When it comes to our health, there still seems to be a gender gap in what we know and how we treat men and women.
Research indicates that women are potentially missing life-saving treatments and tests because doctors and researchers did not consider basic biological gender differences.
Certain behavioral or social factors mean that women are less likely to be diagnosed with certain diseases or are being treated.
For example, one study found that women are not diagnosed in the early stages of Alzheimer's disease because they tend to have superior verbal memories-the type that helps them remember words from stories or lists.
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In the University of Illinois study, presented to the Alzheimer's Association International Conference earlier this year, women managed to maintain their performance in memory tests, even when scans showed that Alzheimer's began to damage important parts of the brain.
The researchers concluded that "although the female benefit may be functionally beneficial, it can mask the early stages of Alzheimer's disease, leading to a heavy burden of disease at the time of diagnosis and then deteriorating more rapidly thereafter."
For years, heart attacks have been considered a "human disease," mainly because men tend to smoke, have unhealthy lifestyles or succumb to stress.
The symptoms of heart attack in women are often considered less typical and are therefore often overlooked. As a result, cases in women are also overlooked. Women die more often after an attack, partly due to a misdiagnosis.
WOMEN BREAKS CAN INFLUENCE HEART SCAN
"Women with a heart attack are more likely to be hospitalized and discharged with an irrelevant diagnosis, such as panic attacks or indigestion," says Georgios Kararigas, Professor of Translational Gender Studies at the Charité University Hospital in Berlin.
"This means that they are not being treated properly, which adversely affects their health and can lead to unnecessary deaths," he adds.
Another complicating factor is that "typical" heart attack symptoms – such as chest pain, fast heart rate, and shortness of breath – are more common in men.
Poor science: Even if a heart attack is suspected, the diagnosis is difficult in women, as the breast tissue produces confusing shadows during the scan – which leads to sexism
MEN: THE FACTS
According to the National Statistics Office, men are leading women to succumb to nine of the top 10 killer diseases, including heart disease, stroke, pneumonia, diabetes and cirrhosis
– Men suffer from a life expectancy gap that has widened by 400 percent in 90 years
– Men are more likely to get any form of unisex cancer. Nevertheless, they are excluded from fundraising activities such as Race for Life by Cancer Research UK.
– Prostate cancer kills more men than breast cancer women
– Boys are denied the HPV vaccine by gender alone
Women, on the other hand, are more likely to experience fatigue, anxiety, drowsiness and sleep disturbances over a period of several days or weeks than sudden pain. These problems can easily be confused with other, less severe conditions.
Even if a heart attack is suspected, it is difficult to obtain a diagnosis in women since breast tissue produces confusing shadows in the examination commonly used to detect coronary artery disease (Spect (single-photon emission computed tomography).
"Male and female hearts share the same physiology and function, but the response to disease differs significantly," says Professor Kararigas. This is partly because hormones play a role.
Most women have a regular hormonal cycle after puberty, driven by the sex hormone estrogen. This hormone has a protective effect against heart disease, although it is not clear why.
However, once the estrogen level drops after the menopause, this protection is lost and the risk of heart problems increases dramatically.
Heart disease even looks different in men and women. Men tend to have larger fat blocks in their arteries that trigger an attack. These can be treated with a small tube (stent) to open the arteries and restore blood flow.
In contrast, women's arteries tend to "brush" with a layer of fat over a larger area. Stents or similar surgical approaches do not work, and treatment tends to focus on lifestyle changes and on medications such as blood thinning aspirin or beta-blockers to reduce stress on the heart.
These gender differences extend to the perception of physicians by physicians who affect both men and women. A Florida A & E study, published in the Proceedings of the National Academy of Sciences earlier this year, has alarmingly shown that women are more likely to die when treated by male than female doctors.
This is probably due to stereotypical views about the treatment of a "typical" (male) heart attack patient.
RESEARCH STUDIES LEAVE WOMEN
One of the main reasons for the lack of knowledge about the effects of female hormones and biology on a whole range of conditions is the historical focus on the use of males for research.
"In laboratory studies, we need to use animal models to study what's going on – for example, in the brain – to use as few animals as possible, most studies use only men," says Professor Spiers-Jones.
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"Men have less behavioral differences and no hormonal cycles, so they're easier to study, but we miss information about women's behavior and they may be very different."
This lack of women-specific data extends to all aspects of health research, from dementia and cardiovascular diseases to asthma and autoimmune diseases.
For example, one report found that more than one fifth of the studies did not specify the sex of the animals, while 80 percent of those who used male animals.
A large study, published in 2017 by researchers from the Wellcome Sanger Institute, examined data from more than 200 characteristics, including bone mass, metabolism and behavior. It was found that differences between the sexes could influence the results in more than half of the experiments.
One of the authors of the study, Professor Judith Mank of University College London, said the results show how often differences in features appear that would otherwise be considered identical in both sexes.
"The fact that the gender of a mouse affects gender shows that, apart from the underlying genetics, men and women differ in many characteristics. Only studying men paints half the picture, "she said.
WOMEN'S DRUGS ARE TESTED ON MEN
Women not only missed developments in laboratory research, but were long ignored in clinical trials of new therapies.
In 1977, the US Food and Drug Administration (FDA) banned women in most cases as having "childbearing potential," even if they were not pregnant or about to become pregnant. This was lifted in 1994, but today disproportionately few women participate in litigation.
In fact, the anti-anxiety drug Valium – known as the mother's little helper – was never originally tested on women.
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Worryingly, a Brazilian researchers' study published in the Brazilian Journal of Depression and Anxiety in 2016 showed that the menstrual cycle can significantly affect and even render useless the effectiveness of Valium depending on the time of the month.
In a recent study investigating the interactions between alcohol and Addyi, a drug to increase female libido, 23 men and two women were enrolled.
This failure to investigate the efficacy and side effects of women may have serious consequences for safety.
Between 1997 and 2001, it was found that eight out of ten previously approved prescription drugs withdrawn from the shelves by the FDA for "unacceptable health risks" are more harmful to women than men, although half of them were more willing to do so.
"We know that women are more likely to suffer from drug reactions, and the menstrual cycle influences how well treatment works," says Caroline Criado-Perez, author of the upcoming book Invisible Women, which examines gaps in women's research data.
"This was used as an excuse to ignore women, but the reality is that women have these hormones and the medications will interact with them."
In addition, many test drugs do not work when tested on men. However, this means that treatments that may only work in women will be put on ice, so that women may miss out on possible therapies.
"People say women are too complex for medical research, but we need to do more to study the gender gap in men and women," adds Professor Kararigas.
"We need to understand the differences in the underlying mechanisms of disease and to identify novel drug targets for more appropriate treatment of men and women in order to focus on the realization of personalized medicine.
"If we do not study both men and women, how can we find therapies that would be good for any of them?" He says.
Caroline Criado-Perez wants legislation that forces researchers to include data from men and women from the early stages of laboratory research and to properly separate the study data by gender as a prerequisite for the launch of a new treatment.
Professor Spiers-Jones agrees: "We have to make sure that we help 100% of the population, not half."
FEMALE PAIN is often rejected
Variations in the treatment of men and women are found in almost all areas of medicine, suggesting that more complex social factors are involved than mere differences in physiology.
For example, women's pain is less often taken seriously than that of men, and women are given sedatives rather than effective pain medications.
Chronic, debilitating conditions such as endometriosis are often dismissed as "period problems". This causes the Health Watchdog NICE to issue guidelines urging GPs to listen much more closely to their patients.
Sorority: Women's pain is less seriously treated than men, and women are more likely to take sedatives than effective painkillers
The symptoms of aggressive ovarian cancer are often attributed to "flatulence". And psychiatrists have only recently realized that autism is far more prevalent in girls and women than previously thought, because the state may differ between the sexes.
Dementia is another area where women are left behind.
Women have a higher risk of developing dementia than men in their lifetime, and about two-thirds of people with dementia are women.
Although some of these differences are due to the fact that women tend to live longer than men, we still do not know how sex affects the risk of dementia, says Professor Tara Spiers-Jones, an Alzheimer's expert at the University of Edinburgh.
"Male and female brains are different, but that does not mean that one is better or worse," she says.
"Both have about 100 billion nerve cells with more than 100 trillion connections.
These are especially affected by hormones, such as estrogen, that change during the menstrual cycle and menopause.
"There is so much we do not know – the brain is incredibly complicated and complex, so adding hormones and sex differences will make it even harder."
Given that Alzheimer's disease is more prevalent in women than in men, it seems likely that there are fundamental biological differences.
This suggests that gender testing or treatment could be beneficial.
However, Professor Spiers-Jones emphasizes: "We simply do not know because there is not enough research in this field."