It’s Time to Be Seen: Re-architecting Healthcare for Women—And Why Everyone Gains

Summary

• Women's health is often narrowly defined by reproductive care, overlooking critical issues like cardiovascular disease, infective endocarditis, heart failure, and mental health. The gender data gap contributes to misdiagnoses and ineffective treatment for women.
• To create equitable healthcare, we must prioritize women's unique needs and incorporate sex-disaggregated data into research and practices. By focusing on women's healthcare, we empower individuals and strengthen communities, leading to a healthier future for all.

A smoother path forward: from problem to plan

For too long, women’s health has been treated as a subset of men’s health, an afterthought rather than a priority. It’s time to change the narrative.

Caroline Criado Perez, author of Invisible Women: Data Bias in a World Designed for Men, argues that much of our modern world still views the male body and male life patterns as the default.¹ The absence of sex-disaggregated data creates a persistent "gender data gap" that shapes design, policy, and medicine in significant ways.

The implications are not abstract: when women are excluded from datasets and clinical trials, or when relevant differences are averaged out, diagnostics, dosing, and symptom profiles tend to skew toward male experiences.¹ This is one reason women are more likely to be misdiagnosed after a heart attack and why “one-size-fits-all” designs, such as personal protective equipment and crash safety testing, can lead to preventable harm.1 In essence, invisibility in data result in inequity in health outcomes.

The issue is not a lack of goodwill: it is a lack of fit-for-purpose design. Women’s health has often been equated with reproductive care alone, even though over 95% of the health burden for women arises outside of sexual and reproductive health.² By reframing the concept to focus on healthcare specifically for women—emphasizing prevention, being responsive to gender differences, and ensuring coordination across life stages—we can achieve better science, safer care, and improved outcomes.

What’s Different About Women’s Health Needs—and Why Does It Matter?

Women’s physiology is distinct and complex—not an adaptation of men’s. Hormonal fluctuations influence immunity, metabolism, and disease progression. Drug metabolism varies significantly: women often have slower clearance rates and higher blood concentrations, contributing to an overall ~15% higher rate of adverse drug reactions compared with men.^3,4 Despite these differences, most dosing guidelines remain sex-neutral,^4,5 and sex-specific factors shape presentation, risk, and treatment response across major disease areas.

1. Cardiovascular Disease (CVD): Traditional risk factors such as hypertension, diabetes, and smoking pose a greater relative risk for women.⁶ Conditions like nonobstructive ischemia and coronary microvascular dysfunction are common, and symptoms often diverge from the classic male pattern, resulting in missed or delayed diagnoses and lower usage of recommended therapies. Actionable fixes include incorporating obstetric and gynecological (OBGYN) history—such as adverse pregnancy outcomes, early menopause, and polycystic ovary syndrome (PCOS) into CVD assessments and establishing pathways for diagnosing ischemia with no obstructive coronary artery disease (INOCA) and coronary microvascular dysfunction (CMD).⁷
2. Infective Endocarditis (IE): Men generally exhibit more predisposing factors (such as devices, coronary artery disease, and poor dental health), worse organ complications, and higher age-adjusted in-hospital mortality rates.⁸ Men benefit when diagnosed within 3.5 days. Conversely, women often present later and have lower surgical rates, leading to long-term consequences. This calls for sex-aware diagnostic timelines and equitable access to surgical options.
3. Heart Failure (HF): Women comprise approximately half of all heart failure hospitalizations but represent only 17-23% of participants in major clinical trials. They more frequently experience heart failure with preserved ejection fraction (HFpEF), report poorer quality of life, and historically receive fewer devices—despite having similar efficacy and occasionally better responses to cardiac resynchronization therapy (CRT).⁹ Implementing standardized eligibility and proactive-device referrals can help close this gap.
4. Alzheimer’s disease: Women make up approximately 67% of Alzheimer’s disease (AD) patients, but they are enrolled at lower rates in clinical trials (~58% in experimental drug trials).10 And only 12.5% of articles reported sex-stratified results.¹⁰

Mental Health: A Missing Lever

Mental health is a crucial component that intersects with every aspect of women's health and significantly impacts the economics of women's healthcare. Depression increases the likelihood of cardiometabolic events like myocardial infarction (MI) and worsens outcomes following such events. In women, depressive symptoms are associated with lower participation in rehabilitation programs and poorer adherence to treatment, further amplifying an already heightened risk profile (including INOCA, CMD, and adverse pregnancy outcomes). Therefore, it is essential to integrate mental health into cardiometabolic care to improve cardiovascular outcomes for women.

Women often experience overmedicalization while remaining underserved. A systematic review and meta-analysis conducted in 2025¹¹ found that women are approximately 45-54% more likely than men to receive psychotropic medications for anxiety and depression, even after accounting for other factors.

While understanding and treating mental health in women is vital to overall health, gender bias in healthcare means women’s pain is often dismissed and mental health concerns minimized—"attributing women's pain to psychological factors or hormonal fluctuations rather than addressing its underlying medical conditions.”¹² Off-label antidepressant and anti-anxiety medication use in women is used to target insomnia, chronic pain, and hormonal issues like PMDD, with SSRIs, trazodone, and benzodiazepines frequently prescribed for these conditions. While providing relief, these prescriptions sometimes overlook root causes—such as perimenopause, trauma, chronic stress, or severe illness—increasing risks of dependency or side effects.¹³

Too often, the consequences of these patterns show up in the moments when women most need to be believed. When symptoms are repeatedly reframed as “just stress” or “just hormones,” the harm accumulates—quietly at first, then unmistakably.

Intersectionality compounds these disparities: in the U.S., Black women face maternal mortality rates of 50.3 deaths per 100,000 live births—over three times higher than white women.¹⁴ These inequities aren’t just statistics—they’re lived realities—part of a broader pattern of being asked to endure more and be heard less.

Finding an Operational Model That Works

Integrating anxiety and depression screenings directly into cardiovascular prevention, diabetes, and menopause clinics creates a clearer path to timely care. Same-day warm handoffs to behavioral health teams reduce drop off and signal to patients that their concerns are heard and deserve immediate attention.

Tracking sex-stratified outcomes then show where care is working and where it falls short. Measures like rehabilitation enrollment, adherence, and quality of life reveal patterns that standard reporting can miss, giving clinicians the evidence they need to course-correct before disparities widen.

Give to Gain

The “Give to Gain” principle captures the strategy in two words: give women equitable prevention, timely diagnoses, sex-informed treatment, and respectful experiences—and we gain healthier lives, better science, and stronger balance sheets. That is the blueprint for healthcare that works—for everyone.