new research women's health

Scientists are finally studying women’s bodies. This is what we’re learning.

Women’s health concerns are dismissed more and studied less. But researchers are beginning to fill in those gaps—from menstruation to menopause.

Going to the doctor can be frustrating when you’re a woman—and even more so if you’re a woman of color .  

That’s because women are more likely to be underdiagnosed with conditions from endometriosis to schizophrenia to ADHD. In the United States, Black women are almost three times more likely to die from pregnancy-related complications than white or Hispanic women. And somehow scientists still don’t have a good handle on why so many women struggle to breastfeed .

None of this is new. We’ve long known that women’s health concerns are dismissed more frequently and studied less . But the good news is that researchers are starting to fill in those gaps. Their research is yielding new biological insights—leading to better diagnoses and more targeted treatments, from menstruation to menopause.

Here’s a look at just a handful of those developments that we’ve covered in recent years.

1. Women and girls tend to experience ADHD differently.

Scientists long considered ADHD “almost exclusively as a boy disorder,” wrote Kaelyn Lynch in a January 2024 story about   the unprecedented rise in ADHD diagnoses among women —which she notes nearly doubled from 2020 to 2022.

What’s behind this massive shift? Experts say it is linked, in part, to the way that ADHD often manifests in women and girls. Although ADHD is typically associated with hyperactivity, there’s also a type called inattentive ADHD, which Kaelyn writes is “characterized by disorganization, forgetfulness, and struggles with starting and staying on task.”

Girls and women tend to have inattentive ADHD and their symptoms are more likely to be mistaken for emotional or learning difficulties—if anyone notices them at all. “They’re more likely to be seen as daydreamers, or lost in the clouds,” said Julia Schechter, co-director of Duke University’s Center for Women and Girls with ADHD. “Their symptoms are just as impairing, but can fly under the radar.” The consequences, Kaelyn writes, can be severe.

( Read the full story here .)

2. Your menstrual cycle can reshape your brain.

Only about half of one percent of brain-imaging research is done in women—and that’s a real problem, writes Sanjay Mishra in a February 2024 story. This disparity is why we’re only just learning now how menstruation reshapes the brain .

That’s right. Reshapes. The. Brain. As Sanjay reported, emerging studies show that your monthly period “dramatically reshapes the regions of the brain that govern emotions, memory, behavior, and the efficiency of memory transfer.”

It’s important to note that these studies don’t prove that these changes are connected to the rollercoaster of emotions that some women experience during their periods. But experts say it highlights the urgent need for more neuroscience research in women, who are more likely to develop Alzheimer’s disease and depression.

"It's high time to make the brain a major focus of women's health," said Julia Sacher, a psychiatrist and neuroscientist at Max Planck Institute for Human Cognitive and Brain Sciences in Leipzig, Germany, who led one of the studies .

3. That severe nausea may not be just ‘morning sickness.’

Most people get morning sickness during pregnancy—so no big deal, right? Well, that perception could be preventing people from getting treatment for a severe condition called hyperemesis gravidarum (HG). As Sam Jones wrote in January 2024 , this condition affects about 2 percent of pregnant individuals and is “characterized by severe, persistent nausea and vomiting that can be life-threatening.”

Although these symptoms can be debilitating, physicians and researchers told Sam that they’ve witnessed their peers dismiss HG as “hysteria.” So, it’s no surprise that research into how to treat it is underfunded.

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Yet that research   is slowly happening. In recent years, studies have pinpointed a specific hormone linked to HG and even unlocked exactly how that hormone causes the condition. These findings could finally yield new treatments—if doctors know to prescribe them.

4. We finally have new tools to save lives during childbirth.

Nearly 800 people die every day worldwide from complications in pregnancy and childbirth, according to the World Health Organization . Even in the U.S. maternal mortality rates are rising, particularly among Black women. But there is hope: Cutting-edge research is giving us tools to prevent the leading causes of maternal mortality , including pre-eclampsia, anemia, and sepsis.

As Rachel Fairbank reported in July 2023 , the U.S. Food and Drug Administration approved the first blood test that can predict which patients are at risk for developing pre-eclampsia—a condition in which high blood pressure restricts blood flow so severely it can cause organ failure and death. Pre-eclampsia is hard to diagnose because it looks like so many other disorders that are common during pregnancy, Rachel writes—so this new test could really make a difference.

Researchers have also found a surprisingly simple solution for anemia , which can cause heavy bleeding during childbirth: iron delivered via IV. Although this has traditionally been treated with oral iron supplements, researchers have shown that one 15-minute IV drip provides the equivalent of four tablets a day for four weeks.

Finally, doctors have long administered the antibiotic azithromycin during cesarean sections to reduce infections that can lead to sepsis. But clinical trials have shown recently that administering a single dose of the drug during a vaginal labor can also reduce the risk of postpartum sepsis by one-third .

( Read our full story about pre-eclampsia here —and our story about anemia and sepsis research here .)

5. Frozen shoulder syndrome is real.

Frozen shoulder syndrome is pretty much what it sounds like: a condition in which the connective tissue in your shoulders becomes inflamed to the point where you can’t move. This painful condition can last for years yet isn’t well understood—perhaps because three-quarters of the people who suffer from it are female, wrote Erin Blakemore in a November 2023 story .

Menopause seems to be a factor. As Erin reports, researchers are investigating whether the joint pain that some 50 percent of women experience during menopause might be tied to the drop in estrogen in their bodies. One recent study suggests that people who undergo hormone therapy to boost estrogen levels are less likely to be diagnosed with frozen shoulder syndrome.

This research is still in the early stages, Erin cautions. But “it’s a first foray into a place where few researchers have gone before. And for those hurtling toward (or experiencing) menopause, it can’t come a moment too soon.”

6. A cure for hot flashes might finally be in reach.

Even more exciting is that researchers finally have figured out how the plummeting levels of estrogen during menopause cause hot flashes, Meryl Davids Landau reported in a December 2022 story .

Up to 80 percent of women experience this debilitating symptom, she wrote—“often accompanied by sweating, heart palpitations, dizziness, fatigue, and/or anxiety.” Hot flashes, which are particularly pronounced in Black people and Native Americans, strike several times a day and can occur for an average of four years.

Mounting research has shown that the drop in estrogen affects a particular bundle of neurons —in the hypothalamus of the brain—that regulate temperature, causing them to fire inappropriately. Now companies are testing drugs that would block those neurons and stop hot flashes for once and for all.

Such drug development is long overdue, Genevieve Neal-Perry, chair of obstetrics and gynecology at the University of North Carolina School of Medicine told Meryl: Since nearly all women who reach midlife experience hot flashes, she said, “the fact that we haven’t understood the biology of hot flashes until the last decade is pretty amazing.”

( Read the full story here —and learn more about what scientists are piecing together about menopause .)

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The lifeflight legacy: 40 years in 40 photos, february 23, 2023, study sheds new light on hormone therapy as menopause treatment.

Vanderbilt research shows that hormone replacement therapy can be safely administered depending on the method used and the patient’s age, time since menopause, and risk of cardiovascular disease.

Hormone replacement therapy (HT) was widely used to treat menopause symptoms as recently as 20 years ago, but its use declined significantly in the last two decades because research showed it increased cardiovascular risks.

However, much has been learned since, showing that HT can be safely administered depending on the method used and the patient’s age, time since menopause, and risk of cardiovascular disease.

Those are the findings of a new review of medical literature just published in the journal Circulation , “Rethinking Menopausal Hormone Therapy: For Whom, What, When and How Long? ,” from senior author Kathryn Lindley, MD, director of the Women’s Heart Center at VUMC. Lindley said HT can make a big difference in women’s quality of life; many have benefited from it, and many more could be good candidates who haven’t been considered.

“I think this paper is going to be a real resource for cardiologists,” said Lindley, associate professor of Medicine. “We wrote this manuscript with the cardiologist in mind to help them frame how to use and how to assess hormone replacement therapy for their patients. This paper brings in experts from cardiology, menopausal health, GYN and endocrinology to integrate information and determine a middle ground for approaching menopause.”

About 6,000 women in the nation enter menopause each day at a mean age of 52, the paper states, with common symptoms including hot flashes and night sweats, and are associated with anxiety, disrupted sleep and reduced quality of life. HT has proven effective in addressing those symptoms and became an increasingly popular therapy from the 1960s through the 1990s — topping out at 90 million HT prescriptions per year.

That plunged to about 20 million yearly HT prescriptions today after seminal primary and secondary prevention trials that showed an excess cardiovascular risk with combined estrogen-progestin.

Lindley’s review found that women with established cardiovascular risk — such as stroke or heart attack — should not receive HT, but those with low to moderate risk should be considered.

Generally, women are considered low risk if they are younger than 60 or within 10 years of the onset of menopause without cardiovascular risk factors such as high blood pressure, diabetes or obesity. Even women with moderate risk could be considered for HT, with appropriate cardiovascular monitoring, because the risks are low, and the quality-of-life benefits could be significant, Lindley said.

Lindley encourages women to consult their primary care physicians, OB-GYNs and cardiologists on the onset of menopause or, preferably, before. If they haven’t already, it is a good time to get a thorough cardiovascular evaluation to better understand their risk of cardiovascular disease and their individual risk of HT use.

“That is a time where we really need to be monitoring their weight, blood pressure, cholesterol and blood sugar so that we can identify changes in those risk factors and treat them very promptly,” Lindley said.

Lindley said the paper suggests an opportunity to better study the use of hormone replacement therapy in patients with cardiovascular risk factors, as the earlier seminal studies are now decades old.

“We really need to look at what symptoms the patients are having, what their overall risk is, and consider the tools available to us to safely provide them with some symptomatic relief,” she said.

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New report calls for more research on women's health issues

by Robin Foster

A new report finds research is sorely lacking on how chronic illnesses affect women, and it urges government agencies to do more to investigate how these diseases strike women differently.

The National Academies of Sciences, Engineering and Medicine analysis , commissioned by the Office of Research on Women's Health and released Wednesday, noted that women are disproportionately affected by chronic illnesses , including Alzheimer's disease, depression and osteoporosis .

"Although women on average live longer, chronic diseases may diminish women's quality of life for years when compared with men," the report authors wrote. "Chronic conditions in women contribute to substantial health care costs and have a significant effect on women's productivity at work and at home."

However, a scarcity of research on women's health "hinders a comprehensive understanding of the impact on women" of chronic illnesses, they added.

"Advances in our understanding of conditions like Alzheimer's, heart disease and even chronic pain have largely been shaped by research focused on men. At best, this means we don't fully understand how these conditions affect women—but at worst, it can mean a misdiagnosis, medical error or inappropriate treatment," Eve Higginbotham, chair of the committee that wrote the report, said in a news release .

"This is not the first report from the National Academies to assert that women's health is understudied," she noted. "It is long overdue for federal agencies to intentionally commit to a new research agenda that will finally improve our understanding of chronic conditions in women."

Right now, women are given short shrift in medical studies , the report authors said.

"One of the biggest frustrations is how often we [saw] examples where women were not incorporated into research, where women's experiences and symptoms were undermined or not given enough attention," report co-author Farida Sohrabji told the Washington Post. "One of the things that comes up quite often is that [women] are aware that their health is sometimes not given appropriate consideration, and their experience of pain is minimized."

Sohrabji added that the medical experiences of women of color in particular have long been overlooked, even though their experiences can differ drastically from white women.

What can be done? The 500-page report calls for focused efforts, led by National Institutes of Health, to enhance diagnostic tools for female-specific conditions such as endometriosis and to distinguish among the overlapping symptoms of various chronic conditions.

Beyond that, the report authors urged the medical community to develop diagnostic tools tailored for chronic conditions in women, noting distinct gender differences in the symptoms of both heart disease and diabetes.

"If there were something that affected a large percentage of men as [some of the diseases that affect] women, we would know exactly what causes it, and then we would have more treatments and diagnostics," Karen Tang, a gynecologist who was not involved in the report , told the Post.

The Society for Women's Health Research has more on women's health issues .

© 2024 HealthDay . All rights reserved.

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• v.6(1); 2022

To Address Women's Health Inequity, It Must First Be Measured

Kathryn godburn schubert.

1 Society for Women's Health Research, Washington, District of Columbia, USA.

Chloe E. Bird

2 Tufts Medical Center, Boston, Massachusetts, USA.

3 Tufts University School of Medicine, Boston, Massachusetts, USA.

4 RAND Corporation, Santa Monica, California, USA.

Katy Kozhimmanil

5 University of Minnesota School of Public Health, Twin Cities, Minnesota, USA.

Susan F. Wood

6 George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA.

Research and data collection related to what is historically known as “women's health” is consistently underfunded and marginalizes the health risks and experiences of women of color and transgender people. In the wake of the pandemic, the United States has an opportunity to redesign and reimagine a modern public health data infrastructure that centers equity and elevates the health and well-being of under-represented communities, including the full spectrum of gender identities. This piece offers a blueprint for transformational change in how the United States collects, interprets, and shares critical data to deliver greater health justice for all.

Introduction

It is time to acknowledge that the United States needs a dramatic reset when it comes to “women's health” and how we measure it. For decades, our public health system has not only marginalized women's health but also viewed it through a flawed monolithic exclusionary lens. Research and data collection related to women's health have been consistently underfunded and excluded the health risks and lived experiences of important populations, 1 such as women of color and transgender people. In this piece, we intend to instigate a conversation on the urgent need for transformational reform in the United States public health data infrastructure that centers equity by including sex assigned at birth, gender identity, race, ethnicity, and other statuses, to achieve more inclusive health policies.

The scarcity of real-time disaggregated data—across variables such as sex and gender identity, race, ethnicity, geographic location, age, and disability—contributed 2 to the devastating toll of COVID-19 and systemic disparities in health outcomes 3 among minority and marginalized populations. The lesson is clear: we cannot fix what we do not accurately measure. This country's data infrastructure must be fundamentally redesigned to center equity and elevate the health and well-being of marginalized populations.

To address our nation's enduring and chronic data failures, the Robert Wood Johnson Foundation 4 created a National Commission to Transform Public Health Data Systems, 5 with the goal of creating recommendations 6 on how to build a modern equity-centered public health data infrastructure that helps policymakers identify problems, target interventions, and allocate resources to those most in need. Informing the Commission's deliberations were five expert panels, which examined population-specific data gaps that contribute to health inequities among American Indians/Alaska Natives, Black people/African Americans, lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and more (LGBTQ+) communities, people living with disabilities, and women.

The women expert panel 7 was tasked with identifying the change needed in data systems to achieve greater sex and gender equity in health outcomes among women. Recognizing the intersectionality among population-specific groups, panelists were selected across race, ethnicity, sex, gender identity, lived experiences, geographic location and backgrounds in women's health research, policy, maternal, and public health. Collectively, participants represented perspectives from government and nongovernment sectors, and public and nonpublic health systems. Central to this expert panel's deliberations were in-depth discussions and analysis of the glaring gaps in women's health equity, across a span of intersecting identities, stemming from the historic lack of inclusion of women in health research and the dearth of accurate, disaggregated sex, and gender data.

We reference studies examining differences between women and men. Most include only cisgender people and/or were not clear as to whether transgender people were included. When we refer to “transgender people,” we mean transgender women and men. Furthermore, we acknowledge the consequences gender identity goes beyond how a person identifies, and includes multiple factors such as access to resources, roles and practices, norms, beliefs, decision-making power and autonomy, laws, policy, and institutions. 8

The Impact of Data Failures on Women's Health Equity

The pandemic provided a stark reminder of how the intersectionality of race, gender identity, and social determinants of health factor into a person's risk for poor health and disease-related outcomes. Although data found that more men than women 9 in the United States died from the COVID-19 virus, critical variables such as race and line of work obscure the risk of death for women from certain communities. * Studies in Georgia and Michigan showed the COVID death rate for Black women three times as high 10 as that for White and Asian men, with disparities further exacerbated by the lack of uniform reporting of race/ethnicity in COVID-19 studies. 11 Without examining the intersections of race and gender, researchers stated, “the blanket claim that women with COVID-19 fare better than men, makes invisible the high death rate among Black women.” *

Women hold 76% 12 of the nation's health care jobs and account for the vast majority of frontline service workers, 13 making them especially vulnerable to exposure. In addition, they are four times more likely 14 to suffer from long COVID. * Alongside longer lifespans 15 and different comorbidities, the ramifications from COVID infections could potentially be more severe and costly for women over time. Without tracking and measuring these data points, we cannot fully understand who is at the greatest risk and the potential lifelong debilitating impacts.

Cisgender women—especially women of color—have been historically and contemporarily to be excluded from biomedical research. Only as recently as 2016 did the National Institutes of Health (NIH) institute a policy that sex as a biological variable be factored into its funded research. This policy aimed to ensure that differences according to sex assigned at birth are considered, but one unintended effect is erasure of transgender people in research. Research institutes and organizations continue to consistently underfund research 16 on women, even when it comes to diseases that have the greatest impact on women's health. A recent analysis of NIH research funding patterns reveals there are roughly three times as many diseases 17 as female-favored diseased in the NIH portfolio.

Furthermore, male-favored diseases are significantly more likely to be overfunded and female-favored diseases more likely to be underfunded. * Nationwide, only one-third 18 of cardiovascular disease clinical trial subjects are assigned female at birth, despite the fact that it is the number one killer of women in the United States. * These glaring inequities are all the more irrational considering the immense societal return on investment that could be achieved through greater women's health research. Another study 19 examining NIH's 2019 funding decisions revealed that a mere 4.5% of funding on coronary artery disease (CAD) addressed questions related to how the disease impacts women, but that doubling NIH funding for research on CAD in women would produce a return on investment of 9500% over 30 years. *

Gender, race, and age biases persist in clinical trials for life-saving vaccines and drugs. Although the FDA's 2020 Drug Trials Snapshots 20 report shows that women made up >50% of drug trial participants, overall—among both women and men—only 8% of all trial participants were Black or African American, 11% were Hispanic, and 30% were over the age of 65. Pregnant people were excluded from COVID vaccine trials, leading to vaccine hesitancy 21 among this population—even though global studies 22 showed that they face significantly higher mortality rates from COVID-19. Unfortunately, it is difficult to determine the true extent of health inequities and impact of the pandemic due to the lack of data on minorities and marginalized populations, including cisgender women of color and transgender people.

Standardizing Data Collection Around Sex and Gender Identity

Developing intentional consistent definitions of sex and gender data and establishing routine data collection are essential to identifying health disparities and achieving health equity. Data collection efforts must recognize evolving terminology related to the spectrum of gender identity, and the range of ways in which people—both cisgender and trans—experience health and the health care system, to capture a holistic understanding of health and its impact over time.

A 2022 report 23 from the National Academies of Sciences, Engineering, and Medicine calls on the NIH to standardize language and practices used for data collection on sex and gender, “including collecting gender data by default, and not conflating gender with sex as a biological variable.” The report argues that, in most contexts, collecting data on gender is more relevant than collecting data on sex as a biological variable, and offers the following five guiding principles 24 for data collection ( Table 1 ).

National Academies of Science, Engineering, and Medicine's Guiding Principles for data collection on sex, gender, and sexual orientation

As inclusive language practices evolve around sex and gender identity in the scientific and medical communities, we must proceed with intention on the use of language and definitions, to center equity in the approach to data collection, and to continually reassess definitions to ensure findings are correctly interpreted, shared, and compared across community-based and national data systems.

Building Women's Health Equity Through Data Systems Transformation

Research and data on women's health are inextricably linked to many facets of identity and other social determinants, impacting health outcomes. Yet our outdated data systems are ill-equipped to capture this vital information. Health care systems that are designed to routinely collect and report a standardized and comprehensive set of essential data points must be structured to allow for intersectional analysis between variables and remain nimble as data are collected over time. The ability to pull data by sex or gender identity, as well as by race, ethnicity, disability, employment, and socioeconomic status, and other variables, will help identify the biggest health gaps and prioritize areas of focus.

After thoughtful deliberations, the women expert panel reached unanimous agreement on four overarching recommendations and calls-to-action to reinvent America's public health data systems, with an eye toward women's health equity ( Table 2 ).

Recommendations and Calls-to-Action

Now is the time to widen our lens on “women's health” to include research and data across the full spectrum of gender identities, sex, race, ethnicity, and other variables to address systemic health disparities. The United States has an unprecedented opportunity—and obligation—to rebuild a modern public health data infrastructure, cemented in a foundation of equity and inclusion. The recommendations outlined earlier by the women expert panel on population-specific data gaps, convened by the Robert Wood Johnson Foundation, offer a blueprint for transformational change in how the United States collects, interprets, and shares critical data on sex and gender that is inclusive of all numerical gender minorities. This disruptive model for data systems reform has enormous potential to transform care, enhance equity, and create empowerment through better health outcomes for generations to come.

Acknowledgments

All persons who have made substantial contributions to the study reported in the article, but who do not meet the criteria for authorship, have given us their written permission to be mentioned here. The authors thank the following individuals: additional members of the women expert panel Wanda D. Barfield, MD, MPH; Juanita Chinn, PhD; Andria Cornell, MPH; Joia Crear-Perry, MD; Georgian Dukes, MHA; Janet Hamilton, MPH, Mara Kiesling; Giannina Ong, MA; and Karen Ellis, MMS Education, expert panel coordinator.

Abbreviations Used

Authors' Contributions

Conceptualization, project administration, writing—original draft, and writing—review and editing by K.G.S. Conceptualization and writing—review and editing by C.E.B., K.K., and S.F.W.

Authorship Statement

All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the study to take a public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the article. Furthermore, each author certifies that this material or similar materials has not been and will not be submitted to or published in any other publication before its appearance in Health Equity .

Author Disclosure Statement

No competing financial interests exist.

Funding Information

Funding for the women's panel convening and findings provided by the Robert Wood Johnson Foundation.

Cite this article as: Schubert KG, Bird CE, Kozhimmanil K, Wood SF (2022) To address women's health inequity, it must first be measured , Health Equity 6:1, 881–886, DOI: 10.1089/heq.2022.0107.

* This research article uses the term “men” and “women” although they do not indicate whether this was inclusive of trans men, trans women or only cis men and cis women.

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Experts can speak about new Biden initiative to better represent women in health research

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• Release Date: November 15, 2023

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CHICAGO --- First lady Jill Biden will now lead a new initiative announced Monday to improve how the U.S. federal government funds health research about women, who historically have been and currently still are underrepresented in medical research.

Myriad experts at Northwestern University Feinberg School of Medicine have had numerous studies published that highlight the lack of sex inclusion in scientific and clinical research. Some have developed technology to help address the gap. The experts can address why there has historically been a lack of sex inclusion in biomedical research, why including more women in health research is so necessary and what this means for scientists going forward. Contact Kristin Samuelson at [email protected] to arrange an interview with the scientists.

“I am passionate about women’s health and making sure that we consider sex in biomedical research instead on continuing along with the assumption that everything works exactly the same in men and women, despite so many very obvious differences in health and disease,” said Barbara Stranger, associate professor of pharmacology at Feinberg who will appear on a Nov. 30 virtual panel, “Sex as a Biological Variable ,” convened by the National Institutes of Health (NIH) Office of Research on Women’s Health.

“I’m thrilled our administration has recognized the need for dedicated and sustained investment in women’s health research,” said Nicole Woitowich, executive director of the Northwestern University Clinical and Translational Sciences (NUCATS) Institute and a research assistant professor in the department of medical social sciences at Feinberg. “Historically, women have been unrepresented in clinical research and this acknowledgement is a tremendous step forward in advancing health equity.”

Below is a brief introduction to several Northwestern experts in this area, along with some of their recent relevant work:

• 2023 study in Lab on a Chip : Device can simulate disease and test how drugs and diseases affect people (including women) differently
• Kim also was involved in an earlier project, EVATAR (a mini female reproductive tract in a dish) , which enables scientists to conduct much-needed testing of new drugs for safety and effectiveness on the female reproductive system.
• June 2021 study in JAMA Network Open: Women and men are each underrepresented in clinical trials of different medical fields : “Neglecting one sex in clinical trials — the gold standard scientific exploration and discovery — excludes them from health innovation and skews medical evidence toward therapies with worse efficacy in that sex.”
• May 2023 study in Cell: She developed a guide outlining best practices for studying and testing for sex-dependent genetic effects.
• 2020 study in Science: Sex influences gene production in every human tissue
• June 2020 study in eLife, Females still an afterthought in research: A 10-year follow-up to  a 2009 groundbreaking study that found females were left out of biomedical research because of how their hormones might skew fragile study designs, an idea that has repeatedly been proven false.  
• Co-launched the Illinois Women’s Health Registry in 2019, which links women to scientists and clinical trials throughout the state to uncover why diseases affect women differently than men.

A Call for Government Agencies to Fill Research Gaps on Women’s Health 

While women represent 50.4% of the US population, the costs of chronic conditions on women are likely underestimated due to underrepresentation of women in medical research.  

To date, much of what is known about chronic disease is based on the bodies and health of men, which disservices women by resulting in inaccurate diagnoses, resulting in poorer health outcomes. And, although women live longer than men on average, women also have more years of disability or lowered quality of life due to disease years.  

A new report by the National Academies of Sciences, Engineering, and Medicine (NASEM) reviews public health research related to many specific debilitating disorders including cardiovascular disease, depression, and metabolic disorders. It provides additional evidence that current efforts to understand women’s health for regulatory science are incomplete—yet they are still used for policy decisionmaking. 

NASEM is the nation’s highest independent scientific body and is charged with providing objective analysis and advice to the US government so that policy can be guided by the best scientific expertise. US government agencies and departments will reach out to NASEM and ask it to investigate topics of interest. If it accepts, NASEM will assemble a committee of experts to investigate and create a publicly available report. NASEM reports can lead to many changes for the better, such as new, scientifically backed government policies, increased federal funding for research on the topic, or additional research projects.  

NASEM report calls for a closer look at women’s chronic health issues

In July, NASEM released a preliminary report identifying gaps in what is known about chronic health conditions that are specific to women or that affect women differently. It outlines glaring gaps in scientific knowledge of women’s health and potential improvements to research methods, sheds more details on structural and social determinants of health, and provides a high-level description of differing impacts on women. The NASEM report recommends:  

• Addressing inequities and women-centered research to improve diagnostic tools for women as it pertains to debilitating chronic disease 
• Developing animal models that more closely resemble the human female 
• Striving to understand, better diagnose, and create improved treatments for women living with multiple chronic conditions 
• Seeking to better understand the mechanisms hormonal changes play in the development and outcomes of chronic conditions in women 
• Creating new and better approaches for addressing symptoms during perimenopause, menopause, and postmenopause for women with chronic conditions  
• Working to better understand the effects of structural and social determinants on chronic health conditions, by also focusing on the life experience of women and on trauma as a risk factor in the development of chronic conditions 
• Investigating the role lifestyle behaviors have on the development of chronic disorders  

Radiation exposure and women’s health is still understudied

Evidence that radiation exposure affects women (and infants, children, and pregnant people) differently has grown over the years and has been examined by NASEM.  

For example, NASEM has published landmark reports on the health effects of exposure to low levels of ionizing radiation. Two of these reports ( BEIR V , BEIR VII ) indicated that infants, children , pregnant people, and the female body are more susceptible than their adult, not pregnant, or male counterparts. This was proven by showing the health harms that can be caused by ionizing radiation disproportionately increased among these vulnerable groups after similar exposures in their counterpart peers.  

Additional studies have been done by international scientific bodies, such as the International Commission on Radiological Protection ( ICRP 84 ), to provide guidelines about using medical radiation during pregnancy, and the US Environmental Protection Agency Federal Guidelines Report examines cancer risk coefficients for environmental exposure to radionuclides ( EPA FGR ).  

Overall, female breasts and thyroids are more radiosensitive (sensitive to radiation) than male organs, which implies that women and girls are more susceptible to harm caused by radiation ( Makhijani et al. 2006 , NCI 1997 ). Children are much more radiosensitive than their adult counterparts due to differences in size and development of organs ( EPA’s 1999 FGR 13 and CD supplement from 2002) . For example, if an adult and infant drank milk contaminated with iodine-131 released by aboveground nuclear detonations, the infant would receive 13 times the radiation dose to its thyroid compared with the adult ( Makhijani et al. 2006 ). 

Unfortunately, the health harms of radiation for females and children are also often underreported when it comes to regulatory science. A briefing by the Nuclear Information and Resource Service (NIRS) explains this underreporting is due to only considering external exposures (gamma and X-rays) and not considering absorbed radiation , which the female body is much more prone to storing.   

Still, there is not enough research or data to support a full understanding of these issues.  

Organizations including the United Nation’s Treaty on the Prohibition of Nuclear Weapons Science Advisory Group (SAG) advocate for newer research on radiation exposure that is not based on location from a detonation (since these exposures are rare).  SAG also suggested further study on women’s radiosensitivity.  

When it comes to determining risks to the general population from harmful exposures to nuclear weapons materials, evidence-based research methods are a must to protect the public. 

Sex and gender have different definitions

Often, the first step in defining women’s health is in determining what defines a woman. Some gender rights problems in the regulatory science field are as fundamental as defining basic terminology. Inherent to this conversation is understanding the difference between sex and gender, and that currently regulatory science doesn’t account for either accurately.  

Within the NASEM report, the term “female” refers to biological sex (based on genetic coding or physical presentation) and “women” refers to the social construct of gender and how the person identifies. However, across the public health literature, these two concepts of sex and gender are conflated with each other, do not have inclusive gender categories, and rarely consider genetic aspects of sex to define biological sex.  

Due to oppressive systems such as sex, gender, and gender expression bias, many studies assume people who identify as women were born female and that those born female identify as girls or women. This is still something the fields of regulatory science and public health need to better consider within their analyses since both can be false assumptions.  

NASEM has also called for more study of low-dose ionizing radiation

There is also still far too little scientific knowledge about the effects of low-dose radiation on the human body in general. An earlier study by NASEM, published in 2022, highlighted the need for better understanding of low-dose radiation exposure (defined by NASEM as a single exposure of less than 100 mGy or 5 mGy/hour) on people across the United States.  

One reason it is more difficult to understand the effects of low levels of radiation on cancer risk is because of the often-long latency from exposure to cancer development, but there is also a lack of research on chronic low-dose exposure and its association with health outcomes.  

This report suggested creating tools for sensitive detection of radiation and precise characterization of cell and tissue changes, harmonizing across national health research databases, and ensuring access to research on low-dose radiation health effects. The recommended program is estimated to cost $100 million annually for its first 15 years of operation. Affected communities reported being excited about the following proposals:  

• more research into non-cancer health outcomes 
• additional focus on differential impacts (how exposure might differ based on gender, age, lifestyle, ethnicity, etc.)  
• the importance of community involvement in research, including appropriate collaboration with Indigenous nations 

More recently, research on low-dose radiation has been associated with increased cancer deaths as well. More specifically, mortality due to solid cancers among workers exposed to ionizing radiation increased with cumulative dose over time by 52% per Gy , when choosing a lag time of 10 years for cancer development. This lag time means that cancers that developed prior to 10 years after exposure are not included, since the science suggests the exposure would require at least 10 years to develop associated cancers.  

“Regulatory scientists can protect all vulnerable people within the United States population by focusing regulations on the needs of those most at risk.” Dr. Chanese Forté, Union of Concerned Scientists

Current models used by regulatory scientists disservice women and children

These two NASEM efforts together highlight a key challenge in addressing low-dose radiation exposure in women and children. The “Reference Man” concept was developed by the International Commission on Radiological Protection ( ICRP ) and is used to estimate radiation doses and assess potential health risks. In a 1975 ICRP repor t, Reference Man is defined as a hypothetical individual with specific characteristics: he is an adult male, aged 20 to 30, weighing roughly 70 kg (154 lb), measuring 170 cm (5 feet 7 inches) in height, and lives in a climate with an average temperature from 10 to 20°C. Reference Man is also Caucasian and a Western European or North American in habitat and custom.  

This model assumes specific anatomical and physiological traits that are considered average for the adult male population. It serves as a standard for designing radiation protection measures and for regulatory purposes. However, it has limitations because it does not account for differences in radiation sensitivity due to age, gender, or individual biological variability. 

It is important to keep in mind the average modern male body is also very different from people who lived in 1975, especially by body mass index (height and weight). 

Alternate models of a reference person exist and should be considered

More recently, regulatory scientists have chosen to average men and women’s health risk estimates, but this overestimates men’s risks and underestimates the risk to women. Regulatory scientists can protect all vulnerable people within the United States population by focusing regulations on the needs of those most at risk: women or children with increased radiosensitivity, and “frontline” communities (those with increased radiation exposure burdens due to their proximity to nuclear weapons testing, production, or waste). There are alternative models to Reference Man that could be employed, and you can learn more about centering women in regulatory science here . 

Many community-led organizations have also called for a better understanding of women’s health and exposure to radiation as well as a more protective standard for women. For example, Tewa Women’s United (TWU), an Indigenous women’s reproductive health and justice organization with a focus on the Pueblos (and a collaborator of UCS), has proposed a reference person called Nava To’I Jiya (Tewa for “Land Worker Mother Model”). The Land Worker Mother is a pregnant person who works and lives off of the land. As a universal environmental protection standard, this model would better protect the general public and the most marginalized in society.  

Additionally, the Gender + Radiation Impact Project suggests “Radiation Girl,” using a girl (15 years and younger) as the radiation model, which would also be more sensitive than current regulatory science methods for understanding women and children’s health.  

Nuclear weapons policy will benefit from more inclusive human health research

There are multiple aspects of the nuclear materials process such as uranium mining and plutonium processing that have harmed, and continue to harm, human health through intentional and accidental releases of toxic materials. Many people are still experiencing the health impacts of past exposures to the more than 500 atmospheric nuclear weapons tests conducted globally before such tests were banned in 1963. A study by the Centers for Disease Control and the National Cancer Institute concluded that any person living in the contiguous United States since 1951 has been exposed to some radioactive fallout. 

Both nuclear policy and regulatory policy would be significantly improved by interrogating biased models of radiation exposure, improving our overall understanding of low-dose radiation, and increasing our sensitivity to the unique ways that women and female-identifying individuals experience chronic health issues.  

Get involved with UCS and learn more about public health and nuclear weapons

The Union of Concerned Scientists is committed to creating more public health research and awareness of the risks to nuclear frontline communities. We would love to have more experts advocating for important changes to US nuclear policy in the name of public health—to join us in our fight against nuclear weapons, sign up here .  

For additional reading on community health, see these previous blog posts:  

• Nuclear Weapons Justice  
• What are Nuclear Frontline Communities?  
• Nuclear Frontline Communities Understand Cumulative Burdens—Let’s Get Policymakers On The Same Page  
• Senate Passes Bill to Help Nuclear Testing Victims, But The Fight for Nuclear Justice Isn’t Over Yet  
• The Global South is Leading the Way in Being A Nuclear Weapon Free Zone  
• Cold War Nuclear Weapons Put St. Louis Community At Risk—in 2023  
• Anti-Blackness in Europe Creates Vulnerability During War  
• Missouri Community and Its Children Grappling With Conflicting Nuclear Waste Exposure Reports  
• The House Has Less Than Two Weeks to Save RECA  
• For People Who Have Been Poisoned by Radiation, the Fight Continues in 2024  
• Why Nuclear Justice for the Marshall Islands is the Biggest US-China Issue You’ve Never Heard Of  
• Why a National Day of Remembrance for Downwinders is Not Enough  
• Resuming Nuclear Testing a Slap in the Face to Survivors  

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Why we know so little about women’s health

Before 1993, women were rarely included in clinical trials. today, the medical field still doesn’t know how well many drugs and devices work for women..

Making progress

Despite the late start in studying many aspects of women’s health, there has been progress in increasing the inclusion of women in medical research, says Maria Brooks, PhD, a professor of epidemiology and biostatistics and co-director of the Epidemiology Data Center at the University of Pittsburgh School of Public Health. Brooks leads several national, large-scale studies, including one focused on menopause.

“I’ve been working in the field for a long time, and I’ve seen clear progress over these last 30 years,” she says. “There’s an emphasis on including women, and a focus on health conditions that everybody has but [that] might manifest differently in women than in men.”

However, when it comes to understanding and properly treating disease, there is still ground to cover in order to achieve equity between men and women, and particularly women of color. Experts say these strategies could help move the needle:

Attract and retain a diverse group of women in leadership roles for medical and clinical research.

Celina Yong, MD, the director of Interventional Cardiology at the Palo Alto VA Medical Center and an associate professor at Stanford University, conducted a study analyzing the sex of principal investigators for cardiovascular clinical trials and found that just 18% of the trials were led by women, but those led by women enrolled more female participants.

“For a long time, the field of cardiology has been male-dominated,” Yong says. “But more and more, we’re seeing women pursue the field, which is changing the pipeline for future leadership.”

Incorporate how biological sex differences affect medical care into medical education.

Gulati, who gives lectures at medical schools about sex differences in the heart and in cardiology care, says many students tell her that they are learning about these differences for the first time from her lectures. Often, she says, male biology is still taught as the “default,” and learning about how female biology is different — from organ systems to hormones to cellular differences — is considered “special interest.”

“I think that’s where we can try to solve things,” she says. “In medical education, [students] need to be educated on sex differences, not just about heart disease, [but for] every organ system, there should be a component about what is the same, what differs, and what is unknown. Students need to leave medical school understanding these differences.”

More robust and inclusive research and data collection.

Just eight years ago, in 2016, the NIH instituted a policy that requires researchers with NIH funding to collect data on biological sex differences in preclinical research and animal testing, analyze the data, and report on differences in the findings. According to the policy, “Appropriate analysis and transparent reporting of data by sex may therefore enhance the rigor and applicability of preclinical biomedical research.”

Still, Gulati says there is a lack of accountability when researchers don’t follow through on their commitment to enroll a certain percentage of women in their clinical trials. Though the NIH’s policies have helped move the needle, she thinks there should be measures in place to further progress, such as requiring a pause in the research until the pre-specified number of women are enrolled.

Researchers can make further progress in recruiting women from other underrepresented in research groups (such as those with low socioeconomic status, older women, or those living in rural areas), by designing trials in a way that makes them more flexible and accessible for people with caretaking responsibilities or transportation issues, Brooks says.

It’s a challenge she hopes the field will embrace. “I feel hopeful and confident that, in general, the research community has become aware and is quite dedicated to ensuring that we enroll and retain a broader group of research participants.”

We undergo two periods of rapid change, averaging around age 44 and age 60, according to a Stanford Medicine study. Ratana21 /Shutterstock.com

If it’s ever felt like everything in your body is breaking down at once, that might not be your imagination. A new Stanford Medicine study shows that many of our molecules and microorganisms dramatically rise or fall in number during our 40s and 60s.

Researchers assessed many thousands of different molecules in people from age 25 to 75, as well as their microbiomes — the bacteria, viruses and fungi that live inside us and on our skin — and found that the abundance of most molecules and microbes do not shift in a gradual, chronological fashion. Rather, we undergo two periods of rapid change during our life span, averaging around age 44 and age 60. A paper describing these findings was published in the journal Nature Aging Aug. 14.

“We’re not just changing gradually over time; there are some really dramatic changes,” said Michael Snyder , PhD, professor of genetics and the study’s senior author. “It turns out the mid-40s is a time of dramatic change, as is the early 60s. And that’s true no matter what class of molecules you look at.”

Xiaotao Shen, PhD, a former Stanford Medicine postdoctoral scholar, was the first author of the study. Shen is now an assistant professor at Nanyang Technological University Singapore.

These big changes likely impact our health — the number of molecules related to cardiovascular disease showed significant changes at both time points, and those related to immune function changed in people in their early 60s.

Abrupt changes in number

Snyder, the Stanford W. Ascherman, MD, FACS Professor in Genetics, and his colleagues were inspired to look at the rate of molecular and microbial shifts by the observation that the risk of developing many age-linked diseases does not rise incrementally along with years. For example, risks for Alzheimer’s disease and cardiovascular disease rise sharply in older age, compared with a gradual increase in risk for those under 60.

The researchers used data from 108 people they’ve been following to better understand the biology of aging. Past insights from this same group of study volunteers include the discovery of four distinct “ ageotypes ,” showing that people’s kidneys, livers, metabolism and immune system age at different rates in different people.

Michael Snyder

The new study analyzed participants who donated blood and other biological samples every few months over the span of several years; the scientists tracked many different kinds of molecules in these samples, including RNA, proteins and metabolites, as well as shifts in the participants’ microbiomes. The researchers tracked age-related changes in more than 135,000 different molecules and microbes, for a total of nearly 250 billion distinct data points.

They found that thousands of molecules and microbes undergo shifts in their abundance, either increasing or decreasing — around 81% of all the molecules they studied showed non-linear fluctuations in number, meaning that they changed more at certain ages than other times. When they looked for clusters of molecules with the largest changes in amount, they found these transformations occurred the most in two time periods: when people were in their mid-40s, and when they were in their early 60s.

Although much research has focused on how different molecules increase or decrease as we age and how biological age may differ from chronological age, very few have looked at the rate of biological aging. That so many dramatic changes happen in the early 60s is perhaps not surprising, Snyder said, as many age-related disease risks and other age-related phenomena are known to increase at that point in life.

The large cluster of changes in the mid-40s was somewhat surprising to the scientists. At first, they assumed that menopause or perimenopause was driving large changes in the women in their study, skewing the whole group. But when they broke out the study group by sex, they found the shift was happening in men in their mid-40s, too.

“This suggests that while menopause or perimenopause may contribute to the changes observed in women in their mid-40s, there are likely other, more significant factors influencing these changes in both men and women. Identifying and studying these factors should be a priority for future research,” Shen said.

Changes may influence health and disease risk

In people in their 40s, significant changes were seen in the number of molecules related to alcohol, caffeine and lipid metabolism; cardiovascular disease; and skin and muscle. In those in their 60s, changes were related to carbohydrate and caffeine metabolism, immune regulation, kidney function, cardiovascular disease, and skin and muscle.

It’s possible some of these changes could be tied to lifestyle or behavioral factors that cluster at these age groups, rather than being driven by biological factors, Snyder said. For example, dysfunction in alcohol metabolism could result from an uptick in alcohol consumption in people’s mid-40s, often a stressful period of life.

The team plans to explore the drivers of these clusters of change. But whatever their causes, the existence of these clusters points to the need for people to pay attention to their health, especially in their 40s and 60s, the researchers said. That could look like increasing exercise to protect your heart and maintain muscle mass at both ages or decreasing alcohol consumption in your 40s as your ability to metabolize alcohol slows.

“I’m a big believer that we should try to adjust our lifestyles while we’re still healthy,” Snyder said.

The study was funded by the National Institutes of Health (grants U54DK102556, R01 DK110186-03, R01HG008164, NIH S10OD020141, UL1 TR001085 and P30DK116074) and the Stanford Data Science Initiative.

• Rachel Tompa Rachel Tompa is a freelance science writer.

About Stanford Medicine

Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu .

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Executive Order on Advancing Women’s Health Research and   Innovation

    By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows:

     Section 1.  Policy.  My Administration is committed to getting women the answers they need about their health.  For far too long, scientific and biomedical research excluded women and undervalued the study of women’s health.  The resulting research gaps mean that we know far too little about women’s health across women’s lifespans, and those gaps are even more prominent for women of color, older women, and women with disabilities.  

     The notion of including women in clinical trials used to be revolutionary — which means many diagnostics and treatments were developed without women in mind and thus failed to account for women’s health.  Over 30 years ago, the Congress passed the landmark National Institutes of Health Revitalization Act of 1993 (Public Law 103-43) to direct the National Institutes of Health (NIH), the largest public funder of biomedical research in the world, to include women and people of color in NIH-funded clinical research.  In 2016, the Congress built on these requirements in the 21st Century Cures Act (Public Law 114-255), which directed the NIH to further its pursuit of women’s health research, including by strengthening clinical trial inclusion and data analysis, developing research and data standards to advance the study of women’s health, and improving NIH-wide coordination on women’s health research.

     These policies led to significant increases in women’s participation in clinical trials, and ongoing investments in biomedical research have supported breakthroughs in women’s health.  Through the discovery of genetic factors that increase the risk of breast cancer and innovations in mammography, we have transformed our approach to prevention, early detection, and treatment, and have improved outcomes for women facing a breast cancer diagnosis.  We have improved access to life-saving treatments for women with severe heart failure by ensuring that the devices they need are the right size for a woman’s body.  We have also identified some of the most characteristic symptoms of heart attack in women, which are different from those in men — discoveries that have helped deliver faster treatment to women when every second counts.  This is what we can achieve when we invest in women’s health research.

     It is time, once again, to pioneer the next generation of discoveries in women’s health.  My Administration seeks to fundamentally change how we approach and fund women’s health research in the United States.  That is why I established the first-ever White House Initiative on Women’s Health Research (Initiative) — which is within the Office of the First Lady and includes a wide array of executive departments and agencies (agencies) and White House offices — to accelerate research that will provide the tools we need to prevent, diagnose, and treat conditions that affect women uniquely, disproportionately, or differently.

     Together with the First Lady’s tireless efforts, the Initiative is already galvanizing the Federal Government to advance women’s health, including through investments in innovation and improved coordination within and across agencies.  We are also mobilizing leaders across a wide range of sectors, including industry, philanthropy, and the medical and research communities, to improve women’s health.

     It is the policy of my Administration to advance women’s health research, close health disparities, and ensure that the gains we make in research laboratories are translated into real-world clinical benefits for women.  It is also the policy of my Administration to ensure that women have access to high-quality, evidence-based health care and to improve health outcomes for women across their lifespans and throughout the country.

     I will continue to call on the Congress to provide the transformative investments necessary to help our researchers and scientists answer today’s most pressing questions related to women’s health.  Investing in innovation in women’s health is an investment in the future of American families and the economy.  At the same time, agencies must use their existing authorities to advance and integrate women’s health across the Federal research portfolio, close research gaps, and make investments that maximize our ability to prevent, diagnose, and treat health conditions in women. 

     Sec. 2.  Definitions.  For purposes of this order:

     (a)  The term “women’s health research” means research aimed at expanding knowledge of women’s health across their lifespans, which includes the study and analysis of conditions specific to women, conditions that disproportionately impact women, and conditions that affect women differently.

     (b)  The term “White House Initiative on Women’s Health Research” means the interagency, advisory body established by the Presidential Memorandum of November 13, 2023 (White House Initiative on Women’s Health Research), to advance women’s health research.

     (c)  The term “agency Members of the Initiative” refers to the Secretary of Defense, the Secretary of Agriculture, the Secretary of Health and Human Services, the Secretary of Veterans Affairs, the Administrator of the Environmental Protection Agency, and the Director of the National Science Foundation.

     Sec. 3.  Further Integrating Women’s Health Research in Federal Research Programs.  (a)  Building on research and data standards issued by the NIH in 2016, agency Members of the Initiative shall consider actions to develop or strengthen research and data standards that enhance the study of women’s health across all relevant, federally funded research and other Federal funding opportunities.  Agency Members of the Initiative shall consider issuing new guidance, application materials, reporting requirements, and research dissemination strategies to advance the study of women’s health, including to:

(i)    require applicants for Federal research funding, as appropriate, to explain how their proposed study designs will consider and advance our knowledge of women’s health, including through the adoption of standard application language;

(ii)   consider women’s health, as appropriate, during the evaluation of research proposals that address medical conditions that may affect women differently or disproportionately;

(iii)  improve accountability for grant recipients, including, as appropriate, by requiring regular reporting on their implementation of, and compliance with, research and data standards related to women’s health, including compliance with recruitment milestones; and

(iv)   improve the recruitment, enrollment, and retention of women in clinical trials, including, as appropriate, by reducing barriers through technological and data sciences advances.

(b)  Within 30 days of the date of this order, the Chair of the Initiative and the Director of the NIH Office of Research on Women’s Health, in consultation with the Director of the Office of Management and Budget (OMB), shall establish and co-chair a subgroup of the Initiative to promote interagency alignment and consistency in the development of agency research and data standards to enhance the study of women’s health.

     (c)  Within 90 days of the date of this order, agency Members of the Initiative shall report to the Chair of the Initiative on actions taken to strengthen research and data standards to enhance the study and analysis of women’s health and related conditions.

(d)  Within 180 days of the date of this order and on an annual basis thereafter, agency Members of the Initiative shall report to the President on the status of implementation of research and data standards.

     Sec. 4.  Prioritizing Federal Investments in Women’s Health Research.  (a)  Agency Members of the Initiative shall identify and, as appropriate and consistent with applicable law, prioritize grantmaking and other awards to advance women’s health research, with an emphasis on:

(i)    promoting collaborative, interdisciplinary research across fields and areas of expertise;

(ii)   addressing health disparities and inequities affecting women, including those related to race, ethnicity, age, socioeconomic status, disability, and exposure to environmental factors and contaminants that can directly affect health; and

(iii)  supporting the translation of research advancements into improved health outcomes.

(b)  Agency Members of the Initiative shall take steps to promote the availability of federally funded research and other Federal funding opportunities to advance women’s health, including through the development and inclusion of standard language related to women’s health, as appropriate, in all relevant notices of funding opportunity and through better facilitating potential grant applicants’ access to information about funding opportunities related to women’s health research.

     (c)  To advance innovation, commercialization, and risk mitigation, agency Members of the Initiative shall:

(i)    identify and, as appropriate and consistent with applicable law, seek ways to use innovation funds, challenges, prizes, and other mechanisms to spur innovation in women’s health;

(ii)   invest in innovation to accelerate women’s health research, including through or in collaboration with the Advanced Research Projects Agency for Health and the Congressionally Directed Medical Research Programs;

(iii)  support the role of small businesses and entrepreneurs in advancing innovation in women’s health research, including through Small Business Innovation Research Programs and Small Business Technology Transfer Programs; and

(iv)   invest in translational science to convert research findings and discoveries into treatments and interventions that improve women’s health outcomes and reduce health disparities, including through the Department of Agriculture National Institute of Food and Agriculture research programs.

(d)  In implementing section 8(b) of Executive Order 14110 of October 30, 2023 (Safe, Secure, and Trustworthy Development and Use of Artificial Intelligence), the Secretary of Health and Human Services, in consultation with the Director of the National Science Foundation, shall consider the opportunities for and challenges that affect women’s health research in the responsible deployment and use of artificial intelligence (AI) and AI-enabled technologies in the health and human services sector.

     Sec. 5.  Galvanizing Research on Women’s Midlife Health.  (a)  Within 90 days of the date of this order, to address research gaps in understanding women’s health and diseases and conditions associated with women’s midlife and later years, the Secretary of Health and Human Services shall:

(i)    launch a comprehensive assessment of the current state of the science on menopause to develop an evidence-based research agenda that will guide Federal and private sector investments in menopause-related research;

(ii)   evaluate evidence-based interventions and strategies to improve women’s experiences in the menopausal and perimenopausal periods, including the delivery of treatments for women experiencing menopause in clinical care settings;

(iii)  consider developing new common data elements and survey tools to expand the ethical and equitable collection of data on issues related to women’s midlife health; and

(iv)   develop new comprehensive resources to help ensure that the public has evidence-based information about menopause, including menopause-related research initiatives, findings, and symptom-prevention and treatment options.

(b)  The Secretary of Defense and the Secretary of Veterans Affairs shall evaluate the needs of women service members and veterans related to midlife health and shall develop recommendations to support improved treatment and targeted research of midlife health issues, including menopausal symptoms.

     Sec. 6.  Assessing Unmet Needs to Support Women’s Health Research.  The Director of OMB and the Assistant to the President and Director of the Gender Policy Council (Directors) shall lead an effort, in collaboration with the Initiative, to identify current gaps in Federal funding for women’s health research and shall submit recommendations to the President describing the additional funding and programming necessary to catalyze research on women’s health, including in priority areas within women’s health as identified by the Initiative, as follows:

     (a)  Within 90 days of the date of this order, the Directors shall, in consultation with the Initiative, develop guidance for assessing additional funding that agencies need to close research gaps in women’s health.

     (b)  Within 180 days of the date of this order, Members of the Initiative shall consult the guidance described in subsection (a) of this section and shall each submit a report to the Directors that identifies the funding needed to catalyze research on women’s health.

     (c)  Based on the reports described in subsection (b) of this section, the Directors shall develop and submit recommendations to the President on steps the Federal Government should take to catalyze research on women’s health.  These recommendations shall identify any statutory, regulatory, budgetary, or other changes that may be necessary to ensure that Federal laws, policies, practices, and programs support women’s health research more effectively.

     (d)  Following the submission of the recommendations described in subsection (c) of this section, each Member of the Initiative shall report annually to the Directors on progress made in response to those recommendations and to improve the study of women’s health.  The Director of OMB shall provide a summary of Members’ progress and any new recommendations to the President on an annual basis, consult with each Member on their women’s health research funding needs during the annual budget process, and calculate Federal funding for women’s health research on an annual basis.

     Sec. 7.  General Provisions.  (a)  Nothing in this order shall be construed to impair or otherwise affect: (i)   the authority granted by law to an executive department or agency, or the head thereof; or

(ii)  the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.

     (b)  This order shall be implemented consistent with applicable law and subject to the availability of appropriations.

     (c)  This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.                                    JOSEPH R. BIDEN JR. THE WHITE HOUSE,     March 18, 2024.

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Why do women suffer more ACL injuries? Research offers possible explanations

Injuries to the anterior cruciate ligament, aka the ACL, occur commonly in sports. However, research shows that female athletes suffer significantly more ACL injuries than their male counterparts.

Previously, studies on gender disparities in ACL injuries has focused on biological factors, such as anatomy and hormones. However, ACL injury rates among girls and women have remained unchanged despite decades of research.

Experts are increasingly considering how a gendered environment and sexism in sports may increase the risk of ACL injuries among female athletes and affect treatment outcomes.

What is an ACL injury?

The anterior cruciate ligament is a strong, thick band of tissue in the center of the knee which connects the thigh bone or femur to the shin bone or tibia, per the Cleveland Clinic.

ACL injuries include sprains or tears to the ligament, which can range in severity. Patients often feel a popping sensation, followed by pain and swelling.

People often injure their ACL while playing sports, especially agility-based sports which involve quick changes in direction or jumping and landing, Dr. Andrew Pearle, chief of sports medicine at the Hospital for Special Surgery, tells TODAY.com. These include soccer, basketball, lacrosse, football, field hockey and volleyball, Pearle adds.

Anyone can suffer an ACL injury, from children playing after school sports to elite athletes. Olympians are no exception.

Rebeca Andrade, the Brazilian gymnast who won gold in the women’s floor exercise at the Paris Olympics, told Olympics.com that she overcame three devastating ACL tears — and three reconstructive surgeries on the same knee — in the years leading up to the 2024 Games. Andrade, 25, is now the most decorated Brazilian Olympian in history.

Unfortunately, ACL injuries are often abrupt and can be season- or career-ending. Several athletes were sidelined from the 2024 Olympics due to ACL tears in recent months.

WNBA rookie Cameron Brink revealed in June that she had torn her ACL in her left knee, disrupting her hopes of competing on Team USA’s women’s 3x3 basketball team in the Paris Olympics.

Courtney Frerichs, an American runner who won silver in the women’s 3000-meter steeplechase in Tokyo, revealed in May that she suffered a complete tear of her right ACL, requiring season-ending knee surgery, NBC Sports reported previously .

ACL injury risk factors

In addition to playing certain sports, other factors may increase the risk of an ACL injury, per the Mayo Clinic .

These include poor conditioning or technique, faulty movements while landing, hyper-mobility, ill-fitting footwear, playing on artificial turf — and most notably, being female.

“It has been known for some time that women have higher rates of ACL injuries ... anywhere from a three to six or four to eight times higher risk of ACL injury as compared to men with the same exposure rate (playing the same level of a sport),” says Pearle.

The rate of ACL injuries among girls and women has not changed in over 20 years, according to a 2021 review published in the British Journal of Sports Medicine .

“There’s been lots of research, but girls and women’s injury rates remain about the same while boys and men’s rates have decreased slightly,” Joanne Parsons, PhD, associate professor in the department of physical therapy at University of Manitoba, tells TODAY.com.

Why are ACL injuries more common in women?

Research on gender disparities in ACL injuries has offered many hypotheses, but there are still more questions than answers, says Parsons, who co-authored the BMJ review.

"Historically, figuring out why women are at such higher risk of ACL injury has been approached from a very biological, biomechanic perspective," says Parsons. Theories have focused on sex-based traits such as anatomy, physiology and hormones, Parsons adds.

People assigned female at birth have wider hips and pelvises, which is thought to affect how their lower bodies move, research shows .

"There are theories about alignment ... women tend to have more of what's called a valgus alignment of the hips, knees and ankles, where their knees cave in a little bit more," says Pearle.

This "knock-knee" alignment can impact the way women jump or land, Pearle adds, which may increase the risk of ACL injury compared to men, who often have a more bow-legged alignment.

“Women may be a bit more more ligamentously lax than men,” says Pearle, adding that this causes looser ligaments and more flexible joints, which may contribute to knee instability.

Muscle strength

"Some people think that there's a difference in muscle development between men and women," Pearle adds.

Typically, women have weaker muscles and less strength overall than men, the experts note. Less muscle mass around the knee may contribute to a higher ACL injury risk.

Another theory is that the menstrual cycle may increase a woman's risk of ACL injury, the experts note.

A 2017 meta-analysis found that the literature suggests a link between hormonal fluctuations and ACL tears.

The research, published in the Orthopoedic Journal of Sports Medicine , found that menstruating women may experience increased laxity or looseness of the joints during the ovulatory phase, which may contribute to heightened ACL injury risk.

"The short answer is we don’t know why ... but it's probably multifactorial," Pearle notes.

Environmental factors

More than 20 years of research on ACL injuries focused on sex-based biological differences has failed to improve outcomes for women, Parsons and her co-authors concluded. "We can't just look at one or two risk factors, we have to look at the bigger picture and the larger sports environment," says Parsons.

Experts suggest that the systemic gender inequality, bias and sexism in sports can affect women from before an ACL injury happens through treatment and recovery.

"We need to ask what kind of facilities girls and women have access to ... do they have the same types of opportunities to train?" Parsons notes. Factors such as the quality of fields, gear and footwear may also play a role.

In a 2024 report , the British parliament's women and equalities committee slammed the sports sector's "slow" response to high rates of ACL injuries among female footballers, highlighting the lack of accessible, affordable cleats designed for women.

Parsons also notes that hypermasculinity and sexism in gyms and weight rooms may be a factor. "We tell girls to get stronger because that'll prevent an ACL injury ... but it's hard to tell girls to get stronger when the environment doesn't support it," Parsons adds.

In general, fewer resources and money are allocated to women’s sports — from college athletics to professional teams. “How they’re valued is not the same,” Parsons says. Even the salary disparity between male and female athletes is well-documented, including the shocking pay gap between WBNA and NBA players .

Overall, there is a lack of data and more studies are needed to understand which factors directly impact ACL injury risk and to what extent, the experts note. "This is another piece of the puzzle, and we need to start considering it so (in research)," says Parsons.

ACL treatment in women

These gender disparities do not stop at ACL injury risk, says Parsons — "it can and does extend into treatment (and recovery)."

Treatment for ACL injuries typically involves a combination of rehabilitation and surgery, depending on the severity of the tear. Recovery can take anywhere from several months to over a year.

Reconstructive surgery is the default treatment for a complete ACL tears, especially for athletes who plan to return to sports, the experts note. There are multiple techniques, but reconstruction surgery typically involves rebuilding the ACL using a graft of tissue from the patient's own body (such as the hamstrings or patellar tendon) or from a cadaver, says Pearle.

However, there’s some evidence suggesting that women are not offered surgery as often as men are, Parsons notes. In addition to being less likely to undergo ACL reconstruction surgery, women may have worse outcomes than men. "Women in general have a higher risk of re-rupture," says Pearle.

Additionally, women typically shoulder more gendered roles such as caregiving, says Parsons, which may affect their recovery. “If you have to take extra time and energy to take care of other people, you don’t have as much time to rehab your own injury,” says Parsons.

ACL injury prevention

While there are ways to prevent ACL injuries, these injury prevention programs are not widely instituted, says Pearle. "50 to 80% of ACL injuries are preventable with neuromuscular training, or ACL injury prevention exercises," Pearle adds.

These may aim to improve muscles around the knees, enhance bodily control while changing direction or refine technique and rapid movements.

Anyone can practice these ACL prevention exercises, but they're especially important for women due to their higher risk of ACL injury, says Pearle. "It actually makes you a better athlete, and it protects you."

Caroline Kee is a health reporter at TODAY based in New York City.

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2022 Women's Health Research Symposium - Women's Health & COVID-19

Please join us in attending, the  2022 Women’s Health Research Symposium , put on by the  Women’s Health Research center in the Institute for Medicine and Public Health (IMPH) , via Zoom every Friday in May (6, 13, 20, 27) at 10 AM CST – 12 PM CST. This year’s theme is Women’s Health and COVID- 19; subtopics are located below on the flier. Attendees must register.  Please  click here to register  and receive the Zoom link to attend! 

If you have additional questions about the symposium, reach out to the programming committee at:  [email protected]

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New Pap Smear Alternatives Are Coming To A Doctor’s Office Near You—And They Skip The Speculum. Gynos Explain

"This is definitely a better option than what we’ve had before.”

Now, there’s a new Pap smear alternative that could help you bypass the speculum. The Food and Drug Administration (FDA) approved self-collection kits from both Roche and BD in May for use inside health care settings, allowing patients to collect a sample themselves and leave it for their provider to test.

This isn’t the only new innovation in cervical cancer screening: A Danish doctor is working on using period blood for screening, too.

Meet the expert: Christine Greves , M.D., is an ob-gyn at the Winnie Palmer Hospital for Women and Babies in Orlando, Florida.

OK, but how does this new test work? Will it be at your doctor’s office? Here’s what you need to know.

What is an alternative to a pap smear?

There are a few of these coming out, but they’re similar at the core. These are self-collection kits that allow you to take a sample at your doctor’s office and then have your healthcare provider test it for cervical cancer.

Given that Pap smears are uncomfortable at baseline and terrifying or traumatizing for some women, it’s a good option to have, says Christine Greves , M.D., an ob/gyn at the Winnie Palmer Hospital for Women and Babies in Orlando, Florida.

Research has found that these are similar to a Pap smear in how effective they are at detecting cervical cancer.

What can I do instead of a smear test?

Instead of getting a Pap smear test, you’ll soon be able to do a self-collection and have your doctor test it for you. (Think of it like the vaginal version of peeing in a cup.)

The FDA-approved tests involve inserting a swab that looks a lot like a Q-tip a few inches in your vagina, swirling it around, and then giving it to your healthcare provider to test.

Does new test replace the Pap smear?

It’s unlike that the Pap smear will actually be replaced, given that it’s been the go-to method of screening for cervical cancer for ages, Greves says.

“But doing this test is better than nothing,” she says. “If a woman has vaginismus—a condition that causes involuntary tensing of the vagina—or is terrified of a speculum exam, this is definitely a better option than what we’ve had before.”

There are two upcoming tests that will allow you to screen yourself for cervical cancer. Those are called Onclarity HPV, made by BD, and cobas HPV, made by Roche, per the National Cancer Institute (NCI).

When will these pap smear alternatives become available?

While they’re not available this second, they should be soon. BD’s kit is expected to be available in September and Roche’s kit will likely be available later this fall.

Worth noting: Similar tests are already available in different countries, including Australia .

Are these new tests covered by insurance?

It’s not clear at this moment. The American Cancer Society (ACS) has applauded the approval of these tests but, given that they’re new, it may take some time until insurance companies decide to cover them.

While Greves says the new tests have value, she also urges women to still get regular speculum exams as recommended.

“There is a lot of information we can learn from a speculum exam that can add value to a woman’s life,” she says. “I found recurrent cancer during a speculum exam in someone who didn’t need to get a Pap. You can just learn a lot from these exams.”

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Brain scans of some unresponsive hospital patients show detectable activity

When a patient with a brain injury is unresponsive, doctors turn to certain basic tests to see if they could still have some awareness: calling their name, clapping near their ear or inserting a cotton swab in their nose.

Those who don’t wake up are often believed to have lost consciousness.

But a new study suggests that a quarter of brain-injured patients who don’t physically respond to commands are doing so mentally. The results were published this week in the New England Journal of Medicine .

The study looked at 353 patients who, from the outside, seemed to have lost consciousness due to a brain injury. The sources of these injuries varied from accidents to heart attacks and strokes. Of those patients, 241 were diagnosed as being in a coma, a vegetative state or having only minimal consciousness.

The researchers gave the patients verbal commands, like telling them to imagine themselves swimming or to open and close their hands. For 60 of the 241 patients, there was evidence that they could still perform those tasks in their head. The study refers to this as “cognitive motor dissociation.” Some doctors prefer the term “covert awareness.”

The mental tasks were demanding enough that even some of the other patients who had recovered enough to physically respond to verbal queues couldn’t perform them, said Dr. Nicholas Schiff, an author of the study and a neurologist at Weill Cornell Medicine.

The findings suggest that covert awareness is more common than originally thought: Small studies previously estimated that around 10%-20% of unresponsive patients had it. The new study is larger than its predecessors.

“It’s both an incredible finding, but also kind of scary,” said Caroline Schnakers, assistant director of the Casa Colina Research Institute, who studies the same phenomenon but was not involved in the new research.

The idea that so many patients “could be able to at least respond to their environment, but are not given the right tools for doing so — that’s very alarming for clinicians,” she said.

Schiff said 1 in 4 patients is likely a conservative estimate.

“We know we missed people,” he said. “We also know that patients who have severe brain injury have what are called fluctuations in arousal. They have good and bad times of the day.”

His team measured patients’ mental activity through brain wave tests and functional MRIs. Unlike a standard MRI, which produces 3D images of the brain, a functional MRI measures activity in the brain based on blood flow. When conscious people are told to follow a command, certain areas of the brain become more active, and blood flow to these areas will increase.

Not all hospitals have this technology, however, meaning doctors could miss out on diagnosing patients. Many hospitals use CAT scans or standard MRIs — along with physical exams — to determine if a patient’s mind is still active. If those tests don’t show signs of consciousness, doctors may falsely assume there’s no hope for improvement.

“They’re going to be treated as if they’re fully unresponsive,” Schiff said. “No one’s going to guess that they’re there.”

Dr. David Greer, chair of the neurology department at Boston University School of Medicine, pointed to one limitation of the study: The patients didn’t all have the same injuries or level of brain dysfunction.

“It’s a fairly heterogeneous group, and I think that has to be a caveat,” said Greer, who wasn’t involved in the research.

Schiff, however, said brain dysfunction tends to be relatively similar across injuries.

Among the patients in his study, young people and those with traumatic brain injuries — the kind linked to external events like falls or car crashes — were more likely to have covert awareness.

“Traumatic brain injury patients are notorious for looking really bad for weeks to even months, and then having a remarkable delayed recovery at six months or 12 months,” Greer said. “Those are the ones that I’m always super cautious about to make sure I’m not making any snap judgments.”

But he noted that even if a patient is conscious, it’s not a guarantee that they’ll return to their normal lives one day.

“The worst message that people can take from this as a family is to say, ‘Oh, they’re in there and they’re going to make a full recovery,’” Greer said. “I think that would be very misleading for families to have that kind of false hope, because many if not most of these patients will still have a severe disability.”

But the findings do offer hope for connecting patients to certain treatments in the future. For now, the options are limited: A Parkinson’s drug, amantadine, has shown some promise in helping people recover consciousness. Some doctors also prescribe Ambien, stimulants or antidepressants.

Brain implants or neuromodulation (using electrical currents to alter brain activity) could represent the next wave of treatments, Schnakers said. She emphasized the need to provide families with options for their loved ones.

“The family will ask, ‘What can we do?’ It’s actually something that we have not thought about very seriously,” she said, adding: “This is not acceptable anymore.”

Aria Bendix is the breaking health reporter for NBC News Digital.