Keep Pushing Women’s Health Research Forward

Keep Pushing Women’s Health Research Forward

By Paul J. Fadel, PhD

Women’s health research has gained a lot of well-deserved attention in recent years, and while important advances have been made, we have much more work to do to make up for a long history in which women were regularly overlooked in research.

Researchers excluded women from studies due to concerns about their menstrual cycles and hormonal fluctuations. There was also the notion that there was more inherent variability in females compared to males. The latter has definitively been shown to not be the case; there is plenty of biological variability in both males and females. Plus, fluctuations in hormones does not justify the exclusion of women.

The need to study both sexes is clear and should no longer be ignored. APS has been at the forefront of promoting research in women, and to further these efforts the Society has announced the 2024–2025 Women’s Health Research Initiative. This initiative aims to elevate women’s health and highlight the research conducted by APS members to address health and disease in women. We should applaud these efforts because while progress has been made, more work is needed.

A recent study found that women only accounted for 41% of participants in clinical trials from 2016 to 2019. While this may sound good, for many of the diseases being studied, women make up over 60% of the population affected. Another major issue is the exclusion of women from minority groups. For example, non-Hispanic Black women are at equal or even greater risk than non-Hispanic Black men for hypertension and cardiovascular disease—rates much higher than any other racial group. But in many clinical trials, race is not being fully considered and non-Hispanic Black women remain underrepresented.

The National Institutes of Health policy on sex as a biological variable has maintained the expectation that all studies in vertebrate animals and humans will factor sex into research design, analysis and reporting. This policy has undoubtedly facilitated the inclusion of women in research studies, and we now also see many vertebrate animal studies including female animals. While this is needed and encouraging, care needs to be taken to make sure comparisons between males and females are statistically powered when drawing conclusions.

Many studies that now include males and females will have low numbers of each because the intention is not to investigate sex differences per se. This is fine. However, sometimes reviewers will ask about sex differences and authors will be obliged to say there are no differences. The problem is that statistical power is not being fully considered, and now a false finding of “no” sex differences is in the literature. All of us—from editors to reviewers and authors—need to make sure this does not happen! Let’s not take a positive of including both sexes and turn it into a negative because it’s not statistically powered.

Despite tremendous progress, we still have a way to go in advancing women’s health research to continue to close the gap and make sure health-related decisions for treatment are well-founded for women.

Paul J. Fadel, PhD, is a professor in the Department of Kinesiology, associate dean for research, director of clinical translational science and the Moritz Chair in Geriatrics, College of Nursing and Health Innovation at the University of Texas at Arlington. His research focuses on the investigation of neural control of the circulation at rest and during exercise in human health and disease, with a specific emphasis on the sympathetic branch of the autonomic nervous system.

This article was originally published in the January 2025 issue of The Physiologist Magazine. Copyright © 2025 by the American Physiological Society. Send questions, comment or column idea to tphysmag@physiology.org.