Women struggle with anxiety at a rate two times higher than that of their male counterparts. These high levels of anxiety extend into the medical world and for good reason - women are not prioritized in medical research at the level they should be. In fact, the way in which medications impact the bodies of people assigned female at birth have not always been included in research studies (at all) or in the FDA approval process.
While strides have been made to improve women's involvement in clinical trials over the last four decades, there is much room for improvement to address gender bias in medicine and attain research that specifically considers the impact of treatments on women. It is the existence, and sizable nature of this gender gap, that directly contributes to women experiencing high levels of medical anxiety and, in some cases, reduced levels of care.
Brief History of Women's Inclusion (and Exclusion) from Medical Trials
Women's lack of inclusion in medical trials is a concept that doesn't seem to fit into the modern world. Yet, even some recent medical studies and treatment vetting processes (let's take the covid vaccine for example) are still patriarchal in nature. This causes high levels of mistrust and anxiety for women entering doctors' offices and hospitals every day.
According to the National Institute of Health's (NIH) summary of women’s participation in clinical research, women of childbearing potential were excluded from phase I and II drug trials as recently as 1977. Obviously, this led to a shortage of data on how drugs affect women in this age range and created a precedent that women's rights advocates have been trying to overturn ever since.
It wasn't until 1986 that the NIH created a policy (just a policy, not a law) that encouraged researchers to include women in studies. In 1990, the Government Accountability Office conducted an investigation that showed the aforementioned policy was poorly communicated and inconsistently applied.
Shortly after the NIH adopted its first female director, Dr. Bernadine Healy, who launched the Women’s Health Initiative, Congress finally wrote the NIH inclusion policy into Federal law in 1993. This law required women and minorities to be included in clinical research design studies so it would be possible to analyze whether the variables being studied affect women and minorities differently than other participants. It also required that women and minorities not be excluded from studies due to cost and promoted programs that encourage women and minorities to volunteer for clinical trials.
What the FDA is Doing Now to Improve Women's Inclusion in Clinical Trials
Since the NIH Revitalization Act of 1993 (Public Law 103-43) titled Women and Minorities as Subjects in Clinical Research, the FDA has made progress in being more intentional to include women in medical trials and evaluate if studies are producing data that provide clarity on how treatments impact subgroups delineated by things like age and sex.
The most recent initiatives include an action plan to enhance the collection and availability of demographic subgroup data published in 2014, which centers on goals related to improving the completeness and quality of subgroup data and identifying barriers to subgroup enrollment into clinical trials.
FDA initiatives in 2015 and 2016 are similar in focus, centering mostly on raising awareness about the importance of participation in clinical trials by diverse groups of women. This highlights a lack of medical data showing exactly how treatments will impact women of different ages and ethnic orientations when compared to their male counterparts. The recent initiatives also focus on sharing best practices about clinical research design, recruitment, and subpopulation analyses in order to one day produce adequate data that shows the differences in benefits or side effects among sex, race, and age groups.
Recent Example of Patriarchal Influence in Medicine - the Covid Vaccines
History shows that the FDA and related organizations have made positive strides in addressing gender disparity in clinical trials over the past few decades, but it is not enough. Despite the laws and regulations put into place, there is still a patriarchal influence in healthcare that prevents women from having complete knowledge about how treatments will (or won't) work for their bodies and what side effects they may encounter that are different from those experienced by those of the male sex.
The rapid development of highly effective covid vaccines was nothing short of a medical marvel that saved millions of lives and gave us some sense of normalcy after quarantine. Yet, many menstruating people who elected to receive the vaccine turned to social media in the weeks and months following their vaccine to report changes in their menstrual cycle - a side effect that was not shared (or studied) prior to releasing the vaccine to the masses.
An article published in Science Advances by Katharine M. N. Lee et. al. notes that the covid "vaccine trial protocols do not typically monitor for major adverse events for more than 7 days, and additional follow-up communications do not inquire about menstrual cycles or bleeding. Therefore, manufacturers had no way of addressing the extent to which this observation was a coincidence or a potential side effect of the vaccines."
Tracking major side effects for only 7 days is an example of gender bias and patriarchal influence in health care, as it excludes the fact that menstruating people's bodies function on a monthly hormone cycle while providing more than adequate data for those of the male sex who function on daily hormone cycles.
How Women Can Reduce Medical Anxiety
All of this history can be a lot to reconcile. Yet, awareness over the patriarchal nature of medicine and how women's inclusion in medical research is relatively recent validates why women experience higher levels of medical anxiety and often feel as if their voices are not heard or valued in doctors' offices. In order to help women cope with medical anxiety, below are a few therapist-approved tips for female-identifying patients to help reduce medical anxiety and get the care you deserve.
1. Educate Yourself
Perhaps the most important and empowering step towards reducing medical anxiety is educating yourself about the healthcare system and your diagnosis. For women, it is helpful to know the historical background shared above, but that is just a start to being informed at the level required to know what questions to ask and how to advocate for yourself in medical appointments. It is also critical to have a solid foundational understanding of the US Healthcare System Overview and how private pay and health insurance factor into any proposed treatment.
In addition to gender bias and the logistics associated with the medical system and insurance’s place within it, it is imperative that you do independent research on your proposed diagnosis. It is the responsibility of your physician to provide you with the education needed to sign an informed consent. But without some foundational understanding of the condition you're facing, you'll be unable to identify questions during that education process that you need answers to in order to decide which treatment to consent to or request.
2. Learn to Self Advocate, and Have Backup Advocate or Proxy on Standby
Communicating with and questioning medical professionals can feel intimidating. But remember, medical professionals are there to serve and help you. When it comes to deciding on medical treatment, it is a shared decision-making process between you and your healthcare provider, but you always have the final say (as long as you're conscious and mentally stable enough to communicate wishes and provide consent). You also have the right to request copies of medical records and receive clear answers to questions related to the following:
The criteria that lead the provider to assign the diagnosis of your condition(s)
The specific name and purpose of the proposed treatment(s)
The benefits, risks, and alternatives to proposed procedure(s)
The benefits and risks of each alternative treatment(s)
Access to second opinion(s)
Providers' qualifications and success record treating your diagnosis
In some instances, decisions may need to be made about the course of treatment quickly, when you are not conscious, or when you are not in the right frame of mind to do so. For example, women in active labor may not be able to take time to calmly calculate the pros and cons of certain medical interventions or advocate for themselves to providers while enduring a contraction.
For these moments, it is important to discuss your wishes and values regarding medical care with a trusted partner or family member authorized to make decisions and communicate with medical staff on your behalf. This is usually your closest relative, but you can also complete a medical power of attorney if you want to legally ensure the person you choose is the one speaking for you. Depending on the healthcare situation you're facing, there may also be professionals that you can hire to step in to be your advocate. An example would be a birth Doula, a professional labor assistant who provides physical and emotional support to you and your partner during pregnancy, childbirth, and the postpartum period.
Whether you're relying on a professional or a loved one as your advocate, below are considerations to discuss with your advocate, doula, or formal healthcare proxy that would cover most major medical decisions that might need to happen without your direct consent:
Would you want CPR resuscitation if your heart were to stop?
Would you want to be put on a ventilator if you could no longer breathe on your own?
Would you wish to have tube or needle feeding if you lost the ability to swallow?
If you had a life-limiting illness, would you wish to receive antibiotics that might prolong life?
If you had progressive dementia, what health treatments would you want?
Would you want to be an organ donor?
At what point would you want palliative care rather than aggressive treatment?
These questions can feel very scary and daunting to talk about openly, but discussing them with your trusted advocate and receiving assurance that they will respect your wishes can bring a sense of peace that reduces the anxious thoughts and fears that might be preventing you from seeking the care you need.
If you're not sure where to start on this, visit The Conversation Project to find information about healthcare planning and access free advance directive forms. Once you have these resources, a therapist can help you process these choices and develop communication strategies that promote confidence around sharing your medical directives.
3. Get a Second, or Third Opinion
Consider setting up multiple appointments with physicians known to treat the medical issues you’re facing before consenting to the first medical treatment proposed. This can help reduce medical anxiety by providing reassurance that the initial diagnosis and treatment plan are accurate and appropriate. A second, or third, opinion can also offer alternative treatment options or confirm that the initial treatment is indeed the best course of action.
Taking the initiative to consult with a few medical professionals is excellent practice in self-advocacy, which helps you to feel more empowered and involved in your own care. Essentially, seeking a second opinion can help alleviate anxiety by creating the opportunity to know you have a doctor you trust, who listens to you, and is offering a treatment that is vetted by multiple professionals.
4. Weigh the Pros and Cons of Proposed Treatment
For women who are unsure how to choose between one medical treatment or another, weighing the pros and cons of each option can be a helpful strategy to reduce medical anxiety. It is not uncommon for women to experience biases and gender-based stereotypes in healthcare settings, which can make it difficult to take the time to truly consider your options, validate your emotions, and move to a space of feeling in control of their healthcare decisions. Women can make more informed choices that are best for their individual needs and preferences by actively participating in medical appointments by seeking clear and accurate information about the risks and benefits of each treatment, reviewing recovery timelines, and bringing your pro/con list into the doctors' office to review with the provider.
Unfortunately, insurance coverage and financial concerns can also contribute significantly to medical anxiety for women in the United States. It is important to consider the costs of each treatment option, as well as the extent of insurance coverage, to make an informed decision that is financially feasible. Healthcare providers can help alleviate these concerns by discussing the cost of each option and exploring potential financial resources that can help mitigate the financial burden. Remember, hospitals are now required to provide you with a Good Faith Estimate listing the costs of your procedure before it occurs. If this isn’t provided to you or the cost far exceeds what was quoted, you have the right to report and contest medical charges.
5. Control What You Can, then Trust the Experts
Ultimately, to reduce medical anxiety focus on controlling what you can and then trust the experts. This concept is based on operating within your locus of control. While it is important to widen our locus of control by gaining education that helps us to advocate for ourselves, it is also important to trust the expertise of healthcare professionals who have spent many years earning credentials and experience in the field. A healthy balance resides between being informed and involved in decision-making while also recognizing the limits of your own understanding of medical conditions and treatments.
When your locus of control or level of knowledge feels uncomfortably limited, another method of taking action on medical advocacy is to get involved in the larger conversation around women's health. You can take the important role of being a women’s advocate by educating others on this topic (by sharing this article), attending or organizing rallies focused of progressing research and access to women’s healthcare, sign petitions, and even making the choice to go into healthcare as a female provider (or encouraging other talented women in your life to do so).
7. Process Medical Anxiety and Learn Coping Skills with a Licensed Therapist
A reduction in medical anxiety can be achieved through a variety of therapeutic techniques, such as cognitive-behavioral therapy (CBT), positive affirmations, and guided meditations. CBT involves reframing anxiety-producing thoughts by challenging negative beliefs and replacing them with more adaptive, realistic ones. Affirmations can help promote a positive mindset by repeating improving self-talk in stressful moments and in doing so reinforcing feelings of confidence and control. Guided meditations centered around visualizing your procedure and recovery going well have been proven to keep patients calm throughout treatment and lead to better outcomes. Combining these techniques with the help of a licensed therapist before going into a medical procedure will help you create a positive mental space, reduce anxiety, and promote a feeling of preparedness and resiliency.
If you are struggling with medical anxiety, find it difficult to cope with chronic illness, or are unsure how to manage your mental health through a life-disrupting event such as a cancer diagnosis, schedule a free consult call with a therapist at Her Time Therapy, LLC. We are an integrative group counseling practice comprised of licensed therapists in Colorado who specialize in providing convenient and empowering online therapy for women. You can feel confident working with a Her Time therapist because we recognize that women like you experience a unique set of biological, environmental, economic, and social challenges that have a real impact on your mental health that is deserving of specialized support.
About the Author
Meagan Clark, MA LPC NCC BC-TMH is a Licensed Professional Counselor and the Founder and Clinical Director of Her Time Therapy, LLC, a group therapy practice specializing in teletherapy for women. She received her Master of Arts degree in School and Clinical Mental Health Counseling from Adams State University and is a Board Certified Telemental Health Provider and Nationally Certified Counselor. As a women's therapist, Meagan specializes in working with female-identifying teens and adults who suffer from trauma, relationship issues, anxiety, depression, and grief. She is also a Certified Holistic Cancer coach and specializes in supporting cancer patients and caregivers. Meagan believes strongly in the empowering nature of integrative and feminist therapy to give women the knowledge and tools they need to navigate gender-based oppression, increase resiliency, and empower themselves to create a life they love.