The Long Road to Being Believed: A History of the Gender Gap in Healthcare

Published in honor of International Women's Day

Imagine: You've been experiencing debilitating pain for years. You've seen doctor after doctor. You've been told it's stress, anxiety, "just part of being a woman." You walk out of another appointment without answers, without relief, and with the creeping suspicion that if you were a man describing the same symptoms, something would have been done by now.

For millions of women, this isn't a hypothetical, this is an all too-common experience. Time and time again, we hear that women come to Tia on the heels of an experience much like this.

The story of women's healthcare is, in many ways, a story about being overlooked, not because medicine is inherently cruel, but because for most of medical history, the female body simply wasn't considered the standard. Understanding how we got here matters deeply, because the inequities aren't artifacts of some distant past…they are shaping the care women receive today and the work we must do together.

When "Hysteria" Was a Diagnosis

The roots of medical gender bias go back further than most people realize. As early as ancient Greece, physicians attributed a wide range of symptoms in women such as anxiety, fainting, pain, emotional distress to what they called hysteria, derived from the Greek word hystera, meaning "uterus". The theory held that the uterus could literally drift through the body and cause chaos wherever it landed.

This wasn't a fringe belief, rather, it was mainstream medicine, codified and taught for centuries. What it reflected, at its core, was a fundamental unwillingness to take women's physical experiences at face value. If a woman was suffering, the default explanation was emotional instability rather than bodily disease.

The framing of “women's symptoms as psychological, women's pain as exaggerated” never fully left medicine, it’s simply evolved over the years.

The Thalidomide Aftermath and the Exclusion of Women from Research

By the mid-20th century, medicine had grown far more sophisticated. But a tragedy was about to set women's participation in medical research back by decades.

In the late 1950s and early 1960s, a sedative called thalidomide was widely prescribed across Europe and Canada, often to pregnant women experiencing morning sickness. The drug had never been approved in the United States, but its devastating effects were felt globally: thousands of babies were born with severe birth defects.

The fallout was swift and understandable. Protecting pregnant women and unborn children from experimental drugs was a moral imperative, but the FDA's 1977 response went much further. Guidelines issued that year recommended excluding all women of "childbearing potential" from early-phase clinical trials – not just pregnant women, not just women planning pregnancies – but any premenopausal woman, including those using contraception, those with vasectomized partners, and those who were not sexually active.

For nearly two decades, the drugs being developed, tested, and approved were tested almost entirely on male bodies. The data gaps this created were immense. When the FDA finally reversed course in 1993, requiring the inclusion of women in clinical research, decades of drug approvals had already happened without adequate data on how those drugs affected women. Many of those drugs are still in use today.

The Data Gap That Persists

You might assume that with the 1993 mandate in place, the problem was solved, but it was not.

As recently as 2019, women accounted for roughly 40% of participants in clinical trials for three of the diseases that affect women most (cancer, cardiovascular disease, and psychiatric disorders) despite representing 51% of the U.S. population. A 2022 analysis of over 1,400 trials with more than 300,000 participants found that women made up only 41.2% of participants on average. And in 2021, more than 80% of preclinical studies assessing drug safety and efficacy were still being conducted solely on male mice.

This matters in ways that are both concrete and critical. Women have distinct hormonal cycles, metabolic rates, immune responses, and fat distribution, all of which affect how medications are absorbed and processed. Studies have found that 76 out of 86 commonly used drugs show sex-based differences in how they move through the body, yet dosing guidelines frequently fail to account for this. As a result, some research indicates that women experience adverse drug reactions at nearly twice the rate of men.

Why does all of this matter? When research doesn't include women, mainstream medicine doesn't know how to treat them.

Heart Disease and the Cost of Being the "Atypical" Patient

Nothing illustrates the danger of this gap more starkly than heart disease.

Heart disease is the leading cause of death for both men and women in the United States. But for most of medical history, it was treated as a man's disease. The "classic" symptoms, crushing chest pain, pain radiating down the left arm, were identified based on research conducted on men. Women frequently experience heart attacks differently: fatigue, nausea, jaw pain, shortness of breath, upper back pain.

It wasn't until 1999 that the American Heart Association published a dedicated guide to preventive cardiology for women, formally acknowledging that the presentation in women differs from men.

The consequences of this knowledge gap show up in emergency rooms. A study published in the Journal of the American Heart Association found that women with chest pain waited longer longer than men to be evaluated for possible heart attacks. A study from The New England Journal of Medicine found that women are seven times more likely than men to be misdiagnosed and sent home in the middle of a heart attack. Middle-aged women presenting with chest pain were twice as likely as men with the same symptoms to be diagnosed with a mental illness rather than a cardiac one.

The Pain Gap: When Women's Suffering Becomes "Emotional"

The dismissal of women's pain has been well-documented and is extraordinarily widespread. In a 2022 Gender Pain Gap Index Report, over 56% of women said their pain had been dismissed by healthcare providers, and nearly a third had avoided or delayed care because they were afraid of not being taken seriously. In U.S. emergency rooms, a study showed that women experiencing acute abdominal pain wait an average of 65 minutes before receiving pain medication, while men in the same situation wait 49 minutes.

Subconscious logic, rarely spoken aloud, echoes all the way back to ancient Greece: that women are emotional, dramatic, prone to exaggeration. Research shows that physicians consistently rate pain severity lower in women than in men, even when clinical symptoms are identical.

Endometriosis: A Case Study in Years Lost

If you want to understand what happens when a condition affecting primarily women gets treated as a low-priority mystery, we can examine endometriosis.

Endometriosis is a disease where tissue similar to the uterine lining grows outside the uterus, often causing severe chronic pain, heavy periods, and in many cases, infertility. It affects an estimated 1 in 10 women of reproductive age globally, and diagnosis takes, on average, between 5 and 12 years from first symptoms (a figure that has remained stubbornly unchanged for over a decade despite growing awareness and medical advances). That delay breaks into two parts: patients typically wait 1 to 4 years before even seeking care, often because their symptoms are normalized or dismissed, and then face another 0.3 to 8.6 years navigating a medical system that frequently misidentifies what it's seeing.

The gap isn't evenly distributed. Longer delays are seen in younger patients, those who are overweight, those with infertility or multiple comorbidities, and Black patients compared to white patients.

During that time, women are often told their pain is normal. One scoping review found that adult women see an average of four or more doctors before receiving a diagnosis. In this same review, it was noted that over a quarter of women with endometriosis report having discussed their symptoms with a provider more than 20 times before getting an answer.

This delay is shocking but should not be surprising. It stems from a culture that has long normalized menstrual pain and dismissed the women reporting it. “Painful periods are just part of being a woman”, a phrase so many of us have heard, has cost many women years of quality of life, and in some cases, their fertility.

Autoimmune Disease and the Invisible Burden

Endometriosis is not an outlier. Autoimmune diseases (conditions where the immune system attacks the body's own tissue) disproportionately affect women occurring at a rate of 2 to 1; this gender bias not yet well understood.

Lupus, rheumatoid arthritis, multiple sclerosis, Hashimoto's thyroiditis are diseases that often take years to diagnose because their symptoms are diffuse, can mimic other conditions, and are frequently dismissed as psychological or "just stress." Women with these conditions describe fighting for years to be believed, to be tested, to be treated.

The pattern between endometroisis & autoimmune is not coincidental. When medicine is built around a male default, conditions that present differently in women, or that affect women predominantly, end up in a diagnostic blind spot. Research funding lags, clinical guidelines are sparse, and women often bear the cost.

The Weight of History on Modern Care

The throughline is clear; this is not a collection of isolated failures or “bad luck” occurring to a few hundred patients. This is a systemic problem, because the system was built, tested, and refined with one patient in mind…and that patient was not a woman.

The good news is that awareness has grown significantly. The NIH's 2016 policy requiring researchers to account for sex as a biological variable in preclinical research was an important step. Advocacy organizations have pushed for more women in clinical trials, more research funding for conditions that disproportionately affect women, and better training for clinicians on sex and gender differences in disease presentation.

But policies take time to change practice. A 2022 Harvard Medical School study confirmed that women remain substantially underrepresented in clinical trials for leading diseases. Medical curricula at most institutions still contain minimal content on sex and gender differences in care. And in well-meaning doctor’s offices every day, women are still being sent home with their pain unaddressed, their symptoms reframed, their bodies misunderstood.

What Whole-Body Care Actually Means

Here's where the conversation needs to shift. For too long, "women's health" has been treated as a euphemism for reproductive health. Annual gynecological visits, prenatal care, contraception matter enormously, but they are not the whole picture.

Women's health is cardiovascular health. It is autoimmune health. It is mental health, bone health, neurological health. It is how medications work in a female body and how diseases present differently in women. It is how the female hormonal milieu impacts nearly every organ in her body, not only her reproductive ones. It is the recognition that a woman's experience of her own health is valid and deserves to be taken seriously.

Holistic care for women is not just gynecology as a box to check, but a model of healthcare that sees the whole person, her hormones and heart, her stress and her spine, her history and her future.

Women deserve providers who understand that their pain is real, that their symptoms are physical until proven otherwise, that their bodies are not simply smaller versions of men's bodies, but beautifully complex biological systems that have been understudied and underserved for too long.

This International Women's Day, the most important thing we can recognize is this: women's health has never just been about reproductive organs. And the healthcare system that women deserve, the one many of us are still fighting to access, has to reflect that truth in every exam room, every clinical trial, every diagnosis, and every conversation between a patient and the provider who has the power to believe her.