Introduction
Medical science has learned an enormous amount about the human body, but not equally about every body. For most of modern history, women were largely absent from the clinical trials that shape how disease gets diagnosed and treated, and what we “knew” about the body was learned primarily from male subjects, then simply assumed to apply to everyone. That absence shapes what happens in healthcare every day, especially when a woman’s symptoms don’t fit a template that was never built with her in mind.
This isn’t a post about doctors failing to care. Instead, it shines light on a knowledge base that has real, documented gaps and what it means for women in seeking treatment, especially in mental healthcare.
When the Default Answer is “Anxiety”
One distinct memory from my time in undergrad captures this experience well. I was experiencing random, sharp chest pains every once in a while. There never seemed to be a precipitating cause, but it was concerning enough that I sought medical advice. After some tests that came back inconclusive, my cardiologist told me that it was “probably anxiety,” but prescribed me an inhaler just in case it was asthma. Although that wound up being untrue, thankfully I managed to find care elsewhere and am completely fine.
My experience is just one example, and an incorrect or incomplete diagnosis on its own doesn’t tell us why it happened. But research has documented broader sex and gender disparities in how symptoms are recognized, investigated, and treated. Women’s physical symptoms, for example, may be more likely in some settings to be attributed to psychological causes such as stress or anxiety.
That problem is distinct from—but exists alongside—another longstanding gap in medicine: women have historically been underrepresented in important areas of medical research. When the evidence base itself doesn’t fully account for differences in how diseases and treatments may affect women, clinicians can be left with an incomplete picture. Understanding that history helps explain why achieving equitable care requires looking not only at what happens in the exam room, but also at the research on which those decisions are based.
A Research Foundation Built Without Half the Population
For most of modern medical history, women were largely absent from the clinical trials that shape how we diagnose and treat disease. It wasn’t until the passing of the NIH Revitalization Act of 1993 that women were required to be included in NIH-funded clinical research at all. Before that, much of what we knew about how the body responds to disease and medication was learned primarily from male subjects, and then simply assumed to apply equally to everyone.
Progress has been made since then, but the gap hasn’t closed. In psychiatry, for example, women account for a majority of people living with psychiatric disorders, yet make up a significantly smaller share of participants in psychiatric drug trials. And conditions that disproportionately affect women, from migraines to endometriosis, remain underfunded relative to how much they affect quality of life. The result is a medical system that still doesn’t fully understand how disease and treatment show up differently in women’s bodies.
Mental Healthcare Implications
This research gap follows women directly into mental healthcare. Diagnostic criteria, symptom checklists, and even our sense of what a “typical” case looks like were often built on research samples that lean male. When women’s symptoms don’t match that template exactly, it doesn’t mean that everything is okay, it often indicates that the model itself is incomplete.
One of the most common ways this plays out is an almost reflexive explanation. A woman raises a concern, and it gets attributed to stress or hormones before anything else is considered. This is not to say that hormonal fluctuations don’t affect mood – it is worth taking seriously in its own right. However, treating “it’s probably hormones” as a default answer rather than one possibility among several can delay accurate diagnosis and appropriate care. It cuts both ways too. Some women are diagnosed too quickly with conditions like depression, when a fuller picture might reveal something else entirely, while others go undiagnosed for years because their symptoms were minimized from the start. A more familiar version of this story is ADHD and Autism Spectrum Disorder. Both were defined largely around how they present in men – hyperactivity and impulsivity for ADHD, more overt social differences for ASD. Girls and women more often show the quieter, inattentive form of ADHD or learn to mask autistic traits so effectively that clinicians miss them. The average girl with ASD is diagnosed noticeably later than the average boy, and many women are not diagnosed with either condition until well into adulthood after years of being told that their symptoms indicated something else like anxiety, low motivation, or simply their personality.
The Deeper Gap: Perinatal Mental Health
Nowhere is this evidence gap more consequential than in perinatal mental health (the period
spanning pregnancy through the first year postpartum). Postpartum depression and anxiety are common, affecting somewhere between 10 and 20 percent of new mothers, yet anxiety in particular tends to be underrecognized compared to depression, even though it can be just as disruptive. Postpartum psychosis is far rarer but far more serious, and it’s often poorly understood outside of clinical settings, and sometimes even within them. Early symptoms can be misread as insomnia, adjustment difficulties, or simple exhaustion before the fuller picture becomes clear, which can delay the urgent care these cases require. It’s also worth noting that a significant share of what looks like “postpartum” depression may have actually begun during pregnancy itself, which shapes how and when screening should happen. Layered on top of all of this is the fact that we still know surprisingly little, with real scientific certainty, about how psychiatric medications affect pregnancy and breastfeeding. Ethical and practical barriers make it extremely difficult to run the kind of rigorous trials we’d normally rely on for data in this population. Much of what clinicians use to guide these decisions comes from
observational studies, patient registries, and case reports. While the information is still valuable, it is a different tier of evidence than a randomized controlled trial. That leaves patients and clinicians navigating the difficult decision of whether to start, continue, or stop a psychiatric medication during pregnancy or while breastfeeding with less certainty than almost any other area of medicine would tolerate.
Toward More Equitable Mental Healthcare
This is not intended to be a reason for alarm, but rather a reason for awareness. A moreequitable model of healthcare could include a wide range of ideas, such as clinical trials thatreport and analyze results by sex and gender as standard practice or real financial investment in perinatal psychiatric research so treatment decisions can be made with better evidence. Medical science has not failed women outright, but it has left significant blind spots. Mental healthcare, especially around perinatal periods, is one of the clearest examples. Understanding where those gaps exist doesn’t just inform better research policy. It helps patients ask better questions and clinicians listen more closely when the standard answer doesn’t quite fit.