“Text me when it’s a good time to talk.”
That’s never a message you want to receive when you’re awaiting lab results. After my pregnancy and a year of post-natal physical therapy, I had become close with the nurses and staff at my OBGYN’s office. This was the first time my nurse practitioner had ever texted something so direct yet so ambiguous.
It had been at least two months since my last period, and we’d begun to worry. With another pregnancy ruled out, I’d undergone a battery of additional testing—ultrasounds, physical exams, blood work—to pinpoint a cause. Pending my diagnosis, we had already agreed upon a tentative treatment plan for follow-up visits that might include hormone injections to help “jump-start” my cycle. I sat on the couch gnawing at my cuticles, waiting for the call from my N.P. The first of many insurance bills had already arrived and sat splayed on the table.
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“Your results are in,” she said when I answered the phone. “How old were the women in your family when they went through menopause?”
According to my blood work, my hormone levels were “postmenopausal.” At 40 years old, with no other symptoms, and a toddler at home, how could this possibly make sense?
I had speculated, googled, and doom-scrolled as much as anyone might in the lead-up to that call, but the thing I kept returning to was that my problems started soon after receiving my second dose of the Pfizer vaccine for COVID-19. Before hanging up the phone, I sheepishly asked whether the vaccine could be the culprit. After a pause, the nurse practitioner replied, “Anecdotally, other women have been reporting the same thing.”
“Anecdotally,” meaning that, despite thousands of women reporting disruptions to their menstrual cycles, ranging from excessive bleeding to missed periods, irregular periods are not an officially recognized side effect of any of the vaccines granted emergency use approval by Food and Drug Administration (FDA).
To be clear, amid an ongoing pandemic, I encourage everyone to get vaccinated and for anyone experiencing unusual symptoms to seek medical care and report their experiences. I am grateful that I had the resources to be evaluated, and I have no regrets about receiving the COVID vaccine—or any other vaccine or medication demonstrated to be safe and effective. I don’t know for certain that the vaccine is responsible for my health concerns. But not knowing is precisely the problem.
My cycle eventually returned on its own, offsetting a need for more aggressive intervention, but that made the rollercoaster of my initial diagnosis even more bewildering. Watchdog groups have increasingly noted that cases like mine are going under-reported. No one can say for certain how many of the millions of physiologically female persons and people who menstruate who have been vaccinated continue to undergo—perhaps unnecessary—procedures or to experience significant emotional and financial strain as a result of potential side-effects of an otherwise vital, life-saving vaccine.
In the meantime, grassroots efforts by female researchers on platforms like Twitter are encouraging more conversation about this issue. Those efforts offer some of the only venues where women can network with one another or perhaps find some solace knowing that they are not alone when they leave their doctors’ offices or the ER without answers.
And answers may not be forthcoming. A recent article published in The Sunday Times asked representatives at the U.K.’s Medicines & Healthcare products Regulatory Agency (MHRA) pointedly why period irregularities not been “added to the official list of possible side effects” for the COVID vaccines? Their response was simply “that there was no need to do so” despite nearly 4,000 women formally reporting problems, with many more likely either unaware of the reporting procedure or not on the lookout for symptoms.
This reporting out of the U.K. reflects a larger trend within medical research, which has historically defaulted to male test subjects. In the United States, for example, women have only been included in clinical research trials since 1993, following a federal mandate through the National Institutes of Health Revitalization Act. Prior to this policy change, researchers were under no obligation to consider “whether the variables being studied affect women and minorities differently than other participants.”
Certainly, the thalidomide crisis of the 1960s demonstrated that greater scrutiny was warranted in the case of women likely to bear children, and yet, until their inclusion became mandated by law, the FDA advised “excluding even women who used contraception, who were single, or whose husbands were vasectomized” from drug trials. According to the NIH’s .gov site, women were also deliberately excluded from initial trials of HIV medications. Further, sex and “sex-specific reporting… distinct from inclusion” wasn’t required of clinical research in the U.S. until 2016.
A recent article studying “sex-specific differences” in clinical trials suggests that “males, frequently of the Caucasian race, were considered to be the ‘norm’ study population” while females remain “confounding and more expensive test subjects.” There are several theories as to why medical researchers have struggled to consider outcomes for women. Both governmental agencies and academic studies have consistently identified systemic gender bias as a primary factor, but researchers’ concerns over variables like hormone fluctuations complicating their baseline results might also be at issue.
To some extent it seems as though women have always confounded science. As a scholar of the ancient Greek and Roman world, the notion that men are the “default” in matters of medicine is nothing new to my own research. To the extent that ancient thinkers discussed women’s health and physiology at all, the assumption was that they were, by nature, inferior to men.
The ancient philosopher and physician Galen, for instance, argued that women’s sex organs were internalized male genitalia that failed to develop properly in the womb or, as he put it, “Just as the blind mole rat has incomplete eyes... so too woman is more incomplete than man in the generative parts.” Ironic given that mammalian embryos start life as anatomically female. Yet, Galen believed women were simply malformed men even as he ultimately deemed this unfortunate accident of nature a good thing since, without these imperfect men, human beings would be unable to procreate.
Not that other writers didn’t try to imagine a world without women. In his tongue-in-cheek, proto-sci-fi fantasy True History, ancient Roman author Lucian imagines a world of moon men able to have babies on their own by either growing their offspring inside their calves or by planting their right testicles into the ground.
Even the venerated Greek philosopher Aristotle got simple, empirical facts about women wrong. He implies that women are inferior to men time and time again by suggesting, among other things, that women have fewer sutures in their skulls (smaller brains), lesser-quality sperm (male sperm contains the soul while a woman’s “sperm” is comprised only of base, physical matter), and even that women have fewer teeth. To quote the 20th-century Nobel laureate Bertrand Russell, “Aristotle could have avoided [this mistake] by the simple device of asking Mrs. Aristotle to keep her mouth open while he counted.”
Or he simply could have asked her.
While we may no longer be contending with male fantasies about female sperm and wandering wombs, what is traditionally termed “women’s healthcare” still suffers from some measure of misunderstanding or outright neglect. Pharmaceutical companies continue to test primarily upon male subjects, calibrating and “optimizing” their products and dosages “to work on male bodies.” A recent study out of the University of Chicago demonstrated that medications routinely present “clear differences in how they acted in men’s and women’s bodies—nearly all with more adverse side effects for women, including nausea, seizures and cardiac arrhythmias.” Such oversights—or disregard—in medical research is not only potentially unsafe for cisgender women and intersex and trans people but could sadly contribute to vaccine hesitancy and a general mistrust of cutting-edge medicine and science.
During the initial trials of the COVID-19 vaccines, for instance, sex was not used as a significant metric in results data. When Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, announced to the Associated Press in July 2020 that a vaccine was imminent, there was still little knowledge of whether men and women would react differently to treatment. Studies conducted in the intervening months have indicated that women are more likely than men to experience adverse side-effects from taking the COVID vaccines, even if those side-effects were relatively mild or short-term.
Of the 13.7 million Americans who received the vaccine by January 2021, nearly 80 percent of reports of side-effects came from women. Some health-care professionals claimed that these statistics are attributable to women simply being “more likely to report how they're feeling after a vaccine,” but evidence suggests that “cisgender females tend to develop higher antibody response and, relatedly, higher efficacy and more side-effects, suggesting the need for sex-differentiated dosing regimens.” Multiple studies that have demonstrated that hormones like estrogen can also have an effect—at times, an adverse one—when it comes to vaccines. And given that “lack of knowledge” and “concern over side effects” are the primary reasons that women cite when refusing vaccines like the one for HPV, making reproductive health a priority in vaccine research would ultimately benefit everyone.
If we want our cutting-edge medicine to be truly modern, then women need to be seen, heard, and factored into what remains male-centric research. Further, if public health officials seek greater public acceptance of medical advancements and wish to alleviate vaccine hesitancy, the medical community must develop research and reporting practices that more fully and inclusively study for whom their breakthroughs are “safe and effective”. Without this, though we might regard our technology as innovative and modern, its development and deployment will remain stubbornly stuck in the past.
