A woman goes into the emergency room with stomach pain. She’s on the verge of having a heart attack, but because her symptoms are different from a man’s, her doctor gives her antacids and refers her to a gastroenterologist.
Studies show women are significantly more likely than men to have cardiovascular symptoms misdiagnosed. And cardiovascular disease is just one area where medicine’s understanding of women’s health lags behind men’s. At the University of South Carolina, researchers in multiple fields are working to address the women’s health care gap.
One of them is Alyson McGregor, an emergency medicine physician, professor and associate dean of faculty affairs and development at the School of Medicine Greenville. She is nationally recognized for her pioneering work as an academic, advocate and author on the topic of sex and gender in medicine.
When it comes to health care, McGregor says the differences between men and women historically have been defined by the reproductive systems — a bias that has been called “bikini medicine.”
“Medicine long treated the male body as the default. We built much of our understanding of physiology from studies in men and then applied those findings to women, except when it came to reproduction. But we now know that organs like the heart differ in women all the way down to the cellular structure of their arteries,” she says.
The field of cardiovascular health was one of the earliest areas in medicine to recognize that differences between men and women warranted more attention. When McGregor was completing her residency with The Warren Alpert Medical School of Brown University, she began to explore the topic.
“I thought, ‘Well, if women have different symptoms of heart attack, is that because they have different ways of developing a heart attack? If so, why is that the case?’ That really brought me into the world of sex and gender and females being different from males down to our DNA.”
Back to the basics in biology and history
McGregor had to unlearn some of her earliest science lessons. In high school biology class, students learn that a human embryo gets XX or XY chromosomes. Those chromosomes tell the fetus to develop either male or female sex organs, which determine which hormones come into play as the person grows up. End of story.
“We thought those hormones primarily affect reproduction, and that’s it, but that’s not the case,” she says. “Those chromosomes are in every cell in our body, and they’re not dormant. They are still doing things: They are affecting inflammatory conditions, affecting your liver, your kidneys and how your body metabolizes and excretes medications.”
“What’s encouraging is that this is no longer really a question. We now understand that good evidence-based medicine means studying both males and females — and analyzing those data separately instead of pooling them together.”
In addition to these DNA differences, McGregor says men and women have receptors all over the body that respond to hormones like estrogen and testosterone. The differences in how men and women are socialized — how gender norms influence lifestyle — also play their part in creating a complex picture of overall health and wellness.
Yet, women were largely excluded from medical research until relatively recently. In 1974, the FDA’s National Research Act listed pregnant women among its groups of “vulnerable” populations. McGregor says the purpose of the act was to protect developing babies from the harm of non-consensual research, “though it’s not a good way to look at it because we do need to study pregnant women.”
In the 1950s and ’60s, the world was rocked by the Thalidomide tragedy, as babies were born with devastating limb defects caused by a medication believed safe for pregnant women. The act aimed to prevent another such tragedy, but the legislation was interpreted so broadly as to prevent any women who could possibly become pregnant from participating in a research study. The result was a deepening of the sex and gender divide.
Looking toward a better future for women’s health
This divide is deeply entrenched and can still be seen in many areas of medicine and research, such as clinical trials for prescription drugs. While the U.S. passed legislation in the 1993 overturning the National Research Act and requiring NIH-funded clinical trials to include women and minorities, these groups remain underrepresented.
Still, McGregor is optimistic about the progress being made in women’s health.
“What’s encouraging is that this is no longer really a question. We now understand that good evidence-based medicine means studying both males and females — and analyzing those data separately instead of pooling them together,” she says.
Women’s health care is also gaining ground as the next generations of students come into a system that is more aware of sex and gender. McGregor joined the faculty at the School of Medicine Greenville in 2022 to help launch the school’s Office of Faculty Affairs and Development. In 2023, she received a grant from the National Institutes of Health for a new program to help faculty integrate gender and sex into their practice and teaching.
McGregor and her team are creating a toolkit for educators to do just that. The grant has been extended through 2026 so that the work can continue. They are now updating the medical school’s hallmark lifestyle medicine curriculum.
“We’re at the point where students have broken the curriculum up into pieces, looked at their assigned topics and are updating the curriculum to include the new information using the toolkit,” she says.
The curriculum is available online internationally, and the team is going to publish their work separately to spread even more awareness of the importance of sex and gender in medical education.
As a teaching physician herself, McGregor is doing her part to get her students up to speed on the issues that still affect women’s health care. As a researcher, she’s excited to see what the coming years hold in bridging the gap in knowledge of female bodies.
“Technologies like AI give us powerful new tools to identify gaps in women’s health research,” she says. “We still need to collect more data on women, but the encouraging part is that the conversation is now focused on how to close those gaps.”