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Opinion

“Let the activists keep beating the drum around female health inequalities”

By Nicola Finn, associate director at OggaDoon

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For decades medical research has been based on data from the male body, but we now know that women’s bodies respond in different ways to drugs and disease.

The research and application gap in healthcare is starting to be recognised and thankfully, the landscape is changing. After all women account for 50 per cent of the global population.

We are going to witness a massive explosion in female health solutions over the next five years. Femtech is predicted to grow at around 15 per cent CAGR, with solutions around mental health, ovarian health, menstrual health and menopause health – to name a few.

More female founders who connect and understand the different health challenges women face are starting businesses to help fill the female health gap in different ways. However, this is not for the faint of heart as the female founders must overcome other barriers such as the bias in capital funding, access to business loans and support for childcare to help free up women’s time.

In the UK, there is a widening funding gap between male-founded and female-founded companies. In 2020, just 2.3 per cent of VC funding went to women-led start-ups. This fell to 1.7 per cent in 2021.

There is additional research conducted by Extended Ventures which also spotlighted the huge investment gap facing diverse founders over the past decade, according to race, gender and educational background, with all-ethnic teams and female entrepreneurs receiving just a fraction of available funding versus all-white teams and male founders. The finding of baked-in bias holds true across all funding stages, per the findings.

Lack of diversity across the capital landscape – angel, venture capital (VC) or private equity (PE) – is no secret. At present, it is a male-dominated space globally.

In 2019 women comprise 30 per cent of venture capital personnel – a small increase from 27 per cent in 2017. Whilst this is encouraging and implies more representation, it still lags behind the average of UK working professionals.

All groups of humans have similar biases, naturally gravitating to people and scenarios that they can personally relate to. This extends to bias around investment decisions, intentional or not. But we need more female investors to be in these positions, as they can personally understand the impact of innovations, specifically targeting female health.

After years of male investors ignoring the female health space, it is finally being recognised as a hotbed for investment due to its predicted growth.

Thankfully, more women are coming into the female health investment industry and more funds are also headed by female investors.

This is needed to drive and ensure inclusivity and unbiased access to the industry and will need historic investment for innovation and collaboration.

In order to build towards the brave new world that prioritises individual female needs in healthcare, there needs to be a movement. Not just front-line activists championing and fighting for equality in female health, but also activist angels, VCs and PEs, providing funding support to visionary founders.

Right now, it is a critical time to keep taking those meaningful steps to bridge the gender health gap. With that, here are some of the UK femtech founders bridging the gender health gap:

Forth

Sarah Bolt, founder of Forth has always been part of the movement to highlight and bridge the female gender data and health inequality gap. Forth’s mission is to empower women to become experts on their own body through scientific knowledge and understanding. Historically, women’s bodies were deemed too complicated for clinical trials due to the complexities of their hormone network. This has resulted in women reacting differently to drugs and often misdiagnosed as they do not present with the same symptoms as men.

It was only six years ago that the National Institutes of Health required medical investigators to consider sex as a biological variable. But there is still a long way to go in closing the gender data gap in health.

Forth’s contribution to closing this gap in data is their ground-breaking solution MyFORM™, an advanced female hormone blood test that addresses the lack of clinical insight from current single day hormone blood tests. The single-day tests assume every woman has an average length cycle of 28 days and offer little in the way of personalisation.

MyFORM™ uses a combination of blood analysis, advanced mathematical modelling and endocrinology expertise to scientifically map how a woman’s hormones are fluctuating across their entire menstrual cycle rather than a single day.

With two blood tests taken on day 14 and day 21, the test is able to predict the woman’s own cycle length, creating charts of her four key female hormones across her menstrual cycle, as well as providing personalised ranges for each hormone.

Forth has also developed a unique way to assess a woman’s ovarian health. The Forth Ovarian Response Metric (FORM) takes the results from the blood tests to provide a score on how well a woman’s ovaries are responding to her control hormones. A score above 75 indicates a healthy hormone network. This is particularly useful for women entering perimenopause when their ovaries begin to become less responsive.

The product is designed for women who are experiencing natural menstrual cycles and not using any hormonal treatments such as the pill, Mirena coil or hormone replacement therapy (HRT). It is particularly useful for:

  • Women who want to check for hormone imbalance
  • Women in their 40s who want to understand if the symptoms they are experiencing are due to perimenopause
  • To identify or manage an existing hormone related condition
  • Women who consider starting a family
  • Exercisers, athletes and dancers who want to perform to their personal best throughout their cycle and ensure their hormones have not been compromised by their training load and fuelling strategies
  • Women whose menstrual cycles have recently resumed following recovery from RED-S – relative energy deficiency in sport – discontinuation of hormonal contraception or in the postnatal period.

The highly accurate, personalised results are based on eight hormone measurements, which are translated through AI and delivered on the Forth app. This offers scientific data and actionable insights as hormones are intrinsically linked to a woman’s wellbeing and have an important role to play not only in fertility but in heart health, bone health and the nervous system.

LatchAid

Dr Chen Mao Davies started LatchAid after facing her own struggles with breastfeeding, pain and subsequent depression. She realised that mothers needed maternal support fit for the 21st century in an interactive way.

With the pandemic currently paralysing the predominantly face-to-face support model in place, her app is more necessary now than ever.

LatchAid supports breastfeeding mums and their families through interactive 3D technology, artificial intelligence, virtual peer support groups and live healthcare specialists to combat problems experienced with the latching technique. The app prides itself on being inherently accessible and democratic, empowering women everywhere, regardless of their economic or environmental circumstances.

As well as positive health outcomes for mothers and babies, breastfeeding offers social, economic, and environmental benefits. The UK, however, has the lowest breastfeeding rate in the world. 90 per cent of women give up breastfeeding before they want to because of pain, health issues or lack of support. Unsuccessful breastfeeding also costs society around US$1B per day globally.

LatchAid is an app that utilises 3D interactive technology to help mothers learn breastfeeding skills intuitively from 3D avatars. It offers virtual peer support groups to connect mothers to a close-knit peer-to-peer support network and an AI-powered virtual supporter chatbot to provide users with personalised expertise and companionship 24/7.

Elvie

Elvie is a women’s healthcare company providing products which take women’s tech out of the dark ages. Tania Boler started the business after working on women’s health policy for global NGOs and the United Nations.

She believes that the release of health products targeting a female audience must go alongside the breaking down of societal stigmatisation of women’s health.

One such product is the sleek, innovative breast pump – the smallest and lightest wearable electric one on the market. It is a silent, wire-free, fully electric device that fits subtly into a nursing bra, ensuring new mothers can pump whilst moving around comfortably.

The pump connects to a mobile app which releases a notification when the bottles are filled. The app can also be used to adjust the suction, monitor pumping history, monitor real-time milk levels and pause and start pumping. The product also includes bra adjusters to ensure less pressure on the breast.

Another product by Elvie is the pelvic floor trainer. Now available on the NHS, this product connects to the Elvie app and encourages training with fun games for five minutes, three times a week.

The trainer is fully waterproof, rechargeable and covered with medical-grade silicone and it is safe to use with an IUD and coil. The app encourages use with four different skill levels and six different exercise types including strength and lift.

Clementine

Kim Palmer founded the women’s mental health app Clementine in 2017 which uses hypnotherapy to lower stress levels and build confidence. She created Clementine after suffering herself from panic attacks during pregnancy. The app has both a free and a subscription-based version with sleep sessions, confidence and anti-anxiety courses as well as mantras.

Nua Fertility

Deborah Brock founded Nua Fertility following the challenges she had through her own fertility journey. Following her own successful pregnancy through optimising diet, she started researching the connection between the gut microbiome and reproductive health. After three years of research, Deborah developed two fertility supplements – one for men and one for women – that focus on the microbiome to optimise fertility health.

Nua fertility supplements, have a microbiome focus and are designed to support the nutritional needs of men and women when trying to conceive. The company’s NuaBiome Women supplements combine fertility-supporting vitamins and minerals with a blend of strains of good bacteria to promote healthy conception, egg health, and foetal development.

The friendly bacteria offer three significant benefits: absorption of essential fertility vitamins and nutrients, strengthening the immune system and reducing inflammation in the body.

All these female founders have fought to gain funding for their propositions and succeeded despite the obstacles due to the baked-in bias and lack of diversity across the business capital arena.

However, more female investors need to be appointed as they can personally understand the impact of female health tech innovations.

Let the activists keep beating the drum around female health inequalities. As we continue to make these meaningful steps to bridge the gender health gap we can remember that necessity is the mother of all invention.

Opinion

The continued struggle for female representation in drug trials  

Dr Janet Choi, chief medical officer at Progyny

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Dr Janet Choi, chief medical officer at Progyny

The exclusion of women from drug trials undermines efforts to ensure equitable and effective healthcare for all individuals.

In 2002, the Women’s Health Initiative (WHI) was forced to pause its study on hormone therapy’s effect on menopause symptoms due to results showing it increased the risk for breast cancer, stroke and heart disease, and thrombotic events like pulmonary emboli.

Over 20 years later, in May of this year, JAMA published a review of this study and determined that, given current available hormone therapy formulations as well as risk/benefit analysis, younger menopausal women may actually derive significant benefits from menopausal symptom relief with appropriately prescribed hormone therapies.

The initial study had looked at women who were older and typically years post-menopause – the average age of the study participants was 63.3 years – and the age-related changing of blood vessels, among other things, may be the key to shifting from greater risk to greater benefit with hormone therapy.

I wish this more measured summary of the study’s findings and recommendations had been headlined back in 2002 – and I imagine thousands of my OB/GYN colleagues and billions of menopausal women over the years feel the same.

Yet, due to these 2002 over-generalised published findings, doctors and patients shied away from hormone therapy, which led to unnecessary suffering for many symptomatic menopausal women.

The irony of the WHI study is that after decades of women being excluded from clinical research, Congress finally passed an act in 1993 requiring that the National Institute of Health (NIH) enrol women and persons of colour in clinical trials.

On the heels of this landmark decision, the intentions of the WHI study were excellent – a first of its kind for women – but may have unintentionally set back women’s health innovation.

The reality

If you’re wondering why we are just now reevaluating and reinterpreting findings made in a 2002 women’s health study you may (or may not) be shocked to learn that while there is growing inclusion of women into research trials, they are still underrepresented in key therapeutic research areas, such as cancer and cardiovascular disease.

Excluding women from drug trials can have several harmful consequences. First, it can lead to a lack of understanding about how medications affect women differently than men, as their physiological responses may vary due to hormonal and metabolic differences, among other factors.

This can result in ineffective or potentially harmful treatments for women. It can also hinder progress in medical research by preventing the development of sex-specific treatment approaches.

Additionally, while the amount of research conducted on the behalf of women has grown in the past two decades, research involving pregnant women has been restricted.

This leads to a limited understanding of how best to medically care for pregnant women: for example, less than 10 per cent  of prescription medications have been studied enough to understand the impact in pregnancy on both the woman and her foetus.

While the NIH and American College of Obstetricians and Gynecologists (ACOG) both acknowledge pregnancy as a “medically complex” state that can alter metabolism of medications, and the course of various diseases, increased pregnancy-specific data needs to be collected to optimise the care of women in pregnancy.

Another recent, glaring case study: initial COVID vaccination trials did not include pregnant women, which led to restrictions on the availability of the vaccines as well as restrictions of the use in pregnant women with dire consequences – as unvaccinated pregnant women are more likely to develop severe COVID infections requiring ICU admissions and are more likely to develop other pregnancy-related complications like preeclampsia and preterm birth.

How do we move forward?

The exclusion of women from drug trials undermines efforts to ensure equitable and effective healthcare for all individuals.

It’s crucial for the government and pharmaceutical companies to put more resources and funding into women’s health so we can have a deeper understanding of how to treat diseases that impact over half of the population, for more female and diverse talent to enter the medical field – either as doctors, researchers, healthcare executives – and to incorporate how biological sex can affect medical treatment into provider education.

And, for pregnant women, the answer was proposed by ACOG back in 2015: “A more careful examination…points to the need for evidence-based consideration of pregnancy exposure in research rather than broad exclusion of all pregnant women”.

If evidence demonstrates minimal risk to the foetus as well as potential benefit to the pregnant woman, why should she be denied the right to give informed consent to enrol in a clinical trial?

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Opinion

‘Women are left in limbo’: how telemedicine can cut down NHS gynaecology waiting times

By Kat James, director of new projects at Consultant Connect

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Almost 600,000 people in England are waiting for gynaecology treatment. It is clear the current system is not fit for purpose.

The NHS, across the board, is struggling to reduce waiting lists, but gynaecology health, in particular, has been sent to the back of the queue.

Referral numbers are about 60 per cent higher than pre-pandemic, which represents one of the three highest specialties in terms of volume increase since pre-COVID.

Not only are women left feeling neglected, but longer wait times also result in them needing more complex treatment or even emergency admissions to hospital.

Then, there is also the impact on family life, work, and women’s mental health. A survey of the Royal College of Obstetricians and Gynaecologists found that four-fifths (80 per cent) of women said their mental health has worsened due to the wait and that one in four of those whose mental health had deteriorated, pain was given as a reason.

More than three-quarters (77 per cent) of women said their ability to work or participate in social activities had been negatively impacted.

One of the main stumbling blocks impacting patient waiting times is the disconnect between primary and secondary care. Often, patients who have faced long waits for their appointment are discharged after their first hospital appointment and told that their care is best taken care of by their GPs.

The good news is that new ways of working better connect primary and secondary care and ensure patients receive the right treatment first time. If applied at scale, these solutions considerably reduce waiting lists.

For example, giving GPs immediate access to speak to a consultant on the phone for specialist advice and guidance for their patient. In ordinary circumstances, a GP would have to call the hospital switchboard or send a written advice request which might take days to be answered.

Often, these queries would go unanswered or aren’t transferred to the correct department, resulting in patients being referred sometimes unnecessarily or presenting at a busy A&E department.

Technology like Consultant Connect allows GPs to directly “hunt down” a specialist consultant from a pre-defined rota for expert advice via a phone call, ensuring GPs can direct their patients to the right care first time. This service is available for gynaecology in almost 50 NHS areas across the country.

In Coventry, for example, a 54-year-old patient presented with obvious advanced gynaecological cancer. While the two-week wait referral had already been made, the GP couldn’t move the appointment sooner than 14 days later.

Meanwhile, the patient started deteriorating, and the GP considered an urgent admission. The GP used Consultant Connect and, within seconds, was connected to a gynaecologist, who then arranged for the patient to be scanned that day. The patient got the care they needed and avoided an acute admission.

In June 2023, the service expanded to cover a menopause advice and guidance line as referral data in one local area showed increased referrals relating to menopause-specific questions, many of which did not require to be seen in a hospital setting.

This meant that trusts weren’t seeing patients who needed to be seen, and patients with menopause symptoms were on waiting lists for a prolonged duration without management plans.

With the new Consultant Connect Menopause line, GPs can get through to a consultant with special interest in menopause matters within 26 seconds.

Data shows that 87 per cent of calls resulted in the GP receiving “enough” advice for their patient to benefit from an immediate treatment plan via their GP rather than waiting for a hospital appointment with a specialist unnecessarily.

Another way to tackle the wait problem is to leverage remote ways of working, which opens access to a new pool of workforce that otherwise wouldn’t exist.

Consultant Connect runs a network of NHS consultants who review gynaecology referrals remotely, with no need to travel to local hospitals and with consultants choosing their own working hours. This is often attractive to consultants who work part-time in hospital or are on parental leave, for example.

For patients, it means they get access to treatment plans faster: the remote working consultant determines the urgency of a referral and writes up a management plan, which means that treatment can start immediately.

Often, the health problem can be resolved through this plan, and for those still needing to be seen, it means they come to their first appointment on a more informed basis.

At the same time, it ensures patients are on the correct pathway, and any diagnostic test needed for a diagnosis are initiated in a timely manner.

Last year, Consultant Connect’s team triaged over 5,000 gynaecology referrals across the UK, resulting in 43 per cent of referrals being safely removed from the waiting list.

Many of these patients were returned to their GP with a treatment plan devised by the consultant. By fast-tracking urgent cases, women are not put through unnecessary stress and pain while waiting to be referred to a gynaecologist. Among these referrals, one in ten cases were upgraded to the urgent and suspected cancer pathways.

By reviewing current systems to make them more joined up and to allow for efficient ways of working, we can speed up care for women and make sure that clinicians have the right tools to help the NHS deal with the mounting gynaecology backlog.

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Opinion

‘We are not allowed to talk about our bodies’: why we need to address social media censorship

By Clio Wood, women’s health advocate and founder of &Breathe

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Social media censorship is just another example of women’s issues being sidelined and women being made, yet again, to feel small.

The gender data gap is huge and, if you’ve ever read the great Caroline Criado Perez’s book, Invisible Women, you’ll know what I mean. It touches every day of a female life.

That impact includes social media too. Because while the social media platforms are notoriously secretive about their internal workings, it’s a pretty safe bet that social media algorithms, like most of the rest of life, are built on male data and trained on male behaviours.

This means that as long as women have different behaviours and priorities of what they want to see on these platforms, we’re going to find it a struggle.

Meta and Tiktok are silencing women’s health and sexual wellbeing content. Censorship harms women’s health: it increases women’s pain, and disempowers women, which in turn means the gender health gap cannot close. What annoys you when you’re on your phone scrolling has long-lasting impact for us and our children.

I’ve experienced this censorship first hand on Instagram, with my reach being restricted for simply posting a body confidence reel of me dancing in a bikini.

That in itself – one example of many – is infuriating, but what’s especially galling is that everyday men’s health topics are left uncensored, and hyper sexualised women’s bodies, unsolicited “dick pics” and fake accounts using nearly naked female profile pictures are making their way into social media feeds and inboxes unchecked. The hypocrisy of the situation is clear.

All the while charities are being forced to use male nipples instead of female ones, and female-led period brands are losing hundreds of thousands of pounds when their ad accounts get deleted.

Creators, charities, medical practitioners and brands are being censored constantly through algorithms picking up words like sex, vagina, vulva, or period. Which are all normal human functions or body parts and integral to these creators’ missions. You can’t be a period care brand without talking about periods.

CensHERship aims to alter the trajectory of the current algorithms and end the routine censorship of women’s health content online

Creators end up using written symbols and numbers to disguise these words and bleep them out in speech to try to get around this censorship.

It’s examples like this that finally led me – after many years of finding this situation ridiculous – to do something about it.

Together with Anna O’Sullivan, we’ve created CensHERship, a campaign which aims to alter the trajectory of the current algorithms and hopefully restore some balance to what is allowed on social media. Our ultimate aim is to bring the platforms to the table for discussion by this time next year.

We launched a survey in late January 2024 to try to collect as much information as we can about the incidences of muting and censorship that female creators are experiencing, whether they are educators, charities, brands or medical professionals. The results emphasised that this is a widespread issue taking in all of women’s health and sexual wellbeing.

In tandem we hosted an intimate roundtable to launch the CensHERship campaign and found, to our astonishment, that the problem goes much deeper than social media. Women’s health and sexual wellbeing brands are being refused bank accounts, insurance and being kicked off payment platforms without warning.

Social media censorship is just the tip of the iceberg. It’s just one more example of women’s issues being sidelined and women being made, yet again, to feel small.

We’re not being allowed the freedom to talk about our own bodies and health, because speaking up goes against the male-gaze archetype of the female role and body. Let’s end CensHERship once and for all.

Clio Wood is a women’s health advocate, journalist, author and Founder of &Breathe.

Anna O’Sullivan is a communications and marketing professional and writes FutureFemHealth 

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