04/07/22 | Menu-Editors-Pick

A History of Women’s Health

The theme for Women’s History Month 2022 was Healing and Hope, calling attention to women’s role as caregivers and the hope they instill and sustain for the future. This feels particularly important after two years living through the pandemic in which women’s role as caregivers has increased even further. 

There’s another way of looking at this theme, and that’s about how we empower women in also taking care of their own health. Historically, women’s health has been marginalized and maligned by the medical community, researchers, and investors. As we reflect back on women’s history month, it’s important to reflect on and highlight how we collectively contribute to the healing of women in our society. 

The way our society approaches women’s health is influenced both by biological sex differences as well as the gendered roles and norms we impose on women because of their perceived female sex. The points discussed in this article are influenced by both sex and gender, but predominantly refer to people assigned female at birth and cisgender when we refer to women. Non-binary, trans, and intersex people experience many similar but also different intersecting challenges, and are arguably just as, if not more, underserved as cis women. When we work to improve health outcomes for women, it’s important to always consider the needs of these communities as well. 

There are multiple conditions that affect women which are significantly under-innovated and underfunded, yet which represent  huge potential markets. For example, endometriosis is a chronic condition that affects 1 in 10 women, yet it takes an average of ten years in the US for women to receive a diagnosis via invasive surgery (Invisible Women). This painful condition is frequently misdiagnosed, misunderstood and stigmatized and sufferers’ pain is dismissed, with women being told they are stressed, anxious, that it’s in their head and that there’s nothing wrong with them. Often it’s when there are fertility problems that endometriosis is finally diagnosed. 

The medical community has a long history of treating women with an air of skepticism and hand-waving. In fact, some of our cultural narratives about women’s health and wellness can be traced back as far as Ancient Greeks, where doctors conceived of women’s ‘wandering wombs’. The uterus was seen as a living thing which they believed could freely move around the body, and different symptoms signified the place it had relocated to (Unwell Women). Almost any symptom or illness a woman experienced was attributed to this phenomenon and numerous treatments were used to encourage the uterus to return to its proper place. 

The word ‘hysteria’ is derived from the Greek word for womb and has influenced the scientific approach to women for thousands of years, even to this day. While we no longer lock women up in asylums for hysteria, we tend to more easily view women as sensitive, anxious and prone to exaggeration. When women come to the hospital with pain symptoms, they are more likely than men to be prescribed anti-anxiety medications, and are more often written off as psychiatric patients. Meanwhile, research in the 1990s shows that between 30-50% of women diagnosed with depression had been misdiagnosed (BBC Future).

As the practice of medicine became more firmly rooted in science, the idea that women’s biology made them the weaker sex dominated medical practice and shaped the social fabric. In fact, it was used to justify and rationalize women’s exclusion from public life, often on false and misplaced ideas about women’s bodies. Much of this is also rooted in social class and racist beliefs, as it was thought that white middle and upper class women’s bodies were not fit for strain or vigorous activity, while little thought was given to lower class women who were not so ‘privileged’ (Unwell Women). We see the legacy of this today, where the pain of women of color is taken even less seriously. 

These ideas have left strong imprints on medicine and women’s health today in numerous ways. Women’s pain and (un)wellness is dismissed, taken less seriously and is less understood. This attitude permeates medical practice and research and continues to influence our understanding of women’s pain, women’s symptoms and the conditions that disproportionately or solely affect women. 

Conditions that affect only women haven’t been a medical priority

When medical students are studying to become doctors, they are taught ‘physiology’ and ‘female physiology’ (Invisible Women), embedding from the start the male body as the default.  Conditions that only affect women are not well understood and research is chronically underfunded. Take premenstrual stress (PMS) and period pain (dysmenorrhea), both of which affect around 90% of women. Despite the fact that these are commonly experienced by women once a month, the causes of PMS and period pain are poorly understood, under researched, and have limited treatment options. One study found 5 times as many studies into erectile dysfunction compared to PMS, while it is estimated around 5-15% of men experience ED (Invisible Women). 

Our perception of women’s pain shapes our attitudes and has been used to reinforce our social norms. For hundreds, if not thousands, of years, menstruation has been used to justify women’s exclusion from education, the medical profession and public life more broadly. While the women’s movement was growing in the nineteenth century, women’s menstruation became a key argument used to justify their continued oppression (Unwell Women). Opponents to gender equality started to warn of the dangers of women’s education and the deficiency of women’s bodies and minds to operate on equal footing with men. They argued that active work of the body or mind would interfere with their periods and natural rhythms – and, crucially, with their natural duty as mothers. It took a number of female doctors – Elizabeth Garrett Anderson, Julia Ward Howe, Eliza Bisbee Duffy – to rebuke the claims made by male physicians, and Mary Putnam Jacobi, in particular, whose methodological research into women’s menstrual cycles which monitored women’s vital signs and energy levels across their whole cycle and used it to show that most women didn’t need to be confined to their beds for a week which was the believe at the time – thus challenging the standard belief that women’s periods did not incapacitate them for one week a month (Unwell Women). Over 100 years on, this seems pretty ridiculous, but these ideas and beliefs are still rooted in society and medicine. 

Women have been excluded and underrepresented in clinical trials

When it comes to clinical trials, women are routinely excluded or represent just a small percentage of the sample. Nonetheless, the results are assumed to apply to men and women, as the data typically aren’t analyzed to observe how results vary by sex, race, or other important distinctions. There are many significant and harmful racial disparities in health care, such as the history of gynecology that involved performing brutal surgeries on slaves (Medical Bondage).

In the United States, women were banned from clinical trials altogether from 1977 to 1993. In 1977 the FDA excluded all women of childbearing age from clinical trials because of a scandal caused by Thalidomide, a drug which was prescribed to women for morning sickness but was found to cause fetal deformities.  While the original intention was to protect pregnant women, this decision has resulted in extremely harmful effects for women by not studying how drugs affect them differently. Women are more likely than men to experience an adverse drug reaction. Why? Perhaps because, as a 1992 study found, sex differences have been analyzed for less than half of widely available prescription medications (Invisible Women).

If women are generally overlooked in clinical trials, pregnant women are routinely excluded altogether, giving limited understanding of how to treat health issues. Their exclusion from COVID vaccine trials led to (misguided) advice for pregnant women to refuse the vaccine, and resulted in needless deaths. We also still don’t fully understand the impact of the vaccine on the menstrual cycle because this was not considered during trials and further research.

Women’s hormones and hormone cycles are seen as an added complication in medical research, because women’s hormones change at different points in their menstrual cycle, as well as during and after pregnancy and the menopause. However these are realities for women which can’t be controlled for and need to be understood. It has been shown, for example, that some antidepressants affect women differently at different times during their cycle. Impacts have also been found for antipsychotics, antihistamines, antibiotics and heart medications (Invisible Women). By failing to consider this in clinical trials, we will continue to fail women. 

Moving forward: Investing in Women’s Health

The historic perception of women’s bodies can no longer be allowed to influence how we treat half of the world’s population. We need to move away from seeing the male body as the default, and properly invest in women’s health, treatment and medication, in relation to all health issues as well as those that solely or predominantly affect women. The issues that matter to women need to be funded and prioritized. When women drive decisions, we’ve seen it’s possible to make a breast pump that is functional, comfortable and discrete. We’ve seen a growing number of menstrual products that give women real choice, confidence and freedom, in addition to more environmentally conscious solutions. And we’ve seen a growing conversation and awareness on the menopause and tailored treatments and services to support women. 

Investing in women’s health is an ethical imperative. It is also a financial opportunity. Coyote Ventures and FemTech Focus previously published a report that calculated women’s health as a $1 trillion market opportunity (Crunchbase). This includes 97 health conditions that solely, disproportionately, or differently affect girls, females and women. Menstruation, maternal health, fertility and sexual wellness account for 51 percent of the total femtech startup landscape and there are many more issues to solve. All areas of women’s health are still in desperate need of research, investment and innovation. 

This is why at Coyote Ventures we have chosen to focus on women’s health. Coyote Ventures was set up one year ago to help right this wrong; by choosing to invest in companies with innovations and solutions for conditions that solely, disproportionally, or differently affect women. Let’s use Women’s History Month this year to reflect on how we can better heal women and give them the hope they deserve for the future. 

We put some questions to three founders of Coyote Ventures portfolio companies about how they’re helping change the future of women’s health. 

How is The Flex Co. changing the future of women’s health?

The Flex Co. designs thoughtful solutions to manage menstrual health with sustainable and comfortable alternatives to tampons and pads. Flex products spend years in R&D before launch so they can invent solutions to real period pain points such as leaking, bloating, cramping and odors, to provide 100% body-safe options for all people with periods. Their R&D process is customer-led, meaning that product design, marketing, and messaging are iterated on based on feedback from people who menstruate. 

– Lauren Schulte Wang, The Flex Company

How does Hera see advancing science for endometriosis as part of the solution for women’s health?

Hera is working to develop a simple test that diagnoses endometriosis more quickly and less painfully, as opposed to the current standard of care which is invasive surgery. The technology they use has existed for many years but has never been brought to help solve this pain point in women’s health. Hera was founded by a serial entrepreneur and research scientists who combined their expertise and passion for this problem to find a new solution to diagnose endometriosis. This diversity of thought, unique approach, and the application of existing technology in a new way is a central theme in the wave of innovation we’re seeing in women’s health. 

– Somer Baburek, Hera Biotech

How will Wile move forward the conversation around menopause?

Given the state of the world, we cannot have our best people (women in the second half of their lives) benched by unnecessary perimenopause symptoms. The world needs the unique creativity, power, wisdom, clarity, leadership, and insight this life phase delivers to address the increasing numbers of challenges our planet and societies face. This is where Wile steps in with a product ecosystem that is not only unprecedented in terms of efficacy, but also in terms of giving women products that they want and need for the experiences and symptoms that they are going through on a day to day basis. All via formats and delivery that feel more like self care than treatment of an illness. Because we are not ill, we are growing, and should be thriving. 

– Gwen Floyd, Wile Women

How does sexual wellness play a role in overall health?

Sexual wellness, which includes not just basic sexual function but also pleasure, gender identity and expression, as well as sexual orientation and expression, is an important facet of overall health. Organizations like the WHO, ACOG, and the UN support this value, and soon products that help people express and enjoy their sexuality will be treated just like any other product that improves health like meditation, nutrition, or fitness. 

– Andrea Barrica, O.School

As we put Women’s History Month behind us for another year, it’s important to continue to redress this historical imbalance towards women’s health. Coyote Ventures will continue supporting/seeking innovative ideas and products that help right this wrong and allow women to live life to the fullest. 

This article was written in collaboration with Jennifer Sawyer, Gender Expert at Jennifer Sawyer Consulting. Jennifer has worked on women’s rights and gender equality for over 10 years, providing tailored support to companies and non-profits on strategy and implementation. She has a diverse background designing, implementing and evaluating strategy and programmes for social justice and gender equality, with particular expertise on women’s health, empowerment and financial inclusion. 

This article originally appeared on LinkedIn and was published here with permission.

Jessica Karr

Jessica Karr

Jessica Karr is a Founding General Partner of Coyote Ventures, an early stage venture capital fund investing in women’s health and wellness. Jessica worked for 6+ years designing and launching the Impossible burger as the 12th employee. She consulted with over a dozen startups internationally on product strategy and led the investment team at DuContra Ventures, a celebrity-founded impact VC fund. Her angel investments have all grown to become unicorns, and she’s a proud LP in women-led funds.

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