For decades, medical developments focused on male physiology. The differences between the biological sexes were neglected, although voices were raised in the USA as early as the 1980s that women were underrepresented in clinical studies. Since the early 2000s, the WHO and the Swiss Federal Office for Public Health have been actively trying to draw attention to the gender gap in medicine. Now, especially in recent months, female health is getting more and more attention. We at the Centre for Digital Health Interventions have also recognized the urgency and, together with Dr. Marcia Nißen, have launched the Core Digital Female Health. Today, on International Women’s Day, Marcia tells us what her research involves and which trends in women’s health are particularly exciting and essential.

CDHI: Happy International Women’s Day, Marcia! So, where do you think the increased interest in female health is coming from? 

Marcia: Happy International Women’s Day, Giuliana! In my opinion, several “movements” are currently converging and joining forces. First, I think that the growing interest in women’s health heavily stems from the general shift towards personalized medicine. Second, the availability of extensive behavioral, physiological, and environmental real-world data from consumer technologies wearables is a real game changer. Third, there is this strong push towards gender equality in our societies and healthcare with women and individuals assigned female at birth demanding to be seen with their individual, unique needs. And finally, it seems that the market is waking up with policymakers, companies, and startups increasingly recognizing the untapped economic potential in women’s health.

CDHI: Which aspects of women’s health or diseases are currently the focus of research? 

Marcia: Traditionally, research (and funding) in women’s health has primarily focused on fertility and reproduction or diseases with high mortality. Like oncological conditions such as ovarian or breast cancers and maternal mortality. Conditions leading to disability, such as polycystic ovary syndrome (PCOS) or endometriosis, and how female-specific physiological processes affect various other health conditions, from cardiovascular diseases to mental health disorders, have been mainly overlooked. Now, research is  slowly picking up on that.  

For instance, we already know that menstrual cycle health can be considered a health endpoint and a risk factor for women’s general health and well-being. Eight to thirteen percent of women suffer from PCOS; ten percent of women suffer from endometriosis during their reproductive years. Another ten percent of women experience period pain so intense that they cannot perform everyday routines. Vice versa, cycle length and regularity have been associated with hormonal imbalances, gynecological diseases, infections, and the risk of developing chronic diseases such as, e.g., ovarian or breast cancer. A healthy menstrual cycle is so critical to women’s overall health that the American College of Obstetricians and Gynecologists declared menstruation a fifth vital sign, as crucial as pulse, temperature, breathing rate, and blood pressure.  

CDHI: How do you think digital tools or therapeutics can help support women’s health? 

Marcia: Digital tools and therapeutics have immense potential to revolutionize women’s health by offering personalized, accessible, and timely interventions. There are countless possibilities, from menstrual cycle syncing apps that empower women to better understand their bodies to wearables that predict hot flashes and give perimenopausal women a chance to understand their unique symptom patterns. I truly believe that these tools can enhance health monitoring, disease management, and overall well-being. They could also facilitate standard clinical trials to take female-specific data into account. 

CDHI: What is the focus of your and your team’s research? 

Marcia: Half of our population is born female, going through menarche, puberty, reproductive age, pregnancy, perimenopause, and postmenopause, and they increasingly want, can, and need to take ownership of their health and well-being. So, we started our new CORE with this vision “to empower women and individuals assigned female at birth to have a complete understanding of the power of their hormones and use that knowledge to make the best health and lifestyles decisions every single day across their lifespan through innovative, digital solutions.”  To be more precise: My team and I are determined to develop and evaluate tools and instruments that empowHER (1) women to tailor health-related behaviors, such as exercise routines or dietary habits, to their hormonal needs and (2) researchers and health professionals to evaluate (a) the impact of personalized interventions on menstrual and general health, and (b) the impact of the menstrual cycle on risk factors for chronic diseases. 

CDHI: Can you give us an example of a project? 

Marcia: Well, let me give you two examples. On the one hand, we are dedicated to enable research projects, focusing on digital biomarkers and just-in-time adaptive interventions. For instance, MULTICAST is a large and interdisciplinary SNF-funded project dedicated to developing a digital tool for the prediction and prevention of suicidal ideation and behaviors. With our “EmpowHER MULTICAST” endeavor, we now also collect female-specific data that allows us to account, for instance, for participants’ menstrual and menopausal health history and, for example, through which cycle phase they are going through during data collection periods. On the other hand, we are developing proprietary tools to facilitate and perform our research on female-specific conditions. For example, with ‘VOGUE’, we are creating a data collection pipeline to investigate how the menstrual cycle phases affect individuals’ general engagement with technologies in their daily lives. We later want to expand this app into a comprehensive digital application that allows us to study the effects of cycle-oriented interventions on female-specific or other health conditions. This tool will enable us to provide personalized guidance on lifestyle choices such as exercise tailored to each phase.  

CDHI: Thanks a lot, Marcia! 

Marcia: My pleasure! Thank you for your insightful questions on this important day celebrating women’s achievements and health and for sharing our excitement about our new Digital Female Health CORE!   

References  

American College of Obstetricians and Gynecologists. (2015). Menstruation in girls and adolescents: Using the menstrual cycle as a vital sign. Obstet. Gynecol, 126, e143-e146. doi:10.1097/aog.000000000000f1215 

Mumford, S. L., Steiner, A. Z., Pollack, A. Z., Perkins, N. J., Filiberto, A. C., Albert, P. S., … & Schisterman, E. F. (2012). The utility of menstrual cycle length as an indicator of cumulative hormonal exposure. The Journal of Clinical Endocrinology & Metabolism, 97(10), E1871-E1879. doi:10.1210/jc.2012-1350  

Schoep, M. E., Nieboer, T. E., van der Zanden, M., Braat, D. D., & Nap, A. W. (2019). The impact of menstrual symptoms on everyday life: a survey among 42,879 women. American journal of obstetrics and gynecology, 220(6), 569-e1. doi:10.1016/j.ajog.2019.02.048 

swissinfo.ch (2021). Unterschiede zwischen Frauen und Männern gibt es auch bei der Gesundheit. https://www.swissinfo.ch/ger/gesellschaft/medizin_unterschiede-zwischen-frauen-und-maennern-gibt-es-auch-bei-der-gesundheit/46344206 

World Economic Forum (2024). Closing the Women’s Health Gap: A $1 Trillion Opportunity to Improve Lives and Economies. https://www.weforum.org/publications/closing-the-women-s-health-gap-a-1-trillion-opportunity-to-improve-lives-and-economies/

World Health Organization (2023). Polycystic ovary syndrome (PCOS). who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome  

World Health Organization (2023). Endometriosis Factsheet. who.int/news-room/fact-sheets/detail/endometriosis