In May 2024, the Dutch government announced a €27.5 million investment to finally tackle one of the most persistent blind spots in healthcare: the gender health gap (1). For decades, medicine has been built around the male body as the “standard,” leaving women underrepresented in research and underserved in treatment. The consequences are everywhere—from contraceptive procedures that are still performed with little pain relief, to life-threatening conditions that are misdiagnosed because women’s symptoms look different than men’s (2).

Science is only beginning to uncover what was overlooked. Researchers at Amsterdam University Medical Centers, for example, found that female elite athletes’ hearts adapt to training in a completely different way from their male peers—yet diagnostic guidelines remain largely male-based (3). Or take the case of Ambien, a popular sleep medication. Approved after trials that mainly involved men, it was prescribed at the same dosage to women. Years later, studies showed women metabolize it more slowly, leaving them impaired the next morning—linked to higher rates of drowsy driving and car accidents. Only in 2013 did regulators cut the recommended dose for women in half (4).

This article explores the roots of these gaps, their wider social and economic impact, and the efforts now underway to close them.

The missing half in medical knowledge

Despite advances in medicine, women continue to face significant disparities in research and healthcare, affecting diagnosis, treatment, and quality of life. One of the clearest examples is the understudy of conditions that predominantly affect women. Disorders such as endometriosis, polycystic ovary syndrome (PCOS), autoimmune diseases, and menopause-related health changes remain poorly understood, with limited treatment options and delayed diagnoses. Mental health conditions—including postpartum depression, anxiety, and mood disorders linked to hormonal fluctuations—also suffer from insufficient research and tailored interventions (5).

Drug dosing and side effects further illustrate the consequences of these knowledge gaps. Women metabolize some medications differently than men, yet many drugs have been tested primarily on male participants, leading to miscalibrated dosages and overlooked risks. Although about 90% of trials now include both sexes, this doesn’t guarantee meaningful analysis of sex-based differences. A review of a decade of U.S. preclinical studies found that while inclusion improved, reporting by sex did not. Across disciplines, only 5–14% of studies examine outcomes by sex, and fewer than a third of phase three trial results are broken down by sex in medical journals (6).

A striking example comes from heart disease, one of the leading causes of death for women. Research and training have long been shaped by the male presentation of heart attacks—crushing chest pain radiating down the left arm. Yet women often present with different symptoms, such as nausea, shortness of breath, fatigue, or pain in the back and jaw. As Caroline Criado Perez, feminist author, activist and journalist, highlights in her book Invisible Women, these differences mean women are more likely to be misdiagnosed or dismissed, sometimes as suffering from anxiety or indigestion. The result is that women receive treatment later than men, contributing to higher mortality rates after cardiac events. This is not a rare oversight; it is a systemic failure rooted in decades of male-centered research (7).

A further gap lies in pain management. Many women receive none or inadequate pain relief for reproductive procedures such as IUD insertion, endometrial biopsies, or childbirth. Chronic pain syndromes like fibromyalgia are often dismissed or undertreated, reinforcing the perception that women’s suffering is “normal” or exaggerated (8). That pain experienced by men and women is approached differently by doctors is no new information. A study from 2008 shows that women who report having acute pain while in the emergency room, are less likely than men to be prescribed any sort of painkillers. If they are prescribed, men receive them quicker than women (9). A study from 2014 in Sweden shows that women who are taken to the emergency department are less frequently classified as urgent and have to wait longer before a doctor comes to visit them while in the emergency department (10).

Funding plays a big part here. Although there are interventions possible where, for instance, an IUD would be less painful, funding would remain a challenge (11). In most countries, women are expected to pay for such procedures themselves. This is in stark contrast with issues that affect male health. Research on the funding by the U.S. National Institutes of Health shows that in nearly 75% of the cases where a disease affects primarily one gender, the funding pattern favours males (12). This enables more proactive approaches focused on male health.

In sum, the current gaps are multifaceted: insufficient research, underrecognized conditions, inadequate treatment protocols, and uneven attention to pain and mental health. These gaps are not merely academic—they shape women’s experiences, health outcomes, and quality of life at every stage of life.

Understanding the causes of the gap

The disparities in women’s health research and care are the result of intertwined historical, social, and institutional factors. Historically, medicine has treated the male body as the default, with women often excluded from clinical trials and preclinical studies. Female animals’ hormonal cycles (for instance in mice or rodents) were thought - this assumption has later been proven wrong - to introduce variability into results, making data “messier.” Researchers believed that male animals would give “cleaner” data, so they defaulted to using them. Concerns about hormonal variability and potential pregnancy risks led to a male-centered knowledge base that still shapes diagnostics, treatment protocols, and drug dosing today (13).

Social attitudes and cultural norms have further reinforced these gaps. Women’s pain—particularly in reproductive or gynecological contexts—has often been minimized or dismissed as “natural” and “normal.” Conditions like menstrual pain, endometriosis, and postpartum depression have historically been overlooked, resulting in delayed diagnoses and limited treatment options. Mental health is similarly affected: gendered stigma and the insufficient study of hormonal influences contribute to under-recognition and undertreatment of depression, anxiety, and stress-related disorders in women (14).

Similarly, politicians, most notably American President Donald Trump, continue to politicize women’s rights, especially female reproductive rights. This feeds into a culture where true gender equality is a topic of discussion, a topic that can be agreed or disagreed with, rather than a culture where women’s health is recognized as a fundamental human right (15). The exclusion of women and their experiences from research has once again become normalised. In February of this year, Trump's federal funding cuts shut down studies on Alzheimer’s care, uterine fibroids and pregnancy risks, specifically because these studies focus on gender (16). respect for reproductive rights and is having a much broader impact on the health and economic rights of women and girls inside the United States. Abortion is currently illegal in 12 of the 50 US states, which does not only affect the health of women and girls, but also impacts their socio-economic opportunities. With Trump cutting down on global aid programs supporting women and female health, Trump's second time in office will negatively affect women’s health all around the world (17).

Together, these factors create a self-reinforcing cycle: systemic neglect and political opposition leads to under-researched conditions, which perpetuates clinical oversight, misdiagnosis, and inadequate care.

The social-economic impact of the health gap

The health gap is not confined to hospitals and research labs; it has far-reaching consequences for women’s economic independence and societal participation.

One of the most visible effects is in the labour market. Chronic and untreated conditions such as endometriosis, migraines, autoimmune disorders, or menopausal symptoms lead to higher rates of absenteeism (missed work) and presenteeism (working while unwell and less productive). Women are also more likely to stall or step back in their careers due to untreated or poorly managed health issues, contributing to persistent gender gaps in career progression and leadership positions. According to research by the World Economic Forum and McKinsey Health Institute, addressing 9 female health conditions can create around $400 billion in annual global GDP by 2040 (18).

The impact extends into financial independence. Women often face higher out-of-pocket healthcare costs, whether for fertility treatments, contraception, or management of chronic conditions that are insufficiently covered by insurance (19). Combined with lower lifetime earnings due to interrupted career trajectories, whether as a result from motherhood or other health concerns, this contributes to the well-documented pension gap, leaving women financially more vulnerable in later life (20).

At a macro level, the broader economy loses out. When large portions of the female workforce are underutilized due to untreated health conditions, overall productivity and GDP suffer. The World Economic Forum and economic studies increasingly highlight that addressing women’s health is not only a matter of fairness but also of economic efficiency (21).

Finally, there are intergenerational impacts. Maternal health strongly influences child health, development, and educational outcomes. Poorly supported maternal care or untreated conditions during pregnancy can perpetuate cycles of inequality, affecting not just women but families and communities (22, 23).

In this way, the gender health gap is more than a scientific oversight—it is a driver of economic inefficiency, social inequality, and political underrepresentation. Addressing it is not just about better healthcare; it is about unlocking broader societal potential.

Closing the gap: emerging initiatives

In recent years, recognition of the women’s health gap has begun to translate into concrete action. Governments, research institutions, and advocacy groups are working to correct decades of neglect and reorient healthcare towards a more equitable future.

In the Netherlands, the government announced in 2024 an unprecedented €27.5 million investment to expand women’s health research and improve clinical care. This initiative aims to address under-researched conditions such as endometriosis, menopause, and cardiovascular disease in women (24). Similarly, there is increasingly more attention - and with that financial means available - to understand hormonal issues that women might experience and how this impacts their working career (25).

At the European level, the EU has placed women’s health on the political agenda. The EU Strategy on Gender Equality explicitly names health equity as a priority, while Horizon Europe funding calls have begun to mandate sex- and gender-sensitive research (26, 27).

In the United States, the National Institutes of Health (NIH) have introduced policies requiring that sex be considered as a biological variable in both animal and human studies. This shift, introduced in 2016, marked a turning point: researchers must now justify single-sex studies and design experiments that account for differences between men and women. While compliance has been uneven, it has spurred a wave of new insights into drug efficacy, disease patterns, and treatment responses across genders (28).

Alongside these institutional changes, there is increased focus on patient-centered innovation. Research into reducing pain during IUD insertions, for example, has accelerated with a new tool showing up to 73% less pain and up to 83% less bleeding, and further studies exploring local anesthetics, new insertion techniques, and device redesigns (29). Similarly, more attention is being paid to menopause care, with clinical trials of hormone replacement therapies tailored to women’s diverse needs (30).

Advocacy and public pressure also play a crucial role. Women’s health NGOs, patient groups, and campaigns have amplified stories of neglect, helping shift cultural attitudes and political priorities. What was once dismissed as niche is now recognized as a matter of equity and economic efficiency (31).

These initiatives mark the beginning of a paradigm shift. Closing the health gap will require sustained investment, enforcement of equity policies, and a cultural commitment to valuing women’s health as central to public health and societal progress.

From oversight to opportunity

The gender health gap is not merely a clinical oversight; it is a structural inequity that undermines women’s wellbeing and economic participation. From misdiagnosed heart disease to poorly managed chronic pain, from underfunded research to reproductive health procedures still performed without adequate pain relief, the consequences are profound and far-reaching.

Closing this gap requires more than incremental improvements. It calls for a systemic shift: research that fully accounts for sex and gender differences, policies that prioritize equitable access and funding, and a healthcare culture that listens to and values women’s lived experiences. Progress is visible—through investments such as those in the Netherlands, policy reforms at the EU and NIH, and growing advocacy—but much work remains.

Investing in women’s health is not only a medical necessity; it is a social and economic imperative. By addressing these disparities, societies unlock healthier lives, stronger economies, and fairer futures for everyone. Social dialogue between citizens, healthcare workers, government officials, and researchers is fundamental to realise this shift. Shall we?

This article is part of The Outside World, ftrprf’s very own research center.

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