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Why women’s health is so under-funded and under-researched – history to the present day
Summary
From ancient myths of "hysteria" to male-default research, women's health has been sidelined for centuries - shaping today's gaps in diagnosis, treatment, and funding. This article traces the historical bias, the exclusion of women from clinical trials, and the real consequences for care and outcomes. It also highlights momentum for change: better study design, smarter funding, and a louder public conversation. The takeaway is clear: investing in women's health is both a moral imperative and an economic necessity.
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🌿 Key takeaways
The history of women's health: what to know
- The concept of "hysteria" - originating from the Greek word for uterus - shaped centuries of medical dismissal of female symptoms
- Medical research has historically defaulted to male bodies, with female bodies treated as simply a smaller variant - despite significant biological differences
- Female-specific conditions receive disproportionately low funding - just 4% of US biopharma R&D, and less than 2.5% of UK publicly funded health research
- The consequences are measurable: women are seven times more likely to be misdiagnosed during a heart attack, and more than 40% of those with PMS do not respond to available treatments
- The World Economic Forum estimates that a $300 million investment in women's health research could yield a $13 billion economic return
Why is women's health not taken seriously? A historical backdrop
Most of us are familiar with the word hysteria. We would also probably agree that it tends to be applied almost exclusively to women. The word can be traced back to the Greek word for uterus, "hystera". Its modern usage dates to the 17th century, when women were thought to be driven to madness by a malfunctioning womb. Plato suggested that an angry womb could wander through the body and suffocate its host. According to this school of thought, everything from menstruation to menopause was a disease of the body or mind. In Hippocrates' words: "the womb is the origin of all diseases."
In her book Pain and Prejudice, Gabrielle Jackson traces the medicalisation of hysteria from the late 1600s onwards. The eventual birth of gynaecology, neurology, and psychiatry in the 19th century did not resolve the problem - if anything, it rooted sexism more firmly in science and medicine.
As recently as 1933, Freud stated that "throughout history, people have knocked their heads against the riddle of femininity." Lynn Enright, in Vagina: A Re-education, observes that the female body has been so long misunderstood that the misinformation still lingers - and causes real harm - today.
🧪 In context: The word "hysteria" was once used as an official medical diagnosis - applied almost exclusively to women - to explain a vast range of symptoms that doctors did not understand. It was only removed from the Diagnostic and Statistical Manual of Mental Disorders in 1980.
Why is women's health neglected? Let's start with clinical trials
All healthcare starts with research. And the problem starts there too. As Caroline Criado Perez writes in Invisible Women, science has historically assumed a "default male" position - treating the female body as essentially a smaller version of the male body, with different reproductive functions. Aristotle famously described female bodies as the "mutilated male."
As a result, research has standardly been conducted on male bodies and then generalised to females, intersex, and trans people. The consequences are starkly visible:
- 70% of chronic pain sufferers are women - yet 80% of the research is conducted on male bodies
- Women are 50% more likely to be misdiagnosed after heart failure, yet heart failure trials have generally used male participants
- Some argue that the menstrual cycle makes female bodies "too variable" for trials - but this logic simply means we remain ignorant of how drugs and treatments affect the female body
⚠️ Worth noting: Other studies cite pregnancy as the reason for excluding women from trials - to protect an unborn child. But this creates a circular problem: without research on pregnant bodies, we have almost no evidence base for treating women who are pregnant. The research gap is itself a safety risk.
Clinical trials and change on the cards
In the US, female participants were first included in clinical trials in the late 1980s. It was not until 1993 that such inclusion was made mandatory. Since then, advocacy groups and governmental agencies have pushed for new guidelines and policies.
A particularly important development is not just inclusion, but sex-specific analysis of data. Surprising numbers of trials that have included women have historically not separated results by sex. Given how differently male and female bodies respond to viruses, drugs, and other stimuli, disaggregating data by sex is essential to accurate, safe medical knowledge for everyone.
Is women's health underfunded?
Male bias in trials is one issue. Funding is another. For conditions affecting females specifically, the figures are stark:
- US studies on sex-specific conditions favour male diseases three times out of four
- The funding per woman with diabetes is estimated to be 1,500% higher than the funding per woman with endometriosis - despite both conditions affecting similar proportions of women (12% vs 11%)
- Female-specific conditions represent just 4% of US biopharma R&D spending
- Only 2 of the 37 prescription medications that received FDA approval in 2022 were for women's health conditions
- In the UK, studies looking exclusively at reproductive health made up less than 2.5% of publicly funded research (as of 2014)
🧪 The catch-22: There is five times more research into erectile dysfunction (affecting 19% of men) than into PMS (affecting 75% of people who menstruate). One PMS researcher has reported having grants rejected on the grounds that PMS is "merely a product of culture and society." Without funding, no one learns more about these conditions. Without knowledge, no one funds the research. The cycle continues.
Funding women's health: seeds of hope
There is reason for optimism. 2021 was a record year for women's health funding in the US digital health start-up space. Efforts are also being made to accelerate investment in female health equity, with the World Economic Forum estimating that a $300 million investment in women's health research could yield a $13 billion economic return.
Why biology matters
Before addressing the wider consequences, it is worth being precise about why male-body research cannot adequately stand in for female-body research. In clinical studies, biology matters. It matters because certain conditions are far more likely to affect females than males. It matters because female and male bodies respond differently to drugs and viruses. And it matters because health risks can be more or less severe across sexes.
- A female smoker is between 20% and 70% more likely to develop lung cancer than a man who smokes just as much
- Women are 70% more likely to suffer from depression than men
- Acetaminophen (a common pain relief ingredient) is eliminated by the female body at 60% of the rate it is eliminated by the male body - meaning standard male dosing can expose women to higher effective concentrations
Hormones, body fat distribution, and metabolic rate all affect how medications are absorbed and processed. Findings from trials conducted on male bodies cannot be safely assumed to apply equally to female bodies.
The outcomes: failing female bodies
The consequences of under-research and underfunding are measurable. The statistics are not abstract - they represent real harm to real people.
General health outcomes
- Women are seven times more likely than men to be misdiagnosed and discharged in the middle of a heart attack
- Men are 2.5 times more likely to be referred to a cardiologist when experiencing chest pain
- Women wait significantly longer in A&E and are less likely to receive pain relief
- Of the medications recalled by the US FDA between 1997 and 2000, eight out of ten posed greater health risks for women
Female-specific conditions
- 80% of pregnancy-related deaths in the US are estimated to be preventable
- Diagnosis of conditions like endometriosis and PCOS typically takes years of persistence and multiple appointments
- On average, it takes 12 years to receive a PMDD diagnosis in the UK
- More than 40% of people with PMS do not respond to available treatments
Culture, shame, and stigma
Beyond medical shortcomings, centuries of patriarchal legacy have created a broader knowledge gap - and contributed to shame and stigma that keep women from seeking help. When gynaecological cancer charity The Eve Appeal surveyed people in the UK, only half could identify the vagina on a diagram, and 65% felt uncomfortable using the words vagina and vulva in conversation. A Plan International report found that almost half of girls in the UK are embarrassed about their period, while 14% did not know what was happening when they first started bleeding.
Conditions like pelvic organ prolapse are steeped in shame, and many of those who live with them are too embarrassed to tell anyone.
This is the catch-22 in cultural form: if people lack the language to describe what is happening to them, or feel too embarrassed to raise it, there is no public debate to drive change, normalise experience, or push women's health up the funding agenda. The lack of research perpetuates the knowledge gap, which creates a culture of silence, which means funding goes elsewhere.
Why female health matters for everyone
The moral argument for change is clear. The economic one is equally compelling. Women's maternal and reproductive health is, according to McKinsey Global Institute, a key driver in achieving gender equality that could raise global GDP by up to $28 trillion. It is increasingly accepted that the welfare and empowerment of women are a prerequisite for the health and wellbeing of communities and societies worldwide.
Final thoughts
Change is happening - it is just slower than it should be. The public conversation on everything from miscarriage and menopause to periods and pelvic floors is growing louder, and both policymakers and health experts increasingly agree that the inclusion of women in clinical trials is not just fair, but essential.
As for what we as individuals can do: not everyone needs a megaphone. Talking helps. That might mean speaking to your doctor about something you have been nervous to raise, or starting a conversation with a friend, partner, or family member about your cycle or your symptoms. No effort is too small to matter. Evelyn is committed to driving change in the PMS and PMDD space - for those who experience these conditions, and for everyone around them. Every moment of stigma-busting brings us one step closer to a culture where women's health is funded, studied, and taken seriously.
At Evelyn, we often use the word "women" in our articles as a shorthand to describe the people in our community and others who experience PMS and PMDD symptoms. We acknowledge that not everyone affected by these conditions identifies as a woman, and we want to be clear: Evelyn is for anyone navigating the hormonal challenges associated with PMS and PMDD, regardless of gender identity. We welcome people of all identities and expressions to our community. In our educational content, we aim to be both inclusive and medically accurate - most scientific studies relevant to PMS and PMDD have been conducted with cisgender female cohorts, and we will continue to evolve our language as the conversation around hormonal health expands.
Disclaimer: This content is for informational purposes only and is not intended as medical advice. Always speak to a qualified healthcare professional about any health concerns.
