Women are Underrepresented in Research. Why Should You Care?

As a woman, you have unique health needs and experiences that can differ from those of men. If women are underrepresented in research studies, the results may not accurately reflect their health outcomes or address their health concerns. This could lead to inaccurate diagnoses, ineffective treatments, and missed opportunities for preventative care.

Women comprise half of the population, and their voices and experiences should be equally represented in research studies. It is a matter of fairness and equity that women have the same opportunities as men to participate in research that impacts their health and well-being.

Research is critical for advancing our understanding of diseases, treatments, and health outcomes. Our knowledge in these areas may be limited if women are underrepresented in research studies. This can slow down progress in medical advancements and result in missed opportunities for discoveries and breakthroughs that could benefit everyone.

It’s our mission at Rumblings to ensure you have the science-based facts and education you need to understand what can impact your health so that you can take informed actions. We feel it is crucial for all women to care about underrepresentation in research because it can directly impact our health and well-being.

So this month, we interviewed women’s health expert and assistant professor at the University of Minnesota, Manda Keller Ross, Ph.D., DPT. Dr. Keller Ross shares her research background and interest in women's health in this interview. She discusses the gender gap in research, particularly in heart disease risk in women, which has been historically studied more in men. She focuses on studying the influence of menopause symptoms on blood pressure regulation and heart disease risk in women. Additionally, she highlights the barriers women face when participating in research and the importance of addressing the diversity in experiences and physiology among women. Lastly, she emphasizes the need for more women to participate in research to improve preventative strategies and treatments for women.

Rumblings Interview with Dr. Keller Ross.

Can you tell us a little bit about yourself, your background, and how you became interested in the research that you’re currently doing?

I am a mother of three young girls (8, 7, and 5 yrs), a scientist, and an educator. I have been studying blood pressure regulation and heart disease risk for about 10 years. In the last seven years, our laboratory has transitioned to studying primarily women’s health due to the dearth of information regarding heart disease risk in women and, in particular, how age and menopause influence this risk. The majority of the research in the area of heart disease has primarily been on men, and women have been traditionally underrepresented in medicine and science, particularly women with a non-white racial and ethnic background. This also means we have less available information regarding safe and effective therapies for women who are at risk for or have already developed heart disease. Our laboratory hopes to close this knowledge gap and be able to better understand some of the early risk factors of heart disease for women to identify effective preventative and therapeutic strategies to reduce heart disease risk for women.

We know that there are many age-related changes that women go through that increase their health risk, but is there a particular reason why you decided to focus on research related to menopause?

From what the literature suggests, prior to menopause, men have a greater prevalence of high blood pressure and increased heart disease risk compared with women. After the typical age of menopause, around 50-51 years, this risk increases substantially in women and surpasses that of men. This means that there is something in particular about the loss of sex hormones (estrogens and progesterone) in women that contributes to this greater risk. There is also evidence that menopause symptoms can be associated with heart disease, particularly hot flashes, night sweats, and difficulty sleeping. Our lab focuses on the influence of these symptoms and how the age of menopause influences blood pressure regulation to contribute to these greater risks.

Why is research on women’s health so important?

Women are important and have traditionally been ignored in research and science. For example, women participate in clinical trials much less than men for many reasons; however, this means that many drug trials are conducted only in men, but these same medications are given to women. Much of what we know about physiology was determined in men. Now we are playing catch-up to understand women’s physiology. It’s frustrating, but we are trying to be part of the solution.

What are the barriers for women to participate in research?

Women often carry several responsibilities simultaneously, and participating in research is not often at the top of their priority list. Women are working; they may be primary caretakers and are often not able to get the time off, cannot afford to take the time off, or need to be with their children. We have opened up our laboratory on the weekends for studies to help reduce this barrier, but often childcare is an issue. We have tried to set up childcare at the University for parents, but we have not been successful as there are some liabilities with this process. In addition, there is a lack of information provided to people in general about research and clinical trials, and information about menopause is often not shared with women unless women inquire directly with their physicians. There are often additional barriers for people of color, particularly the African American community, who have been traditionally exploited in research, and as scientists, we need to do a better job of connecting with their communities and building strong relationships and trust before engaging them in research.

Are there certain subsegments of women where we particularly need more research information, and why is that necessary? Can’t we generalize women’s research to all women?

Yes, there are definitely subsegments of women that we particularly need additional knowledge on regarding their health and strategies for disease prevention and treatment. We cannot generalize across subpopulations of women because life experiences have a strong impact on our physiology. One of the strongest examples that I can provide is racial stress. Non-white communities have experienced macro- and micro-aggressions for centuries, and we haven’t even really begun to understand how that has impacted their physiology. We know diverse communities are often at a greater risk for high blood pressure, heart disease, and kidney disease, just to mention a few, but we don’t have a clear understanding of why. These factors are often erroneously discussed in the literature as being connected to genetic or physiological differences, but we, as scientists, need to incorporate how life experiences, such as the trauma and stress surrounding racial discrimination, influence risk factors for these diseases.

Why is it important for women to participate in research studies from a researcher's perspective? What benefits can women experience by participating in research?

The majority of the knowledge we have obtained from the research, including clinical trials, drug trials, etc., has come from studies conducted in mostly men, in particular white men. This knowledge gets generalized to the community when it doesn’t always apply to women. Over the last 20 years, we have identified many breakthroughs in how the physiology of men and women are different. Sex hormones, including estrogen, progesterone, and testosterone, influence our muscles, heart, lungs, and blood vessels differently, and men and women have varying levels of these hormones. Thus, it is important for women to participate in research so that we can delineate differences in physiology between men and women, which will lead to improved preventative strategies and treatments for women.

Another important benefit of women participating in research is that they would contribute their experiences to the depth and breadth of knowledge on women. This knowledge will lead to better treatments for them, their daughters, and generations to come. If women do not participate in research, we can’t make strides in understanding risk factors that are specific to women and develop tailored treatments to prevent/reduce heart disease risk in women.

How can women learn about research studies they may be eligible to participate in?

• There are national websites that women can browse for research studies, such as clinicaltrials.gov

• Women can learn about studies at the University of Minnesota’s StudyFinder website: studyfinder.umn.edu

• Women can learn more about our lab and studies occurring in our lab by visiting: https://med.umn.edu/rehabmedicine/research/labs/cardiovascular-rehabilitation-lab.

What questions should women ask before participating in a study?

• What is the purpose of the study?

• What procedures are involved in the study?

• What are the risks of the study?

• How long does the study last, how many visits are there, and how long is each visit?

• Is there compensation for being a part of the study?

What should we do to advocate for getting more women involved in research?

We should educate women on what we know and do not know about women’s health and the consequences of that lack of knowledge. In addition, we should build relationships with the community and discuss the importance of their participation in research.

What is your hope for the future if we could close the gap in women’s health research?

My hope for the future is that we significantly reduce the risk of high blood pressure, heart disease, and mortality in women; that women know their risks and how to reduce their modifiable risk factors for these diseases; that women feel there is a space and place for them in research and clinical trials; and that women feel comfortable enough to talk to their family, friends and health care providers about menopause and advocate for themselves.

Thank you to Dr. Keller-Ross for taking the time to highlight the progress made in recent years to include more women in medical research and acknowledging that there is still a way to go to ensure equal representation in research. As moms, daughters, sisters, and friends, we need to spread the word and advocate for women to be included in research studies and to raise awareness of the importance of why our representation matters to our health and health care.

Learn more about Dr. Keller-Ross, The Cardiovascular and Rehabilitation Lab, and The effects of menopause on cardiovascular health in women study by clicking the links.