Women's Health 9 (1), pages 21-26.
14. Jacoby VL, Fujimoto VY, Giudice LC, Kuppermann M, Washington AE. Racial and ethnic disparities in benign gynecologic conditions and associated surgeries. Am J Obstet Gynecol. 2010, 202(6), pages 514-521
15. Manuel JI. Racial/Ethnic and Gender Disparities in Health Care Use and Access. Health Serv Res. 2018, 53(3), pages 1407-1429.
16. Moradi M, Parker M, Sneddon A, Lopez V, Ellwood D. Impact of endometriosis on women's lives: a qualitative study. BMC Womens Health. 2014, 14, 123. Published 2014 Oct 4