Science magazine has dedicated a special issue to women’s health, and the editors are explicit about why they chose this moment. The issue, published Thursday, focuses on sex differences in health that go far beyond the reproductive system — including chronic pain, aging, and menopause. The editors are four women: Yevgeniya Nusinovich, Sacha Vignieri, Joana Osório, and Sarah Ross.
They frame the project as a response to political attacks on women’s rights and health care, as well as funding cuts affecting research in this area. “Biomedical science has come a long way over the years, and it has become increasingly clear that there are sex-dependent differences in many diseases that do not involve reproduction and that occur at all ages,” according to the introduction.
The issue’s core argument is simple: women’s health has received more attention than ever before, but the actual science lags behind. Women remain poorly represented in clinical trials, and female health remains poorly understood compared to male health. The issue aims to highlight recent findings on sex-dependent biological differences beyond reproduction, while also taking stock of the gaps.
Pain, Hormones, and the Microbiome
One review in the issue zeroes in on functional pain, which affects women at about twice the rate of men. Persistent pelvic pain often becomes a debilitating factor in daily life, and the review identifies several mechanisms that explain why.
Sex hormones play a role. So do immune-neural interactions and the gut microbiome. Ovarian hormones also influence pain responses. But the review authors note a deficit in efforts to understand female pain.
“Women are desperately waiting for concrete answers that might help eliminate the common ‘all in your head’ approach to their illnesses.”
The review’s authors want to move past that dismissive approach. They present the science that could back it up, even as they acknowledge how much remains unknown.
Aging, Chromosomes, and Precision Medicine
Another review looks at the impact of XX and XY chromosomes on aging and disease. The authors argue that sex chromosomes should always be considered when developing precision medicine strategies.
That is a bold claim. It suggests that doctors should routinely factor in a patient’s sex chromosomes when designing treatments, not just assume that men and women respond the same way to the same drugs. The review makes the argument for why that matters.
Reproductive Health and the Gaps
Not all of the issue’s content stays away from reproduction. Some contributions address menopause research and treatment, calling for a more individualized approach. Others investigate the immune system’s role in preparing for and carrying out a pregnancy. Still others consider the role of the ovary’s postmenopausal function.
Nusinovich, a senior editor at Science, distinguishes post-reproductive health from reproductive investigations. “The focus here is not on improving reproductive success but on considerations for a woman’s own health,” she said.
She considered including other medical conditions unrelated to reproduction in which sex differences play a role, such as cardiovascular and metabolic disease. But she decided against it. “It didn’t seem like there would be enough new biological insights (with mechanisms, not just clinical observations) for entire coherent review articles.”
That admission speaks to the depth of the problem. Even a major scientific journal found that the available research was too thin in some areas to support full review articles.
Why the Issue Matters Now
The editors see urgency in their work. They named political attacks on women’s rights and health care, as well as funding cuts affecting research in this area, as urgent motives behind their planning.
“The importance of doing clinical trials specifically in women has gained recognition over the years, and it’s something that should continue to be elevated, including as research funding cuts are targeted at this and other women-specific research, threatening the quality of women’s future healthcare,” they said.
Tiarney Ritchwood, a professor in the department of public health at Wake Forest University School of Medicine who focuses on health equity, agrees that the conversation is expanding. But she notes that institutions still drive research priorities toward reproductive years.
“We tend to focus on women in their reproductive years, and a lot of that I do think is driven by what institutions are willing to fund,” she said. “But I do think that the greater discussion on women outside of the reproductive years is really important.”
What the Experts Notice
Nicole Woitowich, executive director of the Northwestern University Clinical and Translational Sciences Institute, made a similar point about the history of women’s health research. “There is still so much we don’t know about women’s health simply because sex is often considered an extraneous variable,” she said.
“For many years, women’s health was synonymous with reproductive health,” she continued. “I’m glad we’ve broadened this perspective to consider the influence of sex across human physiology. Yet, pregnancy and menopause, for example, remain unique aspects of women’s health and we are just beginning to understand how these events can shape our long-term health and well-being.”
Woitowich recently researched the reporting of sex differences in NIH-funded papers.
Omisade Burney-Scott, a menopause justice advocate, saw the issue’s attention to menopause as especially welcome. She runs the Black Girl’s Guide to Surviving Menopause, a platform pushing for inclusive menopause care. But she also noted gaps in the coverage.
“There is still so much we don’t know about women’s health simply because sex is often considered an extraneous variable,” she said.
“We must take into account the significant impact of environmental factors, such as systemic oppression (racism, classism, homophobia, transphobia, carcerality) on menopause health outcomes,” she added.
Burney-Scott said the journal article lacked some perspectives, including discussion of early menopause due to gender-affirming care or medical intervention. Those topics show the limitations of current research.
Funding, Not Just Attention
The editors want the issue to do more than raise awareness. They want to show how much there is left to learn.
“Out of all the special issues I’ve encountered, this one stood out to me as highlighting a ton of open questions and things that are just beginning to be studied, especially in the article on chronic pain, pointing to many opportunities for future productive research,” said Nusinovich.
The experts STAT spoke with agreed that a high-profile journal such as Science dedicating an issue to women’s health is a step forward. But they also noted that attention alone is not enough.
| Stage | Detail |
|---|---|
| Publication | Thursday |
| Editors | Yevgeniya Nusinovich, Sacha Vignieri, Joana Osório, Sarah Ross |
| Focus | Sex differences beyond reproduction, including pain, aging, and menopause |
| Motive | Political attacks on women’s rights, health care, and funding cuts |
The issue is a snapshot of where women’s health research stands today — and where it needs to go. The reviews identify real mechanisms, from hormones to chromosomes. But they also expose the gaps: the areas where researchers have barely begun to look.
The advocates who commented on the issue are pleased to see menopause covered prominently. But they want more. They want research that includes the full range of women’s experiences, including those affected by gender-affirming care and systemic oppression.
The journal has done its part by publishing the issue. The funding question remains open. Without money, the science that the issue highlights will remain underdeveloped. With it, the answers women have waited for might finally arrive.
The issue is a sign of progress. But it is also a reminder of how far there is still to go.
Source material: “Top journal’s special issue on women’s health casts spotlight on menopause and pain,” STAT.
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