Op-Ed: Let’s Stop Equating Female and Male Bodies

The buzzword “femtech” has been floating around the healthcare sphere for some time now. This term references a boom in the creation of software and technology companies that address women’s biological healthcare needs. It’s about time. A recent New York Times article questioned whether femtech is the next big thing in healthcare, highlighting the increase in companies that have cropped up in the last decade tackling women’s needs from fertility to breastfeeding.

The reality is that femtech is a massive step forward in bringing visibility to women’s health needs and addressing them in clinical practice and medical technology design. Historically, research informing medical practices avoided including women’s bodies in data sets, one reason of many being that menstruation was hard to control for in clinical studies. Researchers viewed women as confounding and more expensive participants because of their fluctuating hormone levels, which has left us with large knowledge gaps in our clinical practice and supporting medical device technology designs.

And while femtech is carving out a much-needed space within the medical technology industry, isolating and addressing women-exclusive conditions isn’t the only way forward. Within the femtech space, retroactive consideration needs to be given to conditions that aren’t specific to the biological female body, but that affect women’s bodies differently. Considerations of male versus female management of a condition should be a requirement, not a supplemental add-on to the default care practices.

Insulin-requiring diabetes is an example of where the healthcare system needs to do better for people with female reproductive organs. For many, hormonal shifts that occur as a result of puberty, menopause, and menstruation add on an entirely new level of complexity to managing blood glucose levels. Some of the existing literature suggests that the “common” menstrual cycle affects blood sugars in a specific pattern: blood glucose rises (insulin resistance) 2 days before bleeding and this effect continues for the first 3 days once the period starts (follicular phase). The association is tricky, however, because the actual sensitivity change and length of a period aren’t exactly lined up. The online publication diaTribe, which provides diabetes insights and actionable tips for people with diabetes, offers a slightly more nuanced perspective. In an article focused on women’s health, they note that people who menstruate who are “using insulin pumps may have to increase their basal rates 2 to 3 days before their period starts, to cover higher blood sugars,” while also acknowledging that others may notice at the start of their period blood glucose is lower and they may have to decrease their basal rates.

In the last few years, some clinical research has been conducted to single out predictive factors for changes to glycemic variability and insulin sensitivity correlated to the menstrual cycle, but overall the research is not fully conclusive. Insulin sensitivity refers to how sensitive the body is to insulin and is measured via the insulin sensitivity factor, which tells you how many points, in mg/dL, someone’s blood sugar will drop for each unit of insulin that they take. In one study, Sue Brown, MD, and colleagues found “an increased risk of hyperglycemia was observed during periovulation and early luteal phases compared to the early follicular phase; these changes appear to be associated with decreased insulin sensitivity during the luteal phase.” However, outside of a few studies, the research on the link between diabetes and menstruation is few and far between, an indicator that this is an area that could benefit tremendously from an increased focus from the technology and clinical research sectors.

Our recently completed Tidepool Period Project, a 3-month pilot initiative to collect self-reported menstrual data from people with insulin-requiring diabetes in order to isolate indicators that can improve period management, is one example of this type of research. While our pilot focuses on menstruation, it is paving a pathway for broader advocacy, research, and design that addresses other key hormonal changes that can affect day-to-day diabetes management, such as puberty, pregnancy, or perimenopause. Beyond just diabetes, medical technology companies addressing all kinds of conditions need to start thinking about how to add a femtech component to their products.

Until the tools and technology catch up to the unmet need and opportunity, clinicians can start by being proactive and talking to patients about menstruation as a key factor that may impact diabetes management. This is especially important to consider when working with young patients entering puberty in order to provide optimal anticipatory care. While period trouble may not be an issue for all, it is a possibility, and one that people with type 1 diabetes who menstruate should not be left in the dark about.

Another practice for clinicians to consider while the technology catches up is looking beyond 2-week data periods initially presented by most diabetes data management software and reports. Assessing the patient’s last 2 weeks of data alone may inhibit understanding of potential patterns in glycemia, behavior, and technology issues that occur as a result of a monthly cycle. While it’s difficult to ask patients to add additional tracking into their lives, clinicians can encourage patients to keep a note of period start and period end and review data in 4-week cycles at appointments. Larger sampling intervals of a patient’s data that includes menstruation may offer clinicians additional context to the data that enables more optimal assessment of blood glucose patterns; allow for more meaningful conversations around menstruation and diabetes management with patients; and improve clinical recommendations that may be necessary for some as a result of menstruation.

It is easy to celebrate and get swept up in the burgeoning industry of femtech. But, equally as important is for clinicians and medical technology companies to look critically within their industries to account for the biological differences in women’s bodies that affect the presentation and management of medical conditions. Whether it’s diabetes or any other condition, we need to — as part of the femtech wave — think about the ways to retroactively make up for the lack of data, design, and clinical practices around women’s bodies in conditions that are gender agnostic.

Maya Friedman, MFA, is a women’s health designer and founder of the Tidepool Period Project. Abby Bayer-Pratt RN, CDCES, is the lead tech support and clinical consultant on the Tidepool Period Project.

Last Updated May 27, 2021