When it comes to their hormone health, visiting a doctor is the last thing many women want to do. Why is this? Writer Maya Dusenbery explains why in her new book called “Doing Harm”. I came across her work recently. I want to highlight a few points. Her research points to one of the most common things I hear in clinic.
“I Feel Dismissed by my Doctor”
For decades women have been left out of clinical research. It wasn’t until the 90’s that law suits changed this. Isn’t this shocking! It was to me. Huge studies happened with no women involved. The FDA was excluding all women of childbearing age. It’s not surprising that we are still seeing a huge gap in women’s care. Especially if you consider the number of years it takes for research to filter into the conventional medical system,
Endometriosis is a good example. There is very little research on this topic yet 1 in 10 women are affected. It is common that a woman suffers debilitating pain for a decade before receiving a diagnosis. This is partially because it takes time for the condition to develop. Women’s symptoms are also minimized in a system with insubstantial evidence to support what they are experiencing.
The Knowledge Gap
Women’s health concerns have not been prioritized. Diseases and syndromes that affect women more than men receive less attention. There is a gap in knowledge because of the lack of research. Doctor’s don’t know. We see intelligent women dismissed when they know something isn’t right. Opportunities for early intervention and preventative treatments are lost. Compounding this, women are also more likely than men to have negative responses to pharmaceuticals.
Let’s continue to discuss endometriosis to understand how this plays out. The level of pain a woman with endo experiences is much more intense than regular menstrual cramps. Her symptoms are dismissed as ‘just part of being a women’ and she feels unheard. Wouldn’t you start to feel crazy?
Hormones are Neglected
Hormones are rarely tested but hormones are offered as treatment all the time. There are obvious problems here. Estrogen dominance may be an underlying cause. Instead of finding out why estrogens are building up in the system, it’s assumed that progesterone is low. I’ve seen patients with excess estrogens who don’t have low progesterone. Natural progesterone isn’t always the answer. Even if it is indicated, there are likely other imbalances to rule out including autoimmunity. Endometriosis is often autoimmune and this is usually ignored.
Imagine this patient who has suffered for years. She has likely made some changes and can manage symptoms better than before. Then a stressful life event occurs. Perhaps she’s pursuing a Masters degree. Maybe she’s trying to get pregnant and can’t. Without the right information and support its difficult to maintain a lifestyle that prevents endometriosis from spreading. Finally she gets a referral to a gynecologist. Surgery is offered. Then multiple surgeries. Then a hysterectomy.
Surgery doesn’t treat the root cause
Whether surgery happens or not its not addressing the underlying cause. Autoimmunity effects women far more than men. There are reasons for this. Our hormones influence our gut health differently. We are more susceptible to IBS or SIBO. On the flip side our hormones protect us from heart disease. When we do present with heart disease it takes longer for us to be treated because the presentation is different. There are reports of young women being turned away at the ER during a cardiovascular event because of this.
The researcher I mentioned discovered that women commonly take a male family member with them to the doctor so they are taken seriously. I had one patient who did this at my clinic. After she discovered that I listened, she stopped bringing him along. We made significant progress. She thanked me several times for helping her understand why she was having the symptoms she was having.
The added stress and anxiety of not being heard is compounded by the fact that a male voice might be given more weight. When it comes to your body, you are the expert! Women know they might be considered a difficult patient and passed along.
Learning To Listen
My focus for many years was working with marginalized populations. I’ve always been curious about the strength and resilience of people who are treated unfairly in a broken system. Within this current medical system there are heroes.
There is a gynecologist who is listening to what’s happening to his patients and responding. He knows that avoiding hysterectomies is ideal. He discusses best practices, the role of diet and the sinister side of pharmaceuticals. I met him in one of my functional medicine forums. People like him inspire me to continue this work.