Mind The Gap: Why Women’s Brain Health Is Still Underresearched

The brain, as they say, is still the “vast unknown” of this century. Despite large strides made in this space in the last few decades, especially since the advent of MRIs, we still don’t know what we don’t know. A crucial aspect of this, is the understudied field of women’s brain health. The gender health gap exists across the spectrum of women’s health research, funding, diagnostic loopholes and outcome management. The consequence of this is not only millions of lives affected by disease and their caregivers, but it also elevates global economic burdens. 

According to the Global Burden of Disease Study 2019, the number of people diagnosed with dementia is expected to almost triple by 2050. That is why gender differences in brain health matter- for research, mitigation, and treatments.

What is the Brain Health Gap?

More than 50,000 human-brain-imaging articles have been published since MRI came on the scene in the 1990s. But of those, less than 0.5% consider health factors specific to wom

The brain, as they say, is still the “vast unknown” of this century. Despite large strides made in this space in the last few decades, especially since the advent of MRIs, we still don’t know what we don’t know. A crucial aspect of this, is the understudied field of women’s brain health. The gender health gap exists across the spectrum of women’s health research, funding, diagnostic loopholes and outcome management. The consequence of this is not only millions of lives affected by disease and their caregivers, but it also elevates global economic burdens. 

According to the Global Burden of Disease Study 2019, the number of people diagnosed with dementia is expected to almost triple by 2050. That is why gender differences in brain health matter- for research, mitigation, and treatments.

What is the Brain Health Gap?

More than 50,000 human-brain-imaging articles have been published since MRI came on the scene in the 1990s. But of those, less than 0.5% consider health factors specific to women. In more recent times, this number is estimated to have increased to 2-6% of all neuroscience studies.

The WHAM Report (Women’s Health Access Matters) found that just in the US alone, women are 66% of the 7 million people with Alzheimer’s, and yet just 12% of 2019 NIH Alzheimer’s fund went to projects focused on women. Additionally, the report showed that doubling the funds for women’s Alzheimer’s research pays for itself three times over. Adding $300 million for research on women generates $930 million in economic gains, adds back 4,000 years of life, eliminates 6,500 Alzheimer’s disease and related dementias, and saves 3,500 years of nursing home care and costs.

From a clinical and neuroscience perspective, there is a clear sex and gender gap in outcomes for brain health disorders across the lifespan, with strikingly negative outcomes for women. Approximately 70% of those diagnosed with Alzheimer’s disease worldwide, are women. Women are twice as likely to be diagnosed with depression anxiety disorders and migraines. These are all specific risk factors for developing dementia.

Are Men and Women’s Brain Health Different?

“A gendered world creates a gendered brain”, wrote Gina Rippon, a cognitive neuroscientist and author of A Gendered Brain. A persistent stereotype has been that men’s brains are more suited for logical reasoning whereas women’s brains are attuned to more nurturing and empathy. However, decades of research have shown that men and women’s brains are more alike than different. Even though men’s brains are typically 10% larger, it does not impact intelligence.

This “neurosexism”, or “the practice of claiming that there are fixed differences between female and male brains”, is detrimental to an equalising approach to health research and funding allocation. Hormones do have an impact on brain structure, but there are no correlations in research that those hormonal fluctuations preclude women from certain abilities, even though these differences are important for the possible development of sex-based therapeutics and the treatment of neurological disorders.

Role of Estrogen and Women’s Brain Health

Two 2023 studies performed detailed brain scans of women at multiple points across the menstrual cycle, finding that the volume or thickness of certain regions change in sync with hormone levels. The areas of the brain highlighted by both studies are those that govern emotions, memory and behaviour. Nature Mental Health published one study and the other was conducted by the University of California at Santa Barbara, and published in the preprint database bioRxiv.

Increases in estrogen and progesterone were associated with parts of the brain linked to sharpness of memory. Could this point to a possible correlation between memory challenges and brain fog that occurs in the perimenopause years, and the sharp decline of estrogen levels in the body?

Another independent study published in the American Academy of Neurology suggested that estrogen may be key to brain health, with women who have more exposure to the hormone having less damaged white matter. This indicates that reproductive history needs to be integrated to manage brain health in post-menopausal women.

Way forward for Women’s Brain Health

Needless to say, we need more research and funding for gendered research on brain health. Clinicians need to be made aware of the gender and sex-based factors that affect the treatment of perimenopausal brain fog or challenges with memory. Early signs of dementia and Alzheimer’s differ in men and women and both communities as well as clinics need to factor that in for mitigation. Governments can no longer neglect the intersection of ageing, economics of elder care, and gender differences in dementia and Alzheimer’s. Closing the Brain Health Gap will help economies create recovery and prepare our systems for future global shocks.

Swarnima Bhattacharya is currently pursuing a Masters in Public Health from the Yale School of Public Health. Views expressed by the author are their own.