There's this general belief from both physicians and patients that, except for the breasts and reproductive organs, women are pretty much little men—smaller versions of their male counterparts who experience an occasional bout of PMS or a menopausal hot flash. But practicing this type of “bikini medicine” is costing women their health and in some cases their lives.

We see the effects of this one-size-fits-all healthcare mentality across the board: Five years after a heart attack almost half of women die, compared with 36 percent of men. Women are more likely than men to be susceptible to certain diseases such as orthopedic injuries, autoimmune disorders such as lupus and even lung diseases like COPD (chronic obstructive pulmonary disease). Yet many of these conditions go unrecognized or are diagnosed in late stages, after years of women suffering unnecessary pain and even shame due to providers brushing off their concerns. We won’t be able to move forward in the field of women’s health care until we focus on the real, crucial differences between women and men.

Women present with different symptoms, respond to treatments differently and may even be more vulnerable to certain drug side effects than men. The sleeping pill Ambien (zolpidem) is a perfect example. In 2013, the Food and Drug Administration (FDA) cut the recommended dose of Ambien (zolpidem) in half for women after numerous instances of women exhibiting bizarre behavior like sleepwalking, sleep-eating and even sleep-driving. How is it that it took 20 years after the drug was first approved to figure out women were taking twice the necessary dose? Even after this happened, the FDA declined to review the recommended dosage of other drugs. If women metabolize Ambien differently, do we metabolize statins differently? Antidepressants? These are all crucial questions, and we don’t have the much-needed answers.

Stacey Rosen, MD

Men are not the gold standard.

As a practicing cardiologist, I see the consequences of this bias every single day. For much of my career, we assumed women didn’t get heart attacks, and we focused our research and treatment efforts on men. After research on women’s heart disease risk started to gain traction in the late 1980s, we gradually began to realize that women were not only having heart attacks, but that they were actually dying of heart disease at higher rates than men. This happens for several reasons. Women are more likely to have  “atypical” symptoms, such as shortness of breath, fatigue, nausea and jaw and back pain. Even when a heart attack is suspected, an angiogram—which checks for blocked coronary arteries—may miss a type of heart disease more common in women, called coronary microvascular disease. Women can actually have a heart attack without showing any signs of plaque in their blood vessels. And when women do experience a heart attack, they’re less likely to be prescribed the best medications to lower the risk of a second heart attack or to be referred to a cardiac rehabilitation program. 

Yet despite all this, the American Heart Association didn’t issue its first scientific statement addressing heart attacks in women until 2016, more than a decade after it first released guidelines on female cardiovascular disease prevention. We still haven’t made much ground: women represent only about one in five participants in cardiovascular disease clinical trials and only about half of women polled are aware that heart disease is the leading cause of death for women and men alike. 

We won’t be able to move forward in the field of women’s health care until we focus on the real, crucial differences between women and men.

While it’s now clear that there are differences between women and men when it comes to heart disease, we’re still in the dark about a myriad of other diseases, including autoimmune conditions, gastrointestinal disorders, depression and certain non-reproductive cancers. Women who have never smoked, for example, are more than twice as likely to develop lung cancer than men classified as “never smokers”, but we don’t know why.

We can’t blindly expect women to conform to a male model of health. We now know that male and female physiology differs well beyond the body parts covered by a bathing suit. These differences can be traced right down to our cells. Each of these cells has a sex, which in turn affects the thousands of genes contained in them. In fact, about a third of the genes that people carry are expressed differently in men and women, according to a 2017 Israeli study.

Medicine moves at a glacial pace, and it may take several more decades before we start to unpack these mysteries. That’s why it’s critical that we ask pointed questions now. And in the meantime, women themselves need to make sure that they’re demanding the health care that they deserve. I tell my patients that being their own advocate is imperative. They have to trust their instincts, speak up and not feel guilty or embarrassed about being pushy with physicians because if they don’t take care of themselves, they won’t be able to run the world! Here are my top three recommendations for women:

• Make sure your doctors, especially your primary care doctors, truly get you. It may take a few tries, but you need to find someone who doesn’t roll their eyes when you express your concerns. If you don’t like a physician, fire him or her. Don’t worry that your doctors will be mad or that their feelings will be hurt. You need to put yourself first. 

  
  

   

• Prepare for your doctor like you do for your accountant. You wouldn’t show up at a tax professional’s office without all of last year’s tax forms, right? The same rule goes for your physical health. It’s important that you keep copies of all your recent medical records—that's never been easier, since you can now access many of them digitally. It’s also important that you make sure you have copies of your latest physical and test results, as well as a full list of all medications and supplements you're taking, important family history and your past medical history. Bring this information to each doctor’s appointment.  

  
  

   

• Make the most of the visit. I always recommend that patients write down their questions before each appointment, and take notes during it. Those 15-minute office visits go by fast, and if you hear a term like “hypertension” or “diabetes,” it can be hard to focus. It can also be helpful to bring your partner, or another family member or close friend, to act as an extra set of eyes and ears. And if there’s something you don’t understand? Be assertive. Protect your health by asking for more details and getting the explanations you need.