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Misdiagnosing: A Barrier Between Advocacy and Proper Care for Women

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Misdiagnosing: A Barrier Between Advocacy and Proper Care for Women

Tiffany Chow
October 2025

Women’s Health

The upkeep of one’s health, particularly for women, can be unnecessarily difficult at times. A simple check-up or yearly pap smear can unexpectedly become a nightmare for some women. Although there are a multitude of exams, screenings, and appointments to further women’s health, there seems to be a crumbling foundation waiting to break.

Misdiagnosing

A diagnosis can hopefully lead to a form of treatment and prevent the spread of disease, but diagnosing conditions can be difficult, especially when time is of the essence.^[1] Yet, the prevalence of misdiagnosis is significantly higher for women. In a survey tracking the number of men and women who had received a misdiagnosis in the past 2 years, more than 50% of respondents were women.^[2]Alongside the many barriers to receiving healthcare, such as insurance costs, expensive care, and accessibility to quality care, women tend to face further difficulties involving misdiagnosis.

From a clinical perspective, the prevalence of misdiagnosing women stems from the overall lack of knowledge regarding conditions that pertain more to women, as well as teaching methods that prioritize treatment for conditions that present themselves in males.^[1] The outcome is a lack of quality care for women due to systemic differences already set into place by medical education, as well as current practices of hospitals and providers.

From a societal perspective, misdiagnosis raises concerns over inequality, insensitivity towards women, and the negative stigma that arises as a result of such differences. It is known that symptoms can present differently amongst individuals and sexes. Too often, women are dismissed for their concerns, being called dramatic when, more times than not, their symptoms are real and bothersome.^[3]

Advocacy

With systemic differences widening the barrier between proper care and seeking treatment for women, engaging in substantial acts of advocacy can be empowering. As reproductive care is fundamental to women’s health, there are ways to provide support in getting sufficient care. For example, Planned Parenthood has many opportunities to engage and support the cause alongside a community of like-minded people.

Another opportunity is the March of Dimes, where participants walk to support all mothers throughout pregnancy. The walk is empowering as many walk as proof of their unwavering support. Funds are raised to call for better resources that prioritize the well-being of mothers and their babies.

While advocacy is important for change, many of the barriers between patients and doctors are systemic ones. As providers, many health professionals receive the brunt of those impacts on patients. Therefore, it can be helpful to have informed discussions with doctors about treatment and conditions. By doing so, this is a form of self-advocacy that can be very effective in maintaining a positive relationship between doctors and patients. Some questions include:^[3]

What are all of the treatment options available?
Why are you recommending this particular plan of care?
Why am I not being offered this treatment option?
What else could this be, beyond mental health or anxiety?

Raising Awareness of Under-Researched Conditions

Alongside the need to advocate for better care, it is also important to raise awareness of conditions amongst the greater community and practicing physicians. Many conditions that impact women, ranging from chronic illnesses to reproductive conditions, have not been researched enough. From providing treatment for symptoms presented in the male body, to the lack of understanding of female-specific symptoms, there needs to be more research focused on how conditions present themselves in women, and the prevalence of conditions in females specifically.^[4]

With research itself, there is a constant battle with censorship. Although many female-oriented conditions are heavily under-researched, the growing list of banned words for writing research grants has included both ‘female’ and ‘women’. This adds to the systemic barriers that continue to act as a divide between quality care and women’s health.

Yet, with growing efforts to initiate research on these conditions, we can begin to not only reverse misdiagnosing amongst women, but also to understand women biologically and from a societal perspective. For example, early life experiences and environmental factors can increase the risk of developing chronic conditions in women, as well as the onset of menstruation and fluctuations in hormones.^[4] By simply acknowledging these initiatives, we are making these prevalent issues relevant and talked about.

References

[1] Sun T., et al. (2023) Large-scale characterization of gender differences in diagnosis prevalence and time to diagnosis. MedRxiv (Cold Spring Harbor Laboratory). https://doi.org/10.1101/2023.10.12.23296976

[2] McGovern G., (2024) Survey: Women More Likely to Receive Misdiagnoses and Unsatisfactory or Poor-Quality Care. Pharmacy Times. https://www.pharmacytimes.com/view/survey-women-more-likely-to-receive-misdiagnoses-and-unsatisfactory-or-poor-quality-care

[3] (2025) Breaking the silence: How women can advocate for their health | CWRU Newsroom | Case Western Reserve University. CWRU Newsroom (Case Western Reserve University). https://case.edu/news/breaking-silence-how-women-can-advocate-their-health

[4] (2024) Significant Lack of Data and Research on Chronic Conditions Affecting Women Is Hindering Diagnosis, Treatment, and Prevention; Report Calls for Enhanced NIH Research Effort. (Nationalacademies.org). https://www.nationalacademies.org/news/2024/07/significant-lack-of-data-and-research-on-chronic-conditions-affecting-women-is-hindering-diagnosis-treatment-and-prevention-report-calls-for-enhanced-nih-research-effort

The Graveyard Shift and Its Effect on Women

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The Graveyard Shift and Its Effect on Women

Harika Maganti
October 2025

The clock strikes five pm, and for many jobholders, they breathe a sigh of relief as they start to unwind and head back to their homes. However, for some, the alarm clock rings, as this is the time to wake up and start heading to work. Nicknamed the ‘graveyard shift,’ night shifts are an essential aspect in certain industries such as healthcare, manufacturing, and customer service. But how does this unnatural timing affect the health of the women who work there? Let’s light a lantern and take a closer look at the research.

General Effects

A major effect is on the body’s circadian rhythm. It is our biological 24-hour internal clock that regulates our day-to-day sleep/wake cycles and other physiologic processes, relying on light and environmental cues. Therefore, staying up at night and working under artificial lights can disturb our body’s natural rhythm.^[5]Sleep is the first to get affected as melatonin production gets thrown off balance, leading to fewer hours and poorer quality of sleep, especially for rotating shift work.^[5] This in turn can affect mental health, causing fatigue, irritability, depression, anxiety, and an increase in making mistakes on tasks.^[5] Evenings are usually when families and friends will spend time together, so night shifts can negatively impact the family and social lives of the workers, who can feel like they are missing out on life events.^[2] Gastrointestinal issues are also quite common, such as constipation, indigestion, and heartburn as workers may drink more caffeine and eat more snacks in an attempt to stay awake.^[1] Lifestyle modifications such as these and smoking could also be a reason why night shift workers are more prone to obesity compared to their daytime counterparts.^[2] Unsurprisingly, there is also an increased risk of developing diabetes mellitus and cardiovascular diseases such as hypertension, heart disease, and others.^[1]

Effects on Women

Night shift work can negatively impact the reproductive health and fertility of women in particular because the secretion of many female endocrine hormones is regulated by the circadian rhythm. Sleep deprivation can cause increases in hormones such as luteinizing hormone, estriol, and thyroid-stimulating hormone.^[6]One study shows that 53% of female nurses who worked graveyard shifts reported menstrual irregularities, and 18% of them reported increased dysmenorrhea.^[6] There is also an increased risk for developing endometriosis and early onset of menopause.^[6]In pregnancy, melatonin can aid in neurodevelopment, control oxidative stress for the growing fetus, and regulate uterine contractions during labor.^[3] Thus, changes to the circadian rhythm have a negative impact on pregnancy and delivery such as miscarriage, low birth weight, and preterm labor.^[3] In addition to this, women who worked night shifts for many years had an increase in the risk for developing breast or ovarian cancers. ^[6]

Ending Thoughts

Although we cannot control everything in our lives, women who work nightshifts can try to implement certain practices for the sake of their health: Try to prioritize sleep after work by using black-out curtains, eye-masks, and limiting noise in the house.^[4] Choose healthy foods, stay hydrated, and check vitamin D levels to see if you need to supplement. ^[4]Talk to your employer to see if they can reduce rotating shift work or schedule your night shifts in close succession.^[4] And on your days off, try to engage in self care practices such as meditation or journaling, and exercise with a friend or family member. ^[4] And as always, be sure to speak with your physician for advice and support.

References:

[1] Aliouche, H. (2022, January 24). What are the health effects of working night shifts?. News. https://www.news-medical.net/health/What-Are-the-Health-Effects-of-Working-Night-Shifts.aspx

[2] Brum, M. C. B., Filho, F. F. D., Schnorr, C. C., Bertoletti, O. A., Bottega, G. B., & Rodrigues, T. da C. (2020, February 10). Night shift work, short sleep and Obesity – Diabetology & Metabolic syndrome. BioMed Central. https://dmsjournal.biomedcentral.com/articles/10.1186/s13098-020-0524-9

[3] McCarthy, R., Jungheim, E. S., Fay, J. C., Bates, K., Herzog, E. D., & England, S. K. (2019, September 13). Riding the rhythm of melatonin through pregnancy to deliver on Time. Frontiers in endocrinology. https://pmc.ncbi.nlm.nih.gov/articles/PMC6753220/#s5

[4] Mozafaripour, S. (2024, October 28). How to work night shift and stay healthy: 12 essential tips: USAHS. University of St. Augustine for Health Sciences. https://www.usa.edu/blog/how-to-work-night-shift-and-stay-healthy/

[5] Silva, I., & Costa, D. (2023, May 12). Consequences of shift work and night work: A literature review. Healthcare (Basel, Switzerland). https://pmc.ncbi.nlm.nih.gov/articles/PMC10218650/#B132-healthcare-11-01410

[6] Yaw, A. M., McLane-Svoboda, A. K., & Hoffmann, H. M. (2020, December 30). Shiftwork and light at night negatively impact molecular and endocrine timekeeping in the female reproductive axis in humans and rodents. International journal of molecular sciences. https://pmc.ncbi.nlm.nih.gov/articles/PMC7795361/#sec5-ijms-22-00324

Racial Disparities and Resiliency in Mental Health

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Racial Disparities and Resiliency in Mental Health

Helena Huynh
October 2025

Socioeconomic status has often been implicated as a major predictor when it comes to mental health issues in children and adolescents^[4] in a number of different types of disorders. One theory that potentially explains this relationship, known as the social causation hypothesis,^[4] posits that chronic stress, typically associated with lower-income households, can contribute to mental health onset. In addition, early life adversities have been suggested to contribute to this issue.^[6] This can entail experiences like physical or emotional abuse, experiencing domestic violence, substance use, or incarceration that occur in childhood.

Studies have shown that African American and Latinx communities are more likely to be adversely impacted, with a higher likelihood of attending high-poverty schools.^[1] Furthermore, minority groups are more likely to experience discrimination, which has cascading impacts that can affect health care access or quality of care.^[1] These all impact psychological well-being, potentially creating disparities when it comes to mental health.

Gender Disparities Within Racial Inequalities

Gender identity is another factor that contributes to disparities in mental health. For example, women experience certain mental illnesses at a higher prevalence rate compared to men, such as PTSD and depression.^[2] However, in order to understand how to best address mental health concerns, we need to adopt an intersectional approach and incorporate multiple aspects of an individual’s identity. For example, we must consider how gender identity intersects with racial identity, especially throughout the lifespan. About 1 in 3 women going through pregnancy experience symptoms related to depression and anxiety, with higher rates reported in women of color.^[2] Later in life, African American women are more likely to experience depression symptoms when transitioning to menopausal periods.^[2] In spite of these differences, women of color are less likely to seek psychological help, further widening the gap when it comes to mental health equity. Research aimed at dissecting why this is can help pioneer changes for women of color to seek mental health resources.

Addressing Inequalities: Resiliency in Mental Health

Research has focused its efforts on understanding different factors that might be protective when it comes to racial minority mental health. Ethnic identity, for example, has recently been identified as a potential resilience factor and is defined as a sense of belonging, pride, and attachment to ethnic group membership.^[5] Having a stronger ethnic identity creates a sense of belonging within a group, and this can promote positive self-esteem and coping mechanisms that lead to better mental health outcomes. Additionally, ethnic identity is closely tied with social support,^[3] which can also contribute to positive mental health outcomes. One study found that increased traumatic exposure was associated with increased lifetime psychiatric diagnoses, with race and ethnicity implicated as significant predictors of these diagnoses.^[5] Interestingly, ethnic identity actually served as a moderator between these relationships: individuals with stronger ethnic identities reported lower numbers of psychiatric diagnoses. In the study sample, both African American and Caucasian women experienced buffering effects associated with stronger ethnic identities.

In continuing research on resilience, particularly resilience factors that might relate to racial identity and experience, we can look to inform interventions. In doing so, we can address this pressing disparity in minority mental health and provide tools to bridge the gap, creating a healthier, supportive future for all.

References

[1] American Psychological Association. (2017). Ethnic and Racial Minorities & Socioeconomic Status. American Psychological Association. https://www.apa.org/pi/ses/resources/publications/minorities

[2] Ballone, N., & Richards, E. (2023). Racial/ethnic disparities and women’s mental health. Psychiatric Clinics of North America, 46(3), 571–582. https://doi.org/10.1016/j.psc.2023.04.011

[3] Moore, K., Munson, M. R., Shimizu, R., & Rodwin, A. H. (2022). Ethnic identity, stress, and personal recovery outcomes among young adults with serious mental health conditions. Psychiatric Rehabilitation Journal. https://doi.org/10.1037/prj0000523

[4] Reiss, F. (2013). Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review. Social Science & Medicine, 90, 24–31. https://doi.org/10.1016/j.socscimed.2013.04.026

[5] Townsend, T. G., Kaltman, S., Saleem, F., Coker-Appiah, D. S., & Green, B. L. (2017). Ethnic disparities in trauma-related mental illness: Is ethnic identity a buffer? Journal of Interpersonal Violence, 35(11–12), 2164–2188. https://doi.org/10.1177/0886260517701454

[6] Zhang, X., & Monnat, S. M. (2022). Racial/ethnic differences in clusters of adverse childhood experiences and associations with Adolescent Mental Health. SSM – Population Health, 17, 100997. https://doi.org/10.1016/j.ssmph.2021.100997

Surviving More Than Cancer: Why Women of Color Struggle for Adequate Care

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Surviving More Than Cancer: Why Women of Color Struggle for Adequate Care

Harshita Sharma
September 2025

When we hear ‘cancer survivor,’ it is easy to imagine an inspiring and hopeful story. But for women of color, this battle continues beyond beating cancer. It’s about overcoming the systemic barriers that continue to persist long after diagnosis.

Black women are 38% more likely to die from breast cancer than white women, despite slightly lower incidence rates⁽¹⁾. Black people have lower survival rates than White people for almost every cancer type and have the highest death rate for many cancers, including breast and prostate, the two most common cancers in men and women⁽¹⁾. What is the reason for these disparities?

African american doctor and woman looking at computer screen for information about appointment and healthcare system. Patient sitting at desk with medic for annual checkup visit.

Systemic Barriers and Bias in the Exam Room

Lack of insurance and economic instability delay screening and treatment, with Hispanic and Black women being disproportionately affected. Even after adjusting for factors like income or insurance, race and ethnicity still predict the quality of care received from diagnostics to treatment access.⁽²⁾

Dr. Lovell A. Jones, PhD, an oncologist at the MD Anderson Cancer Center and equity pioneer, shares inside stories in a 2014 interview⁽⁴⁾ about how he led research on synthetic and natural estrogens, gynecologic cancers, and fought for minority representation and health equity in medicine. The interview was conducted by Tacey A. Rosolowski, PhD, under MD Anderson’s Making Cancer History program. He gives an example of how African-American patients are inappropriately labelled “difficult” and so they are excluded from clinical trials. He recalls a black patient labelled “noncompliant” turned out not to be defiant; he simply lacked a refrigerator to store insulin. Once that barrier was removed, he “became one of our most compliant patients⁽³⁾.”

Dr. Jones next recounts a story about the NCI and bias. Dr. Jones emphasizes that he uses the term “bias” instead of “racist.” He notes that there is little bias in dealing with pediatric cancer, but once children turn sixteen, bias begins to be evident in their treatment⁽³⁾. Dr. Jones’s experiences and reflections serve as a call to action for the medical field to critically examine and dismantle the biases that hinder equitable care.

Research Gaps and the Fight for Representation

Historically, women of color have been neglected in clinical trials, which limits the understanding of how they are affected by certain cancer treatments⁽⁵⁾⁽⁶⁾.

It has also been noted on various instances that black women are often prescribed lower doses of pain medications. The stereotype that Black women have higher pain tolerance leads to dismissive care, sometimes with fatal consequences⁽⁷⁾⁽⁸⁾

Women of color frequently experience microaggressions, mistrust, and gaslighting in healthcare settings. And such demeaning experiences can develop adherence to seek future care.

Healing the Cracks

The cancer journey for women of color can often begin with a disadvantage: late detection, lack of support, and systemic bias. And this is not because their disease is untreatable, but rather because the system that should help often fails them. But their lives are not defined by those forces alone. The growing visibility of their experiences, combined with research, is slowly reshaping the narrative one step at a time. But there is still a lot to be done.

Pain management protocols need to be standardised to eliminate racial disparities in analgesia. Physicians and care providers should receive bias training to confront the biases that are unconsciously instilled in us. Women of color should be recruited in trials to ensure studies reflect diverse populations. Access to insurance, screening, and timely referral should be expanded to underprivileged communities.

Cancer equity is not an aspiration—it’s a human right. The tools to achieve it are already in our hands: community, advocacy, policy change, inclusive science, structural introspection. We have seen what works. Now, we must bring that hope to everyone.

References

[1] Cancer Facts & Figures for African American/Black People Retrieved from https://www.cancer.org/research/cancer-facts-statistics/cancer-facts-figures-for-african-americans.html

[2] Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.

Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK220358/ doi: 10.17226/12875

[3] Chapter 15: Minority Experiences in Healthcare: The Origins of Health Inequity

Retrieved from https://openworks.mdanderson.org/mchv_interviewchapters/611/

[4] Complete interview: https://openworks.mdanderson.org/cgi/viewcontent.cgi?filename=0&article=1100&context=mchv_interviewsessions&type=additional

[5] Verywell Health. (2020). Breast Cancer Risk: Disparities That Affect Black Women. Retrieved from https://www.verywellhealth.com/breast-cancer-risk-black-women-6740824

[6] Javier-DesLoges, J. et al. (2022). Disparities and trends in the participation of minorities, women, and the elderly in breast, colorectal, lung, and prostate cancer clinical trials. Cancer, Wiley Online Library. Retrieved from https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.33991

[7] Medical News Today Article (2020) Retrieved from https://www.medicalnewstoday.com/articles/90-us-primary-care-offers-lower-pain-relief-doses-black-patients

[8] University of Michigan Health System Study (2010)Retrieved from https://www.sciencedaily.com/releases/2010/08/100817090806.htm

Burnout: Why Modern-Day Women Are More At Risk Than Men

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Burnout: Why Modern-Day Women Are More At Risk Than Men

Georgia Schonberg
September 2025

The term ‘burnout’ emerged in the 1970s, when the psychologist Herbert Freudenberger used it to describe how chronic stress and high expectations in caregiving jobs had impacted his own health ^[1]. Fast forward to 2025, and women are now 23% more likely to face burnout at work than men ^[2]. But why is burnout in women such a growing issue and how can we move forward?

The “Having-It-All” Mentality

In the ‘80s and ‘90s, as professional opportunities increased, the potential for women to ‘have-it-all’ became idealized. These were unknown territories and left women attempting to juggle a successful career, keep a happy family, and maintain friendships, all at the same time.

Nowadays, we’re more aware that the ‘having-it-all’ ideal can be overwhelming, but we still feel a pressure to somehow achieve it. Maybe this stems from society and the media praising women who appear to have it perfectly together. Or perhaps it’s more of an internal pressure, conflated by not wanting to waste opportunities previous generations could have only dreamt of.

In the US, mothers still handle 70% of household tasks, from childcare to cooking and cleaning ^[3]. For working mothers, this is known as the ‘second shift’ that takes place late into the evening after their 9-5 finishes. It’s not a new concept, but most workplaces still don’t acknowledge or offer support during these years of working double time.

For women earlier on in their careers, there’s a different kind of pressure that’s felt from the need to tick off personal and professional goals quickly – to prepare for having children down the line.

This push to get ahead before motherhood is such a common modern-day experience that there’s now even a ‘pre-baby burnout’ label for it ^[4]. With labels like these popping up more and more, it seems the traditional ideal of “having-it-all” continues to impose unrealistic expectations across each stage of our working lives.

Imposter Syndrome

Imposter syndrome is described as a feeling of inadequacy that persists despite evidence of success ^[5]. Those who experience it may attribute their achievements to luck, rather than intelligence, commitment, or hard work. It’s most common in women and minorities ^[6].

I’ll admit, I’ve been skeptical of this term. There’s no doubt that I have experienced feelings of inadequacy at work, but is this worthy of a “syndrome” title? Or is it instead linked to a lack of confidence or self-esteem – both of which are normal to feel in high-pressure work environments, regardless of your gender.

But following more research, I’ve come to accept that the definition of Imposter Syndrome fits my own corporate experience perfectly. It’s not that I have a negative self-perception, but at work I couldn’t shake the feelings of fraudulence; that I had been lucky to get there, and someone would soon see through it ^[7]. For me, this led to overworking, anxiety, and a lack of boundaries.

A contributing factor to Imposter Syndrome could be a lack of relatable role models. If we can’t see people like us at the top of our fields, or within our families, how can we feel secure in our positions and set healthy workplace boundaries? It’s clear how these feelings and behaviors may lead to burnout if experienced over long periods or without a strong support system around us.

The Remaining Gender Gap

While opportunities for women in the workplace have grown, we’ve got a long way to go. As of today, only 17% of all new CEOs at S&P500 companies are women, and it’s expected to take another 123 years to close this gap ^[8]. It’s no wonder women feel the need to work harder, longer, and more consistently to get where we want to be.

This scarcity mindset can also fuel a cut-throat dynamic between women. If all you’ve ever been told is there’s only room for one, but you finally secure a leadership position, surely you’ll do all you can to keep that title, even if it means repeating toxic work patterns. What’s the result? Women are left competing against each other or unsupported by those above them, and the cycle of burnout continues.

Moving Forward

Burnout can be hard to spot in yourself and even harder to speak up about. Of course, targeting the bigger systemic issues like the gender gap is essential. But with estimates of over 100 years until that’s solved, we should focus on the smaller steps we can take now.

Keep sharing your perspectives on the ‘second shift’, Imposter Syndrome, and other workplace challenges. The more we overcome the fear of sharing, the more these conversations will become easier and respected. Over time, this will help us to gain the remaining recognition, support, and resources needed for women in the workplace.

References

[1] Freudenberger, H. J. (1974). Staff Burn-out. Journal of Social Issues, 30(1), 159-165. https://doi.org/10.1111/j.1540-4560.1974.tb00706.x

[2] Nuffield Health. (2022, March 8). Why women are more at risk of burnout. Nuffield Health. https://www.nuffieldhealth.com/article/why-women-are-more-at-risk-of-burnout Nuffield Health

[3] British Psychological Society. (2025, January 23). Mothers report taking the brunt of household mental load. BPS Research Digest. https://www.bps.org.uk/research-digest/mothers-report-taking-brunt-household-mental-load British Psychological Society

[4] Savin, J (2025, January 6). The pre-baby burnout struggle is real – and its leaving women utterly exhausted. Cosmopolitan. https://www.cosmopolitan.com/uk/reports/a63348561/pre-baby-burnout/

[5] Home, J. (2025, September 3). Imposter syndrome. British Medical Association. https://www.bma.org.uk/advice-and-support/your-wellbeing/insight-and-advice/first-times-in-medicine/imposter-syndrome

[6] British Medical Association. (2025, September 3). Imposter syndrome. BMA. https://www.bma.org.uk/advice-and-support/your-wellbeing/insight-and-advice/first-times-in-medicine/imposter-syndrome BMA

[7] Psychology Beverly Hills (2022, December 2). Imposter Syndrome vs. Low Self-Esteem: What’s the Difference? https://www.psychologybeverlyhills.com/blog

[8] World Economic Forum. (2025, June 11). Global Gender Gap Report 2025. https://www.weforum.org/publications/global-gender-gap-report-2025/

Understanding the “ACL Pandemic” in Women’s Sports

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Understanding the “ACL Pandemic” in Women’s Sports

Kashish Patel
September 2025

In recent terms, the “ACL Pandemic” refers to a surge of anterior cruciate ligament injuries striking female athletes two to eight times more often than men. These injuries are especially evident in sports that require jumping or pivoting, such as soccer, basketball, lacrosse, and skiing^[1].

What is an ACL Injury?

An injury in the ACL occurs when the ACL, which is a strong band of tissue connecting the thighbone to the shinbone in the knee, is stretched, partially torn, or completely ruptured. There are different levels to ACL injuries.

Grade I: Mild injury with minor tears.

Grade II: The ligament is loose and considered a moderate injury with a partial tear.

Grade III: A severe injury with a complete tear of the ligament, and the knee joint is unstable^[2].

The ACL’s role is important for keeping the knee stable. When injured, it often causes a “popping” sound or sensation, which is followed by pain, swelling, and instability. ACL injuries can require months of rehabilitation or surgical reconstruction to restore strength and function^[2].

Why are women more at risk?

Women are at a greater risk for ACL injuries because of biological and even systematic differences. Women often have a wider pelvis and Q-angle than men, which indicates that the line from the hip to the knee slopes inward sharply. This adds additional stress to the ligament during quick movements^[3].

It has been studied that hormonal fluctuations may also affect ligament laxity, making the ACL looser and more vulnerable to tears during menstruation. Research has shown that during the ovulatory phase, when estrogen levels are elevated, the ACL is less able to handle the intense forces of sudden movement. Hormonal effects reduce joint stability and alter muscle activation, making knee injuries more likely to occur^[4].

Alex Morgan’s Story

Alex Morgan suffered a torn ACL during her senior year of high school, an injury which forced her to sit out for an extended period. She needed surgery, which would entail months of recovery and physical therapy. While this process usually takes about a year, she was able to return back on the field in around 5 months.

She talks about how this personal experience has shaped the way that she perceived major injuries, especially in female athletes. She went on to win Olympic gold and a World Cup with the U.S. Women’s National Team, but she continues to carry the lessons from her injury. (5)

References

[1] Are ACL tears really more common in women? > news > yale medicine. (n.d.-a). https://www.yalemedicine.org/news/sports-injuries-gender

[2] Northwestern Medicine. (n.d.). Why women have more ACL injuries than men. https://www.nm.org/healthbeat/healthy-tips/why-women-have-more-acl-injuries-than-men

[3] U.S. National Library of Medicine. (2016, March 24). The female ACL: Why is it more prone to injury?. Journal of orthopaedics. https://pmc.ncbi.nlm.nih.gov/articles/PMC4805849/

(4) ACL tears and the menstrual cycle: Is there a connection? | northwell health. (n.d.-a). https://www.northwell.edu/news/insights/acl-tears-menstrual-cycle-health-podcast

(5) Advances in orthopaedic surgery have reduced the ACL Recovery Timeline. Shortened ACL Recovery Timeline | Alex Morgan Overcomes Injury | GBO. (n.d.). https://www.greatbasinortho.com/articles/advances-orthopaedic-surgery-have-reduced-acl-recovery-timeline

How Stress Affects Women Differently

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How Stress Affects Women Differently

Manushree Kanchi
August 2025

Imagine there are two people experiencing the same stressful situation, such as a close deadline or a family conflict. While both feel the pressure, science reveals that a woman’s brain and body often react more intensely for a longer period than a man’s. While stress is a universal experience, it is not one that is equal for all. Research indicates that women usually experience higher levels of stress with more physical symptoms, such as headaches, and additional stress-related disorders.^[1]

Neuroscience of Stress in Women

The brain’s stress response comes from the hypothalamic-pituitary-adrenal axis, playing a crucial role in the neuroendocrine response to stress. This system regulates the body’s response to stress by releasing hormones like cortisol ^[2]. Studies show that women usually demonstrate higher baseline cortisol levels and prolonged stress responses in comparison to men during times of emotional stress. This can lead to women becoming more vulnerable to anxiety disorders over time^[3].

MRI studies also indicate that women and men process stress differently at the neural level. When exposed to stressors, women show increased activity in the amygdala, a region in the brain involved in emotional processing. On the other hand, men show more prefrontal cortex activity associated with cognitive regulation. This difference highlights why women may experience stress as more emotionally overwhelming^[4].

Hormonal Influences

Hormones such as estrogen and progesterone play an important role in regulating stress responses. Estrogen has been proven to increase the HPA axis response to stress, while progesterone may have a decreasing effect^[5]. These fluctuations occur during the menstrual cycle, leading to variations in the NPA axis reactivity. This can make it increasingly difficult to maintain consistent stress management strategies while also causing disruptions to fertility.

Social and Psychological Factors

Social and environmental factors largely contribute to the gender differences in stress response as well. Women are more likely to endure chronic stressors because of caregiving and other social expectations, strengthening neuroendocrine stress responses ^[6]. Long-term exposure to stressors such as these has been repeatedly linked to high rates of stress-related disorders in women.

Implications for Wellbeing

Recognizing the way in which stress affects women differently is crucial for the development of prevention and disorder treatments. In the meantime, methods such as incorporating physical activity into daily routine and utilizing mindfulness practices have been shown to aid in decreasing gender specific reactions to stress.^[7]

Stress is not a one-size-fits-all experience. Biological and social differences combined can cause women’s stress responses to be more complex, and eventually more damaging. Acknowledging these existing differences is the first step in creating methods that genuinely meet a woman’s mental and physical needs.

References

[1] Reid, M. (2024, July 30). Are Women More Stressed than Men? Experts Say Yes—Here’s Why. Evie. https://eviering.com/blogs/news/are-women-more-stressed-than-men-experts-say-yes-here-s-why

[2] Sharan, P., & Vellapandian, C. (2024). Hypothalamic-Pituitary-Adrenal (HPA) axis: Unveiling the potential mechanisms involved in stress-induced alzheimer’s disease and depression. Cureus, 16(8). https://doi.org/10.7759/cureus.67595

[3] Balhara, Y. P. S., Verma, R., & Gupta, C. S. (2012). Gender differences in stress response: Role of developmental and biological determinants. Industrial Psychiatry Journal, 20(1), 4. https://doi.org/10.4103/0972-6748.98407

[4] Why Men and Women Need Different Stress Strategies – The American Institute of Stress. (2025, January 22). The American Institute of Stress. https://www.stress.org/news/why-men-and-women-need-different-stress-strategies/

[5] Sun, Q., Li, G., Zhao, F., Dong, M., Xie, W., Liu, Q., Yang, W., & Cui, R. (2024). Role of estrogen in treatment of female depression. Aging. https://doi.org/10.18632/aging.205507

[6] Liat Helpman. (2023). On the stress of being a woman: The synergistic contribution of sex as a biological variable and gender as a psychosocial one to risk of stress-related disorders. Neuroscience & Biobehavioral Reviews, 150, 105211–105211. https://doi.org/10.1016/j.neubiorev.2023.105211

[7] Kinghorn, K. (2023, December 12). Therapy Utah. Therapy Utah -. https://www.therapyutah.org/is-womens-mental-health-taken-seriously-enough/

Telehealth and Tele-Abortion: The Unlikely Guardian of Access in Restrictive States

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Telehealth and Tele-Abortion: The Unlikely Guardian of Access in Restrictive States

Sanya Talwar
August 2025

A New Wave of Access

In the years since Dobbs, abortion access has fractured sharply across the U.S., yet a surprising trend is emerging—medication abortions delivered via telehealth are rising sharply, even in states with outright bans. A recent study found abortion pill provision rates were over three times higher in states that ban abortions compared with those without bans, and more than double in states banning telemedicine abortions altogether.^[2]

Shield laws in states like New York and California are fueling this shift, protecting telehealth providers from prosecution when prescribing across state lines.^[3] For many, this is the only viable option where clinics have closed.

The Power and Limits of Shield Laws

Shield laws work—recently, a New York court blocked Texas from punishing a doctor who prescribed abortion pills (mifepristone and misoprostol) to a Texas patient, reinforcing the strength of these protections.^[3] But legal risks remain. Patients in banned states face higher costs, delays, and the possibility of targeted lawsuits.

Just last week, a Texas woman filed a federal wrongful death suit against Aid Access, a telemedicine abortion provider, and her ex-partner—alleging he drugged her with abortion pills without her consent. The suit cites Texas abortion law and the federal Comstock Act, raising new questions about whether telehealth abortion could be attacked through civil suits or revived federal statutes.^[4]

Balancing Innovation and Equity

Telehealth and medication abortion represent a powerful tool for resilience, keeping access alive where it’s most at risk. Yet, inequality deepens—people in states where abortion is banned are more than twice as likely to receive care later in pregnancy, with greater financial and logistical burdens.^[1] This burden falls disproportionately on low-income women and those with limited health literacy, who face higher risks of delayed care and complications. National data shows that women of color, particularly Black and Latina patients, are more likely to experience financial and travel-related barriers, exacerbating existing health disparities.

As legal battles intensify, the future of tele-abortion may hinge on stronger shield laws, continued innovation in care delivery, and recognition that reproductive health is inseparable from health equity itself.

References

[1] University of California, San Francisco. (2025, June). How state bans increase costs and delay abortion care. UCSF. https://www.ucsf.edu/news/2025/06/430261/how-state-bans-increase-costs-and-delay-abortion-care

[2] Levin, S. (2025, August 11). Medication abortions drove up number of US procedures after Roe’s repeal, study shows. The Guardian. https://www.theguardian.com/us-news/2025/aug/11/medication-abortions-performed-study

[3] Nash, E., & Cross, L. (2023, December). Abortion shield laws: Protecting providers in hostile states. Guttmacher Institute. https://www.guttmacher.org/article/2023/12/abortion-shield-laws-protecting-providers-hostile-states

[4] Axios Staff. (2025, August 12). Texas woman claiming she was tricked into abortion sues pill provider. Axios. https://www.axios.com/2025/08/12/abortion-pill-wrongful-death-suit-texas

Out of Control: Why No One Talks About Post-Partum Rage

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Out of Control: Why No One Talks About Post-Partum Rage

Brenda Cali
August 2025

Most people imagine new motherhood with thoughts of cozy baby snuggles, lullabies, and maybe a few tears from sleepless nights. What’s rarely discussed, both in the medical world as well as in most social circles, is the overwhelming and explosive anger that can sneak up on you at random and very unexpectedly. While most new mothers are warned to look out for signs of postpartum depression or anxiety in those early days of motherhood, they are not usually warned about the raw and intense emotions that can feel like a volcano erupting inside. This experience is called postpartum rage, and despite how common it is, hardly anyone talks about it.

If you’ve ever found yourself screaming into a pillow, snapping at your partner over something small, or feeling a sense of uncontrollable anger after having a baby, you’re not alone.You’re not wrong or failing at motherhood, but could be experiencing postpartum rage, something that’s all too real and widely misunderstood.

Postpartum rage refers to intense and often irrational anger that occurs during the postpartum period, sometimes without any warning or clear triggers. This rage can happen in the blink of an eye. You may be shocked by the sudden outburst and left shaken and scared, wondering if it will happen again.¹²³

Common symptoms include:

Explosive outbursts or yelling

Violent thoughts or uncontrollable urges

Irritability that feels constant or overwhelming

Feelings of guilt or shame after an episode

A desire to isolate or withdraw

Physical outbursts such as throwing things

It is not an official diagnosis, but it is commonly a symptom of postpartum depression, anxiety, or obsessive-compulsive disorder (OCD). According to reproductive psychiatrist Dr. Carly Snyder, “Postpartum rage is frequently a symptom of another underlying perinatal mood disorder.”⁴

What Causes It?

In many cases, this intense anger becomes the only outward symptom of the emotional overload new mothers often feel. Women are not just sad, they are quite literally enraged. There isn’t one single cause of postpartum rage but experts believe it stems from a complex mix of hormonal, emotional, and environmental factors. Partum Health Care’s article Postpartum Rage: What It Is, and How to Cope describes several causes, which can include:³

Hormonal changes: Estrogen and progesterone drop dramatically after birth, affecting mood regulation.

Sleep deprivation: Chronic exhaustion can erode emotional resilience.

Mental overload: New mothers are often burdened with the invisible labor of parenting, household management, and emotional caregiving.

Underlying mental health conditions: Rage is often connected to untreated or misdiagnosed postpartum depression or anxiety.

When Does It Occur and How Long Does It Last?

Postpartum rage can begin within days, weeks, or months after childbirth.² Some mothers experience it shortly after delivery while others may not notice symptoms until they’re back at work or going through a stressful change. It can last several months to over a year if left untreated.

Who Is at Risk?

According to McLean Hospital, while postpartum rage can affect anyone, certain risk factors can increase the likelihood of experiencing it.⁶

Some risk factors can include:

A history of mental health challenges

Lack of social support

Traumatic pregnancy or birth

Sleep deprivation

Financial stress

Inadequate healthcare

Further, McLean Hospital reports that postpartum depression and anxiety are also more common among Black women, with some estimates showing rates more than double those of white women.⁶

Perinatal mood and anxiety disorders (PMADs), which include rage, affect 1 in 7 women after childbirth.⁷ In fact, as many as 6.5 to 20 percent of women will experience a postpartum depression more serious than the “baby blues,” indicating a much broader spectrum of maternal mental health struggles than is often acknowledged.⁸

Why Is It So Misunderstood and Misdiagnosed?

The medical system and society fail to recognize maternal anger as a valid emotional response. Because postpartum rage is not a stand-alone clinical diagnosis, many women are misdiagnosed or treated for bipolar disorder, borderline personality disorder, or simply brushed off as a shift or adjustment in hormones. Women are also dismissed and often told they’re simply just tired or overreacting. This dismissal only adds to the shame and silence surrounding the issue.

The Role of Stigma

There is a deeply ingrained cultural expectation that mothers should be patient, nurturing, and selfless. Anger doesn’t fit into this narrative. As a result, many mothers feel embarrassed or afraid to speak up.“Rage is not something society is comfortable seeing in mothers,” says Karen Kleiman, founder of The Postpartum Stress Center. “So they suffer quietly, feeling ashamed of a very human reaction.”⁵

When to Seek Help

If your anger feels out of control, is persistent, or harmful to yourself or others, it’s time to seek help.⁹ Here are a few signs it may be the right time to talk to a professional:

You’re having daily or frequent outbursts

Your anger is damaging your relationships

You feel guilt, shame, or regret regularly after reacting

You have thoughts of harming yourself or others

How Is It Treated?

The good news: postpartum rage is treatable and help is available. Common treatment options include:¹⁰

Therapy: Cognitive Behavioral Therapy (CBT) is a highly effective first-line treatment for postpartum mood disorders, helping individuals identify triggers and develop practical strategies.

Medication: Antidepressants and anti-anxiety medications are commonly prescribed and can be effective in stabilizing mood.

Support groups: Peer groups—offered in-person or virtually—provide validation and solidarity.

Lifestyle changes: Prioritizing rest, nutrition, and reducing overwhelm can significantly improve outcomes.

But the most important step is recognizing that you are not alone, and this is not your fault.

Current Research and Where to Seek Help

Preliminary research emphasizes the protective role of social support—leaning on friends, family, and community can help alleviate feelings of emotional overwhelm.¹¹ If you’re feeling overwhelmed, here are trusted resources you can access right now:

Postpartum Support International (PSI): Offers a toll-free helpline (in English and Spanish), local resource referrals, peer support groups, and online communities.¹²

The National Maternal Mental Health Hotline: Provides free, confidential, 24/7 support in English and Spanish. Call or text 1-833-TLC-MAMA to reach trained counselors.¹³

The Postpartum Resource Center of New York (PRCNY): Offers peer-led support, weekly virtual and in-person groups, and a statewide helpline (1-855-631-0001).¹⁴

Final Thoughts

The truth is that postpartum rage is more common than most people realize, and silence only makes it worse. It’s time we expand the conversation around maternal mental health to include all emotions, including anger. If this sounds like you, please know you are not crazy, and you are not a bad mother. You are navigating one of the most intense transitions a human being can experience. The good news is you don’t have to navigate this alone, and help is available.

References

1. Cleveland Clinic. “Postpartum Rage: Symptoms, Causes, and Management.” Last modified February 28, 2023. Accessed August 27, 2025.

https://my.clevelandclinic.org/health/diseases/24768-postpartum-rage.

2. COPE. Postnatal Rage. COPE Australia. Accessed August 27, 2025. https://www.cope.org.au/new-parents/adjusting-to-parenthood/uncomfortable-feelings-an d-expectations/postnatal-rage.

3. Partum Health Care Team. “Postpartum Rage: What It Is, and How to Cope.” Last modified July 7, 2025. Accessed August 27, 2025.

https://www.partumhealth.com/resources/postpartum-rage.

4. Snyder, Carly. “Postpartum Rage Is a Real Symptom of Mood Disorders.” Healthline. Last modified 2020. https://www.healthline.com/health/postpartum-rage.

5. Kleiman, Karen. The Art of Holding in Therapy: An Essential Intervention for Postpartum Depression and Anxiety. New York: Routledge, 2017.

6. McLean Hospital. Beyond the Baby Blues: Addressing Postpartum Depression. Accessed August 27, 2025. https://www.mcleanhospital.org/essential/postpartum-depression.

7. Children’s Hospital of Philadelphia. Perinatal or Postpartum Mood and Anxiety Disorders. Accessed August 27, 2025.

https://www.chop.edu/conditions-diseases/perinatal-or-postpartum-mood-and-anxiety-dis orders.

8. Centers for Disease Control and Prevention (CDC). “Depression During and After Pregnancy.” Last modified May 15, 2024. Accessed August 27, 2025.

https://www.cdc.gov/reproductive-health/depression/index.html.

9. Cleveland Clinic. “Postpartum Rage: What It Is, and How to Cope.” Last modified February 28, 2023. Accessed August 30, 2025.

https://my.clevelandclinic.org/health/diseases/24768-postpartum-rage.

10. Mayo Clinic. “Postpartum Depression: Diagnosis and Treatment.” Last modified November 24, 2022. Accessed August 30, 2025.

https://www.mayoclinic.org/diseases-conditions/postpartum-depression/diagnosis-treatm ent/drc-20376623.

11. Palo Alto University. “Where’s the Village? How Social Support Eases Postpartum Rage.” Accessed August 30, 2025.

https://concept.paloaltou.edu/resources/translating-research-into-practice-blog/wheres-the -village-how-social-support-eases-postpartum-rage.

12. Postpartum Support International (PSI). “Help for Moms.” Accessed August 30, 2025. https://postpartum.net.

13. Health Resources & Services Administration (HRSA). “National Maternal Mental Health Hotline.” Accessed August 30, 2025.

https://mchb.hrsa.gov/programs-impact/national-maternal-mental-health-hotline. 14. Postpartum Resource Center of New York. “Support Groups and Helpline.” Accessed August 30, 2025. https://postpartumny.org.

Cold Water Immersion, Yes or No?

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Cold Water Immersion, Yes or No?

Harika Maganti
August 2025

Cold plunges and cold showers have long been popular in healthy living circles although originating from traditional practices in many northern cultures. It involves either immersion or showering in cold water for a given period of time. This is done mainly to improve focus, circulation, and many other purported health benefits. However, is it truly helpful for women? Let’s take a plunge into the research and find out.

General Systemic Effects

The main effect one can notice immediately with a cold shower or plunge is that the body tries to regulate heat production to maintain the normal temperature. So, although at first you might feel cold, after some time the water feels more bearable. What exactly is happening here? Our skin gets heat from the underlying blood vessels (our blood is warm!). When we get exposed to cold, our body first tries to preserve warmth by restricting the vessels, then after a few minutes it dilates the vessels to try and get that area warm again. ^[1] A secondary response to cold exposure is shivering, which attempts to increase heat production by continuous contraction of the skeletal muscles.^[1] This activity in turn increases the body’s metabolism and makes us warmer. Typically shivering starts when the body’s core temperature falls between 36.2°to 36.5° C. ^[1]

Pros and Cons

Now coming to some benefits of cold water immersion, the first noticeable benefits are mental. Many people report that they feel sharper, more alert and focused after just a few minutes, and in a study the participants also had significant positive changes in their mood. ^[7]There is also evidence that regular cold showers can help boost our immunity, specifically through increasing immunoglobulin, interleukin levels, and T-lymphocytes. ^[1] Another key benefit of cold water immersion is increased insulin sensitivity due to the changes in fat cells. ^[1] There are also cardio-protective effects in cold-adapted individuals; research participants were found to have reduced levels of homocysteine and oxidative-stress markers in their blood samples. ^[1] So as we can see, this is a practice that can help improve general well-being, but are there any downsides? The answer is yes. Staying in the icy water for too long may lead to hypothermia, but how long is too long? ^[2] That may vary based on a person’s weight, body fat percentage, and other factors. Generally in water at 0°C, it takes less than 30 minutes for the body’s core temperature to decrease to the point of entering into a hypothermic state. ^[2] There are also cardiovascular risks, especially in individuals with pre-existing heart conditions, caused by the shock of icy water leading to arrhythmias and even cardiac arrest. ^[2] And studies show cold water swimming can increase blood pressure and cardiac troponin even in healthy individuals, which can lead to cardiac arrhythmias. ^[2] Finally, there is also the risk of drowning when plunging into cold water, caused by the initial shock and subsequent hyperventilation ^[2]

Effects on Women

Studies show that there are some differences between the genders when it comes to bodily responses to the cold water, men tend to have more of a metabolic response while women tend to have more of an insulative response. ^[1] Meaning men’s bodies increase heat production via shivering while women’s bodies prioritize the basal temperature and reduce the skin temperature. ^[3] This is because women tend to have more body fat, and men tend to have more skeletal muscle. ^[3] Men also have more neuroendocrine and immune responses compared to women. ^[1] Cold water immersion is used to help muscle recovery after exercise, however a recent study determined that it did not have a similar effect for women. ^[6] In another small study, it was shown that women tend to have more cardiovascular strain compared to men when doing cold water immersion. ^[4] It’s also interesting to note that general exposure to cold is a factor (among many) that can increase dysmenorrhea. ^[5] In general there are fewer gender-specific studies on the effects of cold water-immersion, so more research is needed to get a clearer picture.

Conclusion

Cold water immersion is a practice that has the potential to improve our health when done safely, it is best to start small at first and slowly let the body get adapted to the cold water. After all, research indicates that cold adapted individuals tend to experience more benefits compared to others. ^[1] It may be helpful for women to avoid the practice during and a few days before menstruation. People with cardiac conditions should use caution when attempting cold plunges, and should talk to a medical professional before starting.

References:

[1] Esperland, D., de Weerd, L., & Mercer, J. B. (2022, September 22). Health effects of voluntary exposure to cold water – a continuing subject of debate. International journal of circumpolar health. https://pmc.ncbi.nlm.nih.gov/articles/PMC9518606/#s0003

[2] Knechtle, B., Waśkiewicz, Z., Sousa, C. V., Hill, L., & Nikolaidis, P. T. (2020, December 2). Cold water swimming-benefits and risks: A narrative review. International journal of environmental research and public health. https://pmc.ncbi.nlm.nih.gov/articles/PMC7730683/#sec14-ijerph-17-08984

[3] Solianik, R., Skurvydas, A., Vitkauskiene, A., & Brazaitis, M. (2014, May 6). Gender-specific cold responses induce a similar body-cooling rate but different neuroendocrine and immune responses. Cryobiology. https://www.sciencedirect.com/science/article/abs/pii/S001122401400087X?via%3Dihub

[4] Tsoutsoubi, L., Loannou, L., Mantzios, K., Ziaka, S., Flouris, A., & Nybo, L. (2022, July 5). Cardiovascular stress and characteristics of cold-induced vasodilation in women and men during cold-water immersion: A Randomized Control Study. Biology. https://pubmed.ncbi.nlm.nih.gov/36101432/

[5] Wang, L., Yan, Y., Qiu, H., Xu, D., Zhu, J., Liu, J., & Lu, H. (2022, May 3). Prevalence and risk factors of primary dysmenorrhea in students: A meta-analysis. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research. https://pubmed.ncbi.nlm.nih.gov/35523614/

[6] Wellauer, V., Clijsen, R., Bianchi, G., Riggi, E., & Hohenauer, E. (2025, May 7). No acceleration of recovery from exercise-induced muscle damage after cold or hot water immersion in women: A randomised controlled trial. PLOS ONE. https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0322416#:~:text=The%20findings%20of%20this%20study,72%20h%20follow%2Dup%20period.
[7] Yankouskaya, A., Williamson, R., Stacey, C., Totman, J. J., & Massey, H. (2023, January 29). Short-term head-out whole-body cold-water immersion facilitates positive affect and increases interaction between large-scale brain networks. Biology. https://pmc.ncbi.nlm.nih.gov/articles/PMC9953392/#sec4-biology-12-00211