For much of modern medicine, the male body was treated as the default.

In 1977, FDA guidance recommended excluding women of childbearing potential from early phases of drug trials. That policy changed in the early 1990s, and in 1993, the NIH Revitalization Act made the inclusion of women in NIH-funded clinical research a matter of federal law.

We’ve come a long way since then. But we’re still learning how much these differences matter.

Being female can influence how disease shows up, how we respond to medications and how our health risks change over time. Pregnancy, reproductive history and menopause can also offer important clues about future heart, bone, metabolic and brain health.

Being female is more than a box to check when you’re filling out medical paperwork. It should influence how we think about your health and prevention throughout your life.

Heart Disease Can Look Different in Women

Think about how a heart attack is usually portrayed on television or in movies. Someone suddenly grabs their chest with crushing pain, often with pain shooting down an arm. That image is so ingrained that it can shape what we think a heart attack is supposed to feel like.

Women can absolutely experience that classic chest pain. In fact, chest pain or discomfort is still the most common heart attack symptom in women. But women may also experience symptoms that don’t fit that familiar picture, including:

  • Extreme or unusual fatigue
  • Shortness of breath
  • Nausea
  • Pain in the back, neck or jaw
  • Discomfort that feels more like indigestion or heartburn


If you’re expecting a heart attack to look like the dramatic version you’ve seen on television, those symptoms can be easier to dismiss.

That is especially important when you consider that heart disease remains the leading cause of death for both women and men in the United States.

There’s another part of the story that I wish more women knew: your cardiovascular history starts much earlier than you may realize.

Preeclampsia, high blood pressure during pregnancy and gestational diabetes aren’t just pregnancy complications that disappear from your medical history once the baby is born. They are associated with a higher risk of cardiovascular disease later in life.

Menopause adds another layer. As estrogen declines, we can see changes in cholesterol, body composition, blood pressure and other cardiovascular risk factors.

That’s why I want to know your reproductive history when I’m assessing your heart health. What happened at 30 or 35 can still be relevant at 50 or 60.

We Need to Think About Bone and Muscle Before There Is a Problem

There’s another message women have heard for decades that I think we need to reconsider: smaller is better.

Women have traditionally been encouraged to stay thin, burn calories and do cardio. Strength training was often viewed as something men did because women didn’t want to get “bulky.”

When I think about healthy aging, though, I’m much more interested in whether a woman is strong than whether she can make the number on the scale smaller.

Women already have less muscle mass than men on average. Menopause then creates an important shift for both muscle and bone. As estrogen declines, bone loss accelerates.

Yet routine osteoporosis screening for women at average risk generally doesn’t begin until age 65. Younger postmenopausal women may qualify for earlier screening based on their risk factors. That doesn’t mean we should wait until 65 to start caring about bone health.

This is where prevention matters. Strength training, adequate protein and making sure you’re getting enough calcium and vitamin D when appropriate can all help support healthy aging. For some women, menopausal hormone therapy may also be part of the conversation because one of its established benefits is helping prevent bone loss associated with menopause.

I think of muscle as an insurance policy for aging. It supports our bones, metabolism, balance and our ability to remain active and independent later in life.

Women’s Brain Health Deserves Attention, Too

Almost two-thirds of Americans living with Alzheimer’s disease are women.

For a long time, one of the easiest explanations was that women simply live longer. Age is the biggest risk factor for Alzheimer’s, so longevity certainly plays a role. Researchers are continuing to investigate whether there is more to the story, including hormonal changes, genetics and cardiovascular and metabolic health.

There is also a lot of interesting research happening around estrogen, menopause and the brain. Hormone therapy is not currently recommended specifically to prevent Alzheimer’s or dementia, so I would not prescribe it for that purpose alone. I do think this is an area worth watching as the research evolves.

What we already know is that the brain doesn’t exist separately from the rest of the body. Many of the things we do to protect the heart also support the brain:

  • Regular exercise
  • Healthy blood pressure
  • Good metabolic health
  • Quality sleep
  • Not smoking


This is one reason I don’t think we should talk about heart health and brain health as if they’re two completely separate conversations. The same habits that protect us in one area often have benefits throughout the body.

Women’s Symptoms Have Not Always Been Taken Seriously

Autoimmune disease is one of the clearest examples of why listening to women matters.

About four out of five people diagnosed with an autoimmune disease are female. That includes conditions such as lupus, rheumatoid arthritis, Sjögren’s syndrome, multiple sclerosis and autoimmune thyroid disease, although the degree of difference varies by condition.

The challenge is that autoimmune disease doesn’t always announce itself with one obvious symptom. It may start with fatigue, joint or muscle aches, rashes or brain fog. Sometimes it’s simply a collection of symptoms that can be difficult to explain and easy to dismiss.

That intersects with another part of women’s medical history.

Women have faced a long history of having symptoms attributed to being emotional, stressed or simply “complaining.” Even today, I hear from women who have been told they’re tired because they’re busy, achy because they’re getting older or that what they’re experiencing is “just hormones.”

Of course, fatigue doesn’t automatically mean you have an autoimmune disease. There are many reasons someone may not feel like themselves.

But persistent symptoms deserve to be taken seriously and looked at in context. When something doesn’t feel right over time, it’s worth asking why.

Even Medication Dosing Can Be Different

If you want a very concrete example of why including women in medical research matters, look at the sleep medication zolpidem, better known by the brand name Ambien.

Researchers found that women, on average, cleared the medication from their bodies more slowly than men. That meant some women still had enough medication in their system the following morning to impair activities such as driving.

In 2013, the FDA required lower recommended starting doses for women for certain zolpidem products. I think this example is fascinating because it takes this entire conversation out of the theoretical.

The same medication at the same dose does not necessarily behave exactly the same way in a woman’s body and a man’s body. Differences in body composition, hormones and how drugs are absorbed, distributed and eliminated can matter.

This is exactly why studying women specifically matters. Better representation in research can change the way we prescribe and use medications.

Hormones Don’t Only Affect Your Period

For too long, we’ve treated reproductive health as if it sits in its own little corner of women’s medicine. You see the gynecologist for periods, fertility and menopause. You see someone else for your heart, bones, metabolism or sleep.

Your body doesn’t operate in those separate boxes.

PCOS isn’t only about periods and fertility. It can also be associated with insulin resistance and increased metabolic risk.

Pregnancy isn’t only relevant while you’re pregnant. What happens during pregnancy can tell us something about your future cardiovascular health.

Menopause isn’t simply the end of your period, either. Estrogen drops significantly around menopause, while testosterone, which women naturally produce too, also changes with age. These hormonal shifts can affect bone, muscle, body composition, sleep, sexual health and more.

This is why I often tell women that menopause is a window of opportunity. It’s a time to look at what has changed, assess your risks and think proactively about how you want to age.

We shouldn’t wait until a woman develops osteoporosis, cardiovascular disease or significant muscle loss to start having these conversations.

Your Women’s Health History Is Part of Your Whole Health History

If you’re a woman, I want you to know more than your cholesterol and blood pressure.

I want you to know your reproductive history:

  • Did you have gestational diabetes, preeclampsia or high blood pressure during pregnancy?
  • Do you have a history of PCOS or irregular cycles?
  • When did you go through menopause?


I also want you to know your family history of heart disease, osteoporosis, autoimmune disease and dementia. Pay attention to your strength, muscle mass, sleep and metabolic health as you age. These issues are connected.

For much of medical history, we didn’t always look at women’s health this way. We separated reproductive health from whole-body health. We studied men and assumed much of what we learned would apply equally to women. We taught women to recognize symptoms based on presentations that weren’t always representative of their experience.

We know better now.

Women are not small men. The more we understand the clues that are unique to women’s bodies and the different stages of women’s lives, the better we can move from reacting to disease to preventing it.