Women make up more than half of the population of the United States. They use health care services more frequently than men do and they make most of the health care decisions for their families. However, while women live longer, they experience poorer health than men on a variety of outcomes. To date, too few institutions have established interdisciplinary research institutes dedicated to advancing science in the field of women’s health.
Three researchers—two leaders and one prominent new addition—are among the many at the Icahn School of Medicine at Mount Sinai who are dedicated to addressing these gaps in knowledge and clinical care. Recently, they took a moment to share their thoughts.
Michal A. Elovitz, MD
Dean, Women’s Health Research
Professor, Obstetrics, Gynecology and Reproductive Science
Director, Institute of Female Biology
Women’s health and women’s health science have remained stagnant for decades. The United States has one of the highest rates of maternal morbidity and mortality among industrialized nations. One of the leading drivers of this is preeclampsia. One hundred years ago, preeclampsia was described as “toxemia,” as it was believed a toxin must be responsible for the multiorgan injury resulting from this disease, which affects one in 12 pregnancies. The treatment for toxemia was simply delivery, and 100 years later, that remains the only definitive treatment for this life-threatening condition. In 2023, preeclampsia remains mostly unsolved.
Pregnancy health remains one of the most understudied areas in medicine. The phenomenon of how a mother tolerates a fetus—a semi-foreign being within her own body—remains poorly understood. Better understanding of how immune cells traffic between the mother and child would undoubtedly advance discovery, not only for maternal-fetal health but also for cancer and transplant biology.
We remain not just in the dark about pregnancy but truly about women’s health across the lifespan. We have seen what can occur when there is focus and commitment to advancing health. For example, cardiovascular well-being has improved over the last few decades because of a continuous research focus, development of new therapeutics, and advancement of a precision-based approach to care.
However, these benefits have accrued disproportionately to men. Failure to attend to sex-specific biology has significantly hampered improvement in cardiovascular health for women. Importantly, the lack of scientific focus on female-specific diseases, such as infertility, endometriosis, pelvic floor disorders, menopause and gynecologic pre-cancers and cancers, has resulted in a failure to make significant improvements in health outcomes for women at all points in their lifespan.
But this does not have to be our truth. We can do better for ourselves, for all women, and for our daughters. Mount Sinai saw this opportunity, and I am so ready and enthusiastic to lead this charge. As the inaugural Dean for Women’s Health Research, I am being empowered, along with amazing colleagues at Icahn Mount Sinai, to create a new paradigm for advancing women’s health. We will develop new opportunities in women’s health science by leveraging existing expertise in diverse fields, creating collaborative networks and empowering investigators to pursue understudied areas in women’s health research. Importantly, we are creating a new Institute of Female Biology (IFaB) whose main mission will be to advance understanding of biology that drives health and disease in women. IFaB will focus on conditions that—while common and creating an undue burden for women—have remained largely unattended to, such as infertility, preterm birth, preeclampsia, endometriosis, fibroids, polycystic ovary syndrome, menopause and so many others.
Mount Sinai recognized that we have all the tools to make things different for women’s health. If we have learned anything from the COVID-19 pandemic, it is that bringing together multidisciplinary teams, innovating new approaches, revealing key biological processes, and targeting plausible therapeutics can result in rapid scientific discovery and viable therapeutics to immediately improve health. With the support and innovation of Mount Sinai, we intend to leverage all of these tools and approaches to transform women’s health science and improve women’s health.
Women should not have to suffer because we do not have answers. They should not have to suffer because no one has invested in understanding female biology. They should not have to keep being told that there is no answer and that no one knows why they are in pain, or cannot have a baby, or why they lost a baby, or why they do not feel normal in midlife. At Mount Sinai, we are choosing to do more. To do so much more. We are choosing to make a difference, to understand biology, to improve women’s health. It is way past time to make women’s health science, women’s health and women a priority.
Leslee Shaw, PhD
Director, The Blavatnik Family Women’s Health Research Institute
Professor, Obstetrics, Gynecology and Reproductive Science, Cardiology and Population Health Science and Policy
There has been a recent focus on women’s health, and what is striking is the paucity of medical knowledge available to practicing clinicians to guide everyday decision-making with their female patients. At Icahn Mount Sinai, we have decided that revolutionary ideas and targeted research are the key to rectifying challenges women face in health care.
We have created a dedicated Women’s Health Research Institute that seeks to link all stages of a woman’s life to provide a more comprehensive view of disease precursors and identify novel strategies for early intervention—the important means to improve the lives of women. By creating an institute that has dedicated programs from birth to death, we bring together scientists and physicians who learn from one another’s expertise and understand the varying causes of disorders like cancer or cardiovascular disease. Our research teams include scientists with wide-ranging skills such as the use of artificial intelligence methods to explore electronic health records, or interfacing obstetrics with cardiology to form a better understanding of hypertension in women. Early-stage illnesses, such as pregnancy-related hypertension or diabetes, lead to lifelong patterns of uncontrolled blood pressure and glucose and contribute to many adverse complications of stroke, heart attack or heart failure.
For all conditions, there are many precursor features that, once identified, can lead to great advances in diagnosis and treatment. Putting together these intricate patterns of risk features requires pioneering research led by internationally renowned scientists who focus on thinking longitudinally about the woman—across the lifespan. This would allow links to form between common chronic conditions, including cancer and cardiovascular disease, and help us find novel associations with disorders such as depression.
For women, early detection has an immeasurable benefit in preventing advancing disease and early death. The ultimate goal is for women to live their lives fully across all stages of their lives. However, research is way behind, and our knowledge gaps in women’s health are too wide — contributing to unnecessary illness and death. Inadequacies of care for women have been reported for nearly 30 years, and we believe that it is time for this to change.
For women’s health scientists and physicians, research innovation requires challenging all our existing knowledge and creating novel approaches to unearth sex-based mechanisms across diseases. We propose that a newly revised approach to women’s health research is possible and will help to realize major strides in improving the health and well-being of women.
Roxana Mehran, MD
Professor, Medicine (Cardiology), and Population Health Science and Policy
Director of the Women’s Heart and Vascular Center at Mount Sinai
Director of Interventional Cardiovascular Research and Clinical Trials
Despite being responsible for causing 35 percent of deaths in women each year, cardiovascular disease (CVD) in women remains understudied, under-recognized, under-diagnosed and under-treated.
With colleagues within Mount Sinai and around the world, we have long been working to address these inequities. In 2021, I proudly collaborated with 17 experts from 11 countries on the Lancet Women and Cardiovascular Disease Commission, producing the first-ever global report on CVD in women. The all-female-led commission outlined 10 ambitious recommendations to tackle inequalities by targeting diagnosis, treatment and prevention strategies to reduce CVD in women. These include educating health care providers and patients on early detection tactics to prevent heart disease in women, scaling up heart health programs in highly populated and underdeveloped regions, and prioritizing sex-specific research on heart disease in women.
These ideas will be further explored during a half-day symposium on Friday, February 17, at the InterContinental Barclay in New York City, featuring field-leading experts in cardiovascular care and research. The event will be held in conjunction with our nonprofit organization, Women as One, as part of its flagship conference, RISE, which supports the professional growth of women in medicine—a relevant combination of events in February, now known as Heart Month.
Women supporting women is essential, among physicians but also across provider and patient lines. Women trust each other, and we must find ways to capitalize on this trust for the betterment of patient care and their workplace environments.
Support for women in cardiology is integral to our work at Mount Sinai Heart, where we are launching a multispecialty Women’s Heart and Vascular Center, with clinics specifically designed to screen, assess and educate women about their level of individual risk for cardiovascular disease. This will be done through a cross-disciplinary team of cardiologists, subspecialists and researchers with expertise in women’s heart health. The goal is to assure that no stone is left unturned and that care providers are informed of their patients’ needs throughout their entire experience at Mount Sinai.
Women tend to be stereotyped into certain categories of health problems, such as anxiety or hormonal changes, and physicians miss the fact that what they really have is heart disease. For example, symptoms such as angina and chest pain in women may be misdiagnosed as anxiety or other psychosomatic disorders. Strategies are urgently needed to tackle such inequities in the diagnosis, treatment, and prevention of heart disease in women.
Another goal of the Mount Sinai Women’s Heart and Vascular Center and across my collaborative work is to ensure women have a greater presence in cardiovascular research. Women are historically underrepresented in cardiology at large and disproportionately so in the world of clinical research. With fewer women in research, fewer women enroll in clinical studies, leading to a lack of evidence for what treatments are actually effective for women patients. Many research organizations now recognize this as an opportunity but struggle with how to bring more women into the research fold.
We want women to know they truly matter. We also want to bring realistic solutions to the forefront. The work we are doing through Mount Sinai and our partnership initiatives around the world speak to this. We know we can make a difference.
To learn more about Mount Sinai Heart visit mountsinai.org/care/heart
To learn more about the Lancet Women and Cardiovascular Disease Commission visit womencvdcommission.org
To learn more about Women as One visit womenasone.org
