A significant gender gap exists in the diagnosis, treatment and management of coagulation disorders such as thrombosis and bleeding disorders. According to a new report published by The Lancet Haematology, this gap is driven by structural shortcomings in medical research, clinical guidelines and everyday healthcare practice. An international group of experts, including researchers from Radboud university medical center, has outlined ten recommendations aimed at reducing these disparities.
Women are more likely to experience delayed diagnoses, have their symptoms dismissed or underestimated, and receive care based on medical evidence that has historically been derived predominantly from studies involving men. These inequalities have important consequences for conditions such as thrombosis, in which a blood clot obstructs a blood vessel, and for bleeding disorders. For example, women with a bleeding disorder wait an average of sixteen years before receiving a diagnosis. One reason is that heavy menstrual bleeding is still too often considered a normal part of life rather than a potential symptom of an underlying condition. Bleeding disorders also frequently remain undetected despite being a major cause of severe postpartum haemorrhage.
Recognizing the need for change, The Lancet Haematology convened an international commission of experts to examine sex- and gender-related disparities in coagulation disorders and identify ways to improve outcomes for women.
Thrombosis
One of the report’s authors is Saskia Middeldorp, Professor and Head of the Department of Internal Medicine at Radboudumc. As a vascular internist, she specializes in thrombosis and pulmonary embolism in women. ‘The risk of thrombosis increases during pregnancy, particularly in women with an inherited predisposition or a history of thrombosis,’ says Middeldorp. ‘Anticoagulant treatment can significantly reduce that risk. At the same time, there is still considerable uncertainty about which medications and dosages can be used safely during pregnancy and breastfeeding.’
Hormonal contraception
The authors also highlight the need for greater investment in research on hormonal contraception. ‘Millions of women rely on hormonal contraception,’ says Luuk Scheres, Radboudumc researcher and resident in internal medicine. ‘Its benefits are widely valued by society, yet the associated health risks, including thrombosis and pulmonary embolism, are borne almost entirely by women. Despite this, only a small fraction of research funding is dedicated to improving the safety of these medications.’
Recommendations
The commission presents ten recommendations to help close the gender gap in care. Among them is a call for new medicines to be evaluated using evidence from studies in which women and men are represented equitably. The authors also argue that research findings capable of improving women’s health should be incorporated much more rapidly into clinical guidelines for the diagnosis and treatment of thrombosis and bleeding disorders. ‘Only then can women with these conditions benefit sooner from advances in care and avoid unnecessary suffering,’ says Middeldorp.
Want to know more about this subject? On the evening of 14 September 2026, Saskia Middeldorp will be among the speakers at an event organized by Radboud Reflects and Radboudumc at Lux in Nijmegen. The discussion will focus on the health gap between men and women and the steps needed to reduce it.
About the publication
This research was published in The Lancet Haematology: Reducing mortality, improving outcomes, and establishing equity for women with classical haematological disease: a Lancet Haematology Commission. Luuk Scheres, Angela Weyand, Maureen Baldwin, Jecko Thachil, Maha Othman, Saskia Middeldorp, […], Tahira Zafar, Bethany Samuelson Bannow. DOI: 10.1016/S2352-3026(26)00079-7.
The publication coincides with the newly established ISTH Women's Health Hub, a comprehensive global initiative dedicated to advancing education, collaboration, research and advocacy for bleeding and clotting disorders across every stage of a woman's life.
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