Advances in drug delivery for women’s health: A matter of gender equity

Global gender equality remains elusive, with many women and girls¹ still facing prejudicial treatment in many aspects of their daily lives. The urgent need to close gender gaps and reinforce the fundamental role of women in our society is well recognized by the United Nations, leading to the inclusion of a specific Sustainable Development Goal for 2030 for achieving gender equality, and women and girl empowerment [1]. Key among the goals is fairness in accessing quality healthcare. Reaching gender equality in health (or, more relevantly to the field, gender equity) means that biological differences between women and men need to be considered. Apart from the most obvious ones related to the existence of distinguishing sex organs and related diseases, gender medicine has further highlighted differences in pharmacokinetics and pharmacodynamics for various drugs, which have been explained by fundamental physiological and genetic features of each sex [2]. Such dissimilarities may also pose substantial repercussions and challenges when devising drug delivery strategies and designing drug products intended for women’s health, which need to be comprehensively explored and considered from early on in the development process and into their clinical testing.

With these principles in mind, we set out to compile the present Article Collection of Advanced Drug Delivery Reviews on advances and perspectives in drug delivery for women’s health. We had the opportunity and privilege to collect the contributions of distinguished academic researchers and experts in medical product development in different topics pertaining to drug delivery for the treatment and/or prevention of conditions exclusively (or majorly) affecting women and girls. Madia et al. [3] set out the tone for this Article Collection by elegantly discussing how sex is a key biological variable that needs to be carefully considered during the drug development process and, further on, in clinical practice. The specific case of nanomedicines and how sex affects their pharmacokinetics and pharmacodynamics is addressed in the article by Mahmoudi and colleagues [4]. Essential insights and clinical use of the different drug delivery routes that are specific of women are then detailed by das Neves et al. [5]. This last article is nicely complemented by the overview of Palmeira-de-Oliveira et al. [6] on how women perceive and accept such delivery routes as compared to more standard ones (e.g. the oral route), and its influence on preferences and acceptability of drug products. Next, key aspects of particular drug dosage forms and delivery systems that have been shown useful for developing innovative preventative and therapeutic options intended to be used in women’s health are addressed by Krovi et al. [7] (long-acting injectables, implants and vaginal rings) and Paredes et al. [8] (microarray patches). Specific drug delivery strategies for diseases affecting the upper female genital tract are highlighted by Patel et al. [9], while Vanić et al. [10] provide an interesting discussion on how nanomedicines can help tackling the issue of antimicrobial resistance in the particular case of vulvovaginal infections. Furthermore, VanBenschoten & Woodrow [11] address the challenging topic of vaginal immunization and how precise engineering of mucosal vaccines can provide new solutions for fighting sexually transmitted infections. Targeted and localized treatment approaches to genital cancers are also outlined in the reviews by Zhong and colleagues [12] and Xie and co-workers [13]. Although breast cancer can also affect men, the disproportionate incidence and specific pathophysiology of this disease in women fully justifies a closer look on nanomedicine-based approaches that are currently under development or already in clinical practice. Such discussion is provided in two complementary articles by Yu et al. [14] and Jiang et al. [15]. Last but not least, novel drug delivery solutions and strategies intended to be used during pregnancy and peripartum in order to address either maternal and fetal health conditions are elegantly reviewed by Zierden et al. [16] and Sharma et al. [17].

We sincerely hope that this Article Collection of Advanced Drug Delivery Reviews provides not only a useful and timely overview on advances made so far in the field of drug delivery for women’s health, but also an important reflection on remaining challenges and hurdles that need to be addressed towards the goal of gender equity in global health.