February 9, 2025. By Emma Myers.

Did you know that nearly 80% of those affected by autoimmune diseases are women, yet many endure years of misdiagnosis before finding answers? Maria, for example, visited five doctors over three years before finally being diagnosed with oral lichen planus. Her story is far from unique. Women with autoimmune diseases often face long, frustrating diagnostic journeys—delays that lead to unnecessary suffering and worse outcomes. For women in underserved communities, the barriers to timely diagnosis are even more daunting. According to the North Carolina Department of Health and Human Services’ 2024 Health Disparities Analysis Report, women in rural areas face significant challenges, including limited access to specialists, exacerbating diagnostic delays. It’s time for medical institutions to address these disparities and take gender bias in healthcare seriously.

Autoimmune diseases, where the immune system mistakenly attacks the body’s tissues, are complex and difficult to diagnose, especially in women. A recent article in Frontiers in Neuroendocrinology notes that autoimmune diseases disproportionately affect women due to genetic, hormonal, and environmental factors. However, healthcare professionals often attribute women’s symptoms—such as fatigue, joint pain, or rashes—to stress or psychological issues rather than consider autoimmune diseases. Moreover, the North Carolina Institute of Medicine reports that the state’s uninsured rate is higher than the national average and disproportionately impacts women, creating additional barriers to care and further delaying diagnoses.

Implicit bias plays a significant role here. A 2019 study in The Lancet found that female patients, especially those with subtle or nonspecific symptoms, are more likely to have complaints dismissed as mental health concerns, stress, or menopause, rather than autoimmune disease. This bias results in missed diagnoses, delayed treatment, and worsening health conditions. When doctors overlook autoimmune diseases in women, they miss critical opportunities to intervene early, increasing the risk of permanent damage.

As an NC Schweitzer Fellow at UNC School of Medicine, I’ve worked with Rashmi Deshmukh from the UNC Adams School of Dentistry on the OASIS (Oral Autoimmune Support and Intervention Squad) initiative. Through OASIS, we help providers recognize the link between oral health and autoimmune diseases, as oral manifestations are often early signs of systemic conditions. In our clinic, I’ve seen how women, especially in underserved communities, have historically had their symptoms dismissed as stress or anxiety, leading to delayed and harmful misdiagnoses. By educating both patients and providers, OASIS reduces these diagnostic delays and improves patient outcomes.

The consequences of these delays are severe, with significant physical, emotional, and systemic impacts. A 2020 study in Medicine showed that diagnostic delays in primary Sjögren’s syndrome (one of the most common autoimmune diseases) can lead to irreversible organ damage. Women whose symptoms are ignored or misdiagnosed may suffer chronic pain, disability, and even death. Emotionally, the toll of not being believed can also be devastating, often compounding the physical health challenges that women face. A 2021 study in the Journal of Psychosomatic Research highlighted the role that stress plays in autoimmune disease progression, underscoring the need for a more supportive healthcare environment.

To address these disparities, we must focus on three key areas: improving diagnosis, addressing emotional and systemic impacts, and implementing systemic reforms. First, mandatory training on gender biases in autoimmune disease diagnosis should become standard in medical curricula. Healthcare professionals and medical educators need to recognize how gender influences clinical decision-making, especially for diseases that disproportionately affect women. Second, fostering patient advocacy is vital. Women must feel empowered to ask questions, seek second opinions, and push for further testing if their concerns are dismissed. Finally, policymakers and researchers must allocate more resources toward understanding gender differences in autoimmune diseases. Greater funding for research on these differences could reveal new insights into how autoimmune diseases develop and manifest differently in women.

The time for change is now. We must demand more from our healthcare system. Medical institutions need to prioritize gender bias training, equip healthcare providers to recognize autoimmune symptoms in women, and fund research that uncovers the scope of these biases. By addressing these systemic issues, we can build a healthcare environment where every patient is heard, believed, and treated with the care they deserve. How many more women must suffer before we take gender bias in healthcare seriously?

Emma Myers

2024-25 NCOHC Schweitzer Fellow

UNC School of Medicine, Class of 2026