Women get sick differently than men. What sounds like a truism has only been studied scientifically since the 1990s. Especially in Germany, so-called gender medicine has a lot of catching up to do, even if some things are happening in the meantime. We spoke with Prof. Dr. med. Gabriele Kaczmarczyk, Senior Consultant at the German Association of Women Physicians, about the significance of gender-specific differences in medicine.
Kalapa: Prof. Kaczmarczyk, gender medicine is a comparatively young discipline. In which areas are the differences between men and women particularly evident?
The Corona pandemic is giving gender medicine a real boost. For example, it has become clear quite quickly that men and women are affected differently by Covid-19: On average, men get sick more severely than women and have a higher mortality. The female sex, on the other hand, shows stronger reactions to the vaccination against SARS-CoV-2 – from which we can draw conclusions about gender-specific differences in the immune response.
Unfortunately, the vast majority of ongoing clinical trials on SARS-CoV-2 and covid-19 nevertheless make no reference to gender-specific data. This means that we are missing the opportunity to treat men and women differently and thus more efficiently in the case of covid disease. Professor Sabine Oertelt-Prigione from the Chair of Gender-Sensitive Medicine at the new Faculty of Medicine at Bielefeld University suspects that data on sex and gender are not evaluated due to time constraints (pressure to publish).
We also see epidemiological differences, for example in autoimmune diseases such as rheumatic diseases. Here, women are clearly more affected.
Kalapa: When we look at the effect of medicines: What gender-specific differences need to be taken into account?
These differences mainly affect the absorption, distribution and metabolism of medicines. For example, some medicines are broken down more slowly in women because the enzymes in the liver work differently. In addition, for a long time medicines were only tested on male mice and interactions with the female cycle were ruled out. All this leads to overdoses of active substances and thus to frequent side effects of medicines in women. A typical example is the beta blocker metoprolol.
Any side effects that may occur should therefore always be discussed directly with the practitioners. It is perfectly okay to ask whether test results, diagnoses or side effects may have something to do with your own gender.
Kalapa: In which areas of women’s health do you currently see the greatest need for action? Can you confirm from your experience that a lack of gender-sensitive diagnostics leads, among other things, to heart attacks in women being diagnosed too late?
Women sometimes show different symptoms of a heart attack than men. They often lack the typical pain in the chest area, which is accompanied by pain radiating into the arm and a feeling of pressure. Sometimes they only suffer from nausea, dizziness or shortness of breath. In fact, heart attacks in women were often not recognised immediately in the past, but in the meantime these symptoms are quite well known in practice.
I consider the problem of the already mentioned medication side effects in women to be far more serious. We urgently need a targeted gender-specific recording of these side effects and publications on this topic. Furthermore, it was about time that women were more involved in the testing of new medicines – as the European Medicines Agency is now also providing for.
Last but not least, it is important that more women are perceived as experts in specific medical or general health issues. Currently, women make up over 60 percent of medical students, but are still rarely found in leadership positions. This disproportion is particularly glaring in the proportion of women in leadership positions at German university hospitals (chair, hospital directorate, independent department head): according to a publication by the German Association of Women Physicians, the proportion was just 13 per cent in 2019.
Kalapa: What do you think needs to happen to put the issue of gender-sensitive medicine adequately on the agenda of health policy care?
Gender medicine is not an abstract science, but has relevance for the medical care of the entire population. It is therefore indispensable that the curricula at medical faculties are more strongly supplemented with gender-specific content. Gender medicine is not so much a new field as a cross-sectional subject. It must not be regarded as a voluntary extra subject. Rather, its contents must be compulsory examination subjects in medical examinations. Of course, this applies not only to human medicine, but also to teaching in other health professions: for example, nursing or physiotherapy. I am very glad that the governing parties have laid down corresponding regulations in the coalition agreement.
Aus Zeitmangel kaum Genderforschung zu Corona? ärztin, Zeitschrift des Deutschen Ärztinnenbundes e.V., 12/2021, Page 10. Access from: aerztin_3.21_web.pdf (aerztinnenbund.de) (3.2.2022)
Medical Women on Top. Dokumentation des Anteils von Frauen in Führungspositionen in 15 Fächern der deutschen Universitätsmedizin. Deutscher Ärztinnenbund (Update 2019). Access from: MWoT_update_2019.pdf (aerztinnenbund.de) (3.2.2022)
Koalitionsvertrag zwischen SPD, BÜNDNIS 90/DIE GRÜNEN und FDP (2021): Koalitionsvertrag (bundesregierung.de) (03.02.2022)