Exploring the gap between normal pathology and lived experience in women’s health
You go to the appointment and describe the sore joints, low energy, flat mood, and broken sleep. Some blood work is run. You are told everything is normal. What you know is, you feel anything but fine.
During Women’s Health Week, we encourage women to listen to their bodies, prioritise their health and seek help when something doesn’t feel right. But what happens when they do exactly that and the answer they receive is that nothing appears to be wrong?
This is a common story. What nobody is talking about is the reason your experience doesn’t match what the test results are saying isn’t because you’re being dramatic or that what you are experiencing is psychosomatic. It’s that the evidence base your care is built on wasn’t designed with women’s biology at its centre.
Your bloods may have come back normal because routine pathology was built to rule out disease, not to explain why you feel unwell. Medicine is exceptionally good at the first job and much less good at the second, especially in the years before anything has tipped into something a test can name. For many women, particularly through the reproductive years and perimenopause, that difference is the whole story.
To add to this, for most of modern medicine’s history, the default research body was male. Women were treated as though we were small men, when there are in fact profound biological differences in hormones, immune function, cardiovascular disease, metabolism and drug responses. Drugs were commonly developed and tested in men, with the expectation that the findings would apply equally to women.
The science of how a female body actually moves through midlife, how hormones shape mood and metabolism and the brain across decades, was never done in any great depth. In some places it got skipped entirely. One recently graduated doctor told me that they were taught about menopause in one lecture. A transition that can take a decade to move through with systemic signs and symptoms that is leading to women prematurely leaving the workforce and suffering personally, a transition that 100% of women go through gets one lecture.
In 1975 medicine settled on a standard human body for its calculations and named it Reference Man: white, 20 to 30 years old, 70 kilograms, 170 centimetres tall. Originally developed to model safe radiation exposure, the concept of ‘Reference Man’ came to influence many areas of medicine, occupational health, safety standards and product design, reinforcing the idea of the male body as the default.
Women’s biology was reduced to their reproductive organs, and the rest was treated as a rounding error: the heart that beats faster, the bones that thin sooner, the brain that is mapped differently, the liver that clears a medication at its own rate.
That gap doesn’t stay in the journals. It walks into the appointment with you, as the test that wasn’t ordered, the symptom that didn’t fit the panel, the result that is interpreted as normal while you know you are struggling.
This isn’t a feeling. It’s a measurement. Only around 5-10 percent of clinical trials report their results broken down by sex. Look at specific conditions and it gets worse. Roughly 7 percent of migraine trials publish sex-specific findings. About 17 percent for ischaemic heart disease, the thing most likely to kill us. We are half the population and a footnote in the data.
Footnotes have consequences. Because so much of what we’re prescribed was tested mostly on men. Women experience serious adverse drug reactions substantially more often than men, and serious or fatal ones about 36 percent more often. We get handed the male dose, then are treated as a mystery when our bodies object.
Then there’s the cost of that gap, sized properly for the first time. Women spend 25 percent more of their lives in poor health than men. The average woman will spend around eleven years of her life unwell. Not dying. Living, working, mothering, leading, while unwell, often without a formal diagnosis.
And it doesn’t spread itself evenly across a life. More than half of that gap lands in your working years, the stretch where you’re earning, raising people, holding things together. The years you can least afford to run at sixty percent. McKinsey costed the other direction too, what closing the gap would give back: around seven healthy days a year for every woman, more than 500 days across a lifetime. Close to a year and a half of yourself, returned.
And when women’s health does get attention, it gets shrunk to one thing: reproduction. Periods, pregnancy, fertility. Yet sexual and reproductive health account for only about 5 percent of the actual burden women carry. The other 95 percent, the metabolic, the cardiovascular, the cognitive, the long midlife transition that can run for more than a decade, is exactly the territory that’s been studied least.
Follow the funding and the same pattern shows up. There’s up to ten times more new treatment in development for women’s cancers than for the conditions that quietly take the most years: menopause, endometriosis, PMS, PCOS/PMOS. Put it next to this. When Viagra launched in 1998, for a condition affecting an estimated 152 million men, it made 400 million dollars in US sales in three months. The contrast illustrates how investment has historically followed commercial incentives more readily than the conditions affecting women’s health. It’s where the attention has been pointed.
So let me say the thing your normal bloods couldn’t. What you’re feeling is not a personal failing. It’s often the space where medicine hasn’t yet found a disease to name.
Medicine excels at identifying pathology once it is measurable. It has been far less successful at helping women understand the long years when something is changing, but nothing is yet considered medically wrong.
The map is finally being drawn. The World Economic Forum now frames women’s health not as a niche or a welfare line but as economic infrastructure, a trillion-dollar opportunity sitting in plain sight. The research is catching up. The money is starting to follow.