Chapter 02

The same disease, a different story

Women experience cardiovascular disease, cancer, osteoporosis, depression, and autoimmune conditions differently — yet medicine has been designed around the male body.

Key findings

Gender differences in frequent health conditions

Diagnosis, symptoms, and treatment disparities across five major disease areas.

Leading Cause of Death in Women

Cardiovascular Disease

CVD kills more women than men in the EU, yet is persistently treated as a "male disease," leading to systematic misdiagnosis and undertreatment of women.

37%
of all female deaths in EU 2024
7×
more likely to be misdiagnosed
€282B
annual EU cost of CVD

What the data shows

  • 41% of women wait over 12 hours before seeking help for chest pain symptoms
  • Women with total coronary artery blockage are 59% more likely to be misdiagnosed than men
  • UK women had more than double the 30-day mortality rate after heart attack compared to men
  • A woman in Lithuania is 13× more likely to die from heart disease than a woman in France
  • Women are less likely to receive acute reperfusion therapy or evidence-based pharmacological treatment
  • Takotsubo syndrome occurs almost exclusively in women (90%+ postmenopausal, aged 58–75)
  • Only 22% of primary care physicians felt "extremely well-prepared" to assess CVD risk in women (2014 survey)
Sex-specific presentation

Cancer

Cancer manifests differently in men and women — yet clinical trials and diagnostic protocols are still built on male data, leading to worse outcomes for women in several cancers.

2.11M
new cancer cases in EU women (2022)
34%
more likely to have chemo side effects
24%
projected rise in cancer cases by 2035

What the data shows

  • Bladder cancer presents much later in females, leading to poorer survival rates
  • Tumour mutational burden tends to be lower in females across various cancer types
  • Women experience adverse events during cancer treatment 34% more frequently than men
  • Women's survival rate for melanoma is almost double that of men's
  • Breast cancer therapies affect cardiac function — asymptomatic left ventricular dysfunction in 10–40% of patients
  • Cancer takes 2.5 extra years to be diagnosed in women vs. men (Danish 21-year population study)
Predominantly female, widely undertreated

Osteoporosis

Over 23 million Europeans are at high risk of osteoporotic fractures. The disease is 3× more prevalent in women, yet treatment gaps remain enormous across EU member states.

22.1%
of European women aged 50+ have osteoporosis
4.3M
fragility fractures per year in Europe
€56B
annual cost to EU health systems

What the data shows

  • 1 in 3 women and 1 in 5 men over 50 will experience an osteoporotic fracture
  • Menopause-linked oestrogen decline can cause up to 20% bone density loss
  • Only 57% of women with osteoporosis receive treatment
  • Only 3% of the €56B annual healthcare cost is allocated to medical treatment
  • 25.5 million women vs. 6.5 million men have osteoporosis in Europe (2019 data)
  • Men are often diagnosed later because DXA screening primarily targets perimenopausal women
1.5× more prevalent in women

Depression & Mental Health

Women are 1.5× more likely to experience depression than men, yet mental health care is rife with gender bias — women are over-diagnosed with depression while men are under-diagnosed.

8.7%
of EU women report chronic depression (vs. 5.5% men)
10%
of pregnant and postpartum women affected
332M
people worldwide with depression

What the data shows

  • 1 in 10 healthy life years lost by women is attributable to depression (1 in 20 for men)
  • In Sweden, women were 44% more likely to receive a depression diagnosis, even after controlling for actual symptoms
  • Women are 2× as likely to use psychotropic medication compared to men across Europe
  • Depression affects 17–20% of women with coronary artery disease — mostly undiagnosed
  • Hormonal fluctuations (menstrual cycle, pregnancy, menopause) contribute to higher female risk
  • Gender-based violence is a significant contributor to women's higher rates of depression
Women make up 80% of all cases

Autoimmune Diseases

About 13% of women are affected by at least one autoimmune disease — compared to 7% of men. Conditions like lupus, rheumatoid arthritis, and multiple sclerosis overwhelmingly affect women, yet chronic pain is routinely dismissed as psychological or exaggerated.

80%
of autoimmune diagnoses are in women
13%
of women affected (vs. 7% of men)
5–10%
of population affected in industrialised countries
X chr.
contains most immune-related genes — women have two

Key conditions and findings

  • Most common conditions in women: rheumatoid arthritis, systemic lupus erythematosus, Hashimoto thyroiditis, Sjögren's syndrome, multiple sclerosis
  • Sjögren's syndrome symptoms (fatigue, dry eyes, vaginal dryness) are frequently confused with menopause, leading to delayed diagnosis
  • Women with lupus from Black, Hispanic, and Asian backgrounds experience more severe disease due to intersecting healthcare barriers
  • People with one autoimmune disease are significantly more likely to develop a second — creating compounding disability
  • Oestrogens enhance immune responses, increasing autoimmunity risk; androgens exhibit immunosuppressive effects
  • Women are more likely to have adverse drug reactions to autoimmune treatments due to sex-specific pharmacokinetics largely unstudied in trials

The "Yentl Syndrome": Bias in Practice

The term describes how a woman's illness can only be taken seriously if she can prove she is as unwell as a male counterpart. Research has exposed unconscious bias against women in medical treatment — manifesting as dismissal, delayed care, and misdiagnosis.

Women's pain is routinely underestimated. Gender stereotypes treat women's pain as exaggerated, leading to insufficient treatment and referrals to psychological care instead of analgesics.

University College London research, 2021

Only 50% of the most widely used medical interventions used sex-disaggregated data. When they didn't, 64% of those interventions placed women at a disadvantage due to low efficacy or limited access.

World Economic Forum, 2024

Studies on asthma — similar prevalence across genders — show treatments were 20 percentage points less effective in reducing exacerbations in women compared to men.

WEF, Closing the Women's Health Gap, 2024

In a 21-year Danish population study, women were diagnosed later than men in 770 diseases. Metabolic diseases took an average of 4.5 extra years to be diagnosed in women.

Westergaard et al., Nature Communications, 2019