Women have historically been underrepresented in heart disease clinical trials, leading to inadequate understanding of sex-specific differences. Despite policy changes since the 1990s, women remain underrepresented in trials, particularly in heart failure with reduced ejection fraction (HFrEF) studies. Factors contributing to this include logistical barriers, lower awareness, and differing decision-making processes. Addressing these requires comprehensive strategies, including increased opportunities for women to participate, studying sex and gender interactions, and educating clinicians on women's heart disease.