women's health Archives - Hormones Matter

Summer’s Best Bargain: Free Vitamin D

Published on May 14, 2025

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The warmest season of the year is around the corner. Many of us are looking forward to school holidays, work vacations, and relaxing. And shopping often accompanies our summer fun. So take advantage of the best bargain of the season: better health – for free! That’s right, I am talking about sunshine: the light emitting from the fiery heart of our solar system. Ultraviolet B (UVB) rays from the sun provide us with an essential nutrient called vitamin D. Yes, this is the vitamin that not only strengthens our bones and muscles but may significantly protect us from a wide range of serious diseases including autoimmune disorders, cancer, contagious illnesses, diabetes, and heart disease, according to a plethora of credible medical studies from around the world.

Many people—across generations and geographical locations—suffer from low vitamin D levels from lifestyles that do not include unprotected sunbathing. Since the late 1980’s, the medical community has emphasized the need to “shun the sun” to avoid skin cancer. Consumers have embraced this advice by spending billions of dollars so they can slather chemical-laden lotions with exponentially increasing sun protection factors all over their bodies. This behavior has resulted in a vitamin D deficiency epidemic.

Moderate sun exposure is healthy for most individuals. Our bodies possess an inherent mechanism to process only the necessary intake of sun rays, about 20,000 international units of vitamin D. After our skin is exposed to direct sunlight under optimal conditions for about 20 minutes, its safety mechanism turns off the initial production of vitamin D. For many folks, it is then time to move to the shade or don additional protection to reduce the risk of sunburn.

Optimal conditions to enjoy summer’s vitamin D depend on a number of factors that we can, and in some cases, cannot control. These factors include:

Geographic location. The closer you are to the equator and the higher your altitude the better your opportunity to acquire vitamin D-rich sunlight.

Time of day. The window of sunlight between 10:00 in the morning and 2:00 in the afternoon is optimal. If your shadow is shorter than your height, you are in the potential vitamin D-producing time frame.

Sky clarity. An azure sky is highly preferable to cloud cover. UVB light is decreased by about 50 percent when penetrating clouds. Ozone pollution absorbs UVB rays before they reach your skin.

Skin. The less clothing, makeup, and sunscreen you wear, the better the odds that your skin can produce vitamin D. It also is important to understand that melanin, the pigment in your skin, absorbs UVB rays. The lighter your skin, the better chance you can make vitamin D more efficiently.

Age. Youth trumps older ages because the concentration of the vitamin D precursor in our skin, called 7-dehydrocholesterol, decreases with age.

Weight. Less weight means typically more vitamin D production from the sun. As vitamin D is fat-soluble, the body’s fat cells more rapidly absorb vitamin D, decreasing its availability to organs, tissues, and cells.

You may be thinking, “I live near sea level, far from the equator, in mostly cloudy conditions with cool summer temperatures; work full-time during the day; and am dark-skinned and overweight. How on earth (literally) can I get any measurable vitamin D from the sun?” Take advantage of sunny weather by enjoying an outdoor lunch break. Remove that hat, roll up your sleeves, and soak in the sun. Ten minutes of sun exposure is better than none.

Each individual’s options for absorbing nature’s gift of vitamin D may differ.* Fortunately, widely available sources of vitamin D including vitamin D3 supplements may be highly effective in raising your body’s D levels to protect you from a wide array of medical conditions. The information about, and benefits of, vitamin D could fill a book. In fact, I am so impressed with vitamin D’s health benefits that I recently published a book called Defend Your Life to encourage people to improve their health by taking vitamin D.

Happy summer, and happy health!

*Persons who have developed sarcoidosis, specific granulomatous diseases, and rare cancers may experience hypersensitivity to sunlight exposure.

Image by pixel2013 from Pixabay .

This article was published originally on July 2, 2019.

Hormonal Birth Control Solves Everything Right? Wrong.

by Jess Poland

Published on July 9, 2024

15367 views

Hi, my name is Jess, I have two children, whom I gave birth to at age 17 and 19. This saved me in ways I could write a book about. I also had one miscarriage. Members of my family have a history of gynecological problems and some of them struggle with fertility. I also was at high risk for hormonal problems due to my strong family history. What I did not know, was just how limited doctors’ understanding of menstrual and hormone problems was. For every problem I presented with, hormonal birth control and painkillers were the answer. When those didn’t work, surgery. I had 10 operations in the span of a few years, until finally and out of desperation, I had a total hysterectomy in my twenties. I cannot help but wonder if the Depo Provera prescribed to me after the birth of my second child was somehow the root of my illnesses and all of the other prescriptions for hormonal birth control added and worsened my pain. It seems like I was in vicious cycle. Here is my story.

Hormonal Birth Control, Pain, and the Long List of ER Visits and Unsuccessful Surgeries

Depo Provera: The Beginning of My Pain

At my 6-week post birth check-up for my 2^nd child, the doctor I recommended that I go on the Depo Provera shot to prevent any further pregnancies. So, I did. In September 2013, after two more shots of the Depo Provera, I started having “a period” that lasted 7 months! After multiple doctors’ visits, lots of medications and tests, I was referred to my first specialist, a gynecologist.

Operation 1. In April 2014, at 20 years old, I had my first gynecological surgery: a hysteroscopy, along with a D&C and a Mirena inserted to stop the “period” I was having. The Mirena was also for birth control.

The Mirena Chronicles: More Pain and Ruptured Cyst

For the next 8 months, I had extremely irregular periods, unusual pain, and contemplated having the Mirena removed. The specialist recommended that I keep it in and see if it settles. Intercourse was painful, and after, I was guaranteed to wake up bleeding the next day. My pain became unbearable and after I had an ultrasound, they found I had a cyst on my left ovary. I was given prescription pain relief and was told they would do another ultrasound in 4-6 weeks. That didn’t happen because the pain was slowly getting worse. After two more visits to the emergency department with more pain medication, I was still told that we needed to take a wait and see approach. My health was declining. I lost 7 kilograms in 3 weeks from feeling so unwell.

Then one day I collapsed with severe sudden pain. I went to the hospital straight away when another ultrasound revealed the cyst on my ovary had ruptured. I was told I needed to undergo surgery.

Operation 2. I had a laparoscopy, so they could clean out the mess from the ruptured cyst.

Irregular Bleeding, Another Cyst, Endometriosis, and Still, Mirena is the Solution

A couple months went by and my pain once again returned. I still was having irregular bleeding and was still guaranteed to be bleeding after having intercourse. It was like déjà vu. Unfortunately, I was back on pain killers and an ultrasound revealed another ovarian cyst. The pain was often unbearable. Off to the emergency department again. Multiple pain medications didn’t seem to be working and I was told I need to deal with it as there was nothing they could really do. I thought “Are you serious?!?! Why the hell won’t you help me?!?!” I was a mess.

At every hospital visit, I got the “Oh you are on a lot of bad medication; you shouldn’t take so much.” So I would ask “can you please do something? I don’t want to keep shoveling pills down my throat!!”. However, every time the answer seemed to be “here are some more medications for your pain because we can see you’re in a lot of pain and your vital signs are showing you are in a lot of pain”. This wasn’t providing any sort of solution to fix my pain and being told to suck it up and get over it, by one doctor, didn’t help either. I couldn’t help but feel depressed and severely anxious every time I needed to go to the emergency department. I was in so much pain I didn’t know what to do. When did I become a person who needed multiply prescription medicines to control the pain enough that I could function semi-normally? At one point, I weighed only 48 kilograms. I had lost 10 kilograms. I could barely eat. Every day I tried to stay positive, but it was so hard being consumed in pain 24 hours, 7 days a week.

Operation 3. I had another laparoscopy on the 1^st of May 2015, where I had the cyst removed from my left ovary. This is when they told me I had some endometriosis. They inserted another Mirena as a treatment option. It seems as though, birth control and pain killers are the only answers that they have.

Rinse and Repeat and Repeat and Repeat: More Hormonal Birth Control and More Surgeries

By September 2015 the same thing happened again, another large cyst, given away by the extreme pain and accompanied by the irregular bleeding! Another round of multiple hospital visits and admissions, I was again put on really strong pain killers and we discussed treatment options. I was prepped for a procedure called an aspiration and drainage, but my bowel and bladder were collapsed over, and they couldn’t perform it.

Operation 4. On the 24^th September 2015, I had another laparoscopy. Another large cyst and more endometriosis were removed. After surgery, I was placed on a different birth control pill, along with the Mirena IUD, as a treatment option for the reoccurring cysts and endometriosis.

By January 2016 my pain had once again come back, and I was admitted to hospital. The result showed that I had another cyst on my left ovary. (Seriously, WTF!!! So many more tears). They told me they didn’t want to do any more operations on me, and I sure as hell didn’t want anymore. I was now 22 and felt like I was failing as a mum and person because I was always so consumed in pain. There were days where I couldn’t even leave the house. I had the Mirena removed again and was once again on pain killers. I was put on a hormonal birth control pill; a much higher dose, and we all prayed this would give me relief.

I had started to build up a resistance to any sort of pain relief. It felt like I was constantly going to the emergency department and was always sent home with more pain killers. Most of the time, the same ones I already took daily. I was going because my pain was so out of control, everyone around me was telling me to go get help, including my GP because I could barely function. Why were they sending me home on the same pain killers that didn’t control my pain? This affected my emotional state further. Some nurses, doctors and people were really kind to me, and others were extremely nasty and made me feel guilty for being in so much pain. I really didn’t want to be sent home again with no solution. “We must figure something out, please stop doing this to me!!! It has happened too many times!”

By March 2016, I was still in chronic pain and on even more daily medications. I had another ultrasound which reveal that I still had another large cyst in my left ovary. It also showed that I had nephrocalcinoisis (calcium build-up) and a small cyst in one of my kidneys, I was told this could be from long term use of pain medication but not exclusively. My jaw dropped. I had to travel to see a kidney specialist who told me it was nothing much to worry about and if it gets worse then I will be referred back. The advice from him was to ease up on the pain medication if possible and find other ways to deal with my chronic pain.

Operation 5. By May 2016, we were once again going to re-insert a Mirena to try and help my issue, however, it didn’t want to go in, so I had my 5^th Operation to have it inserted on the 2^nd June 2016. (Even if it was only slightly effective for a couple months that gave us time to try figure out what we were going to do). I was using a lot pain medication still, and my bleeding was happening more than it wasn’t. Once again, I was anemic and needed to take supplements to help my iron. Luckily, I never needed a blood transfusion. I had honestly lost count of the amount of times I went to my doctor’s clinic and the emergency department. I couldn’t even tell you the names of all the different types of pain relief and contraception options I had tried. I was labelled as someone who just ‘wanted painkillers’ because the amount I was on would not fix my pain. I was anxious and depressed due to my declining health. I wanted to just stop taking everything, but the pain was so much I couldn’t even move. Still around 50 kilograms and I had now been on pain relief constantly for around 6 months.

Operation 6. At this stage I was feeling worse if anything, so I had my 6^th operation to remove the Mirena once again, after failed attempts to remove it in the gynecologist unit.

Going in Circles: More Birth Control, More Pain and Problems and More Surgery

By September 2016, I had visited the hospital and doctors so many times I was known on a first name basis. By this time, I had begun to research treatment options extensively and spoke to multiple people, including my gynecologists and doctor which led to me to discussing a hysterectomy. By now, I was willing to try any option to rid me of this pain! After extensive discussion it was decided that I would just have my left ovary removed because that was the most troublesome. In September 2016, we scheduled a laparoscopic Left Salpingo- Oophorectomy (Left Ovary and Fallopian Tube Removal).

Operation 7. On the 12^th of October (day after my 23^rd birthday), I had my 7^th Operation. During this operation they found another problem. This is when I was diagnosed with pelvic congestion syndrome/ Ovarian Vein reflux and was referred to another specialist- an Interventional Radiologist.

Pelvic Congestion Syndrome/Ovarian pain reflux
“Pelvic venous congestion syndrome is also known as ovarian vein reflux. It is a cause of chronic pelvic pain in approximately 13-40% of women. Chronic pelvic pain is pain in the lower abdomen which has been present for more than 6 months. Pelvic congestion syndrome is therefore a painful condition often caused by dilatation of the ovarian and/or pelvic veins (rather like varicose veins but in the pelvis) . Varicose veins are commonly seen in the legs when the veins become less elastic and the valves that stop the blood from flowing backwards stop working. This causes the blood to pool, due to gravity, causing enlarged, bulging and knotty veins. This is also what happens to the pelvic veins in pelvic venous congestion syndrome (PVCS). This pressure results in the pain of PVCS and may also cause visible varicose veins around the vulva, vagina, inner thigh, and sometimes, the buttock and down the leg (s).”

Things went well for a short while, but the pain just got worse again. Again, I was on a lot of pain killers. I was always forced to take Panadol first if I was admitted in the ED, before they prescribed anything else.

I was referred to another specialist – an Interventional radiologist.

I drove 5 hours to see an interventional radiologist as there were none locally who could take me in the public system. I was advised by him that I should have platinum coils inserted in my ovarian veins and a foam solution to kill off a bunch of other veins. They thought the PVCS could be the cause to my pain and this treatment could prevent me from getting anymore varicose veins. He told me I am lucky that my legs and vagina hadn’t been affected yet, and that I will need to keep an eye out for this in the future.

Operation 8. I had operation number 8 in March 2017. I wasn’t under general anesthetic this time. Just a “twilight sedation” where they used my main artery in my neck to insert the coils and other treatments. Thankfully, I was out of it for most of it!! I had multiple coils inserted and who knows how many other smaller veins were treated. They wanted me to stay admitted overnight but I couldn’t do it. I was actually a bit traumatized from the whole experience. I felt extremely alone and scared down in a “big city” hospital by myself. At one stage, they were so busy that the head of my bed was in a utility closet to get me out of the way. Unfortunately, this operation did not help my pain as much as I prayed it would. pelvic congestion hormonal birth control

Chemical Menopause, Hysterectomy, and More Medications

I was at my wits end. I was breaking down emotionally, so I reconsidered a hysterectomy even though I was only 23 years old. The gynecologist I was seeing suggested that I go into chemical menopause before I had a hysterectomy so that I could see if it would benefit my pain. So, I did, I went on an injection called Zoladex. It causes chemical menopause and it’s actually used as a treatment for breast and prostate cancer. I was told not to research it but I couldn’t help myself.

I went to a regular GP appointment, but this time came out with more bad news. The results were that I have high cholesterol, which showed in a recent blood test. The doctor was a little confused because I didn’t have any of the major risk factors for high cholesterol. Turns out, that is what chemical (surgical or natural) menopause can do to one’s body. Now I had to add another specialist to the list of doctors and it meant another trip away. He told me if you have a hysterectomy and you take out your only remaining ovary, your cholesterol treatment will greatly differ”. He told me, “what would/could happen and that I must go back after my operation, but for now it was still untreated. So, with that news I felt like I needed to keep my only remaining ovary.

I was now seeing multiple professionals and had been seeing a gynecologist who made me regain hope. We talked about this operation multiple times over a long period of time and I was still suffering “chemical menopause” symptoms at that time, with my pain coming back worse the chemical menopause pellet started to run out. I was excited when the day finally came where I signed the papers to have a total hysterectomy. The advice I received was that I should make serious lifestyle changes to help my body. I was advised to do weight bearing exercises, quit smoking, go on Hormone Replacement Therapy and pray it doesn’t bring my pain back.

One thing that is still stuck in my mind is the line “this could take up to 10 years of your life”. I was in so much pain and I was sick of taking so much medicine that was making me sick in other ways. I really wanted to stop having operation after operation.

Operation 9. On the 2nd of August 2017, I had a total hysterectomy. I had everything except my right ovary removed. I must admit I felt strange, my belly felt empty, but I immediately felt like I had less pain.

It was the best thing I did for my pain. I felt like I had recovered from this operation fast and everyone (including myself) was amazed at how well I was doing physically afterwards. Ten days post op, I was able to stop all the pain medication I had been on! This was massive for me!!! No more pain killers! Or so I thought. My right ovary didn’t “wake up” after my hysterectomy and I began experiencing stronger menopause symptoms. I knew the obvious symptoms after having chemical menopause. This led me to the journey of figuring out and starting my first lot of Hormone Replacement Therapy (HRT). I also came to the realization that it takes up to one year to fully heal from a total hysterectomy.

I must admit this affected me mentally and emotionally more than I thought it would. Some days are so bad, they scare me, other days I’m on top of the world. I think this definitely contributed to my mental health. One of the hardest things about having mental illness is getting up and putting on ‘you’re okay face’ every day. This isn’t makeup. This is the face where you put on a smile and say, “I’m fine”, or “I’m good thanks”. Its where you hope no one sees past your bulls**t smile because the moment they do you know you’ll break down and cry, but at the same time you just want someone to help you and help you not feel the way you feel anymore. Who knew hormones can mess with your head so much? Who knew hormones play apart in so many different things in your body?

Operation 10. On the 28^th of June 2018, surgery number 10 happened. I had my right ovary removed. I had another cyst that was complex in nature and which was making my pain worst, contributing to me being back on pain killers again full-time. They also saw that the coil that was cut during my hysterectomy was exposed at the tip, so they trimmed this up as well. hysterectomy at 23

Surgical Menopause: Medicine’s Only Other Solution

After this operation, I “officially” entered surgical menopause. I have learnt what surgical menopause really is, and how much it differs from natural menopause. I also learned how under-educated people are regarding this condition, including some doctors and specialist. I didn’t know this was the journey I was going to be on for the rest of my life, however, I have learned that I am my only and best advocate. I still suffer from chronic pain every day, and now I have an added stress of menopause. All I can do is stay strong and true to what I know and keep fighting for myself and women like me. I will continue to try and get better health care for myself and I will not give up until I am satisfied, I have achieved this. This is not how my story ends.

Thank you for taking the time to read my story. Kind Regards, Jessica Poland (Firth). Queensland, Australia.

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If you have had similar experiences with hormonal birth control and/or medications and surgery, write and share your story on Hormones Matter.

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This article was published originally on November 29, 2021.

Vitamin D3 and Thyroid Health

by Susan Rex Ryan

Published on May 29, 2024

20819 views

The benefits of vitamin D3 garner a plethora of glowing press these days but little information has been reported about how this essential nutrient may be associated with thyroid disorders. An alarming number of Americans—over 25 million—suffer from thyroid disease. Women are four times more likely than men to develop a thyroid disorder. The thyroid, a butterfly-shaped gland located in your neck, regulates your metabolism and affects every cell in your body. When your thyroid is not working properly, your body becomes unbalanced, potentially causing symptoms including weight gain or loss and chronic fatigue as well as autoimmune disease and cancer. Let’s look at how vitamin D3 may affect thyroid health:

Thyroid Hormonal Balance

Vitamin D receptors (VDR) are present in the cells of the pituitary, the pea-sized gland located at the base of the brain that controls your thyroid. The pituitary produces a hormone called thyroid stimulating hormone (TSH) that signals your thyroid gland to make thyroid hormone (T3 and T4). Thyroid hormone constantly circulates throughout your body, regulating metabolism. Either inadequate or excessive thyroid hormone can wreak havoc to your health, culminating in hypo- or hyperthyroidism. Understanding the regulating effects of VDR in our cells, I surmise that the amount of activated vitamin D3 in the pituitary’s VDR may be connected to the balance of thyroid hormone.

Autoimmune Thyroid Diseases

Adequate levels of vitamin D3 may protect the immune system from attacking itself. Low vitamin D3 levels have been linked to autoimmune thyroid diseases including Hashimoto’s and Graves’ thyroiditis.

Discovered one hundred years ago by a Japanese physician, Hashimoto’s disease is caused by abnormal blood cells and white blood cells constantly attacking and damaging the thyroid. About 95 per cent of Hashimoto’s disease patients are women. A study published in a 2011 issue of the journal Thyroid revealed that 92 per cent of Hashimoto’s thyroiditis cases had insufficient circulating vitamin D3 levels.

Ten times more likely to develop in women than men, Graves’ disease is caused by antibodies that overstimulate thyroid hormone production, causing hyperthyroidism. Researchers, who investigated Japanese female and male patients with Graves’ disease over a one-year period, found a high prevalence of woefully low circulating vitamin D3 in the female patients compared to the male subjects.

Thyroid Cancer

Incidences of thyroid cancer have doubled over the past four decades. The likelihood of women developing thyroid cancer is three times greater than for men. Activated vitamin D3 regulates cell differentiation, cell proliferation, and cell death. If these vital functions go awry, cancer may develop. Epidemiological studies indicate a link between vitamin D3 and thyroid cancer. Vitamin D researcher W.B. Grant, Ph.D. published a paper in a 2012 issue of the journal Anticancer Research that indicated an association between solar ultraviolet B, vitamin D3, and cancers including thyroid.

A relatively rare form of thyroid cancer—medullary thyroid cancer—originates in the thyroid C cells where a hormone called calcitonin is secreted. Calcitonin’s functions include stimulation of vitamin D3 production in the kidneys. The measurement of calcitonin is a diagnostic screening tool for medullary thyroid cancer. VDR are present in the thyroid C cells. Understanding the powerful effect of activated VDR on cell regulation, I hypothesize that activated VDR in the C cells may possibly prevent the development of medullary thyroid cancer.

In conclusion, recent medical literature suggests a connection between vitamin D3 and thyroid health. However, additional research is required to determine if thyroid dysfunction may cause vitamin D3 deficiency, or low vitamin D3 status may contribute to thyroid disorders.

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter.

Photo by National Cancer Institute on Unsplash

Mammography Screening – When an Educated Consumer Is Not the Best Customer

by Caryn Lipson

Published on March 6, 2024

16610 views

The purpose of preventive mammography screening is to diagnose breast cancers that would result in death at an early stage, thereby decreasing the incidence of late stage breast cancer and overall breast cancer mortality.

A number of reviews and studies have been published over the past several years to determine the effects of mammography screening in achieving these goals. They reveal that mammography screening provides little to no benefit in terms of reducing breast cancer mortality, and yields significant risks and harm to women who receive false positive results and especially to those who are overdiagnosed and overtreated. The risk of overdiagnosis of cancers that would never have been a threat to or even discovered by women in their lifetime includes future treatment-induced cancers.

Statistical percentages such as a 20% or 30% reduction in mortality, ordinarily referenced in reports promoting mammograms, mislead women into thinking that a large number of lives are being saved. However, by looking at the actual number of lives saved by preventive screening in light of the total population screened and the actual number of women harmed by false positives and overdiagnosis we have a truer picture of the effects of mammography screening on breast cancer mortality. Real numbers show that the actual risk to women of dying from breast cancer is far less than women are led to believe while the risk of overdiagnosis, rarely mentioned, is far greater than they would expect. Studies showing a mortality reduction with mammography screening often manipulate statistics to misrepresent the perceived benefits.

The perception that mammography is of great benefit is also influenced in part by the promotion of screening as a life saver and by overdiagnosed women believing their lives were saved.

Despite evidence to the contrary, medical and charity organizations support continued mammography screening of women. Women are not made aware of the real evidence against screening. This is in part because of vested interests and in part because of consumer demand for preventive testing based on the even miniscule possibility that it may save their life. However, if women were aware that the possible harm is far more significant than any possible benefit, they would probably opt out of preventive mammography screening.

The breast cancer industry benefits from women’s lack of knowledge. It is not in their best interest to tell women the truth.

Marketing Mammography by Disregarding Data

Preventive mammography screening is supposed to save lives by detecting and treating cancers at an early stage, before they become clinically evident. This is supposed to reduce the numbers of late stage breast cancers and the overall mortality from breast cancer.

This is what every woman who goes for preventive mammography screening believes and what organizations like the American Cancer Society promote and charities such as the Susan G. Komen Foundation will have you believe with those ubiquitous pink ribbons and their “Run for the Cure”.

While you continue to wait for them to finally discover a cure, be aware of the following: despite the assertion that “mammograms save lives” the truth is that millions of women are being misled into undergoing a screening that has been shown over the years to do more harm than good in multiple ways.

If the end result was a really significant reduction in breast cancer mortality we might concede that some of those harms are worth the risk. Unfortunately, too many studies have shown that although more early stage cancers are being detected there is no reduction in the overall mortality from breast cancer and that screening significantly harms more women than it helps. The dangers of screening include many false positives with additional diagnostic testing and, more critically, a high rate of overdiagnosis — the detection of cancers that would never have been a threat to or even discovered by women in their lifetime. Overdiagnosed cancers lead to overtreatment with surgery, radiation, chemotherapy, and hormone therapy that needlessly put women at risk of future treatment-induced cancers. Preventive breast cancer mammography screening has really been a colossal failure and the wool continues to be pulled over women’s eyes.

What the Research Really Shows

Consider the following reviews and studies (published between 2011- 2015):

In a retrospective trend analysis on mammography screening, researchers Philippe Autier, Mathieu Boniol, Anna Gavin, and Lars J. Vatten compared 3 pairs of neighboring European countries having similar population structure, socioeconomic circumstances, quality of healthcare services, and access to treatment where mammography screening was implemented many years apart in order to determine the effect on mortality that such screening had on early detection of breast cancer. “Our study”, they concluded, “adds further population data to the evidence of studies that have used various designs and found that mammography screening by itself has little detectable impact on mortality due to breast cancer.”
Drs. Archie Bleyer and H. Gilbert Welch discussed their 30 year review of United States data related to mammography screening of women 40 years of age or older. They found that while screening mammography has been associated with a doubling in the number of early stage cancers detected, it has only resulted in a decrease of 8 cases of late stage cancer per 100,000 women. This disparity is attributed to an estimated overdiagnosis (and overtreatment) in the past 30 years of 1,300,000 women or an overtreatment rate of 31% of all diagnosed breast cancers.
The Swiss Medical Board, an independent health technology assessment initiative, performed a comprehensive review of mammography screening, noting the controversy over the previous 10-15 years regarding mammography’s benefits. Reviewing mammography screening from the first trials 50 years ago in New York City to the most recent led to the determination that it’s possible that of 1,000 women screened, one death attributable to breast cancer might be prevented although there was no evidence showing that overall mortality was affected. However, the prevalence of false positive tests and overdiagnosis, they concluded, causes women more harm than good. For every breast cancer prevented over a course of ten years of screening, beginning at age 50, between 490 and 670 women will have a false positive diagnosis and repeat examination; between 70 and 100 women will have an unnecessary biopsy; and between 3 and 14 women will be overdiagnosed.
The Nordic Cochrane Report, an independent reviewer of scientific studies, reviewed 7 eligible studies comparing women ages 39 – 74 who were and were not screened using mammography. The authors, Peter C. Gøtzsche and Karsten Juhl Jørgensen, determined that breast cancer screening reduces mortality by approximately 15% and that overdiagnosis and overtreatment is at 30%. Realistically, this means that for every 2000 women invited for screening over the course of 10 years, one woman will have avoided dying of breast cancer while 10 healthy women will have been overdiagnosed and overtreated. In addition, over 200 women will have a false positive diagnosis requiring additional screening.
The 25 year follow-up for the Canadian National Breast Screening Study, by Anthony B Miller, et al., which compared screened and unscreened women ages 40 – 59 for breast cancer mortality, found no reduction in mortality as a result of the screening. They determined that there was an overdiagnosis of breast cancer of 22% among women with screen detected invasive cancers. Screening 44,925 women resulted in an overdiagnosis of 106 women or, in other words, for every 424 women screened, one woman was overdiagnosed.

Statistical Shenanigans in Mammography Numbers

The article that I like most however (a touch of sarcasm here) is this one that headlines:
National screening programme has markedly reduced breast cancer mortality

Read only the headline or just the first two paragraphs and you will have confirmed that mammography screening reduces breast cancer mortality between 20 – 30% in the women who undergo testing.

Continue to the third paragraph and you will find that the study actually corroborates all the other ones listed above – that very few lives are saved by preventive mammography screening and that a far greater number of women are overdiagnosed and overtreated. It reads:

“The evaluation examined a number of sides to the national screening programme and determined among other things that the probability of being overdiagnosed by screening is five times higher than the probability of avoiding death by breast cancer. Overdiagnosis in this context means that without being screened, the women would never have noticed, been aware of or died from the disease. Under the Norwegian Breast Cancer Screening Programme, all women aged 50 to 69 are invited for mammography screening every two years. Under the programme, for every 10,000 women invited to 10 rounds of screening, roughly 377 cases of tumours or pre-malignant breast lesions will be detected. From this group, roughly 27 women will avoid death from breast cancer as a result of early diagnosis and treatment. However, roughly 142 of them will be overdiagnosed with a disease that will turn out to be harmless.”

It should also be noted that the prevalence and harms of false positive results, although not discussed in the article, are considered in the evaluation report. They are also not insignificant.

Although the other reports cited above show even more harm and fewer lives saved, we can clearly see from the intentionally misleading Norwegian report, just how inconsequential mammography screening is in reducing breast cancer mortality.

Declaring a reduced mortality rate of 20-30% due to screening without providing actual numbers is highly deceptive. The key isn’t the percentage but the actual numbers upon which those percentages are based. If we found that 5,000 of these 10,000 screened women were diagnosed with a breast cancer that would have metastasized and 25% are saved from death by early screening, then 1250 women would have been helped. However, given the actual figure of 27 women saved, a 20 – 30% reduction of mortality takes on a very different meaning.

In reality, the headlined “marked mortality reduction” figures were actually calculated based on the assumption that without screening either 135 women (20% reduction) or 90 women (30% reduction) will have been assumed to die of breast cancer. In other words, among 10,000 women not screened, from 9/10 of one percent to 1.35% of the women would likely die from breast cancer. This also means that between 63 -108 women will die of breast cancer regardless of having been screened. (It has been found that breast cancers which metastasize are quite aggressive and often become palpable within a year after screenings that yielded negative results. False negative results can also be to blame.)

The 377 women diagnosed with tumors or pre-malignant breast lesions out of the 10,000 women screened represent almost 3.8% of the screened population. The 27 treated women who avoided death by screening represent not quite 3/10 of one percent (.0027) of the 10,000 screened women. The 142 women needlessly diagnosed and treated represent 1.4% of the 10,000 women screened.

Overdiagnosis Feeds Misperception and Profits

When looking at the actual number of women involved, the 20-30% mortality reduction doesn’t sound so wonderful anymore – but then neither does the risk of breast cancer seem as scary.

Nevertheless, this estimate of breast cancer mortality with or without screening is far less than most women believe population and personal risk to be. According to the Swiss Study cited above women believe that for every thousand women screened 80 will die from breast cancer while for every thousand women not screened 160 will die from breast cancer. The real effect of screening, they found, is that for every thousand women screened 4 will die from breast cancer and for every thousand women not screened 5 will die from breast cancer.

Why the great disparity between women’s real and perceived risk of dying from breast cancer?

As expressed in the Norwegian study’s evaluation report, just the fact of the screening programs alone increase women’s perception of the risk of and mortality from breast cancer.

More importantly, however:

“Overdiagnosis creates a powerful cycle of positive feedback for more overdiagnosis because an ever increasing proportion of the population knows someone—a friend, a family member, an acquaintance, or a celebrity—who “owes their life” to early cancer detection. Some have labeled this the popularity paradox of screening: The more overdiagnosis screening causes, the more people who feel they owe it their life and the more popular screening becomes. The problem is compounded by messages (in the media and elsewhere) about the dramatic improvements in survival statistics, which may not reflect reduced mortality, but instead be an artifact of overdiagnosis—diagnosing a lot of … women with cancer who were not destined to die from the disease.[1]”

This all raises the question: Why the continued emphasis on screening when we have so many studies that all show little benefit to mammograms and in reality significant harms?

Science writer John Horgan in his article Consumers Must Stop Insisting on Mammograms and Other Ineffective Cancer Tests blames the continued use of mammography screening on financial benefits and on consumer demand for testing. About the profit motive he points to an editorial about mammography screening in the British Medical Journal:

“The BMJ editorial urges health-care providers to reconsider priorities and recommendations for mammography screening and other medical interventions.”
“The editorial adds, ‘This is not an easy task, because governments, research funders, scientists, and medical practitioners may have vested interests in continuing activities that are well established’.”

About the consumer demand for testing he says:

“… ultimately, the responsibility for ending the testing epidemic comes down to consumers, who too often submit to — and even demand — tests that have negligible value. Our fear of cancer, in particular, seems to make us irrational. When faced with evidence that PSA tests [yes, prostate cancer as well as thyroid and lung cancer are also overdiagnosed – CL] and mammograms save very few lives, especially considering their risks and costs, many people say, in effect, ‘I don’t care. I don’t want to be that one person in a million who dies of cancer because I didn’t get tested.’ Until this attitude changes, the medical-testing epidemic won’t end.”

Perhaps if they knew that testing may cause them to be one of those several thousand who increase their risk of dying from testing, they would reconsider.

I still remember the commercials made by Sy Syms of discount designer clothing store fame. He would always say: “An educated consumer is our best customer.” For the medical industry, it seems, their best customers are the ones they keep in the dark.

Additional Resources and Reading

Cancer Active
Breast Cancer Action
Screening For Breast Cancer with Mammography
Exposed
The Mammogram Myth: The Independent Investigation Of Mammography The Medical Profession Doesn’t Want You To Know About
Overkill: An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?

This article was published originally on Hormones Matter in June 2015.

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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Photo by National Cancer Institute on Unsplash.

[1] http://jnci.oxfordjournals.org/content/102/9/605.full

This article was published originally on June 20, 2017.

Tangled Ribbons, Tangled Lives

by Christine Kapsa, NP, DNP

Published on February 20, 2024

6803 views

Awareness ribbons looped on lapels. Around trees. Through chain-link fences. Yellow for missing children and bone cancer. Red for heart disease and HIV/AIDS. Blue for chronic fatigue syndrome and arthritis. Even ribbons spotted like Holstein cows raise awareness of birth defects.

The best known ribbons of all; pink for breast cancer.

Tangles of ribbons reminding us of human miseries we’d rather forget. Or have never heard of. But there are no satin ribbons for poor women who die young.

Even as their numbers climb.

Tie a Yellow Ribbon

Yellow ribbons first encircled trees in 1979, signifying hope for American hostages held in Iran. Red ribbons followed in 1992, to proclaim support for people with HIV/AIDS and encourage effort at finding a cure for the disease.

Pink ribbons fluttered on the scene in 1991. The earliest Komen Race for the Cure was held in Dallas, Texas in 1983. Participants in 1991’s Race in New York City were the first to receive the now-familiar pink ribbons.

Marshall McLuhan said “The medium is the message” more than 50 years ago, explaining:

The medium is the message because it is the medium that shapes and controls the scale and form of human association and action.

McLuhan didn’t have awareness ribbons in mind. He died in 1980. Though bright snippets and swathes of ribbon are a medium by McLuhan’s description. The ribbons convey messages that trigger emotional responses and actions.

But what messages are those ribbons sending? Especially the pink ones?

Dying Young

Most Americans expect to die old. We figure our lives will be longer than our grandparents. That our children will enjoy a few years more than we’ll have. Those are reasonable expectations. For most of us.

Not for poor white women. Their lives are shortening, not lengthening, according to a study published in Health Affairs in 2013. Researchers David Kindig and Erika Cheng compared female mortality across US counties. (The paper is available free here.)

They found life expectancy for some women has been dropping for decades. White women between ages 15 and 54 died younger than before in close to half of counties nationwide during the period from 1992 to 2006. The life expectancy for white men declined in just three percent of counties during the same time.

Other research (here, here and here) using different time periods and statistical methods, reach brighter–or gloomier–conclusions. All agree on the underlying fact that poor white women with little education are dying younger than better educated, better off women of similar ages.

Few states escaped increased female deaths. Only the counties in New England, along with Arizona, maintained or increased life expectancy for all women. Some states did much worse. Women across Appalachia, Oklahoma, the Deep South and northern Montana lost the most time.

The culprits that conspire to shorten lives aren’t surprising:

Smoking
Obesity
Narcotic overdoses
Suicide

Smoking, drug use and overeating are symptoms of deeper ills. Poverty, with its allies, hopelessness, no jobs, scanty education, are the true thieves of women’s lives.

The Urban Institute published a study in March, “Death Rates for US Women Ages 15 to 54: Some Unexpected Trends”. The authors Nan Marie Astone, Steven Martin and Laudan Aron, updated the findings from the earlier works. They also suggested a broader, more disturbing interpretation of the rise in women’s mortality:

The recent spike in white women’s mortality may be analogous to the spike in black mortality that accompanied the rise of the crack epidemic in the late 1980s and early 1990s. If so, one might predict that this mortality epidemic will ebb in the same way that several causes of death associated with the crack epidemic subsequently ebbed. The appropriate public health responses to such spikes are targeted interventions for the affected groups. A more troubling possibility is that white women are experiencing a systematic reversal in the long-term trend of mortality decline. Under this more pessimistic scenario, the high, stagnant, or rising death rates we observe among adult women now may persist as these women age, causing a substantial lowering of overall life expectancy in the United States. And because death rates are an indicator of population health, such a reversal in the trend of mortality decline would necessarily reflect widespread deficits in population health.

Ignoring the Evidence: Mammogram Wars

The relentless breast cancer screening debate stormed while poor women were dying in America’s heartland. Few subjects in health care are as acrimonious, riddled by politics and immune to science as the value of mammography.

Women, scientists, doctors and policymakers feud about whether breast cancer screening with mammograms saves lives. The fight has persisted for a generation without clear answers. If mammograms unquestionably saved lives, we’d know by now. We don’t.

Worse, mammography comes with risks. Over-diagnosis with its unnecessary treatment. Frequent false positives accompanied by anxiety, emotional distress and uncertainty that gnaw at women for years.

Truisms are reassuring because, well, they’re true. None truer than “A picture is worth 1000 words.” Two vivid infographics show the miniscule benefit of mammograms. The first is available on the NPR website. Published December 17, 2014, “What Happens After You Get That Mammogram”, estimates benefits and harms for 10,000 women who have yearly mammograms for ten years. It figures that:

3568 women will have normal mammograms each year for ten years
6130 women will have at least one false positive and 940 will have a biopsy they didn’t need.
302 women diagnosed with breast cancer

Of the 10,000 women who have annual mammograms, 302 will be diagnosed with cancer. It sound like a positive outcome, right? Maybe not. Here’s the catch. Of those 302:

173 would have survived with or without screening.
57 will be over-diagnosed with a cancer that would never have become a problem.
62 women will die despite being screened because of aggressive tumors.
Ten lives will be saved.

A 100,000 mammograms must be done to save ten lives!

The other infographic illustrates an article from the New England Journal of Medicine. The piece was written by two Swiss doctors, members of the Swiss Medical Board, recommending against routine mammography screening for women 50-69 years old.

“Abolishing Mammography Screening Programs? A View from the Swiss Medical Board” is free at NEJM. The graph with the review compares American women’s perceptions of mammography benefit to the actual effects. It supposes 1000 women screened every two years for ten years:

Women assume with screening 881 women will live, 80 will die from breast cancer and 39 will die from other causes.
In reality, 956-957 screened women will live, 4 will die from breast cancer, 39 or 40 will die from other causes.

But, the surprising numbers are:

Women expected 801 women to be alive without screening, 160 to die from breast cancer and 39 to die from other causes.
When, in fact, 956 women will live without screening, 5 will die from breast cancer and 39 will lose their lives to other causes.

These numbers are central to the never-ending mammogram wars because women believe two crucially erroneous things about mammograms:

Many more women will die without mammography, 16%, when in reality, it is one half a percent (0.5%)
There’s a large difference in death rates between screened and unscreened women. The difference is just one woman.

No Free Lunch

The dismal performance of mammography screening matters regardless of cost. A screening test with little benefit and recognized harms isn’t a bargain even if it’s free. But mammograms aren’t free. (The Affordable Care Act requires that preventive mammograms be “free”. They aren’t. You pay for them with increased premiums and higher deductibles on other care.)

The annual cost of mammography screening was calculated at $7.8 billion in 2010 by a group of researchers writing in the Annals of Internal Medicine (gated) last year. The group then estimated the total costs for several proposed mammography guidelines for women 40 to 85 years old. Screening every year starting at 40, every other year from age 40 or every other year from 50 to 74. They assumed 85% of women would be screened (probably a high estimate). The price ranged from $10.1 billion for the most frequent screens to $2.6 billion for the least aggressive guidelines.

That is base cost. It does not include the extra fare when false positives and over-diagnoses are added. Mammography over-diagnosis runs another $4 billion per year, according to a recent calculation in Health Affairs. The price is likely much higher because the authors of the study only included women 40 to 59 years old. Older women needed fewer biopsies to find one case of cancer, but women ages 60 to 74 still had false alarms.

Americans are spending roughly $11 billion to $12 billion each year for a test of uncertain value and unneeded follow-up.

So what? Remember the dying women?

Zero Sum Game

The federal government is frozen in place, unwilling or unable to give ground on spending money to save lives. Most state governments are tied in knots, especially the states with climbing female death rates.

Politically powerful women and men fight to head off any cuts to mammography programs. An anguished howl was heard after the US Preventive Services Task Force (USPSTF) updated its 2009 Draft Recommendations last month. The panel found harms of mammograms for women 40 to 49 may outweigh benefits and downgraded their recommendation to “C”, threatening the “free” mammograms.

Senator Barbara Mikulski (D) of Maryland made her displeasure known at once to Secretary Burwell at the Department of Health and Human Services. The senator warned the secretary that:

[S]hould the draft recommendation be finalized, I will actively and aggressively pursue all legislative options available to ensure that women aged 40 and older are able to continue receiving free annual mammograms.

Money spent to care for people is now a zero sum game. One group’s win is another group’s loss. Money devoted to “free mammograms” may be money lost for care to Appalachian women.

After 30 years of worldwide research, billions of dollars and reams of federal legislation, we still don’t know whether mammography saves lives in the end. We don’t know whether $12 billion spent on women in Appalachia, Oklahoma and the Deep South will save lives, either. It’s time to find out.

The Color Of Shadows

What color awareness ribbon for women who die young? No ribbon, but the shadow of ribbons. The shadow cast by every pink ribbon should be their awareness symbol. Komen supporters Race for the Cure in the sunlight. Poor women race for their lives in the shadows.

When breast cancer activists run in races, the shadows running alongside are those of women dying too young.

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter.

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This article was first published on May 26, 2015.

Deconstructing Modern Illness: Idiopathic or Iatrogenic?

by Chandler Marrs, PhD

Published on May 17, 2023

8259 views

A few weeks ago, I had the great pleasure of delivering a keynote address at the Midwifery Today Conference in Eugene, Oregon. As requested, here are my notes and the presentation deck. Enjoy.

Presentation Notes

Before we begin, I’d like to preface this talk with one of my favorite quotes by Maya Angelou:

“You did then what you knew how to do, and when you knew better, you did better.”

The talk I am giving is depressing. The magnitude of the health crisis we face is enormous. Indeed, from every angle we face threats of new diseases and disorders with a degree of complexity current medical practices are not equipped to deal with.

If I were a less hopeful person, I might bury my head in the sand. But I think, rather than sugar coat the difficulties we face, the only way we can find solutions for these problems to know more and do better. And so, in many ways, the quote above provides hope.

At the end of this talk, over the course of the day and course of your career, as you know more, you will do better. And that’s all anyone can ask of you – to keep learning and applying that learning and knowledge to the problems in front of you.

Today, I am speaking about how we deconstruct modern illness in a toxic world – and yes, the world is pretty toxic. What I’d like you to get out of this talk are three concepts.

Pregnancy is a time where we can break the cycles of bad health in a way not possible at other times of life. It has been my experience, that women trying to conceive and those who are pregnant and their partners are hungry for information about health. They want to learn about ways to improve their health so that they can have healthy babies. This means, as healthcare providers, we have an opportunity to affect change and improve the health of not only the adults but the children. And so, we must take this opportunity counsel our clients to better health.

This brings me to the second lesson I hope to impart

Reproduction. I think reproduction should be viewed from a much broader and longer perspective. Some of the aspects of reproduction that we often don’t consider but should, include:

Dad’s health. So often when we talk about conception and pregnancy, all responsibility for the health of the pregnancy and child rests on the mom. This is absolutely shortsighted and as we see with the epigenetic, endocrine disrupting, mitochondrial impairing chemicals we face, dad’s health is equally important to the health of the offspring. Forgetting to include Dad in these conversations means opportunities lost.

Longer time frame both before and after pregnancy. I think we ought to consider reproduction across a much longer time frame. Ideally, both partners would begin cleaning up in the months and year before conception. Barring that, however, if we can begin working with couples earlier, maternal and fetal complications might just be reduced.

Similarly, the health of our children and their children depends upon our health. So any changes we make now, for good or for ill, impacts our children’s health and likely their children’s health. Therefore when we look at reproductive health, we must begin earlier and consider the long game – the transgenerational consequences of our actions.

Everything is connected to everything else. In Western medicine and science, we like to separate things, test theories, compounds, and toxicities individually; discuss diseases by morphological or physiological elements, neatly and concisely distinct from other diseases. And while that works in acute and emergent care, with trauma or injury, with basically everything else, this separateness doesn’t work at all. Think about it for a moment, from a logical or probability standpoint, which is more realistic, that we are a people with multiple, completely distinct disease entities, or the myriad of symptoms so many experience, have coordinate, common, connected, underlying causes that simply express in different organ systems. I think it’s the latter.

With modern illness (or maybe all illness), the kind of conditions that are chronic and where more often than not, multiple organs or systems are involved, simply tackling the health of one organ or remediating one symptom or set of symptoms in isolation, while dismissing the others, misses not only research and discovery opportunities but therapeutic opportunities as well.

So when I talk about deconstructing modern illness, a key portion involves understanding the connections between seemingly disparate disease processes.

Let the Deconstruction Begin

As I considered how to put this presentation together, I struggled with where to begin, what to leave in, what to leave out.

There is so much that needs to be understood about modern illness that we could fill a week of lectures and discussions. And we may, because I have way too many slides.

What I kept coming back to, however, is the notion that if I can teach you how to think health and disease, and medical treatments in general, if I can teach you how to question and evaluate the research, how to find the answers that you need; if I can give you a foundation and a framework for understanding the science, the economics and the politics of modern illness, then each of you can find your own answers, and perhaps, if you are so inclined, contribute back to the knowledge base, so that we all have a better understanding of these issues.

And so it is from that perspective that I have decided to approach this discussion. I want to give you a foundation and a framework from which to build your own house of knowledge. Sounds a little corny, doesn’t it, but bear with me, learning how to think critically about medical science might just save your life or the life of a loved one.

A Framework of Knowledge

I have a background and a natural inclination towards philosophy.

One of the questions that plagues my thinking is ‘how we know what we think we know’. I find that more often not, pondering from where and from whom the knowledge, the science, the politics, even the historical interpretations come from, tells us a lot about what it is we know exactly and what we really have no business claiming knowledge of.

With maternal health and in fact, the entirety of women’s health, when we deconstruct what is known and detach it from how we know it, or at least how we think we know it, it becomes very clear, very quickly, that our knowledge is severely limited.

In the title, I mention deconstruction. It means what it sounds like, a taking apart of things in order to understand the larger picture. The concept is a philosophical one, originating from a French philosopher Jacques Derrida. It was used primarily in literature to separate the text from the cultural associations in order to find a supposedly truer meaning. Ironically, his writing was all but completely indecipherable – so deconstruction of Derrida’s work was prohibitive, at least for me.

Nevertheless, the notion that we should look at a text, in this case medical diagnostics, what we consider illness versus health and the markers that reflect health versus illness, apart from their cultural context and what we assume their meaning to be, to see if they still prove valid, is a useful one. Often when deconstructed, the meaning, the validity of a particular definition of disease, is bundled with so many assumptions that its validity crumbles under its own weight. We’ll see this in many areas of women’s health.

Idiopathic or Iatrogenic?

The second part of the title reflects both the notion of deconstruction and the cultural context that influences the naming of things, but also hints a structural problem in medicine that comes from those assumptions. And if I am honest, it reflects my understanding, my biases towards modern medical care.

Idiopathic and iatrogenic are two terms routinely used in modern medicine.

Idiopathic, in particular is catchall for all of the disease for which we have no earthly notion about causation. A good percentage of the conditions affecting women are considered idiopathic.

When I was in graduate school, I read a report that suggested some absurdly high percentage of pregnancy complications were considered idiopathic – something like 60%. I have long since lost the report and have no idea if I am recalling the number correctly, but it was sufficiently high that I dug a little deeper.

How could it be that in the 21^st century we did not know what was going on with pregnancy? After all, women have been having babies since the beginning of time. It turns out, no one was looking, and if they were, that knowledge did not make into mainstream medicine.

At the time, pregnancy and maternal health funding was less than 2% of the total NIH budget, of which most was allocated towards pregnancy prevention. I would venture that there is wealth of knowledge in this room that if it were to make into mainstream ‘medicine’ might redefine many conditions considered idiopathic, but I digress. Virtually no money went to basic research, understanding pregnancy complications like pre-eclampsia for example, and so, complications that many women suffer from were, and yet are, considered idiopathic.

While the connection between idiopathic and much of women’s health is easy to attribute to a lack of money, the notion of idiopathy is much more complicated than simply funding priorities. After all, cancer is considered idiopathic – and as we all know cancer is an industry, receiving billions of governmental and private research dollars.

Implications of Idiopathy

Claiming something is idiopathic absolves us of personal responsibility and accountability – it means that it does it not matter what we put into our bodies or into the into the environment – a boon for industry and for all of us who want to have our cake and eat it too, but from a medical standpoint, it absolves of an our own willful ignorance.

It means we don’t have to ask any more questions, study anything else. It implies that what we do not know is not our fault – it is random.

It allows us to say cancer is random and that our behavior matters not.

It allows us to ignore research like this, that attributes 80% of cardiovascular disease to lifestyle – to what we put into our bodies.

Or research that says glyphosate is actually dangerous.

Or research that says perhaps we shouldn’t put chemicals of unknown effects into pregnant women.

It allows us to live a bubble, and presume no matter what we put into our bodies, whatever we expose ourselves to will somehow magically dissipate and not affect our health.

It allows us to effectively write-off the differences between women and men in things like drug metabolism. And for our purposes, it allows us to narrowly limit what is considered iatrogenic – to only a few readily acknowledged illnesses. It’s a position that is more akin to magical thinking than what we consider medical science should be.

How does this affect medicine and women’s health in particular?

Deconstructing Modern Illness: Idiopathic or Iatrogenic? from Lucine Health Sciences

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter.

Image credit: Devon Buchanan from Cambridge, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons

This article was first published on April 17, 2017.

Why Don’t We Listen to Women When They Are Sick?

by Chandler Marrs, PhD

Published on March 14, 2023

7501 views

Last week, I posted yet another story on our Facebook group about how women’s health is ignored and psychologized by the medical profession. It is neither a new topic nor something particularly earth shattering. We post hundreds, if not thousands, of these stories both on our Facebook page and on Hormones Matter itself. Indeed, the entire premise of Hormones Matter is that these narratives matter, that there is truth and wisdom in the patient’s account of her or his health, something that has been lost in modern medicine over the last several decades.

The premise of last week’s article was that we rarely, if ever, believe women when they present health issues, sometimes with deadly consequences.

For decades, studies have shown that women with chronic pain conditions are more likely than men to be wrongly diagnosed with mental health conditions and prescribed psychotropic drugs. When men and women offer similar complaints of pain, women are more likely to be prescribed sedatives instead of pain relieving drugs. Further, a newly released study on women’s mortality rates after heart attack offers this insight, ‘Most physicians are male, and male physicians appear to have trouble treating female patients’.

The author of the article argues that the problem rests on the maleness of the medical profession. She is correct, but there is so much more to the story. While it is true that from the beginning of medicine women were excluded from not only the practice of medicine, but also, in building the current medical knowledge base. It is also true that entire body of knowledge cultivated by female caregivers, midwives and the like was usurped and essentially dismantled as our current model of medicine took over, medicine itself was never designed to ‘listen’ to or believe patients, male or female. From an article I wrote on the topic several years ago:

Historically, listening to patients has had a tenuous position in medicine. Some would argue that it was supplanted long ago by the physician’s all-knowing clinical gaze. The clinical gaze, a term used by French philosopher, Michel Foucault, is the ability to see correctly what is unseen, to bring to light and then describe the hidden truth of disease. It was what allowed the physician to penetrate the illusions of the non-scientific engendered by previous generations (16^th – 18^th century medicine) and to see the truth of the disease by correctly perceiving the signs and symptoms. The physician’s power of observation, his clinical gaze, aided by technology, gave him a vantage point inaccessible by mere mortals, and thus, incontrovertible.
The clinical gaze anchored modern medicine in a way that no other concept could. It brought with it the power to see truth, but also, to define it. No matter how potentially relevant to disease diagnosis, the patient’s truth or story could never replace the physician’s truth – the truth that was accessible only by him and through the all-knowing clinical gaze.
And so it was for most of the last century and a half, the physician was the arbiter of what was valid, of what could be seen and of what could be known about health and disease. The patient was no more than a body; living or dead, it did not matter. It was the job of the physician to perceive correctly what the body (not necessarily the patient) was showing him and then classify, communicate, and finally, treat appropriately.

What folks who attribute the problems in women’s health solely to the maleness of the specialty fail to recognize is that the foundation upon which modern medicine was built rests entirely on the physician’s ability to ‘see’ the signs of illness in a body and validate those observations correctly via the appropriate measures. If the physician does not perceive the signs of the illness at all, or correctly, or in a manner that can be measured, then necessarily, the symptoms with which the patient presents are not to be believed.

Certainly, there is gender bias. That is obvious. A system of knowledge designed by men, about men and for men, with women and their bodies viewed as aberrations to the normative male body, comes with a deeply ingrained bias. More than that though, the notion of perception as the defining characteristic of medical reality limits significantly what one can and cannot know about any given topic. Consider the age old philosophical riddle posited by George Berkeley and debated by philosophy students for generations:

If a tree falls in a forest and no one is around to hear it, does it make a sound?

At the root of this question is whether awareness predicates existence. According to Berkeley, material reality, for all intents and purposes, does not exist unless it is observed. Thus, awareness predicates existence. In that same regard, medical reality does not exist unless it too is observed by the physician. Even when observed, however, if that observation cannot be validated by some objective test, then the physician is forced to dismiss his original insight and attribute the suffering to some errant ephemera, typically of the psychological nature.

Inasmuch as women’s symptoms were never ‘seen’ in the first place, never investigated, never documented, never even considered really, then it is to be expected that they would not be believed. Women’s health problems just do not exist, in much the same way that the tree falling in the forest does not. They are immaterial, incorporeal, or as Freud suggested, ‘hysterical’. (Admittedly though, Freud listened to female patients. He simply misattributed what he learned to the machinations of the female mind never envisioning a physical culprit for their ailments.) While this in no way excuses the egregious ignorance about women’s health issues that permeates modern medicine, it does shed light on why it exists. It is a consequence of establishing a system of knowledge based solely upon the perceptive abilities of a specific group of individuals. In this case, male physicians, but one could argue, that any system predicated upon perception and perception alone would have similar limitations (see here or here). If awareness predicates or defines existence, then no matter who is in charge, a good chunk of reality, even medical reality, is immaterial, and thus, unimaginable.

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter.

Image: Wellcome Collection gallery (2018-03-29): https://wellcomecollection.org/works/h5njm9mw CC-BY-4.0

This article was published originally on January 8, 2019.

Conquering the Uterus – Trends in Hysterectomy

by Chandler Marrs, PhD

Published on October 26, 2022

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Every 10 minutes, 12 American women lose their reproductive organs, every day of every year. Hysterectomy is second only to cesarean in common surgeries. Approximately 660 women die each year in the United States from complications related to hysterectomy. Thousands more suffer long term side effects associated with oophorectomy – removal of the ovaries. The most common reasons for hysterectomy include: uterine fibroids or rather the menorrhagia, heavy bleeding associated with the fibroids and endometriosis, an incredibly painful condition where uterine tissue grows outside the uterus. Both conditions are hormonally modulated, plague millions of women and take years to develop.

One would think that with such extended period of disease progression, 5-10 years, researchers and clinicians would have ample opportunity to develop innovative treatment protocols, long before the surgical removal of the uterus was necessitated. One would be wrong. Despite the cost of long term care leading to, and as a result of the hysterectomy; despite the outcry from the hundreds of patient associations, some with high profile members; despite the billions of dollars spent annually on performing what should be last resort surgeries, there has been no innovation in diagnostic tools for these conditions and no new therapeutics for women’s reproductive health developed in over 50 years, unless you call the re-purposing of old meds innovation.

Instead, innovation in women’s healthcare, much like American healthcare in general only magnified exponentially, comes at the end of the disease progression – when no other choice but surgery exists. Let’s build a cool robotic tool to remove even more uteri. Sure it will cost significantly more and have a higher complication rate, but the technology is so impressive that does not matter. Forget about developing early diagnostics and less invasive, more effective therapeutics, just take it all out and look cool doing so. Who would not want to perform surgery remotely with a million dollar piece of medical technology? Women don’t need their uteri anyway – a win win for all involved.

Robotic Assisted Hysterectomy

The robotic, joystick controlled, remote surgical tool is an impressive piece of engineering. With a price tag of over a million dollars per, it provides the cutting edge stature that all top-notch hospitals strive for. An added bonus, it makes gynecology, the long derided medical profession, the cool kid on the block. But does it work?

Well, not really. Sure it removes a woman’s uterus more quickly and with less scarring; a single ½ inch belly button scare versus two or three ½ inch abdominal scars, but it costs more and doesn’t reduce complications – may even increase them a bit. Compared to the minimally invasive laparoscopic hysterectomy, the robotic assisted hysterectomy costs $2000 more per procedure. As of 2010, about a quarter of all hysterectomies were performed robotically. That’s about $300 million dollars per year more to perform a robotic hysterectomy with no added gain health. When combined with the costs multiple hospital stays, ineffective therapeutics and possible other surgeries that often led up to the hysterectomy, it is clear why women’s healthcare is so expensive.

Perhaps we could use our health dollars a little more wisely. Maybe we should spend some of those many billions of dollars or even a fraction of the $300 million spent annually on robot surgery, on prevention, early diagnostics or more effective therapeutics.

Update

Since this article was originally published in 2013, additional reports of complication rates for robotic surgery have been published. In a study of 298 patients undergoing robotic hysterectomy published in 2015, the complication rate was 18%. In 2017, a study of complication rates of a single surgeon using the robot, was 5.5% suggesting that some surgeons are better with this tool than others. In comparison, a study looking at 4505 hysterectomies performed by the same team between 1990 and 2006 (3190 were performed by laparoscopy, 906 by the vaginal route and 409 by laparotomy) saw the complication rates below 1%, significantly lower than that of the robotic surgeries, but again demonstrating that the skill of the surgical team is paramount.

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Photo by Sander Sammy on Unsplash.

This article was published originally on March 18, 2013.

women's health

Happy summer, and happy health!

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