Why doctors and researchers say Canada needs to change course on women's health studies

This story is part of CBC Health's Second Opinion, a weekly analysis of health and medical science news emailed to subscribers on Saturday mornings. If you haven't subscribed yet, you can do that by clicking here.

Despite a rule that requires sex and gender to be considered when funding medical research in Canada, new research shows the number of grants for women's health studies hasn't budged in five years, something doctors say has serious implications for their patients.

The Canadian Institutes of Health Research (CIHR) has mandated the inclusion of sex and gender as criteria for awarding grants since 2010. Despite that, a group of researchers found in 2023 that less than six per cent of Canadian health research funding went to women's health. Now, their new study is also analyzing how narrow the field of women's health research is.

While women's health is currently more focused on areas like pregnancy and breast and gynecological cancers, doctors and researchers say they want to see the field broaden to include other conditions, like migraine headaches, chronic pelvic pain and fibromyalgia, which studies show are more common among women, but garner less research funding.

Dr. Tania Di Renna, the medical director of the Toronto Academic Pain Medicine Institute, who works as an anesthesiologist at Women's College Hospital in Toronto, says she promises her patients she'll study their conditions with the goal of finding the source of their chronic pelvic pain, something she says is important, because traditionally, health-care professionals have brushed off women's pain.

Di Renna says that's partly because before 1993, women were rarely included in clinical trials due to concerns that pregnancy could interrupt the study, or that trials could pose potential dangers to the fetus. Di Renna also notes that medical researchers would even leave female animals out of studies.

These concerns trace back to the use of thalidomide in the late 1950s and early 1960s. The morning sickness drug had debilitating effects on babies in multiple countries, including Canada.

Di Renna sees this lack of female subjects in clinical trials play out when it comes time to prescribe medications for her patients suffering with chronic pelvic pain. She says when she prescribes medications, her patients often tell her about certain side effects they experience.

"Women tell me that, 'I can't take this drug. It makes me nauseous. It makes me gain weight. It makes me sedated.' [Women] have so many things going against us already, and now even the medications that are there to treat you are going against you."

Due to policy and social changes in the 1990s, research into women's health has increased, but Di Renna says there's more work to be done.

For example, the way women respond to opioid pain medications differs from men, but why this is remains unclear, Di Renna said.

In 2022, a review of studies on sex-related differences in response to medications concluded that opioids seemed to produce better pain relief in women, especially when administered for a few days. But responses also seemed inconsistent, with factors like the type of treatment, menopausal status and characteristics of the pain all contributing.

This kind of uncertainty and lack of research means physicians may not be able to find the cause of chronic pain for female patients. In those cases, Di Renna says "we really have to move on and focus on how you can live with a good quality of life."

Other physicians say this may include better medications to treat pain, or other methods of pain management such as physio, meditation, or even heating pads for cramps.