Blueprint to Close the Women%E2%80%99s Health Gap 2025

Menopause, PMS, migraine and endometriosis affect women’s day-to-day health over time, and are under-recognized, under-researched or misunderstood relative to the disability and difficulty they can cause. Menopause, an expected and normal transition for women in mid-life, is among the top conditions leading to profound impacts on health and quality of life for women. Perimenopause and menopause, which can last for more than a decade, are estimated to affect more than 450 million women worldwide at any one time.44 Long-term effects of menopause and untreated symptoms lead to increased risk of chronic conditions, such as cardiovascular disease, neurological diseases (e.g. depression, dementia), osteoporosis, type 2 diabetes mellitus and other gynaecological conditions. Menopause represents potential estimated gains of 2.4 million annual DALYs and $120 billion in annual GDP in the women’s health gap. Based on high unmet need for proper diagnosis and treatment, the estimated global market potential for interventions that address menopause symptoms ranges from $120 billion to $350 billion globally. Premenstrual syndrome (PMS) has the most wide-reaching effect on women’s health when considering the number of women it affects, the number of years a woman can have symptoms, how the symptoms can range in severity and how little is known or treated comparatively. Approximately 1.8 billion women menstruate each month,45 and 20–40% of women of reproductive age experience PMS.46 Caution is taken to not pathologize reproductive health, particularly for girls; and yet, given that societies and social systems were not designed to optimize the health of women and girls and schools and workplaces often do not adapt to the effects of menstrual cycles, the impact of PMS on education, employment and enjoyment of life can be significant. PMS symptoms are far- reaching, ranging from weight gain, abdominal pain and back pain to anxiety and mood changes, with many of these being debilitating for women.47 This can amount to an average of 23 days of lower productivity per year.48 Another recent analysis found that up to 31 million women and girls may have premenstrual dysphoric disorder, a more severe form of PMS.49 For school-aged girls, PMS and menstruation can lead to lower school attendance and lower educational attainment.50,51 PMS represents potential estimated gains of 2.1 million annual DALYs and $115 billion in annual GDP in the women’s health gap.Migraine affects around 21% of women – approximately 0.8 billion women globally.52 While migraines affect both men and women, they are often reported to have a hormonal component, and women report longer attack duration, increased risk of headache recurrence, greater disability and longer time to recovery.53,54 Menstrual migraine, a type of migraine occurring within two days prior to and three days post onset of menstruation, is strongly linked to PMS, causing frequent and debilitating symptoms for many women.55 Women are 3.25 times more likely than men to experience migraines, but lack of research into understanding sex-specific differences and their clinical implications persists.56 Migraine represents potential estimated gains of 2.7 million annual DALYs and $80 billion in GDP in the women’s health gap. Endometriosis is an oestrogen-related condition affecting one in 10 women between the ages of 15 and 45 – more than 190 million women globally, though data gaps suggest this is a gross underestimate.57 Although textbooks have described endometriosis as a “disease of nulliparous women in their late twenties or thirties”,58 endometriosis is likely an adolescent- onset disease. While the disease generally begins when a girl starts her period, it can take decades between onset and diagnosis.59,60 Endometriosis substantially affects all aspects of a woman’s quality of life. It can cause chronic pain and infertility and is associated with higher rates of depression.61 As a result of its wide-ranging and debilitating symptoms, many women may miss work or reduce their working hours.62 Due to the prevalence, lack of treatments and unmet need, the Forum and MHI have estimated that the commercial market for potential endometriosis treatments ranges between $180 and $250 billion globally.63 Endometriosis represents potential estimated gains of 0.25 million annual DALYs and $12 billion in annual GDP in the women’s health gap. Closing the women’s health gap – avoiding nearly 27 million DALYs each year caused by these selected conditions and boosting the global economy – requires the drivers behind them to be understood, quantified and addressed as well as a transformation of health and social systems.1.2 Four conditions affect women’s health span Blueprint to Close the Women’s Health Gap: How to Improve Lives and Economies for All 12