By ALANA SEROTA
Hospital for Special Surgery
For millions of women, TikTok has become a doctor’s office: Scroll through the app and you’ll see endless videos about menopause, joint pain, hormone therapy – featuring no small amount of pseudoscience. Though misguided, this digital quest for medical knowledge is only a symptom of a larger issue: Medicine has left women with too few answers to far too many questions about their health.
While women make up half of the U.S. population, female-specific conditions account for just 5% of all biopharmaceutical research spending. And only 1% of that goes toward non-cancer female conditions, such as menopause and infertility. Chronic underinvestment has left glaring gaps in our understanding of women’s health – with real consequences for the quality of pain assessment, diagnosis and treatment.
This imbalance has deep roots. Clinical trials didn’t even require female participants until 1993. For decades before that, women were excluded – especially after the Food and Drug Administration in 1977 advised keeping women “of childbearing potential” out of studies. Men’s bodies were considered the standard; women’s, with their unique anatomies and hormonal cycles, were deemed too complicated.
With such an entrenched history – and present – of neglect, closing those gaps will require bold moves: investing in research specific to women, equipping patients with trusted information and training doctors to communicate clearly while respecting patients’ experiences.
Musculoskeletal health – encompassing bone strength, joint stability and muscle function – is a prime example of these disparities. New research from the Hospital for Special Surgery found that women with osteoarthritis experience more pain and inflammation than men with the same condition – differences likely driven by biology and hormones, yet still poorly understood.
Women experience pain very differently at various points in their menstrual cycles and lives. During pregnancy, hormonal changes like swelling, ligament stretching and joint laxity can heighten the risk of carpal tunnel syndrome, round ligament pain and joint dislocation – complications that disrupt daily life but remain under-researched.
Later in life, menopause brings its own set of difficulties. When estrogen levels fall as they do during menopause, women face higher risks of muscle mass loss, bone density decline and osteoarthritis, which in turn increases risk for conditions like heart disease, diabetes and osteoporosis. With 40% of a woman’s life now spent post-menopause, failing to properly address these issues consigns millions to decades of preventable pain.
This is the cascade of gaps: women’s biology understudied, pain dismissed, diagnoses delayed and treatments misunderstood. In that vacuum, women are left to manage greater suffering without adequate treatments because their biology has never been studied with the rigor it deserves. And because scientific communication has left them with conflicting – or nonexistent – information, it’s no wonder some turn to nonscientific sources, such as social media, for guidance.
The solution isn’t to blame women for seeking information – it’s to give them better options.
That begins with research. Over the summer, the Gates Foundation pledged $2.5 billion by 2030 for women’s health initiatives, the kind of bold investment others should emulate. Investments like this one are especially important as women’s health initiatives have been threatened by federal funding cuts this year.
In the meantime, physicians must help patients navigate uncertainty by pointing them to trustworthy sources – from established medical sites to reliable professionals online – and by communicating in ways that respect patients’ lived experiences. For my patients, I curate lists of credible resources to help cut through the noise – including The Menopause Society, Bone Health and Osteoporosis Foundation and well-respected physicians with an active social media presence like Dr. Jen Gunter.
The path forward is clear: Invest in women’s health research and build a system where women don’t have to run to TikTok to try to solve their health issues.
Dr. Alana Serota is an internal medicine physician at the Hospital for Special Surgery who specializes in metabolic bone disorders, osteoporosis and women’s health.