In June of 2024 the Washington Post examined a number of issues concerning what many critics say is skewed medical research that shortchanges women, which can in turn often be responsible for gender bias in medical treatment as well. The Post said this has been happening for decades, and “This is particularly true of older women, leaving physicians without critically important information about how to best manage their health.”

The Post also pointed out that women are resilient and outlive men by more than five years in the U.S. Therefore, “If we’re concerned about the health of the older population, we need to be concerned about the health of older women.” The resulting feature article addressed a selection of specific topics and included commentary by various experts. These were as follows:

Statin drugs

Stephanie Faubion, director of the Mayo Clinic’s Center for Women’s Health, said statin drugs to control cholesterol are among many pharmaceuticals widely prescribed to older adults that were studied mostly in men, with results then extrapolated to women. Faubion said it’s just assumed that women’s biology doesn’t matter and that women who are premenopausal and those who are postmenopausal respond similarly, which is not necessarily the case. “This has got to stop,” she is quoted as saying. “The FDA [Food and Drug Administration] has to require that clinical trial data be reported by sex and age for us to tell if drugs work the same, better, or not as well in women.”

Alzheimer’s drugs

According to the Post, the Alzheimer’s drug Leqembi (lecanemab) was approved by the FDA in 2023 after the manufacturer reported an overall 27 percent slower rate of cognitive decline in people who took the medication. But a supplementary appendix to a Leqembi study published in the New England Journal of Medicine revealed that “sex differences were substantial — a 12 percent slowdown [of cognitive decline] for women, compared with a 43 percent slowdown for men — raising questions about the drug’s effectiveness for women.” The Post said this is important because nearly two-thirds of older adults with Alzheimer’s disease are women. Plus, older women are more likely than older men to have multiple medical conditions, based on numerous research studies. Things like disabilities, autoimmune illnesses, depression and anxiety, uncontrolled high blood pressure, and osteoarthritis, among other issues.

Heart disease

“Why is it,” the Post asked, “that women with heart disease — which becomes far more common after menopause and kills more women than any other condition — are given less recommended care than men?” Martha Gulati, director of preventive cardiology and associate director of the Barbra Streisand Women’s Heart Center at Cedars-Sinai in Los Angeles, was quoted as answering: “We’re notably less aggressive in treating women. We delay evaluations for chest pain. We don’t give blood thinners at the same rate. We don’t do procedures like aortic valve replacements as often. We’re not adequately addressing hypertension. We need to figure out why these biases in care exist and how to remove them.” Gulati added that older women are less likely than men to have obstructive coronary artery disease — blockages in large blood vessels — and more likely to have damage to smaller blood vessels that goes undetected. When they get procedures such as cardiac catheterizations, women have more bleeding and complications. She says more data is needed to determine the best treatments for older women with heart issues.

Brain health

How can women reduce their risk of cognitive decline and dementia as they age? The Post quoted JoAnn Manson, chief of the Division of Preventive Medicine at Brigham and Women’s Hospital in Boston, as saying, “This is an area where we really need to have clear messages for women and effective interventions that are feasible and accessible.” Manson is also a key researcher for the Women’s Health Initiative, said to be the largest study of women’s health in the U.S. She goes on to say many factors affect women’s brain health, including stress (such as with caregiving responsibilities), which can fuel inflammation. Women experience the loss of estrogen, a hormone important to brain health, with menopause. They also have a higher incidence of conditions with serious impacts on the brain, such as multiple sclerosis and stroke.

Mental health

Anxiety and depression statistically affect women more than men. Hormonal changes are often a factor. The Post quoted Paula Rochon, a professor of geriatrics at the University of Toronto, as also pointing to “gendered ageism,” a combination of ageism and sexism that she says renders older women “largely invisible.” Helen Lavretsky, a professor of psychiatry at the University of California at Los Angeles and past president of the American Association for Geriatric Psychiatry, was quoted as saying a number of topics need further investigation. E.g., “How does the menopausal transition impact mood and stress-related disorders? What nonpharmaceutical interventions can promote psychological resilience in older women and help them recover from stress and trauma? Think yoga, meditation, music therapy, tai chi, sleep therapy, and other possibilities. What combination of interventions is likely to be most effective?”

Cancer

Can cancer screening recommendations and cancer treatments be improved for older women? Supriya Gupta Mohile, director of the Geriatric Oncology Research Group at the Wilmot Cancer Institute at the University of Rochester, told the Post there should be better guidance about breast cancer screening for older women, broken down by health status. “Currently, women 75 and older are lumped together,” Mohile says, “even though some are remarkably healthy and others notably frail. I think we’re underscreening fit older women and overscreening frail older women.” She also would like to see more research about effective and safe treatments for lung cancer in older women, many of whom have multiple medical conditions. She adds that a person’s health status is important, and differences in treatment tolerability for older men and women need more investigation.

Bone health, functional health, and frailty

How can older women maintain mobility and preserve their ability to take care of themselves? The Post once again quoted Manson of Brigham and Women’s Hospital as saying osteoporosis is “hugely important to older women’s quality of life and longevity, but it’s an overlooked area that is understudied.” She added that osteoporosis causes bones to weaken and become brittle and is more common in older women than in older men, which increases the risk of dangerous fractures and falls. Jane Cauley, a distinguished professor at the University of Pittsburgh School of Public Health who studies bone health, was also cited as saying more data about osteoporosis is needed among older Black, Asian and Hispanic women, who are undertreated for the condition. Lastly, Marcia Stefanick, a professor of medicine at Stanford University School of Medicine, said she wants to see more research in order to know which strategies are most likely to motivate older women to be physically active so they can better preserve muscle mass and strength. “Frailty is one of the biggest problems for older women,” Stefanick said, “and learning what can be done to prevent that is essential.”

Action Being Taken at the National Level

The Post noted that in late 2023 the Biden administration promised to address this problem of gender discrepancy in research and care with an effort called the White House Initiative on Women’s Health Research. This Initiative stated: “Despite making up more than half of the population, women have been understudied and underrepresented in health research for far too long. Research on women’s health is drastically underfunded, leading to significant research gaps, with serious consequences for the health of women across the country. This lack of investment limits our understanding of conditions that are specific to women, predominantly affect women, or affect women differently. …  our nation must fundamentally change how we approach and fund women’s health research.”

This Initiative was to be led by First Lady Jill Biden and the White House Gender Policy Council. Jill Biden was quoted as saying: “Every woman I know has a story about leaving her doctor’s office with more questions than answers. Not because our doctors are withholding information, but because there’s just not enough research yet on how to best manage and treat even common women’s health conditions. That is unacceptable.” More about the Initiative can be found at White House Initiative on Women’s Health Research.

(Acknowledgement: The Post’s reporting on this topic was assisted by KFF Health News, a national newsroom that produces in-depth journalism about health issues.)