For all the sophistication of modern medicine, one remarkably old-fashioned assumption has proved difficult to shake: the standard human body is male
Consider the numbers. In drug trials, 72 percent of studies fail to provide data broken down by sex and gender. Fewer than 0.4 percent of clinical trials in the EU include pregnant women, and just 0.1 percent include breastfeeding women
And over almost four decades of EU-funded research, just 10 projects out of 145,983 have focused specifically on endometriosis, a condition affecting an estimated 10-15 percent of women of reproductive age
These figures tell us something bigger than how much attention women’s health receives. They reveal how medical knowledge itself has been constructed
For decades, research was centred on male bodies. Women, particularly those of reproductive age, were routinely excluded from clinical trials. Hormonal cycles complicated research. Pregnancy complicated it further.
There was a certain scientific convenience to studying the male body. Researchers could avoid hormonal fluctuations and the ethical and medical complexities surrounding pregnancy
But convenience has a price. Removing women from research did not remove biological differences from the real world, it left medicine with less evidence about them. The resulting knowledge gaps became embedded over decades in the way diseases are recognised and patients are treated
That is where the male default becomes consequential
Research becomes evidence; evidence informs diagnostic criteria, drug doses and treatment guidelines; and those guidelines eventually shape the decisions doctors make
When the underlying data is incomplete, those gaps carry through the entire system
Cardiovascular disease offers a telling example. It is the leading cause of death among women in the EU, yet women can experience symptoms historically described as “atypical”
Atypical compared with whom? Women are twice as likely to have heart failure misdiagnosed
Once you start looking for the male default, it appears elsewhere
Endometriosis can take six to 10 years to diagnose, despite affecting millions of women. Menopause symptoms affect 85 percent of women, while medical research has concentrated heavily on the years of fertility, leaving perimenopause and menopause comparatively overlooked
There is a revealing pattern here. Women can be considered too biologically complicated for research, while conditions affecting them are simultaneously poorly understood because the research is missing
The knowledge gap then becomes part of the reason diagnosis is difficult. Symptoms of endometriosis, for example, can still be dismissed as “normal period pain”
Funding reinforces the cycle. In 2020, just five percent of global research and development funding was allocated to women’s health research. What we choose to research determines what we understand; what we understand determines what we can diagnose and treat
A serious approach to women’s health must also include sexual and reproductive health and rights, including access to safe and legal abortion
These issues cannot be separated from the wider question of whether healthcare systems are designed around women’s needs and realities
We need to think more broadly about women’s health policy. Better healthcare for women across every stage of life begins long before the waiting room. It begins in laboratories, research grants, clinical trials and datasets. The quality of care at the end of the chain depends on the quality of evidence at the beginning
For Europe, closing these gaps is also an economic and scientific opportunity. The World Economic Forum estimates that closing investment gaps in women’s healthcare could add $1 trillion [€860bn] to the global economy annually by 2040. Better research can improve lives while opening new areas for European science, biotechnology and medical innovation
Europe already has many tools it needs to close these gaps. Sex and gender-based analysis should become standard in research. EU-funded projects should provide sex-disaggregated data. Research funding should better reflect the prevalence and burden of conditions affecting women, and medical education should prepare doctors to recognise how diseases can present differently across sexes
Europe has spent decades building a health and research system that aspires to lead the world. Scientific leadership also means being willing to revisit the assumptions on which that system was built
Half the population should never be the variation. The evidence base must reflect the population it is meant to serve
For decades, research was centred on male bodies. Women, particularly those of reproductive age, were routinely excluded from clinical trials. Hormonal cycles complicated research. Pregnancy complicated it further
