For decades, women have been underrepresented in clinical research, while conditions that specifically affect them have often remained under-researched. Polyendocrine Metabolic Ovarian Syndrome (PMOS), the condition at the heart of SPIOMET4HEALTH, is part of this wider challenge. Today, however, Europe is taking important steps to change course.
Few people are better placed to reflect on this shift than Maria Pilar Aguar Fernandez, Director of the People Directorate at the European Commission’s Directorate-General for Research and Innovation. With a career spanning research and innovation policy, public health and health regulation, Aguar has witnessed first-hand the evolution of European health research towards greater collaboration, inclusiveness, patient involvement and real-world impact.
Her perspective is particularly timely for SPIOMET4HEALTH. As the project enters its final months, the focus is increasingly moving from generating scientific evidence on PMOS in adolescent girls and young women to ensuring that its findings can contribute to wider discussions around research priorities, clinical practice and health policy.
In this interview, Aguar discusses why closing these gaps matters, how European research policy is evolving, and the role that projects such as SPIOMET4HEALTH can play in shaping a more inclusive and effective future for women’s health research.
You have worked for many years at the forefront of European health research policy. Could you tell us about your professional journey and how you have seen the field evolve over the years?
Over the years, my work in European health research policy has been both demanding and deeply fulfilling. I have been fortunate to work with highly motivated colleagues at the intersection of science, policy and public health. Together, we have helped advancing research, innovation and cooperation across Europe and beyond. What has always mattered to me is the shared belief that EU collaborative research can genuinely improve people’s lives—not only through scientific progress, but also by strengthening health systems, accelerating medical innovation and addressing major public health challenges.
One of the most striking changes has been the evolution of the field itself. In the early days, research was often more fragmented, limited by national or disciplinary boundaries. Over time, there has been a clear shift towards stronger European coordination, closer cross-border collaboration and more interdisciplinary work.
Health research today increasingly brings together clinicians, scientists, industry, regulators and patients, reflecting the understanding that complex challenges require integrated solutions. The contribution of the social sciences and humanities has also become more important in shaping effective responses.
We have also seen new priorities raising, including personalised medicine, digital health, data-driven research and a stronger emphasis on equity, sustainability and patient-centred care. In many respects, the field has become more ambitious, more connected and more responsive to society’s needs.
Another major shift has been the growing focus on innovation and real-world impact. European health research is no longer only about generating knowledge, but about translating it more quickly and effectively into better prevention, diagnostics, treatments and care. The COVID-19 pandemic reinforced the importance of preparedness, resilience and rapid cooperation—lessons that remain highly relevant and that we shouldn’t forget. For some future areas, let me say that the links between health and the environment have also become impossible to ignore. Climate change, in particular, is now a defining challenge, with direct and indirect effects on health—from air pollution and infectious diseases to heat stress and food security. Responding to these challenges requires integrated research and coordinated action if we are to build healthier and more resilient societies.
But one thing remains immutable: It has been a privilege to contribute to that progress and to see how European cooperation in health research can bring real benefits to citizens across the Union.
For a long time, health research did not fully reflect women’s biological and lived realities. How has this influenced the way women are diagnosed and treated?
Indeed, for many years women’s biological and lived realities were not fully addressed in the design of health research. This was not only about women being underrepresented in parts of research and clinical trials. It was also about research not always asking whether diseases manifest differently, progress differently, or respond differently to treatment in women and men.
That has had direct consequences. It has affected diagnosis, because women’s symptoms, risk factors and disease pathways have not always been sufficiently recognised. It has affected treatment, because medicines, devices and interventions have not always been tested or analysed in ways that show whether they are equally safe and effective for women across different life stages. And it has affected care, because some women’s symptoms have too often been normalised, underestimated, or recognised too late.
There are several reasons for the gaps in women’s health research. To name a few we could mention: historical research practices, lack of sex- and gender-disaggregated data, structural barriers to participation in clinical trials, and concerns around pregnancy and breastfeeding.
This is precisely where the Commission focus its research and innovation funding. Under Horizon 2020 and Horizon Europe, the EU has invested over EUR 2 billion in more than 1,000 projects focused on women’s health. These projects cover areas such as cancer detection and screening, cardiovascular health, personalised medicine, reproductive health, maternal and child health, infectious diseases and clinical studies. Investing in clinical research is also part of the answer. The Commission is supporting more inclusive and gender-sensitive approaches in clinical trials implemented by EU-funded projects. For instance, projects such as ConcePTION on medication safety during pregnancy and breastfeeding, and SPIOMET4HEALTH show the direction: better evidence, earlier intervention, and research that is closer to women’s real health needs.
This is not about creating a parallel health agenda. It is about making health research more accurate, more effective, more inclusive and more useful for everyone so that diagnosis is earlier, treatment is safer and more tailored, and evidence better reflects citizens’ health needs.
Why are projects like ours important for Europe, and what do they say about the future of health innovation?
Projects like SPIOMET4HEALTH are important because they address a very concrete and persistent gap in women’s health: conditions that strongly affect girls and women have too often been under-researched, under-recognised and insufficiently treated. PMOS is a clear example of this. This is a part of a wider problem. Although women account for half of the population, less than 1% of medical research funding goes to non-cancer medical research focused on women. As a result, many conditions affecting women have not received the scientific, clinical and policy attention that they deserve.
PMOS is not only reproductive and hormonal condition. It can co-exist with other comorbidities. For example, it can affect young women more broadly, including through unwanted hair growth, central fat accumulation, menstrual irregularity and visible changes in physical appearance. For adolescent and young women, this can have a serious impact on their self-image, confidence and social participation. This is why projects like SPIOMET4HEALTH matter. They recognise that women’s health conditions often co-exist with important physical, psychological and social consequences.
SPIOMET4HEALTH is a step in the right direction for women’s clinical research: moving beyond symptom management and looking at mechanisms, early intervention and long-term outcomes.
Therefore, SPIOMET4HEALTH creates a bridge to better understanding of women’s health, especially in young and adolescent women, and translate discoveries to better innovative treatment options. Besides the contribution to clinical research, the project also contributes to raising awareness among young women by using significant digital marketing campaigns through social media.
More broadly, projects like SPIOMET4HEALTH show the direction that health innovation in Europe needs to take: more sex- and gender-sensitive research, more attention to under-researched medical conditions, and stronger links between science, prevention, treatment and long-term outcomes.
Patient involvement is becoming increasingly important in research. How do you see the role of patients evolving in the design and implementation of health research?
Patient involvement is health research is clearly evolving. It moved from patients being more passive participants as ‘study subjects’ to active stakeholders in design and implementation of health research projects.
Under Horizon Europe, the Cluster 1 ‘Health’ is supporting and enabling patient’s participation and self-management as part of the broader aim to improve health outcomes and strengthen healthcare systems. In this regard, patients are increasingly involved earlier in the health research process. For example, in clinical studies, this can include the involvement of patients, citizens and carers in development of a clinical study protocol.
Horizon Europe projects are expected to integrate patient perspectives from the early design phase to ensure that research questions, endpoints and study procedures reflect real patient needs. Patient and patient organisations are also taking on more structured role. They can participate as beneficiaries involved in task related to design and conduct of clinical studies and communication and dissemination activities.
Finally, what message would you share with researchers and innovators shaping the next generation of health solutions in Europe?
Your work is essential not only for advancing science, but for improving people’s lives, strengthening our health systems, and building a more resilient Europe. The challenges we face — from chronic diseases and mental health conditions, the emergence of new epidemic threats and antimicrobial resistances, to the health impacts of pollution and climate change — require ambition, collaboration, and trust.
I encourage you to keep pushing boundaries, while remaining grounded in ethics, inclusiveness, and real-world impact. The most meaningful innovation is not only breakthrough technology, but solutions that are safe, accessible, affordable, and centred on patients’ needs. Work across disciplines, sectors, and borders. Engage with citizens, patients, healthcare professionals, regulators, and industry from the outset. By turning excellent research into practical, equitable solutions, you can help ensure that innovation reaches everyone who needs it.
References:
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European Commission. (2026, March 10). Meeting with Women’s Health Interest Group (EP): CAB Zaharieva/696 [Internal briefing note].
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Davaki, K. (2025). Gender inequalities in medical research, drug development and access to care. European Parliament, Policy Department for Citizens, Equality and Culture.https://www.europarl.europa.eu/thinktank/en/document/IUST_STU%282025%29778519
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European Commission, Directorate-General for Research and Innovation. (2025, May 27). EU research and innovation on women’s health. European Commission. https://research-and-innovation.ec.europa.eu/research-area/health/womens-health_en
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European Commission. (2025, December 11). Horizon Europe Work Programme 2026–2027: 4. Health (European Commission Decision C(2025) 8493). https://research-and-innovation.ec.europa.eu/document/download/36c7287d-d38f-4a96-94ca-0dfce1375a48_en
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European Research Executive Agency. (n.d.). Gender in EU research and innovation. European Commission. Retrieved June 2, 2026, from https://rea.ec.europa.eu/gender-eu-research-and-innovation_en
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European Union. (2014). Regulation (EU) No 536/2014 of the European Parliament and of the Council of 16 April 2014 on clinical trials on medicinal products for human use, and repealing Directive 2001/20/EC. Official Journal of the European Union, L 158, 1–76.
https://eur-lex.europa.eu/legal-content/EN/TXT/HTML/?uri=CELEX:32014R0536
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European Commission, CORDIS. (2025, August 20). PCOS in adolescent girls and young women: Toward a treatment guided by pathophysiology (SPIOMET4HEALTH), grant agreement No. 899671. https://cordis.europa.eu/project/id/899671
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European Commission, CORDIS. (2025, October 7). Building an ecosystem for better monitoring and communicating of medication safety in pregnancy and breastfeeding: Validated and regulatory endorsed workflows for fast, optimised evidence generation (ConcePTION), grant agreement No. 821520. https://cordis.europa.eu/project/id/821520
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“Less than 1% of medical research funding goes to non-cancer women’s diseases.” – Women’s health is systemically designed out of research, out of data and out of funding systems. We’re building the infrastructure to design it back in.