From Hysteria to Medical Gaslighting and the Path Forward with Dr. Elizabeth Comen

22:38Dr. Mary Claire Haver:Don't miss The Lady, streaming March 18th, only on BritBox. Watch with a free trial at BritBox.com. Perimenopause is not early menopause. It is its own distinct biological phase. And it has been largely ignored. My new book, The New Perimenopause, is about the 7 to 10 years before your period stopped. A transition that is anything but gentle. Hormones fluctuate wildly. And for many women, this is when the anxiety, brain fog, sleep disruption, weight changes, mood shifts, joint pain, and that unsettling feeling of, I don't feel like myself anymore, begin. Long before anyone says the word menopause.

23:24Dr. Mary Claire Haver:Perimenopause often starts quietly. It shows up in the brain first, then the body, then everywhere else. And too often, women are told nothing is wrong. I wrote the new perimenopause because you deserve answers before things spiral. You deserve care before burnout. And you deserve a clear roadmap for a transition that medicine has ignored for far too long. The new perimenopause is now available for pre-order everywhere books are sold. Learn more and pre-order your copy at thepawselife.com. You know that feeling when a workout just clicks? Meet the new Peloton Cross Training Tread Plus. It's powered by Peloton IQ, your new strength coach.

24:08Dr. Mary Claire Haver:Peloton IQ takes the guesswork out of every move. It sets your goals and provides weight suggestions to ensure you're always making progress. With the new movement tracking camera, it actually counts your reps and corrects your form in real time. It's about making training safer, lifting smarter, and making every single rep count. When you're ready to switch gears, the swivel screen makes it seamless. Go for a 45-minute run on the Tread Plus, then in one smooth spin, transition to a 5-minute stretch on the floor. It offers endless ways to train for a well-rounded routine, no matter how busy your day gets.

24:42Dr. Mary Claire Haver:Best of all, Peloton IQ builds your personal workout roadmap. You get weekly recommended classes led by instructors who match your mood, your vibe, and your personality. With personalized plans and deeper insights, Peloton IQ helps you finally unlock those new breakthroughs. Let yourself run, lift, sculpt, push, and go. Explore the new Peloton Cross Training Tread Plus at OnePeloton.com. So in the book, you have your introduction, and then you start doing a deep dive into organ systems, which was fascinating. And you started with, and do I pronounce it correctly? Because I'm not a dermatologist.

25:23Dr. Mary Claire Haver:Integumentary? Yeah, you got it. That is a word I only read in a book and never said out loud. Do you know I think the smartest people can't pronounce anything? I can't pronounce anything. I think I'm pretty smart. So we can just go with it. So you start off with integumentary, which is skin, and basically launch into plastic surgery and the history of how plastic surgery evolved as a field. And it was absolutely fascinating to me to realize when I was like, I guess I kind of knew that intuitively, but plastics evolved because people's faces were getting shot off in wars. Yeah. And we developed anesthesia.

25:54So before that, you know, surgeons were not, before we had anesthesia, surgeons were these They were called butchers? Yeah, they were just these like, you know, barbarians, right? Who were, who could like cut off a limb as quickly as possible because there was no anesthesia. There's no antibiotics. People often died. And then you develop this field where you have the rise of, you know, the ability to operate on people without pain. And oh my God, now you can operate on seemingly healthy people and modify them. So you could fix the guy who had his face shot off on the battlefield, but you could also fix the ugly woman who could now become more marriage material.

26:30And it's really kind of fascinating to see how that evolved. And most plastic surgeons in the field were men initially. And now, of course, we have many more female plastic surgeons, but that's not the way the field arose.

26:40Dr. Mary Claire Haver:So there's a passage that you wrote that really struck me, and I'm quoting from the book. Male doctors acted as both enablers and enforcers of women's beauty, putting the stamp of medical legitimacy on the social pressure to be pretty. I mean, let's be clear. I'm vain myself. I'm not here without the lip gloss. I got a blowout because, you know, it's your podcast and all, right? And my mom likes to joke that her middle name is Vanita. So it's not that I'm opposed to all of these things and the pursuit of aging gracefully, aka with a little Botox. But I think it's important that women understand where the field came from, where these pressures come from.

27:17They're not new. They've been there a long time. And when you look at breast implants, for example. Talk about that. Yeah. Because that one also blew me away. There was a medical term, micromastia, that was developed to say like small breasted women are going to feel insecure about their bodies, develop an inferiority complex, because this was along with the rise of the field of psychiatry. And in order to treat these disorders, you had to give women bigger breasts. And that was only because one of the surgeons liked big breasts.

27:42Dr. Mary Claire Haver:Yeah, in Texas, where you're from. It's fascinating. If women had been from the ground up building the field of plastic surgery, you think things would be really different? I think they might be, but I hope we would still have access to the things that women want. But I think the conversations would be different. And I think the things that we pursue, like Barbie vagina and labiaplasty, it's like... We're going to get there. Yeah. Do you want to get there now? Okay, let's go there now. I saw a Somalian patient and her sister who had both had female circumcisions, which we now call general mutilation.

28:14Dr. Mary Claire Haver:Okay, there's no medical reason to have it. It is a cultural or tribal procedure where you basically, and there's different types, but they go in and basically remove the clitoris, remove the labia minora, and sew the majora together in some configuration. It's, you know, anecdotally, it was done by the grandmother with like a ceremonial knife. There was no anesthesia. These 12-year-old little girls, the minute they showed signs of puberty, were undergoing this condition. So, of course, it's condemned in the U.S. It's illegal, though it does still happen. And so there are certain cultures where women cannot marry or marry well without having this procedure done.

28:51Dr. Mary Claire Haver:And this is very, very wealthy individuals. So there are still a few surgeons. It's illegal in the U.S., but it is, or they'll fly back to whatever country and have it done under anesthesia. But basically, their genitals are completely mutilated. I saw a woman who was trying to get pregnant who had had this procedure done as a child and I sat down to examine her and I didn't understand what I was looking at. Like there's just all of my anatomical references were gone. And this was a 22 year old, beautiful, healthy, educated young woman who had traveled over with her husband from another country to settle in the US.

29:31Dr. Mary Claire Haver:I think she was getting a master's degree or something. And her sister had had the same procedure done and she was having recurrent urinary tract infections. So that particular procedure she had had had blocked the exit of the urethra. So it was hitting this, you know, suture line and having to dribble down. And she was in terrible pain. I've seen a few more in clinical practice because we'd have to send her to a specialist, urogynecologist typically, to figure out, should we take it down? What's the best procedure? I mean, it's just awful. So then when patients come in and start asking me about labioplasty later, not from another country.

30:04Dr. Mary Claire Haver:These are girls who are seeing this stuff on the internet and what labia are supposed to look like. I mean, when I was young, we changed in the locker room together. I spent the night at my girlfriend's house. I mean, I took baths with my friends as little kids and, you know, just very. But I didn't ever look at anyone's labia. I realized mine might be different or longer. And, you know, to be said, I've had patients who've had very large labia that they were falling out of their underwear or not able to do gymnastics or swimming. And so, you know, I can see a medical reason why doing some reconstruction there might be helpful for her from a functionality.

30:39Dr. Mary Claire Haver:But my God, like now it's labia are bad. They should not, you know, the only form is the ones you can't see. And it's all over social media. I mean, I think it's really sad that, and also in medical school, we don't have, I certainly did. And I don't, I mean, maybe you did in the field of gynecology, but there was no real demonstration of anatomical variety. A little bit. I think really hard about it because I say med school, it was probably once I was a residency director and I was in charge of the curriculum. In the more recent years, because, you know, we were seeing more and more patients who were immigrating, they wanted to make sure we understood that they're, but not in medical school.

31:19Dr. Mary Claire Haver:Not in medical school, right? There was one little paint model. And so even the doctors, like if you have a patient coming to you, what knowledge do you have from pornography, right? And so it's really terrifying how many women are mutilating their bodies, potentially getting it from people that are not reputable, having significant dysfunction later on in life. And again, I'm all for people doing what they want to do to feel good about their bodies. Just be informed about where you're getting your information, what and who are giving you the pressure to do it, and then deciding what choices you want to make for your body.

31:50What is bicycle face? Oh, bicycle face. So this is real, okay? So we both love to work out, but I will tell you, when I was researching the history of women in exercise, this is the most bonkers thing. So at the turn of the 19th century, there was the rise of the bicycle, right? And what did the bicycle do? The bicycle gave you mobility from your home, right? And that meant if women were riding by themselves, they didn't need a chaperone. They could go freely from the home. It also became the symbol of the suffragist movement and the women's right to vote. So you see a lot of these suffragists on the big bicycles.

32:27Well, now this shows you the integration and influence of medicine and society and culture. There was a debate in the medical community, including in some of the biggest medical journals. Bicycle, yes or no. Could women ride this? Is this going to be safe for them? Their uterus might fall out. And what could happen to them? It could affect their fertility. But you could have bicycle face. It didn't exist. But what they claimed was that your face would be frozen in a grimace. You would become ugly from the exertion and you would develop bulky muscles and be disgusting and unattractive. So these ads came out in newspapers about the fear of getting bicycle face.

33:08But you know what the worst thing that would happen to you? You were going to masturbate on that bike. Oh, my God. So all of us who are into, you know, Peloton and I mean, I've got I'm not supposed to be why I'm into Peloton. I'm riding it. I've done lots of things on a Peloton, but not that. Nope, nope, nope. So it's really remarkable the things that were said about women and debated in the medical literature. But when you think about exercise in the sphere of bulky muscles, is it that different than when we go to our Pilates class and you look at the frequently asked questions? Am I going to get bulky from, you know, Pilates?

33:37No, you're not. I lift all the time and I lift heavy. I'm not like Hulk Hogan over here. But yet, where does this legacy of women worrying that if they lift things and get stronger, that they're somehow going to look like a dude?

33:50Dr. Mary Claire Haver:Am I going to get bulky? or I, so one of my dearest friends is a physical trainer and she was always in incredible shape, but then she really got into lifting and weight training and she, um, has made a career out of it. And I can remember behind her back, the guys are in our friend group kind of commenting on, she, she didn't want to go too far with this. Cause she might start looking, this is, you know, this was five years ago, too bulky. And like, this was before my, like come to Jesus about frailty and sarcopenia and what are we doing to women? You know, we're creating an epidemic of frailty.

34:24Dr. Mary Claire Haver:I think back now and I'm like, now I'm trying to keep up with her, you know? And back then I was like, oh yeah, we don't want to get too bulky. We don't want to get too bulky. I mean, I grew up as a dancer and playing sports, but it was always about smaller, thinner, and definitely not about lifting to be strong. So what did you learn in medical school? I'm guessing, so I graduated med school in 98. So when were you? A little younger. Okay. and I finished residency in 2002. Okay. All I was taught was work out more, eat less. Your health was tied to your weight. Yeah. And never, never, never, never, never about prevention of osteoporosis or frailty.

35:02Oh, I mean - Was it any better for you? No, there was no, there still isn't any now. I mean, I have patients that we talk all the time about how important exercise is for decreasing breast cancer risk and recurrence. And I've got 20 year olds that have no idea how to do a proper squat. and with weights without hurting themselves. And I think the lack of education, both socially, but in our medical system about how to actually take care of your body is really horrible. We've got all this information about genomics and genetics and DNA, and yet the most basic things about how to exercise and how to eat fall by the wayside.

35:36So I definitely didn't get any training at all, let alone what specifically for women would be important, including during pregnancy. Oh, no. So my kind of, I've got -

35:45Dr. Mary Claire Haver:We didn't want to raise our heart rates above a certain amount. I was telling patients to stop running by the fifth month. I mean, I did all the things. I ate a ice cream cone. I bought like a box of 12 and I was a resident. And so threw it in the freezer. And every night I, you know, treat myself to this giant ice cream cone because I needed, I was underweight when I got pregnant. And so they wanted me to gain some weight. And I was like, I got you, you know? And so, you know, no one, as long as I wasn't diabetic, I was fine. Yes. You know, eating healthy was like porn. You know it when you see it.

36:20Dr. Mary Claire Haver:Yes. I just can't believe the advice I was giving patients or what I actually did to myself during my own pregnancy. Yeah. And thankfully, thankfully it's changing. Yeah. Slowly. My daughter, her undergraduate degree before medical school was nutrition science. Oh, wow. So she was going to go the registered dietitian route, but took the MCAT and said, if I get in, I'll just go straight to med school. So that's what she did. That's amazing. Yeah, but she does have that solid background in nutrition. So you also cover cardiovascular, digestive, immune system, nervous system. I mean, I was just a fish in water through all this.

36:53Dr. Mary Claire Haver:The endocrine system, of course, reproduction. What were some of your biggest aha moments? There were so many. Okay, so let's go cardio. Okay. You know, there are lots of things. Just how much the risk factors can appear earlier on for heart disease later in life. I mean, you're a gynecologist that if you have preeclampsia during pregnancy... Never learned that. I never learned that. I know it now. That it sets you up for heart disease later on in life or that we can have smaller vessel disease and that our vessels are different in our heart. Right, microvascular disease. Microvascular disease, that sometimes heart attacks are not just secondary to plaques, but can be other things that we're still looking into.

37:27Broken heart syndrome, which is, you know, traumatic cardiac events after a traumatic life event, like losing a partner or something like that. I didn't realize this was more common in women. The idea that, I mean, just think about, we learned that women's chest pain was atypical. We are greater than 50 % of the population is the number one killer of women. And why is that considered atypical? And so I went back in time and I read, so William Osler was one of the most famous cardiologists who founded the residency system at Hopkins. And I read his seminal work on cardiovascular disease. And so to kind of feel like, well, where did this start?

38:01Right. So first of all, he didn't believe that women should go to medical school. Okay, fine. So I read, there's over 800 citations in this book. and I read all the primary sources. So I read what this man said about men's heart disease. Okay, so who gets a heart attack? The overworked gray-haired man whose engine is working over time. And then he had this whole pattern of women that he would see and that he wrote about. And he would call each one Miss something by their last name. So Miss C, Miss B, whatever. And he would describe the nature of their chest pain. It was almost always described as neurotic angina, so neurotic chest pain.

38:36And at the end of each one, he would attribute it to something other than a cardiac problem. Psychological instead of psychological. And so much so that by the end he wrote, these women do not die. And I thought, well, there it is. We are dying. You said we don't die. You didn't look into it. You were the forefather of this whole field of cardiology. And you've said it. You've dismissed all these women as neurotic. In the 19th century, we don't die. And here we are. We are still dying. And it's the number one killer of women. And that's why the legacy matters. It matters to understand where it came from before we can really move it forward.

39:12Dr. Mary Claire Haver:So for our listeners, let's go through, because you might save a life today. How do men typically present? What are the typical signs of a heart attack versus how a woman typically present? It can be totally different. So, you know, classically is what we see in Hollywood. These women present, or men presenting with the elephant on the chest, the crushing chest pain. But we should talk about that because it can be quite different. It could be indigestion. It can be fatigue. It can be jaw pain. It can be the left arm pain. But if you don't feel well and something feels off and you know your body, you must call your doctor.

39:44Women are twice as likely to call an ambulance on their husband having a heart attack than they are to call for themselves. And then go through the statistics of what happens if they do make it to the ER. They are far more likely to be misdiagnosed, to not even have an EKG done, to have their heart attack missed, and to die within their first year of having a heart attack. And what are they typically diagnosed with? That you're having a panic attack. Panic attack. Yes, of course. That's the whole point. That's the default diagnosis, the history of hysteria. Translating that either from hysteria to it's all in your head to you're just anxious.

40:14And so much of that is because we don't know what's going on. Because we haven't studied it. And there's an arrogance to medicine. When we don't know what's going on, we blame the patient and say, it must just be you.

40:24Dr. Mary Claire Haver:You're anxious. And it's stress. Yeah. I want to talk a little bit about the endocrine system and immune system, they, you know, for autoimmune disease, let's start there because it affects women. Certain autoimmune diseases preferentially affect women. Yeah, 80 % of autoimmune diseases are in women. And were you taught that that was a women's health problem in medical school? I was not, right? So we don't consider that a women's health field. Okay, it affects 80 % of those with autoimmune diseases are women. That's a women's health problem. When I've looked at the funding to certain autoimmune diseases before, especially the ones that preferentially affect women, it's ridiculous the amount of funding and how the studies are set up when women have so much of a higher burden of disease.

41:06Dr. Mary Claire Haver:Yes, yes. Well, I think that's because the system was not built by women and, you know, people invest in what affects them, right? So they're not going to invest in the same problems unless that, and it isn't just enough to say, oh, it's like my sister or my mom, or I have a wife. We have to care about everyone in our society. And that includes women who are significantly struggling from many disorders that have been understudied, underfunded, and under-researched. So I think this is pervasive in other areas outside of bedside medicine, because I'm a founder. I started a company around menopause, menopause care, education, et cetera.

41:41Dr. Mary Claire Haver:And we've had lots of calls from venture capital and private equity to try to invest in everything. And they'll bring in the big guns to have the conversation and the song and dance. And without fail, if it's a man who leads the company and he's leading the conversation, he will talk about his mom or his sister, but never about the global problem of women being underfunded, underdiagnosed, you know, and that we just don't have enough resources devoted to this. Yeah. We're not just these puppets to show as the softer side of you and that you somehow care about women because you're a dad to a daughter.

42:15I'm so tired of people saying, well, now that I have a daughter, I really get it. You should care because we're greater than 50 % of the population if you care about humanity. Let's talk about the nervous system. Oh my gosh. So that was another point. So I wanted to call that the bitches be crazy school of medicine. And initially my editor was like, are you sure you want to do that? I'm like, I am sure. Bitches be crazy. Yeah, because that's what people say about us, right? Throughout history. Do you know my WW story?

42:44Dr. Mary Claire Haver:Oh yes, yes, Yes, but tell it. So I get to my residency, brand new doctor, convinced I'm going to kill someone. And my very first day on GYN, we had clinic. Okay. Because we spent half time in the OR, half the time in clinic. And so I walk into gynae clinic. They would pull all these women in, have them all have an eight o 'clock appointment. They would all get there first thing in the morning. They'd pack a snack. And we got to them when we got to them. And basically, they just sat all day until we ran out of charge. So this is how old I am. This is paper charts. We're four years of residency.

43:17Dr. Mary Claire Haver:So the fourth years would run to the charts and pull the surgery cases because they want to operate and get their numbers. The third years and the second years would then go and fight over the procedures, the polypectomies, the colposcopies, you know, all the things where you can cut things out and do stuff because it's fun and they need numbers. And that left everything else for the interns. So I go and pick up my first chart and I open it up and it is Miss Smith, whoever, a 40 something year old, Caucasian female, couple of kids, normal deliveries, you know, with multiple vague complaints. I'm not sleeping well.

43:50Dr. Mary Claire Haver:I've gained some weight. I'm having some irregular periods. I'm having headaches, you know, the list. So I go and I look through the chart and she's kind of made the round. She's been to GI. She's been to family. She's had a few consult, you know, and she hadn't been to psych yet. So, but they sent her to gynecology because her periods were a little bit of regular. Go see what you can do. So my upper level comes over. He's in charge of me for the day. And he's this big, tall Texas cowboy with his boots and his scrubs. And he's like, what you got? And I said, oh, Ms. Smith. And I read the way he said, did you check her thyroid?

44:23Dr. Mary Claire Haver:I said, family medicine did. You know, I went through the lab. She done everything look normal. Everything looked normal. And her exam was basically benign and normal to our listeners. And so I'm like, he goes, yeah, you got a WW with that Texas accent. And I said, I didn't know what that was, you know, and he said, don't write it in the chart, but it's a whiny woman. And actually she was Caucasian. It was a WWW, a whiny white woman. He's like, women just go through this at this age. There's not much we can do. Make sure we get all the labs covered, but they're probably going to be normal. Just pat her on the knee and tell her she's going to be okay in its stress.

44:58Dr. Mary Claire Haver:Oh my God. Well, it's horrible and I believe it. And the part that's so tragic when you talk about this time of life is that in my population of breast cancer patients, historically, we effectively castrate, you know, two thirds of breast cancer patients. And if you're - Let me define what castration is. Yeah, so a young woman, many of our breast cancers are affected by the estrogen in their body and the estrogen receptor. I know that's a little controversial to some of this audience to say, but one of the main ways that we treat breast cancer and its decreasing risk of recurrence is by decreasing the amount of estrogen that can bind to the estrogen receptor.

45:36And there are different ways that we do that. And in young women, we have shown that there are improved outcomes when you basically shut down their ovaries chemically. So move them into medical menopause by a shot that shuts down their ovaries. And on top of that, block their ability to make estrogen. So you could take a 25-year-old who you're trying to cure of breast cancer and make them effectively menopausal. And on top of that, decrease their, any additional production of estrogen that they have.

46:02Dr. Mary Claire Haver:So for our listeners, even a menopausal woman will have some estrogen. In my Ask Me Anything, I kind of reviewed the three main forms of estrogen in the body. Estrone from the peripheral cell, you know, and then, which is usually fat cells, the estradiol from the ovary, and then estriol in pregnancy. And that in post-menopause, estrone becomes the dominant estrogen and does still have some effects in the body. Not enough to stop you from getting osteoporosis and insulin resistance and all the things, but it is something. So in breast cancer care, when we're trying to improve her survival and decrease her recurrence, we're going to block everything.

46:36Everything. The problem with that is that, yes, we've improved the survival of breast cancer, but then you have scores of young women and older women who are absolutely miserable. And we've said as a field, oh, but you're alive. You're alive. You may be miserable. Sex may feel horrible. You maybe having these hot flashes, but you're alive. And for so long, for example, even the concept of vaginal estrogen as being safe, which we know is not systemically absorbed and safe to be used, even in breast cancer patients, has not been explored, has not been disseminated as widely known information because it hasn't been something that we valued.

47:11And that speaks to, you know, a long history of devaluing women's sexual health and sexual function. In my field and in almost every other field of medicine, it's been dominated by research into men's sexual health as opposed to women's sexual health.

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49:47Dr. Mary Claire Haver:Tell us what you meant there. And I absolutely, absolutely agree with you. Yeah. And I say this as a very happy, proud mother of three incredible children. Not every woman wants to be a mother, can be a mother. And yet everything around the narrative about women's health from head to toe is about preserving reproduction, which is potentially important, but not the whole story, right? And whether that, even just looking at how we learned about our anatomy in medical school, right? When do you learn about female anatomy? You don't learn about like the lungs in a chest cavity of a female, right? It was always the male body in anatomical studies, except when you're learning about reproductive function.

50:30Then, oh my God, suddenly we have different anatomy, right? Because that's the only anatomy that is valued, our reproductive fitness, as opposed to even studying women's pleasure. The Grey's Anatomy, the seminal, most important anatomical textbook, sometimes didn't even have the clitoris in it in the 1940s. It was missing. It's missing. It was never missing from women's bodies. And the number of men throughout history that claimed to find it and claim it, it's like women knew where it was for a long time, my friends. Women figured that out a very long time ago. Yeah, we figured it out. I'm pretty sure in the cave, they were still having a good time.

51:03Dr. Mary Claire Haver:I did learn something. I learned lots of things, but this one kind of stopped me in my tracks. Endometriosis. That if a woman comes in complaining of infertility, if she has endometriosis, but we haven't made the diagnosis yet, if she presents to the doctor for workup of her infertility versus I'm just having pain. Yeah. She's going to get the diagnosis and treatment a lot faster. Yes. If she's coming in complaining of I can't get pregnant versus I'm having pelvic pain. Yeah. And if you look at the dialogue around women's health, it's about our reproductive capacity in every way, right? This is what gets debated in society, but you probably know better than anybody else.

51:40How many women did you see with GI complaints, urinary complaints, pulmonary complaints, vague complaints that ultimately had a misdiagnosis of endometriosis, and we still don't know how to treat it effectively or had a hysterectomy that they possibly didn't need, or maybe they needed it and weren't offered it because, you know, the only option was to try to preserve their fertility. Talk to me about Anne and the vibrator. Anne was this like photographer in her 80s with like awesome gray hair, always wore like really vibrant clothing and these big round glasses and just super dynamic. She had an early stage breast cancer and I had, you know, I would do it very differently today.

52:19To be quite honest, this was years ago. And I put her on an aromatase inhibitor, which is to decrease the risk of recurrence of her cancer. I don't know what I would do today, but probably not that. But that was this and is the standard of care. And, you know, I told her about the side effects, which could be like joint aches, decrease in bone density, but I didn't talk to her about decreased libido and pain during sex or anything like that, or vaginal dryness. Did you know that? I did, but I think I just subconsciously was like, well, she's like in her eighties. Why does it matter?

52:47Dr. Mary Claire Haver:And I probably would have done the same thing. Yeah. And then vibrant, fun, Anne came in mad at me. She was like, you, you have not properly taking care of me and you didn't ask me about my special friend. And I was like, special friend? I've known Anne a while. Like, where's this partner? And who's like, what do you mean? Like companion, going for walks with a dog? Like, what is this? And she was like, it's my vibrator, Dr. Coleman. It's my vibrator. And I'm not enjoying myself. My vagina feels like a sandpaper. Why didn't you tell me this could happen? You didn't address these needs in mine.

53:23And I was like, I did not, Anne. And I am so sorry. And I want to be like, I want to have her libido when I'm in my 80s. And I want that to matter to me. And I think she really opened my eyes to that, you know, we have to meet women where they're at. We have to really be open to what they want for their lives. We have to ask them, what brings you joy? And how is this affecting your ability to access that? And then really care for what we all want, which is the whole person.

53:46Dr. Mary Claire Haver:I find, you know, my training, if we talked about sexual function at all, which was very, very little. I literally was a deer in the headlights when I had my first then 987th patient complaining of libido issues. Like we just glossed over it. There was no training of it. But then it was also very ageist. Like women of a certain age, not happening, you know, and it probably was the age I am right now. Like I would have thought in my 20s and 30s that I won't want to work when I'm 60. I won't want to have sex when I'm 60. I won't want to, you know, and I never would have imagined this life right now where building a new company completely pivoted my career, you know, built a social media platform.

54:26Dr. Mary Claire Haver:I thought I would have been gray-haired knitting with a grandbaby on my lap. And looking fabulous. Oh, thank you. Yeah. Yeah, I think that we all have kind of supported each other in these different chapters. And so many women have these careers where we thought we had to look a certain way or be a certain way and that there was only one path to it. And certainly for women and their sexuality, there's, it seems like there's joy at every age. Yeah. I love that. One of the biggest learnings in this whole process for me has been that things are not necessarily inevitable. My grandmother lived into her 90s and did the traditional route.

55:05Dr. Mary Claire Haver:She married a man 10 years older, bore him six kids, seven kids. She struggled, unrelated, but she struggled with mental health. She was actually admitted to Galveston, Texas, where I live now, too. There was a big mental hospital there, had shock treatments. My mother took care of the kids. She was the oldest daughter, took care of her siblings while my grandmother went through treatment, came home, cared for her family. My grandfather, I think she learned not to complain anymore. I never heard her complain about anything. And then my grandfather dies and she kind of had a few good years there where she and her sister, who's a little bit older, started traveling.

55:39Dr. Mary Claire Haver:They went on cruises. They were doing all this fun stuff because she was still in her early 80s and really killing it. But the last 10 years of her life, she suffered horribly from dementia and frailty. Yeah. And spent that time in a bed. Okay. I just thought that's what old ladies did. Here comes my mother, the most rough and tumble badass you've ever met. Not the soft, fluffy mom at all. I don't remember being cuddled or like she wasn't that mom. Same fate. Dementia, frailty, incontinence. And for a long time, until I started getting into the world of menopause and getting into the history of why this is happening, I really felt like this is old lady disease.

56:17Dr. Mary Claire Haver:Yeah. This is inevitable. This is in my genetics. And I'll just jump off a bridge at about 85, you know, so I don't have to put my kids through this. But it's not. No. And we're not teaching our clinicians. No. And honestly, I take care of women all day, every day. And I, till I wrote this book, I had no idea that Alzheimer's was two times more common in women than men. How did I not know that? Me neither. until I heard Lisa Moskowitz speak. And I was, you know. Yes, and it points to the devaluing of our cognitive function over time and the dismissal of women's cognitive health, of our brain health, of our mental health.

56:52You know, and I also think about one of the things that really fascinated me looking at the history of medicine was these women that were put in asylums for reading romance novels, for wanting to have more sex than their husband wanted to have. Well, whoa, there's a real problem there, right? And the number of women that have died in asylums for seemingly normal questions. Just being menopausal. Or whatever, yes. Or the mental health changes around menopause. So one of the men that founded Horatio Storer, who founded the Boston Gynecologic Society in Boston, who also stuck a poker, like a poker for a fireplace up a female cadaver in med school, and his friends thought that was normal behavior.

57:28Okay, he's in my book. He's one of my main characters. He also sent his wife to a mental institute at age 39 for catamanial, so premenstrual mania, where she died in Worcester, Massachusetts. These are the people that founded the fields that we are in today. So is it that surprising that when it comes to biology that is affecting women's health, that we've ignored it? And as Lisa Muscowney says, we have hundreds of years of research to make up to women, for God's sakes. Like we are living longer, but we are not even remembering it. That is a real problem.

57:59Dr. Mary Claire Haver:Yeah. Talk about funding. It was McKinsey who put together a report. Yes, it's incredible. The gap that like$3 trillion that we could make by just, this is what I say to these people in finance. You don't have to care about us. You care about your dollar. You want to make money? Invest in women's health. We'll care for you better. And there is money to be made in these fields, these massive gaps. We need to fill them with funding and research and eventually medicines that you could sell. So get on it. But it's a real, it's a real, real problem. And we can't rely on our government to be funding our, there was already massive gaps in our healthcare system.

58:32When I first started off in this work, a mentor said to me, what do you mean women's health? Like, look at breast cancer. We've done so well. We've raised so much money and we have, but breast cancer is not the expanse of women's health. And the statistics are simply terrible about how much we invest in men's health versus women's health. Throw out some numbers because I think it's like 1 % of government funding outside of cancer research goes towards women's health. Pregnancy.

58:54Dr. Mary Claire Haver:When I think if I have the stats right of a$43 billion budget in 2023, about 10 % of that went to women's health. So about 45 million, but like just for menopause, it was less than 1 % of like 0.03 % of all funding went to study a condition that happens to 100 % of women without fail if she lives long enough. Yeah, it's mind boggling. But we're changing that. We are changing that. Well, by raising awareness. Yes. And I really do think that people should vote for people who care about your health. So there's that. You write about this generational myth. We just keep perpetuating this. I was taught that women tend to somaticize their problems.

59:38Dr. Mary Claire Haver:I was taught by venerated, lovely physicians who were not trying to hurt women. Why is it that now? Is it that more women are in medicine and going, wait a minute? I hope so. But it's not just, you know, there are great men in medicine. Yes, absolutely. I've been taught by some incredible men. And women too that have been dismissed, right? It's a systemic problem. You know what's fascinating? I have a friend who's a gynecologist and she said, I don't want to put my diagnosis of IBS in my chart because people will think I'm crazy. And we just don't know enough about IBS. It isn't just that you're nervous and that's why your stomach is cramping and you have diarrhea and you feel horrible.

1:00:14There's something that we're missing that we have to work through. It isn't just that you need to like calm yourself down. Why have we been so dismissive of women? But I do think the landscape is changing. I think even just in the last few years with your work, thinking about how much we've had this groundswell of women and men that want to change the history of women's health.

1:00:34Dr. Mary Claire Haver:I think social media really, and I'd love to hear your experience. For me, all of my practice, you know, you start seeing patterns, right? And things that you weren't trained about. Yeah. So it took me a few years to be like, something's not right here. But I'm in a little room with a door shut. I'm not talking to my colleagues about this. And it took me years and then me going through it myself. And then I kind of start talking about it one day on social media and the world explodes. Oh my gosh. And I think social media, good and bad. But the good part is that women are finding shared experiences and things that were quiet and not talked about.

1:01:09So right now I'm like that swan that's trying to look graceful, but I'm like underneath here because I have had such a personal road in this space. Tell me. Right. Everything from when I started doing media, I had a mentor say to me, why would you ever go on TV? No good comes from a doctor being on TV. And it was just sort of the rise of kind of this misinformation. And I thought, if I'm not going to go out there and debate these snake oil quacks, this is medical communication. What the hell is going to happen? And why are we so arrogant in the medical community that we are not taught how to communicate?

1:01:39We're just an echo chamber of the same thing. You think you don't have people that you could talk to? Oncology is a whole other field. I was criticized for how I dress. I shouldn't wear my hair down. I should wear my hair in a ponytail with glasses. When I just wrote this book, it was, well, what, where are you going to go and talk about? And it was - Yeah, I was wondering about the pushback because you're really critical of the system that you are operating in. I think as so many women have to, at some point in their lives, you have to bet on yourself. And if you really believe in something, good will come from it if your values are aligned.

1:02:11And I'm so grateful to be at this Mignoni Women's Health Collaborative, to have so many people behind me supporting this, to have colleagues that I can talk to, to be able to meet you. This whole world opened up to me. The number of women that I have met on social media who are in medicine, I'm like, Like, oh my God, you had the same experience too. It's been incredible, but we need more of them.

1:02:30Dr. Mary Claire Haver:I think the message is out there. But again, being in the trenches, as we both know, is hard. And you're trying to stay married for a lot of us. And you're raising children for most of us. And you're trying to balance, you know, especially in the academic world, the most arrogant of them all, you know, the gatekeepers of information. It's really hard for the establishment, I find, to accept that people are getting their information from social media. They feel like they should be the only ones to disseminate. It only comes in a medical journal article, and you should get that information from your doctor and nowhere else.

1:03:05Dr. Mary Claire Haver:And I think that that's just not reality. No, I mean, I did one of the biggest academic personal honors of my life this week, which was to give this big keynote address at Harvard at this conference on women's health and innovation. I mean, truth be told, there were some incredible, famous professors there, and I felt super honored. There were probably about 1 ,000 people online and maybe 300 people in person. This is a way bigger platform. And how do we really meet people where they're at and disseminate information? Yes, it's Harvard, and I'm super grateful. And also, we need other spaces and places to really reach the masses.

1:03:39Dr. Mary Claire Haver:So I've been invited three times to major hospital systems to go and educate their clinicians live in person. And it's usually a one hour lecture. So I got to pack as much as I can in in one hour and all three times I've walked in the room and there's three to 500 people and it's all women. It is only the female clinicians who were either invited because it was a women's women in health event, a physician women's event. Yes. Yeah. And I'm doing this massive talk about multiple organ systems affected by menopause. I'm just trying to get them curious and realize where the gaps are. I don't have a time in an hour to teach them everything about menopause.

1:04:15Dr. Mary Claire Haver:I'm not teaching them hormone therapy, nothing, but like, you need to know how menopause is going to show up in your office. And I remember walking into the first one going, where are the men? Yeah. Why aren't the female, I mean, the male doctors here, the male clinicians, the PAs, the nurse practitioners, and they're like, oh, it's our women in medicine. And this happened three times across the country. I'm sure. I'm sure I have the same experience left and right when we have to change that. We do. More than women need to care about women's health. We all need to care. One of the things I say is menopause education.

1:04:48Dr. Mary Claire Haver:I hate just calling it menopause, but like the sex specific differences in health should be required for every single specialty that touches a woman. Absolutely. And that goes all the way back to our medical education where we're not just showing anatomy on male forms, but, you know, sometimes you'll learn about the gastrointestinal system in a female body or the lungs or the heart. It's not just looking at a uterus as the only time you're seeing a female form. The ovaries or the breast tissue. We are not just our boobs and our tubes. A lot of the social media, and I sent out a questionnaire, so I've got some questions from our followers.

1:05:28Dr. Mary Claire Haver:A lot of the oncology patients, especially in the GYN oncology, breast oncology, are frustrated by the lack of attention that their menopausal symptoms, certainly not in your clinic. But what would you tell them if they're in Kansas or Ohio? First of all, vaginal estrogen is safe. We have lots of studies that show this. It can help tremendously with some of the pain and recurrent urinary tract infections that we see with our patients. We do have non-hormonal treatments for hot flashes that many women can pursue and talk to their doctor about. We have ways to address bone health. And then, you know, it is somewhat controversial, but for those women who have a very distant history of breast cancer, they're 20, 30 years out.

1:06:08They want to have a conversation with their doctor about the risks, potential benefits, studies that we could get involved in. Because one of the things I really want to study is for triple negative breast cancer, which is breast cancer that has no relationship to estrogen. Why can we not give physiologic hormone back to those patients? Why do you think those studies haven't happened? Because no one has cared. No one has cared, right? And there's such a fear around breast cancer recurrence, but those studies have not been properly done. We have some big data, but it's not a prospective study that really needs to be done to look at what are the options.

1:06:38And then really having informed decision-making with patients who are really, really suffering, what might we be able to offer them and not just have these blanket statements that you can never do it.

1:06:47Dr. Mary Claire Haver:A lot of them are upset that they weren't even properly counseled, like your sweet patient with the vibrator story. Yeah. They were told you might have nausea and they were premedicated for that. They were told, you know, lots of things, but their sexual health wasn't even mentioned. No. And that's one of the threads in the book is really talking about the history of women's sexual health and how much women's sexual function is blamed or focused on as a way that women need to be controlled and behave. You have scoliosis, you're masturbating. The number of diseases that were attributable to masturbation, it's a wonder like women have even survived.

1:07:22It's kind of extraordinary. I'm like, am I really reading this in a medical journal? And that's why I had to write about it. And I think it really, that legacy absolutely lives on today. We are two times more likely to ask men about sexual side effects from a cancer-targeted therapy than we are women. A guy walks in with prostate cancer. You can be sure the surgeon is talking about his erectile dysfunction. When we give women all sorts of treatment for breast cancer, we're not talking to them about intimacy, and we should be. But increasingly, and certainly at NYU, we have those resources to address women's sexual health.

1:07:53Dr. Mary Claire Haver:It's important. Let me jump back to your new position, where you are now at NYU. What are you proud about? What is different for you than other positions you've held in the past? Well, I've only had one other job someplace else. It is entirely eye-opening to me. That shall not be named. That shall not be named. It is thrilling, exciting to be able to work at a hospital where I have colleagues that care about women in all these subspecialties, under one roof, in one collaborative, thinking about how we research women's health, how we collaborate about women's health, how we change the education for our medical students.

1:08:26NYU is free to all medical students as well, and how we improve the clinical care delivery so that the orthopedic surgeon can talk to the cardiologist, can talk to the gynecologist, can do all the things that will relate to what women want, which is to feel whole in their medical care.

1:08:42Dr. Mary Claire Haver:I love that. All right, now we're going to switch to talking about female physicians versus male. And like, let's preface this. This is not all men. No, not all men, but we're going to talk about statistical differences. Do it. Just pure stats between men and women. So I went digging. It's not pretty. It's not pretty. This is paraphrasing, but you highlight research showing women physicians often spend more time listening, connecting, and this leads to better outcomes. And yet those various skills are not rewarded by the system. In menopause care, I give an hour and sometimes longer for that first visit.

1:09:19Dr. Mary Claire Haver:And there is no way that the insurance system would reimburse me for that the way it's currently set up, you know, for that particular visit. Plus all of the labs, because I'm not just talking about menopause, I'm talking about the next 30 years of her life. So we're looking at, you know, inflammation markers, insulin resistance, you know, kind of all the things. Your checklist is great, by the way. I'm taking that to my Thank you. We worked really hard. I have such a great team. Yeah. Oh, my God. Good job. So thank you. I appreciate that. So here's study. 2024 study published in the Annals of Internal Medicine found that patients treated by female physicians had lower rates of death and hospital readmission compared to those seen by male physicians.

1:09:59Dr. Mary Claire Haver:And number two, the same 2024 study noted that the benefit was even more pronounced for female patients when they were treated by female physicians. And there was a similar study in the surgical world showing that female surgeons had better surgical outcomes, lower risk of death, lower risk of complication than their male counterparts. How does those statistics play into all of your research? It goes back to the history of medicine, I think, where the idea was that doctors cure and nurses, primarily women, care. And yet the system has valued doctors and not the nursing bedside care. And when you translate that and you look at these continuity fields that women are more likely to go into, pediatrics, hospice care, the ones that are psychiatry, where you have to sit and listen with patients, these are also the ones that are paid less.

1:10:49Procedural ones, material ones, where there's something objective that you can hold onto and say, you removed a mole, you removed an organ, whatever it may be, that is often what is valued more. And I think when you look at these qualitative measures of what it means to care for a patient, including this very amorphous word of empathy, This is not what we value in our current medical system at all. There is no billing code for my spending endless amount of time holding a dying patient's hand or spending more time with the patient and connecting with them. If I were to remove a mole, certainly, right?

1:11:21Right. And I think that that really relates to what we value in women in theory, but don't value financially. And it relates to the unpaid labor that women do in so many households, caring for their children, remembering the doctor's appointment, taking extra time to listen to those around them. It translates into these doctor-patient hospital settings as well. It's all interconnected and related. And I think if we valued these more qualitative measures of what it means to be human, what it means to care for the next person, we would have a better society overall. That's just a manifesto. I don't know that I'm going anywhere with it.

1:11:55Dr. Mary Claire Haver:And yet, despite the undervaluation, the bias, the history, I did kind of feel hopeful at the end of the book. So let's talk about that. Let's end on a good note. I'm super hopeful. Yeah. I mean, I love my new job and I'm an oncologist. It's kind of a Debbie Downer of a field, but I love my job. I love the work that I get to do. I love connecting with the patients that I do. I feel like I have the time to do that now. I get to meet incredible women like you. And I feel like we are, despite the political landscape, changing our cultural narrative. and that much like as the history of medicine has showed us, when you change the cultural narrative, you will change these institutions as well.

1:12:34So I am very optimistic and thrilled that you had me on this show.

1:12:38Dr. Mary Claire Haver:Awesome. Well, menopause often feels like society wants us to hit pause, become invisible, slow down, you know, and I don't think you're there yet, I'm guessing, but it's coming. So how are you setting yourself up to unpause when you hit the space of your life? I know you're lifting weights. I am. Yeah. So I had this back injury and I used to be like a crazy runner and now I do kettle boils and I string train and I'm working on my pull-ups. So I've definitely drank the Kool-Aid with, you can tell Vonda, right? I'm in on it. I'm lifting heavy. I don't need hormonal therapy now, but you know, if I need it, I'll, I'll explore it.

1:13:15I think there's also a sense of community too, that women need real community, real connection. And these, this sort of idea that it's, I don't know if you cover this in your philosophy, but that, you know, this sort of effort era that I'm looking forward to.

1:13:30Dr. Mary Claire Haver:We talk about it a lot. Like when we talk about the good things about menopause and there's so, so, so many, but one of the things that women are really, they just love is their filters gone. They don't give a shit about anything. It's effort. They're, they're putting up boundaries. They're putting themselves first because they realize if I don't center myself and make myself the hero of my own story, then who's coming to save me? Well, here's the thing. Here's what's great about your generation is you don't have to wait till menopause to do this. Yeah. Right. I wish I had known that in my twenties, but I kind of am feeling it now.

1:14:04And I'm grateful to be on the shoulders of incredible women like you who are teaching me now to set boundaries, now to kind of pursue what I want. Leave that job and go find one that's going to serve you and your patients. Yes, where you feel valued, right? So we don't have to wait that long, right? We can start doing that work now and find our people and stop apologizing. So I am really grateful for this narrative and for the women that have supported me and said, you know what, like, wear your hair down. It's all going to be OK. Are you scared of menopause? No, not anymore. No, I feel like, you know, we'll get there when we get there and we have the right resources and I'll know who to call.

1:14:40Dr. Mary Claire Haver:Well, Dr. Komen, thank you so much for being on Unpaused. It was awesome having you here today. Lots of love. As a reminder to our audience, you can follow Dr. Komen on Instagram at Dr. Elizabeth Komen. I'd love to hear from you about this topic or anything else that's on your mind. You can find me on Instagram at Dr. Mary Claire and get honest, accurate information on health, fitness, and navigating midlife at thepawslife.com. If you're loving this podcast, be sure to click follow on your favorite podcast app so you never miss an episode. While you're there, leave us a review and be sure to share the show with the women you love.

1:15:18Dr. Mary Claire Haver:We would be so grateful. You can also find full episodes on YouTube at Dr. Mary Claire. Unpaused is presented by Odyssey in conjunction with Pod People. I'm your host, Dr. Mary Claire Haver. The views and opinions expressed on Unpaused are those of the talent and guests alone and are provided for informational and entertainment purposes only. No part of this podcast or any related materials are intended to be a substitute for professional medical advice, diagnosis, or treatment. Stitch Fix. Shopping is hard. Let's talk about it. I don't have time to shop for clothes. I have to buy everything in three sizes to find one that fits.

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