“I was mortified!” groans Emma. “There was this bloody mess at the bottom of the boat – and my coach had seen it. It was one of those awful moments where I wanted the ground to swallow me up.”

Emma Wiggs and I are having a conversation. She is inspirational a double Paralympic Gold Medal winner and a ten-time world champion para canoeist. She is effervescent and joyful, full of energy and purpose. We have only just met and we are having a pretty intimate conversation. We are talking about periods. We are talking about all aspects of female physiology, and how surprising it is that for a very long time, the female body has received very little funding or research.

Physiology Impacts performance

In the past, medicine and the whole biological research community made assumptions that physiology (how the body works) is pretty much the same, regardless of sex. It turns out that there are important differences, and they matter.

In the past, medicine and the whole biological research community made assumptions that how the body works is pretty much the same, regardless of sex. It turns out that there are important differences, and they matter.

Emma explains that she used to train by a standard training plan, thought to be suitable for everybody. In reality, the plan had been largely designed to suit the male body. Back in 2019, she began to adapt her training and her diet to be more physiologically suited to her female body. Emma believes that this change in approach has helped her to tap into a whole new level of performance and health as an Olympic athlete. Enthusiastically, she explains:

“With the knowledge I now have, my menstrual cycle feels like a secret weapon, to be maximised and unleashed, rather than something to be fearful, or ashamed, of. Knowledge of my cycle completely changed my thinking about my performance and training and has led to huge gains. That’s empowering as well as exciting!”

In all my interviews with women, there is a theme of having to adapt or make choices they did not feel comfortable with to preserve credibility.

What Emma is referring to is so obvious and simple it seems strange that it took us until 2019 to get there. It is about recognizing the distinct differences between male and female physiologies. It is about understanding that working with female physiology instead of against it which was the default, is beneficial for both performance and health.

A source of untapped potential

The opportunity to tap into a whole new level of health and performance, as Emma Wiggs and others have done, exists for any woman, and not only in her career. But the path to get there is messy, for historical reasons. Although roughly half the population is female, we don’t understand women’s bodies. It is controversial but, for centuries, we have chosen to study the male body at the expense of the female body and all other bodies. This has led to an under-representation of women in clinical trials, and systemic bias within the medical system and beyond. The bias is so significant that there is a considerable gap in our understanding of the female body. And, as a result, we don’t yet know enough about women. Rachel Gross highlights this elegantly in her beautifully written Vagina Obscura. There are parts of the female body “less known than the bottom of the ocean, or the surface of Mars,” she writes.

In having had to prove themselves in a world where masculine rules still dominate, women have often had to downplay their natural strengths or make adaptations to succeed.

What about those who are transgender, non-binary, intersex or who don’t identify as either sex?

In this article, I talk about female bodies, and I use the terms male and female, woman and man. I appreciate that these terms do not apply to everyone. My aim is not to be exclusive. If we don’t know enough about female bodies, imagine how much less we know about the bodies of those who are transgender, intersex, non-binary or who don’t identify as either sex. The bias is enormous and further research is very much needed for all under-represented groups.

Blinkered by Bias

Even in a group of women, women of colour have been studied far less than white women and experience considerably more bias. Black women in both the US and the UK experience higher rates of preventable pregnancy or childbirth-related deaths than white women. In the UK, black women are nearly four times more likely to die in childbirth than white women. For centuries, it was mistakenly assumed that people of colour experience less pain than white people do. Shockingly, it is very common, even today, for black patients not to receive adequate pain relief.

Male and female bodies respond differently to drugs

Zolpidem Tartrate is a sleeping tablet used to treat insomnia. In 2013, the US Food and Drug Administration (FDA) announced that it was cutting the recommended dose of the drug in half but only for women. Why? Women, more commonly than men, had been reporting serious side effects such as hallucinations. Women and men metabolise the drug in different ways so women had higher concentrations of the drug in their blood plasma the morning after taking it. This increased their risk of impaired driving. Zolpidem was the first drug in the US to have a different suggested dose for men and women.

Chelsea FC Women tailor their training around their menstrual cycles, recognising that physiology has an impact on performance.

But this example is just the tip of the iceberg. Between 1997 and 2000, 80% of the drugs withdrawn from the market were removed because of their harmful side effects on women. Today, in every single one of the top ten selling drugs in the US, there are more side effects reported some serious, some minor in women than in men. And women experience adverse drug reactions nearly twice as often as men. The easy conclusion perhaps to jump to here, is that women complain more than men. The real reason is that physiologically women’s bodies are different to men’s bodies. The systemic bias that has existed in medicine for years has prevented us from seeing and understanding sex differences. Medical research has traditionally been performed on men and the results then applied to women. We have assumed that we can understand everyone by studying men. But why?

One size fits all? Unfortunately not …

The logic was that men are easier to study than women because they don’t have the complexity of menstrual cycles and hormonal fluctuations. Studying men also removes the complexity of ethical complications that might arise should a woman fall pregnant during any scientific research. The thalidomide disaster in the 1960s showed that drugs taken during pregnancy can have serious effects on unborn children. In 1977, the FDA issued guidelines that effectively excluded women of child-bearing age from early clinical trials.

In the same way that diverse ecosystems are stronger, diverse organizations are also stronger.

So, men and women were thought to be pretty much the same, except for ‘bikini medicine’. This derogatory term refers to the areas of a woman’s body that would be underneath a bikini. But the differences are much wider and more complex than the term bikini medicine would suggest. Men and women have different metabolic chemistry, immune system differences, different combinations of muscle fibres, and differences in normal cardiovascular function. These cardiovascular differences are also not well understood, meaning that women suffering from heart disease are often misdiagnosed. And brain differences to this day remain controversial, with many neuroscientists arguing that the brain is essentially unisex, and others stating that there are important differences that we need to learn more about.

Things are improving though, and today legislation exists to ensure that men and women are equally represented in clinical trials. But many researchers simply don’t take the next step of analysing the results by sex. Often those doing the research don’t even question it; it has always been done this way.

A problem for all of us

In 2021, the UK government acknowledged the significant male bias in the medical system. It called for public views to help inform the development of the Women’s Health Strategy. Part of the Ministerial forward states:

For generations, women have lived with a health and care system that is mostly designed by men, for men…

Designed ‘by men for business men too?

Does the statement ‘by men for men’ apply to the world of business too? Self-evident though it seems, it is controversial to say that women have lived with systems in organizations that were mostly designed by men, for men, and have largely stood the test of time. But it makes sense. The first organizations contained only men, so they naturally evolved rules based on what worked well for the group. Arguably, these rules don’t work for anyone anymore because so much has changed. Coming into the corporate world in their own right, women have had to prove themselves against men, rather than being celebrated because of their differences. Even though we have been making record progress, today just 10.6% of the Fortune 500 have female CEOs. And, recently, we have been seeing an exodus of female leaders. For every woman at the director level promoted, two female directors are leaving their company.

Downplaying difference

In having had to prove themselves in a world where masculine rules still dominate, women have often had to downplay their natural strengths or make adaptations to succeed.

Annerie Vreugdenhil, Chief Commercial Officer and member of the Executive Board at ABN AMRO Bank tells me of the adjustments she made in her career and the advice she offers younger women:

“Women say to me we have to be able to be ourselves. I say to them, well … you have to be able to be effective. I’m Dutch. I can be outspoken and blunt. But, if I have to do business in Japan, I will get nowhere by being myself. I have to change my behaviour to be effective. Being a woman in a man’s world is like being an expat in another culture. It doesn’t mean you have to change yourself: you just need to change your behaviour to be effective.”

When my children were very small, and my job involved responsibilities in multiple time zones, my former boss once said to me.

“Emma, you can either be a top performer, or you can have balance. You can’t have both.”

I wonder if she (yes, it was a female boss) would have made that same statement had I been a man? And Eleónore Dachicourt, Head of Sustainable and Responsible Development at a large bank, was told by her boss that she was ‘over collaborative’ and needed to ‘suppress that part of her personality.’ According to Eleónore’s boss, she needed to make people more afraid of her. It did not fit with her values, and she decided that she was better off leaving the organization.

In all my interviews with women, there is a theme of having to adapt or make choices they did not feel comfortable with to preserve credibility. All the women had stories. Being expected to be back at work the day after having a miscarriage; the embarrassment of hot flushes in the middle of meetings; worries about period leaks; struggling despite crippling pain; sexual harassment; having to bind a pregnant belly because of fears of negative consequences. And many had chosen to lie rather than admit to a physical problem related to women’s health because of a fear of being viewed as less competent.

These are real issues faced by real women in today’s world. But does an opportunity exist here? For years in the business world, we have been assuming that people are the same. We have done this with good intent because we want people to be equal. But actually, we are not all the same: there is such beauty and power in difference.

Something women do, all the time, is to ignore, downplay or try to control (through taking hormones or drugs) their feminine biology. Nobody wants to talk about periods or menopause, especially at work. These natural biological events are often viewed negatively by society. And a woman who is trying to be a top performer in the workplace certainly does not want to highlight these issues. She does not want to appear weak. She does not want her biology to be seen as an excuse or something that could hamper her performance. So she is silent about it.

But there is a unique opportunity here. An opportunity for women to tap into something that we have not fully understood or appreciated, largely because we just don’t know enough about women.

Understanding Differences Can Improve Performance

Let me take you back to my conversation with Emma Wiggs. Her face lights up as a thought comes to her mind. Her excitement is visible:

“If I was the coach of a female athlete,” she says, “I would be so excited about the potential she could offer! With our deeper understanding and change in approach, we could take her performance to a whole new level. That’s the real difference we could be making.”

Others are discovering this too. The US Women’s football team credit understanding their unique female physiology as a critical factor in winning the 2019 World Cup. Chelsea FC Women, in the UK, tailor their training around their menstrual cycles, recognising that physiology has an impact on performance. We are right at the early stages in the business world of beginning to recognise how physiology impacts our performance, regardless of sex or gender preference. I hope that the future sustainable organization will recognize the importance of understanding the biological basis of behaviour which is far broader and deeper than I have been able to outline in this article. But there are multiple opportunities for all of us, and they are directly applicable to the business world.

One small example of this, for people who menstruate, is to be aware of the changes that take place within their body as they move through the cycle. Every cycle is unique, but there is a phase where we might feel full of energy - productive and confident. There is a phrase that feels less energetic, where we are more likely to be reflective and perhaps more critical of ourselves. Many women suffer terribly with their menstrual cycles, but tuning into the natural intelligence of the body, instead of being a passive bystander, gives a completely different experience of the cycle, and in many cases significantly reduces symptoms. If we understood this better, women could not only increase their performance but also improve their health and well-being.

In addition, both perimenopause and menopause often represent challenging times for those who go through them. As with other aspects of women’s health, these important life stages still receive inadequate research or funding and are unfortunately not well understood. Many women are simply dismissed by their doctors, diagnosed with a mental health issue, or not given access to the right kind of treatment. There is so much more that can be done, and if we start to talk about these issues more, they become less taboo.

It is time for a re-think

Our knowledge and understanding of the female body are years behind our understanding of the male body. We don’t yet know enough about women, but the time feels right for a re-think about how women can be free to be themselves and to get to know the parts of themselves that they have collectively silenced over the years. This is already starting, in pockets. It feels like we are on the edge of a scientific understanding of differences and a realization that all under-represented groups have been subjected to bias and discrimination. The ‘one-size-fits-all’ approach to medical research and treatment has brought serious consequences for women’s health. Likewise, the one-size-fits-all approach to business has had disappointing consequences for women’s progression in the workplace. It has also had disappointing consequences for other under-represented groups, such as people of colour, people with disabilities, those who are neurodiverse and the LGBTQ+ community amongst others.

Our way of looking at the world with the one-size-fits-all approach has prevented us from seeing the amazing talents that under-represented groups can bring. We have moved beyond the negativity associated with being left-handed. (Interestingly the word originates from the old English ‘lyft’ meaning ‘weak’.) But the world continues to be designed with right-handed people in mind, and because left-handers are not as well understood as right-handers, at school, left-handers can face more difficulties with writing. People who are colour-blind have to adapt every day. At work, colour-blind employees may lose important information simply because certain colour combinations are inaccessible to them (e.g. they cannot differentiate between different colour sections of charts or websites). People who fall on the autistic spectrum are still more likely to be mistreated by peers and have adverse experiences. And simply being required to be in the office without access to quiet spaces can present multiple challenges for neurodiverse people, because of sensory overload. This is only scratching the surface in highlighting the myriad of ways in which we might underappreciate the talents of certain people because of their differences.

Beyond the one-size-fits-all approach and the systemic bias, right at the heart of the problem, particularly in the business world, is the design of the system and the way everyone operates within the system. The first step is to recognise the flaws in the system, even if we don’t know how to change it yet. Concurrently, we can celebrate differences, not just of women but of all under-represented groups. The future sustainable organization will need to be more inclusive, more compassionate, and more relationship driven. An organization is a living thing, and in the same way that diverse ecosystems are stronger, diverse organizations are also stronger.

It seems fitting to end with the words of Alexis Fosler, Chief Operating Officer at Como Shambala Lifestyle. A highly experienced COO and Chief Executive Officer, Alexis offers her view:

“I think women are often forced to mould the way they enact or engage or deliver. Quite often, we are forced to constrain our thinking or formulate our thinking in a vessel that is not necessarily our own. But we learn this way of being and we get used to it, and we wear the shirt that fits.” My reflection is what if we could choose our shirts? What if we could simply be ourselves?