It is an exciting time for science! Yesterday, First Lady Jill Biden announced the first-ever White House Initiative on Women’s Health Research1 that will be led by Dr. Carolyn Mazure, the Norma Weinberg Spungen and Joan Lebson Bildner Professor in Women’s Health Research, and Professor of Psychiatry and Psychology at Yale University.
Source: National Cancer Institute / Unsplash
For those outside of science, it may be less well known just how drastically women are underrepresented in biomedical research, but across both animal and human research, females have been regularly left out and sex differences ignored. Efforts have been made to increase representation of women in research and to understand sex differences. In 1993, the United States National Institutes of Health (NIH) first mandated enrollment of women in human clinical trials. Then, in 2016, the NIH implemented a policy requiring investigators to consider sex as a biological variable in all research. Yet, we are far from catching up on lost time.
As a researcher and psychologist studying the impacts of traumatic stress, I see firsthand why this matters so much in my field. The reason that females have been left out of biomedical research – because of how their hormones might skew fragile study designs – is exactly why it is so critical to study women, as female hormones may be critically important to understanding risk (and resilience) in the context of psychiatric symptoms.
Let me step back for a moment to provide context. Stress-related disorders, including posttraumatic stress disorder (PTSD) and depression, occur at more than twice the rate in women than men. Natural hormonal variation that occurs across the female lifespan has been linked to both depression and anxiety. Periods in the lifespan with significant hormonal shifts, like peripartum and perimenopause, are times of heightened risk for women, yet remain vastly understudied. This is particularly true in PTSD research where we know very little about how natural hormonal variation may influence PTSD symptoms and fear response in women and how that may inform treatment approaches or timing of treatment delivery.
Cutting-edge women scientists in the field are trying to change that, and new funding to support women’s health research by NIH will lead to important discoveries. A recent cross-sectional study led by Drs. Vasiliki Michopoulos and Jennifer Stevens, Associate Professors in the Department of Psychiatry and Behavioral Sciences at Emory University and Co-Directors of the Grady Trauma Project, were the first to examine differences in levels of PTSD and depression symptoms across pre-, peri-, and post-menopause in a sample of 6,093 women (>90% African American) recruited from medical clinics in an urban hospital in Atlanta, GA. The study found that perimenopausal women reported significantly worse PTSD and depression symptoms compared to both pre- and post-menopausal women.
Source: Shane Rounce / Unsplash
There remains a great deal to understand about how sex hormones affect women exposed to trauma, but as longitudinal research by these scientists and others continues across the globe, it is important for clinicians to be aware of the effects of hormonal variation on symptoms. Hopefully, as our science in this area expands and the White House Initiative on Women’s Health Research moves forward, so will improved treatments that account for the unique needs of women at each stage across the lifespan.