An analysis of GlobalData’s Clinical Trials Database shows that over the course of the last ten years or so, Iran has consistently been a leader in terms of the number of Phase III clinical trials carried out in women’s health (Figure 1). The analysis only included planned, active or completed trials, excluding those that had been withdrawn, terminated or suspended. Active trials per year for Iran ranged from 58 in 2015 to 115 in 2019, with the next highest trials per year for a country being the US in 2016 at 22 trials.

Iran’s dominance in this therapy area is spread fairly comprehensively across many indications, with more trials than any other country in most indications. However, the overall data is possibly skewed by an overwhelming lead in Phase III trials for polycystic ovarian syndrome (PCOS), with Iran carrying out more than double the number of trials as all other countries combined. PCOS is difficult to diagnose, generally under-researched, and can lead to infertility or other serious health conditions such as coronary heart disease. Many Iranian trial sites have focused on the effect of various supplements on those with PCOS. In other indications such as pre-eclampsia and endometriosis, while not as large a majority, it is still undoubtedly Iran that leads the area of research.

Following the Islamic revolution in Iran in 1979, there has been a sustained push to segregate healthcare by gender. A key part of this is facilitating the formation of female-only hospitals, with an end goal of them being staffed entirely by female healthcare professionals. At present, the lack of female doctors has caused issues with the development of the programme, but nevertheless, there are several female-only hospitals operational in Iran, mostly attached to universities and medical schools.

One of these hospitals, the Arash Women’s Hospital in Tehran, has been the site for 38 Phase III trials in women’s health over the past ten years, more than any other trial site in the world. It is possible that this process of segregating hospitals invites more attention to women’s health issues than would arise in a typical hospital, and as such are more likely to form the focus of clinical trials.