For many women a visit to the doctor is the last thing they want to do especially when it comes to hormone health. 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 because 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. Many huge studies happened with zero women involved. The FDA was excluding all women of childbearing age. Considering the number of years it takes for research to filter into the conventional medical system, its not surprising that we are still seeing a huge gap in women’s care.
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 7 to 10 years before receiving a diagnosis. This is partially because it takes time for the condition to develop but we also have to consider how women’s symptoms are minimized within a system where there is 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 disproportionately to 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 and their symptoms minimized when they know something isn’t right. Opportunities for early intervention and preventative treatments are lost. Compounding this, women are 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 often for a decade before she is properly diagnosed. Wouldn’t you start to feel crazy?
Hormones are Neglected
Hormones are rarely tested but hormonal treatment is offered as treatment all the time. There are obvious problems here. We know endometriosis can be autoimmune in nature and need to look at this as well. 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.
Imagine this patient who has suffered for years from undiagnosed endometriosis. She has likely made some changes and can manage symptoms better than before. Then a stressful life event occurs. Perhaps she’s pursuing her Master’s or PhD. 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 gynocologist. 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. We know autoimmunity affects women far more than men. There are reasons for this. Our hormones influence our gut health differently. We are more susceptible to IBS but are protected from heart disease. When we do present with heart disease it takes longer for us to be treated because the presentation is different. Again this is often missed. Young women are turned away at the ER during a cardiovascular event because they aren’t taken seriously.
The researcher I mentioned at the beginning of this article discovered that women commonly take a male family member with them to the doctor just so they are taken more seriously. I had one patient who did this at my clinic. After she discovered that I operate very differently she stopped bringing him along. We made significant progress. She thanked me several times for listening to her and 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! There is a fear that she doesn’t want to be considered a difficult patient and passed along. She’s wondering how to express her pain but not be labeled.
Learning To Listen
For years my focus was working with marginalized populations. My education led me to this and I loved it. 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. Many of them practice functional medicine.
There is a gynecologist who is listening to what’s happening to his patients and responds. He knows that avoiding hysterectomies is ideal. He discusses best practices, the role of diet and the sinister side of pharmaceuticals. Stay tuned for this article on contraception.