- It’s All in Your Head
- It’s Normal for Women to Suffer
- Medical Myth #3: Women are Complainers
- Medical Myth #4: You’re a Difficult Patient
- Medical Myth #5 Medical Solutions are the Safest, Most Reliable Health Care Options
- Medical Myth #6: It’s Your Fault, Especially if You’re Overweight
- Medical Myth # 7: We’re Just Small Men
- Medical Myth #8 We Just Don't Know What’s Causes That
- Breaking the Myths that Bind Us
Myths serve as powerful and inspiring stories and metaphors for life. They’ve also been used throughout history to reinforce political, religious, or other power structures – as cautionary tales of what happens when we mere mortals go up against the gods. Medicine is, without a doubt, a cultural institution and power structure, and like other systems it has perpetuated myths that keep us believing in its power, while disbelieving in our own.
Let’s break down 8 prominent medical myths – from ‘It’s All in Your Head’ to ‘It’s All Your Fault’ – that are alive and well, and are profoundly – and sometimes dangerously – affecting women’s health, preventing countless women from receiving important diagnoses and timely treatment – sometimes for conditions that have proven life-threatening or worse. It has led to women reporting symptoms of a heart attack, which may be different than the typical chest pain men experience, to be sent home with anti-anxiety medication – the heart attack completely missed – to women with autoimmune diseases being told their fatigue and aching are ‘just stress,’ to women doubled over with severe endometriosis pain or a ruptured ovarian cyst to be asked “Are you sure it’s not just that time of the month?,” and frighteningly, has led to many deaths, including, notably, several recent cases in which Black pregnant women reported symptoms to their doctor, and had those symptoms minimized, dismissed or ignored. In fact, Black women are much more likely to be affected by the very conditions that are most likely to be missed and misdiagnosed and are less likely to have pain taken seriously,
I’ve written this article so you can spot these medical myths in action, to help you realize, it’s not all in your head and it’s not your fault, to help you break free of them now –– and I give you tools to get more health empowered so that before these myths never prevent you from getting medical care you might need.
Medical Myth #1: It’s All in Your Head
If you’ve been made to feel – or have been told – that your symptoms could be all in your head, whether just stress, anxiety, or overwork, you’re not alone. Well into the 1970s, many common women’s symptoms were attributed to personality types and women’s emotional ‘whims’ or hysteria, a condition that persisted in the Diagnostic and Statistical Manual of Mental Disorders (DSM), until the 1980s
A few examples:
- Women with migraines were described as a having a “migraine personality,” meaning she was neurotic, ‘frigid,’ and unable to accept her ‘womanly responsibilities.’
- Chronically painful periods were considered a symptom of a personality disorder.
- Endometriosis was referred to as ‘the career woman’s disease,’ because it was thought to affect women who were “intelligent, compulsively perfectionist, anxious, and willing to place personal achievement over having children.”
PMS, pelvic pain, migraines, and the symptoms broadly associated with endometriosis have been part of a long history of psychologizing women’s conditions. We were seen as using reproductive symptoms for personal gain – as an excuse to miss work or ditch out on our “responsibilities” (from housekeeping and childcare to sex!). It was also thought that we’d go from doctor to doctor until we got a get the diagnosis that suited our ulterior motives. Yet in a recent study of women with endometriosis, one in ten women was overtly told ‘it’s all in your head” and 20 percent saw 4 to 5 doctors before receiving a diagnosis!
The belief that women are hysterical – that our conditions are psychogenic in origin – persists today. Doctors far more commonly default to a diagnosis of psychologic origin in women than in men. However, instead of being told directly that ‘it’s all in our heads’, we’re now told it’s depression, anxiety, stress, or we’re given the latest diagnosis – “medically unexplained symptoms.” And if you happen to tell your doctor that that you’re under stress or that you’ve had a mental health challenge in the past, this dramatically increases the likelihood that your doctor will chalk your current symptoms up to being psychogenic. There’s even a name for this: it’s called a “meaning shift.” Women who have a mental health diagnosis in their chart – anxiety or depression, for example, which is now the case for about 1 in 4 women – are significantly more likely to have their physical symptoms blown off as psychological in origin.
On top of that, going from one doctor who didn’t find anything wrong with you, to the next doctor, has been associated with an increased likelihood that this next doctor will also consider your symptoms psychological. This is compounded if you tell that doctor that you were frustrated by the previous doctor’s lack of ability to diagnose you.
Further, when the cause of a condition is unknown, as remains the case with PMS, endometriosis, and even most of women’s pelvic pain syndromes, it’s common for doctors to write it off as psychological in origin. But lack of medical evidence for a condition doesn’t mean it’s not happening – it may just mean someone’s either not doing the right testing or asking the right questions. In one study of women who’d struggled with endometriosis for at least 3 years before receiving a diagnosis, 50% had previously been told nothing was wrong by at least one doctor, and in another study, 70% of teenagers with severe menstrual pain for no apparent reason were eventually found to have endometriosis. When it comes to autoimmune disease, in the US, 75% of those affected are women, and it takes e an average of 4.6 years and five doctors before getting a correct diagnosis.
Chalking symptoms up to psychological causes not only causes to feel self-doubt, but we don’t get an appropriate diagnosis or treatment; it often stops further inquiry into the real causes of hormonal problems, and tries to solve the problem with therapy, relaxation, antidepressants or anti-anxiety medication.
When we say something is wrong, our doctors should have enough respect to trust and believe us. If you’re being ignored or dismissed, and need tools to be more empowered in medical encounters, go here. When a woman who has been dismissed like this comes to me or medical care, and I’m able to confirm or provide a diagnosis, her relief fills the whole room. “I knew something was wrong,” I’ve heard so many women say that the validation that she’s not crazy sometimes is the first step in her reclaiming her power and confidence. As one woman said to me, “If just one doctor had listened to me, I wouldn’t have lost years of my life to this.”
Medical Myth #2: It’s Normal for Women to Suffer
Who among us didn’t grow up thinking that period pain was par for the course of being a woman? We’ve been taught to think it’s just normal to need to curl up with a hot water bottle and Netflix, pop Ibuprofen and call it a day – or 2 (or more!) – on the sofa. Doctors not only reinforce pain as normal for women – they may be some of the biggest myth-makers. According to a recent study by Healthy Women, 1 in 3 women who were later diagnosed with endometriosis were initially told by their health care provider that her pain was “a normal part of being a woman.” Women in pain are significantly more likely than men to receive a prescription for a sedative for their pain symptoms, suggesting the need to relax, rather than pain medication. Women also wait an average of 65 minutes before receiving an analgesic for acute abdominal pain in the ER in the United States, 16 minutes more than men – which can feel like a lifetime if you’re in severe pain.
This assumption of ‘normal’ keeps the medical profession – and us – from digging deeper when we have pain, and leads to countless missed diagnoses of endometriosis, adenomyosis, autoimmune conditions, and under-treatment of pain in women with sickle cell disease, as just one example. Gender biases in how pain is approached in our medical system can also have serious and even fatal consequences. A study published in The New England Journal of Medicine in 2000 found that women are seven times more likely than men to be misdiagnosed and discharged in the middle of having a heart attack because women have different heart attack symptoms than men, which also explains why women in most age groups have higher rates of death during hospitalization for heart attack than do men.
Why isn’t this better understood? Though 70% of the people affected by chronic pain are women, 80% of pain studies are conducted on men (or male mice). Few studies have looked at gender differences in the experience of pain, but one that did found that women tend to experience more severe pain, and pain more frequently than men. If you’re experiencing pain, don’t worry about being considered a pain in the ass by your doctor – be persistent and get a proper diagnosis and treatment. Your real pain is more important than their ass!
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Medical Myth #3: Women are Complainers
Being stoic and ignoring our symptoms doesn’t come from nowhere. From the time we’re little girls, we’re taught not to complain. Then as teens and adults we learned that voicing our needs, expressing our dissatisfactions, our discomfort, our pain, is whining, is complaining, and is unacceptable. So, we don’t complain; instead we tough it out, and we tend to make our health and well-being the lowest priorities in our lives, putting our partner’s, children’s, parents’, friends’, and even co-workers’ needs before our own.
I’ve heard stories from patients who discovered that bringing their husband, boyfriend, or father with them to appointments resulted in their symptoms being taken more seriously. As much as these patients find it frustrating and infantilizing to need a male presence in the exam room, they are doing whatever is necessary to get help in a system with terrifyingly little accountability. Because as much as we may intuit that the medical industry is dismissing us, we also really want the medical diagnoses that will validate what we know, and feel is going on in our own bodies.
Many women delay getting help because they worry that they’ll sound like they’re complaining, and instead, they assume they’re overreacting, or even blame themselves for their symptoms. Often we avoid seeming like we’re complaining by going silent, sucking it up, putting on a brave face. We learned somewhere along the line that voicing our real needs, expressing our dissatisfactions, our discomfort, our pain, is being too demanding. But we’re already darn tough enough – we don’t need to try to put up with pain, fatigue, doubling up maxi-pads, or any other discomforts.
Further, we may intentionally downplay our symptoms and dress to appear ‘credible’ as a patient. The problem is that studies show we can’t win. If we downplay our symptoms, we run the risk of not getting any diagnosis; if we look too put together, we couldn’t feel that unwell; if we look too disheveled, we’re thought to be seeking pain killers or an excuse not to work!
We lose our inner compass while becoming hyperaware of how we appear to others – a strange form of objectification we undergo as part of socialization as women, and as part of interacting with the medical community. It’s really important to quiet the voice of doubt in your head that starts to believe that you are ‘just complaining’ or ‘overreacting.”
Medical Myth #4: You’re a Difficult Patient
“Where did you get your degree, Google University?” is a comment at least a dozen women in my practice were asked by a doctor when they presented their thoughts on what might be going on with them. The opposite of the chronic complainer myth, this is the “difficult patient” myth. Difficult patient is a real label, articulated commonly by doctors (or nurses), given to “that kind of patient” a.k.a. the woman who exerts herself in the doctor’s office, labor room, or in any medical encounter. The one who challenges medical authority – or simply asks ‘too many’ questions. She’s often a woman who has:
- Done her own research
- Has formulated a hypothesis about what’s going on
- Has her own opinions
- Wants to be pro-active in her health care
- And (oh my!), perhaps uses alternative therapies or expresses an interest in them
None of us should be accused of being difficult when actually what we are is confident, intelligent, involved, and engaged in our health. And the reality is that sometimes we do have to be what might be considered difficult – pushy, persistent, assertive. The reality has been statistically demonstrated that women who have had their conditions repeatedly dismissed may have to become confrontational or aggressive to advocate for themselves. It’s what saved Serena Williams’ life when she had symptoms of a potentially fatal blood clot in her lungs, told her medical team, and they told her to relax – that it was normal. Further, women with ‘medically unexplained disorders’ are far more likely to be dismissed, met with skepticism, and have negative experiences during medical encounters.
While you’re walking a tightrope between pushing for the care you need and antagonizing a doctor – you have to advocate for yourself. To learn more about why, check out my article How Being a Good Girl Can Be Hazardous to Your Health.
Medical Myth #5 Medical Solutions are the Safest, Most Reliable Health Care Options
It would be nice to believe that current medical practice is based on the most current, accurate, and reliable information. While we all know people whose lives were improved or saved by a medication or surgery, medicine’s primary credo of “first do no harm” is not necessarily what’s driving health care today, and not everything being offered to us is ‘good medicine.’ We don’t have to look very far back in history to find examples of medical ‘whoopsies” – Thalidomide, DES, the Dalkon Shield, and the Essure Device are for examples. The scary part is that each of these products was used before it was properly researched in actual human women, and many persisted on the market for long after it was clear that it was causing major harm.
Estrogen, in the form of hormone replacement, was promoted by a bestselling book to keep women Forever Young. By the 1970s it was being taken by over 30% of women in the US, yet the first full studies of its safety and effectiveness weren’t conducted until 1991. A major study conducted in 2001 found that risks of hormone therapy in women, particularly estrogen alone and estrogen and progesterone in combination, were far greater than anticipated – causing the study to be halted prematurely.
These examples aren’t all relics of the past, either. Women’s health is big business. Two of the top income producing surgeries done in the US are hysterectomies and cesareans. One in three women will have a hysterectomy in her lifetime. Yet at least 20% of these are considered medically unnecessary and increase a woman’s risk of complications, infections, hemorrhage, and even death. When done before natural menopause occurs, a hysterectomy also increases a woman’s risks of bone loss, heart disease, and possibly dementia. In a study of the medical records of several thousand women, over a third were never informed about reasonable medical alternatives to hysterectomy, including women in their 30s, though it’s in recommended medical guidelines to do so.
Diagnostic and treatment errors are another major problem women face disproportionately to men and in worrisome numbers. According to a 2015 Institute of Medicine report, diagnostic errors are a serious silent problem and a major blind spot in medicine, yet there is little to no accountability for misdiagnoses despite medical error being the third leading cause of death in the United States. Let me repeat that: conventional medicine is the 3rd leading cause of death in the US!
Though we have the most expensive health care in the world, we’ve ranked amongst the most abysmal for health outcomes in the world in terms of safety and quality of care. Too often, conventional medical practices leave us trading one set of symptoms or risks for another – often unnecessarily – and sometimes the new set has more serious consequences!
Western medicine also has an extremely limited toolkit to offer us not only for prevention and healing, but even for actual symptom management. (Add in a sentence or two about integrative medicine, nutrition, etc not being taught in most medical schools)
Medical Myth #6: It’s Your Fault, Especially if You’re Overweight
As women, we’re culturally hardwired to assume we’re doing something wrong or causing our own problems. This is reinforced by the way we’re spoken to in the doctor’s office. We’re told it’s our diet, our lack of exercise, we’re too stressed, we’re working too hard. And women who are overweight are especially likely to be told it’s because they’re fat – even if you're barely above what would be medically considered their normal weight.
Fat shaming and fat blaming are common – and not even necessarily hidden. A 2003 survey of 620 primary care physicians found that more than half viewed obese patients as “awkward, unattractive, ugly, and noncompliant.”
A 2014 study found that 53% of women interviewed had experienced fat shaming by a medical doctor while a 2016 survey found that 45% of women cancelled or delayed medical care because they feared being fat-shamed. This is a very common problem in women with PCOS, which affects up to 10 percent of women. Many go undiagnosed for years because doctors view them as “just fat.” Physicians blame these women’s excess weight on over-eating and lack of exercise rather than looking at the root cause – which in the case of PCOS is a metabolic imbalance leading to an imbalance in our sex hormones.
Even the alternative medicine world can make us feel that our health problems are our fault – that if we just ate ‘cleaner,’ did the right yoga class, took the right supplements, and had all the right thoughts, we’d feel great all the time. While there are practices that really can make a difference in your health, that’s a far cry from all of this being your fault!
Your symptoms, your conditions, your diagnoses are not your fault! So put internalized shame and blame down, and get the diagnosis you need – and if your doctor (or any provider) is blaming or shaming you, you can point out that you don’t appreciate their bias.
Medical Myth # 7: We’re Just Small Men
Big Pharma exerts major influence over medical practice. In 2004 Richard Horton, the editor of one of the premiere international medical journals, The Lancet, said, “Journals have devolved into information laundering operations of the pharmaceutical industries.” It is these same medical journals that most doctors use to keep abreast of latest diagnoses and treatments that are then handed to you on a prescription pad! Yet when it comes to pharmaceuticals, which we should be able to assume are properly tested, safety is a major issue. Most medications have never been tested in women; before 1990 only 13% of all pharmaceuticals were studied in women at all, and the situation has improved only slightly. Yet 70% of all pharmaceuticals are prescribed to women, with half of all women over 50 are on at least two and some on as many as ten drugs for daily use. Ninety percent of women are prescribed a medication during pregnancy, however only 10% have been tested for safety on the developing baby, and 50% of those prescribed have actually been associated with fetal harm.
Differences in how we metabolize medications puts us at major risk for adverse events compared to men. Yet research in women's health remains a low research priority. While women in science are trying to change the research agenda to include more women conducting and participating in studies, it doesn’t change the risks of the existing medications we’re using. Even common pharmaceuticals we’ve relied on for common symptoms, ibuprofen for menstrual cramps and migraines, for example, has been associated with a significantly increased risk of heart attack in women users, and just 10 days of use has been found to reduce fertility temporarily. The track-record of safety for most pharmaceuticals may be less robust than we’d like to think. However, side-effects and risks are universally downplayed while benefits are strategically exaggerated by pharmaceutical companies and then unwittingly by our prescribing practitioners. Bottom line: We’re not just small men. If you start a medication and have symptoms or side-effects, remind your prescribing physician of this.
Medical Myth #8 We Just Don't Know What’s Causes That
If you look in any conventional medical textbook you’ll find the phrase “we just don’t know” a whole lot. We just don’t know what causes endometriosis, we just don’t know what causes PCOS, we just don’t know what causes most miscarriages, we just don’t know why women are experiencing higher rates of chronic disease than ever in history. The list of what we just don’t know goes on. And while it’s true that most doctors don’t know, because they’re not taught how to is how connect the dots on women’s health and our environment, safety, economic status, etc., we do know that fewer than 20% of all medical conditions are caused by genetics – and at least 80% are due to preventable or reversible lifestyle causes. I’ve been unable to accept the answer ‘we just don’t know’ for over three decades now – and I’ve never stopped looking for deeper answers.
Guess what I’ve discovered. There’s actually a ton that we do know, with literally thousands of published scientific studies that explain exactly what these reversible lifestyle factors are and just how they’re impacting our health as women, disrupting our hormone balance, and wreaking having in our lives. Just because doctors don’t know it, doesn’t mean it’s not right there at our fingertips. And that doctors don’t know it isn’t that surprising – first of all, we’re not looking for answers in the right places, and second of all, it’s a well know statistic that it takes, on average, about 17 years for medical practice to catch onto what science knows. Nearly four decades of practice in women's health has shown me that there's a lot we do know about the root causes of many women's health conditions – and that's exactly what I teach you on my website, and in my books and courses.
Breaking the Myths that Bind Us
Until now we’ve carried a legacy of silence, marginalization, dismissal and embarrassment over our bodies, and when it comes to reproductive health issues, it runs deep. This has done wonders for the medicalization of our bodies serving the bottom lines of the medical industry, but it has done a great disservice to women’s health – and also our feelings of wholeness and confidence.
We’re taught that it’s impolite to talk about our bodies, we’re never taught a good comprehensive lesson on what’s normal and what’s not, and then when we visit our doctors we feel unheard and unseen. For so long we’ve been encouraged to distrust our bodies and ourselves and that distrust has only been enforced by the medical industry. The message that we get about our bodies is that they’re unreliable and that we should quiet and ignore as much as possible. The harm done by medical biases against women, and medical ignorance about women’s bodies has led to millions of women having had medical conditions dismissed as stress, anxiety, depression – or as normal, with tremendous opportunity loss to make an early diagnosis and prevent suffering, loss, and harm.
The truth is that we’re not complaining when we tell our care providers about our symptoms, and we’re not difficult when we advocate for our health. We’re not fabricating symptoms to get a diagnosis, and we’re not just fine when we say we’re not. But breaking the myths requires us to reject “We don’t know” as an acceptable answer, or simply accepting a diagnosis and medical treatment and moving on. Our health care providers should trust us when we say we're sick.
But we have to do our part, because it's not gonna' happen otherwise. We have to:
- Stop being so polite when we’re being ‘doctor-splained’ to
- Trust our bodies, perceptions, and instincts
- Use our power and rights to advocate for ourselves, ask questions, and get another opinion
- Get loud, however it takes to get heard and get proper testing, treatment, and care.
For tips on exactly how to do all of this see my article How to Talk to Your Doctor and Get the Health Care You Need
Your health may depend on being a bit of a badass.