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How medicine has failed women, with author Elinor Cleghorn

This week Dr Louise is joined by feminist cultural historian Dr Elinor Cleghorn, author of Unwell Women, which unpacks the roots of the misunderstanding, mystification and misdiagnosis of women’s bodies, illness and pain. From the ‘wandering womb’ of ancient Greece to today’s shifting understanding of hormones, menstruation and menopause, Unwell Women is the story of women who have suffered, challenged and rewritten medical misogyny.

Elinor tells Dr Louise how the book draws on her own experience of being dismissed by doctors for years before finally being diagnosed with systemic lupus, an autoimmune condition which is nine times more prevalent among women than men. Dr Louise and Elinor also discuss how women’s health, including menopause, has been viewed through the ages, and the misconceptions that need to be consigned to the history books once and for all.

Follow Dr Elinor on Instagram @elinorcleghorn

Click here to find out more about Newson Health


Dr Louise Newson: [00:00:11] Hello, I’m Dr Louise Newson, I’m a GP and menopause specialist, and I’m also the founder of the Newson Health Menopause and Wellbeing Centre here in Stratford-upon-Avon. I’m also the founder of the free balance app. Each week on my podcast, join me and my special guests where we discuss all things perimenopause and menopause. We talk about the latest research, bust myths on menopause symptoms and treatments, and often share moving and always inspirational personal stories. This podcast is brought to you by the Newson Health Group, which has clinics across the UK dedicated to providing individualised perimenopause and menopause care for all women. So I’ve been incredibly excited about this podcast. I felt like it was Christmas this morning when I woke up because I’ve got with me in the studio a well-known author called Elinor Cleghorn, and I’m going to hold up her book, which is very well thumbed. It’s got lots of pages turned down, and it’s called Unwell Women. And I read it a while ago, in fact, when it first came out in paperback, and then I reread it recently because I was on a long flight to Australia and I wanted to just have uninterrupted time, and I just felt very cross. I felt really sad and I felt like I just wanted to shout the pages out to everyone on the plane or anyone that would listen. And now we’ve got Elinor in front of me on the podcast, so that’s why I’m very excited. So thank you so much for joining me today, Elinor. [00:01:48][97.5]

Elinor Cleghorn: [00:01:49] Ah, thank you so much for having me and for such kind words about the book. [00:01:52][3.3]

Dr Louise Newson: [00:01:53] Well, it’s very interesting. So I tell you, I used to be a prolific reader, and then I started to do menopause work, and I’m a bit swamped with work at the minute. And I really regret, I don’t regret much because there’s not much you can change from the past, of course, but I do regret, like not reading as much as I do. And that’s just because I need sleep and I train myself to sleep les but I still need to sleep. But when your book first came out in paperback not that long ago now, but I, I started reading it and I only read the first few pages and then obviously went to sleep. But I just thought, oh, this is so true. This is so right. But if I’d read it ten years ago, I might have thought it was quite sensational sort of writing. But now I’ve listened to thousands of stories. This 2023, 2024, this might come out, but it’s still like resonating now. Every single word. And that’s what really saddens me, actually. So actually, to read it as a whole, I found, was very enlightening because you’re aware of all the characters and you talk about history so well. But even just reading about Mary, who was incriminated, because of you’ve written her… She was hanged, wasn’t she, that you said she was incriminated because of her age, bodily appearance, low social status and temperament, and she was probably menopausal. And just listening to that. There are women all the time that are not being listened to, I wrote an article in the Times about medical gaslighting. But how is Mary still happening now? And this is something that we can talk about. But so just tell me a bit or tell the listeners a bit about the book and what it does and why you even decided to write it? [00:03:40][107.7]

Elinor Cleghorn: [00:03:41] Of course. So it’s really interesting what you just said about the stories in this book might have seemed quite sensational or sensationalised ten years ago, because I was diagnosed with an autoimmune disease called lupus that affects…90% of sufferers globally of that disease are women. And when I was diagnosed, this is in 2009. So after my second pregnancy, which was a very complicated, medically complicated pregnancy, I didn’t know really anything about gender discrepancies, disparities in the treatment of women’s health conditions across the lifecycle. Like, I didn’t really know that this was a huge systemic political issue, and I’d been really unwell throughout my 20s with, you know, mysterious aches and pains, a lot of joint pain, a lot of really classical symptoms of autoimmunity. And every time I went to see my GP to try and get some answers, I was dismissed with a very sort of typical, but you are a young woman kind of answer, like, well, you must be stressed. You must be, you know, the blanket word you must just be hormonal. You must be not looking after yourself. You must be paying too much attention to your body, is one of the accusations I had. And so when I after I was diagnosed with lupus in 2009/2010, I began to really think about why it had taken so long to get this answer about my health and why the answers really only came when I was pregnant, why was suddenly valuable, and all these kind of questions were circulating in my mind. At the time, I was doing my PhD in feminist history, so it was my impulse to look backwards to the past, to understand where we are in the present moment and where we might be going to in the future. And I started just looking into the history of lupus. And what you said earlier is absolutely true, because I started finding case studies of young women patients diagnosed with systemic lupus in, say, 1900. And reading the studies of these patients and seeing that very often they’d suffered through years of undiagnosed rheumatic pain. Very often it was documented that they were very emotional or that they had a lot of anxiety and then eventually realised that they had a disease, that then was predominantly a skin disease, lupus, and lost their lives to it. And I thought, well, why have we progressed so exponentially, you know, at the laboratory bench in the last century, over the last more than a century. But yet the fundamental attitudes that say that the pain of a young woman, the pain of a woman throughout every stage of her life cycle is not worth listening to, is not worth taking seriously, is worth just sort of parcelling into her gender, her femininity. You know, it’s just a symptom of being a woman rather than information that can be used by a medical professional to answer questions about her body that might then improve her life or enable her to live her life. So that was the germ, if you will excuse the pun of Unwell Women. And I wrote the book pretty much across the first tranche of lockdowns during the pandemic and a very sort of intense flurry of research, but it really felt like it had been a history that I’ve been thinking about, yeah, since about 2010. It was something that I was working towards, that I really wanted to tell this story of, not just what was happening in the present, with the dismissal and denial and misunderstanding that circulates around the pain and illnesses and health conditions of women, but also why, you know. Why are we in this situation now? You know, in 2020. [00:07:37][236.0]

Dr Louise Newson: [00:07:39] Absolutely. And I think when you know the history, it puts now even more in context. But it makes it even worse as well, if that makes sense. And, you know, when you you’re talking about some great physicians and researchers in the book and there are names that I’ve always respected, so you talk about Sydenham and talk about Brown-Séquard and people like Sims who created the Sims’ speculum, names that I learned in a very positive way. Yeah. But then I learned about some of the things that they did to women and how they were just mislabelled, and even this sort of, you know, thinking back about… and I understand when we didn’t have the research, but how the womb, our wombs were controlling our body. And also just this whole thing about, you know, hysteria, the word hyster derived from womb as well. And it took a long time to realise that it wasn’t our womb it was these hormones. But even when they did try and work out, they still didn’t believe that it was any neurological symptoms were associated. And even in 1895, they found that removing the ovaries induced a menopause. But they still now people are having their ovaries removed and not having hormones to replace. And then they described how awful it was for these women, especially the psychological symptoms. And even, well Brown-Séquard was injecting extracts of pig ovaries, wasn’t he? So he must have been thinking there’s something about the ovarian… some women got better, some didn’t. Pig ovaries, slightly different to our ovaries. But it’s also what surprised me and it surprises me now, actually having been a patient as well as a doctor, as a patient you are very vulnerable and you’re so keen to be better that you’ll do anything that a doctor will tell you to. And reading about Brown removing the female clitoris to try and cure hysteria, that shows how desperate these women were to get better, and actually how controlling these men physicians were to even think that actually, it was so degrading for a woman to touch her clitoris that it had to be removed. It’s just, there are so many levels. [00:09:57][137.3]

Elinor Cleghorn: [00:09:58] Yeah. There are. You’re completely right that also many levels because I think what it meant to exist in a female body in, you know, the late 19th century, during the sort of height of the kind of professionalisation of gynaecology and of obstetrics, when there are an awful lot of sort of gentlemen doctors trying to forge their reputations on curing these mysteries of the femaleness of womanhood, that, of course, we now understand what is at the root of many different complaints that existed then and disorders that existed then. But of course, what also compounded the treatment of women in, say, the 19th century were a whole raft of social and cultural beliefs about what women were and what they should do with their bodies and how they should behave. So the sort of ideas for curative procedures, such as the horrendous Isaac Baker Brown, who promoted the idea of removing the glands of the clitoris to cure so-called hysteria. He was undoubtedly barbaric. But there was also, what he was doing was underpinned by this sort of fervent belief he had that female sexuality was at the root of all kinds of illnesses from, you know, extreme menstrual pain to, you know, things that we might now diagnose as multiple sclerosis or other forms of neurological disorder. So it’s fascinating the way that those kind of contemporary social and cultural ideas of each sort of epoch, of each historically era really shaped the way that these advances were made and the way that these procedures were used. [00:11:43][105.9]

Dr Louise Newson: [00:11:44] Yes, absolutely. And it was very interesting because even early on, they’re talking about, you know, not challenging the research that was there and it being a very male dominated space. I mean, even when you wrote about Sophia Jex-Blake the female surgeon and the Edinburgh Seven and how hard it was for her to become a female doctor, and also just this hierarchy of medicine as well. So you talked and written a lot about these male gynaecologists. And when Sims speculum, when they could examine a woman’s cervix, this control that they had because they could visualise part of the anatomy that wasn’t seen by others from the outside. And there is this sort of control nature of medicine that I feel that a lot of my work, I challenge a lot because I’m not a surgeon, I’m not an anaesthetist. I don’t have that control. You know, when my husband’s got his scalpel in his hand, he absolutely has control of that patient. Quite rightly so. If you’re putting someone to sleep, you need to be in control of that patient. But actually, my work is about communicating and sharing decisions and uncertainty and risks and benefits and allowing choice. So it’s very, very different. But that actually gets quite challenged quite a lot by the patriarchal way medicine is. And you know, I’m ‘only’ a GP and I say only in inverted commas because I don’t think I’m stupid. But for many people I’m not a hospital consultant. So therefore I am an inferior doctor. But that was going on in the history of time, and God forbid I’m a female doctor as well. I don’t think that has really changed has it, the perception of who women are and how they can be as medics? [00:13:32][107.2]

Elinor Cleghorn: [00:13:33] That’s so fascinating, the idea that, you know, the one that wields the scalpel is the one that has control. It’s so interesting because throughout history, when surgery began to be rather than a sort of barber, literally something done by barbers, and it became a professional set of expertise, of course, women were completely barred from learning the medical theory that would enable them to use surgical instruments. So there’s always been this sort of gendered hierarchy written into the history of surgery. And I think when surgery was from the kind of medical enlightenment in the 17th century, when surgery became, you know, part of medicine proper, began to be part of medicine proper. There was this real sense that surgeons could see, they could get under the skin. So they see, as you say, they could see inside the body in ways that the body had not been seen inside before. And so I think it’s so fascinating that you bring up that hierarchy between, you know, the objective knowledge, so-called objective knowledge that can be acquired from cutting and going underneath the skin and looking at organs and repairing them and visualising them. And then the other kind of knowledge, which is so often undervalued but should never be, which is communication and listening and sharing information and understanding who a person is, not just in terms of their organs and processes, but in terms of who they are as a human being. And I think that, if I can say it, more feminised side of medicine has what has been undervalued. And of course, it’s what’s often dismissed in women patients is our speech, our stories, our tales about our bodies. [00:15:22][108.7]

Dr Louise Newson: [00:15:23] You’re absolutely right. And it’s interesting because I of course, I don’t know if, you know, I’ve got a pathology degree. So I’m very interested in science but I also have done a lot of hospital medicine. And so I was taught how to pick up a diagnosis quite quickly from a story and an examination and sometimes an investigation. And then I went into general practice, and then I really learned the art of communication and consultations. So in medicine, it can be very frustrating if you can’t fulfil this diagnostic criteria. So if I see someone and they haven’t obviously got a disease that fits into this pattern, or I give them the first line treatment and they don’t get better and and general practice taught me a lot about how to deal with uncertainty and share uncertainty with patients, which is good. But now, fast forward, I’ve done seven years of pure menopause work, I’m listening to stories every single day. I don’t know where I would have before thought, well, that doesn’t fit into a diagnostic criteria. It doesn’t fulfil clinical depression, it doesn’t fulfil a certain condition. But actually now I’m thinking, yeah, no, they’re menopausal it’s due to their hormones. And actually these symptoms where before when women would have said, oh, I’ve got total body pain or I’ve got these restless legs or I’m itching all over, or I’ve got this burning mouth and I’m thinking, what? I don’t know what what’s going on. Now I’m like, yeah well it’s probably related to your hormones. And, you know, every day we see women who have been under psychiatrists and they’ve been diagnosed with treatment resistant depression or bipolar or schizophrenia. They’re on all these heavy duty drugs, but they’re also menopausal. So we rebalance their hormones and then they say, oh, I’ve never felt this good in years. And actually I don’t need the antidepressants and the antipsychotics and the lithium. And then you see this woman appear. It sometimes it can take a few months or sometimes a year or so in some cases. And they’re completely transformed. And the first time it happened to me in a big way was a young lady who’d really struggled with many symptoms. She’d been going back and forth to her doctor who just said, oh, no, your heart scan is fine, your brain scan is fine, your bladder scan is fine, your X-rays are fine. Look, there’s nothing going on. It’s chronic fatigue. It’s fibromyalgia. And she saw me because she was getting period changes and she’d had lots of blood tests. The hormone levels were fine, but they’d only done certain hormone levels. And I said, well, I don’t know whether it’s due to your hormones, but let me give you some hormones, because if you have got an early menopause there’s risks to your health if you don’t have hormones. But I don’t know whether it’s associated to any of your symptoms. And when she came back three months later, she looked very different. Just the way she dressed, the way she moved, the way she walked in. But then she burst into tears and I thought, oh dear, what have I done? And she said, I can’t thank you enough. You have transformed my life well, but I’m so sad because my last eight years could have felt really different. And I’m never going to get that time again. And I hear that every single day in my practice when I see patients. And so I’m reading a book and thinking, do you know what loads of these women, why wasn’t anyone thinking about their hormones? And then we had a little snippet in your book when Robert Wilson wrote that book, Feminine Forever, which I have read, and actually my mother in law has read it when it had just come out. She’d ordered a copy. She had a hysterectomy, she had some cysts on her ovaries. My husband was 18 months and he’s now 53. So it was a long time ago, and she had this dark cloud all over her for a whole year. She felt very low, very flat. She’s a very positive person. She had no reason to feel negative. She had three children, her husband was a GP and she read about this book Feminine Forever and she got it ordered. She read it and her husband Alec came home and she said, Alec, I need some oestrogen. And he went, what? And anyway they gynaecologist in Birmingham, she took some oestrogen and within days the cloud lifted and she felt amazing. Age 86, she’s still taking oestrogen and feels great and her health is amazing. Now her sister sadly a couple of years later, had a hysterectomy and had a really horrible boyfriend and everyone blamed her low mood to her boyfriend. And sadly, she took her own life a year after her hysterectomy and to this day, Kay is thinking could it have been her hormones? And Robert even wrote on the front cover of the book that the menopause shouldn’t really be a thing because everyone should be treated and there is preventative treatment in hormones. The problem with the book is it was all about, well, not all, but there was a bit about sexuality. And, you know, women can be more sexy for their husbands if they take this. And then he was paid by pharma. But actually he was right because he talks about this transformational nature of hormones. And what I find really weird though Elinor is that our hormones are biologically active in our body. They affect every single cell in the body. Yet for the last, however many years since they’ve been really when they were first researched nearly 100 years ago in the 1940s, what we’ve all been trying to do is try and stop women having hormones. It’s like it’s the most unnatural thing to have our hormones. Whereas we can have SSRIs, we can have antidepressants, painkillers, we can have sleeping tablets, we can have all these other medications and even the new draft menopause guidance with NICE are actually recommending CBT as an alternative to HRT. [00:20:53][330.0]

Elinor Cleghorn: [00:20:55] Yes, I’ve read this. [00:20:55][0.2]

Dr Louise Newson: [00:20:55] I was reading, someone just texted me a bit of it just now and I’ll just read you this bit. It said: ‘CBT would benefit the NHS because people may not need other treatments, which would require regular reviews and ongoing prescriptions such as hormone replacement therapy’. So it’s like, oh, these women are a pain. They’re a nuisance because we need to review them. We need to do a prescription. But actually what we’re giving them on prescription? We’re giving them some natural hormones because they’re hormone deficient. Is that such a bad thing? [00:21:27][31.5]

Elinor Cleghorn: [00:21:27] I think what you say is so interesting about, like, you know, we’ve had all this information for a long time, you know, even before endocrinologists knew what the word hormone was. Even back when endocrinologists were looking at the glands and the role of the glands and the sort of essence of what it means to be human. Even back then, there was this idea that women are so sort of fussy, that women are essentially these kind of fussy burdens. And like you say this word burden, these burdensome beings who need to sort of be constantly attended to because they’re so variable and it’s the same story, the same fiction that has been going on since ancient Greece is that women’s bodies are unruly and unmanageable and better just to quieten them down than really think, okay, well, that’s actually quite a simple solution to this, right? So better to quieten them down, better to keep them out of the way, better to silence them then to really think, you know, to separate these sort of antiquated ideas about women being burdens, pains, you know, who needed to be tended. That is the fiction. Once we separate that bit from the objective knowledge, then, you know, this is the problem, these stories and myths about women being so difficult medically are really what I think what holds us back and that’s what they are, they are myths and they have really no place in the kind of care of women in, you know, at this point in our history we should and this is what I always wanted to do with the book. I wanted to say, look, we need to learn from this history about the way that these kind of falsehoods and these stories about women, women’s bodies are, continue in the present moment to impact the kind of care that we get and to really put obstacles in the way of the care that we deserve, which is a lot simpler than, you know, much medical sort of storytelling would have us believe. [00:23:27][120.1]

Dr Louise Newson: [00:23:28] Absolutely. I was doing a talk recently about the role of hormones and wellbeing and, you know, looking at wellbeing, feeling well, is that such a bad thing? And as a doctor, I want to prevent disease. I want people to feel well. But actually, you know, you write about you also in the book about how, you know, in the 50s, 60s, even earlier, ‘mother’s little helpers’, people were given barbiturates. They were given benzodiazepines to quieten them, down, make them more, more invisible as well. But actually then they will be really good and happy for their husband. They can give them their support when they come home. And I saw one advert for some barbiturate-like substances, and there was a picture like someone was behind a jail and each part of the jail, you’ve probably seen it, there was a broom, a broom handle was one of the bars and women were prisoners to their own home. And I see this now. I speak to a lot of women who have this catastrophic anxiety. They won’t go on the tube, they won’t drive, they won’t go on the bus. One lady told me that she just physically vomits, thinking about packing her suitcases to go on holiday. [00:24:37][68.7]

Elinor Cleghorn: [00:24:37] That’s awful. [00:24:37][0.0]

Dr Louise Newson: [00:24:38] But I know it’s related to hormones because when I see them three months later, they say, wow, I’m driving, I’m flying, I’m packing. I’m absolutely fine again. But we forget the power of humans in our brains. And the other thing that I only found out recently, which is ridiculous, as a menopause specialist, I don’t mind admitting my insecurities and lack of knowledge, is that our hormones oestrogen, progesterone, and testosterone also get produced in our brains. So they’re not just produced in our ovaries as well. [00:25:04][26.2]

Elinor Cleghorn: [00:25:04] That’s fascinating. [00:25:04][0.0]

Dr Louise Newson: [00:25:05] Obviously our levels are lower when our ovaries don’t work. But it is so fascinating when we think about, you know, the menopause has always been a period problem or a womb problem or a fertility problem, but actually I think it’s more of a brain problem, actually, because if we don’t get these hormones in our brains, they’re neurotransmitters, and also in our bodies, they’re anti-inflammatory, that’s why we’ve got this increased risk of diseases. But if you look, even in the 1800s when they were describing menopausal women, it’s always about their mood. I know they thought it was about periods, and there were times when they used to draw blood from us because they thought that was a good treatment to improve our mood, because with a period people feel better. And we think about PMS and PMDD. People often do feel better when they have a period because their hormone levels start to come back. And that’s the same now almost. We’re fixated on women’s periods, rather than what’s going on in their brains, and the commonest symptoms of the menopause affect our brains. [00:26:08][62.6]

Elinor Cleghorn: [00:26:09] That’s so fascinating because, again, embedded into the very, very foundations of Western medicine is the idea that the period in a woman is so essential for her general health, not just physical, but also psychological and emotional. And in the Hippocratic writings, which are always seen as the sort of foundation of our modern medical complex. They would often talk about how menstruation could be suppressed in women, and if it was suppressed, then it would produce all these terrible symptoms, which always included really extreme emotional disturbance, really extreme kind of mood disturbance. So it’s really embedded…because when you look at it with this sort of long lens, it’s just extraordinary, isn’t it? [00:26:57][48.7]

Dr Louise Newson: [00:26:58] Absolutely. And you’re totally right. But when people don’t have periods, it’s usually because they don’t have hormones as well. And I was talking to a 30-year-old a couple of days ago who has a good job. She’s bright, she’s done well, but she’s been given this injection which blocks hormones because she’s got endometriosis and they don’t want her to have any hormones in her body. So they’ve given her this injection of something called Prostap and she said, I just can’t function and think. She said, I look at everyone else and think, why are they so clever and I’m so stupid? And I’m just like, hang on a minute. Have they given you any other hormones back? No. They said I’ve got to do this for a good year, and then they might either continue it or they might consider surgery, but they don’t want to do surgery because there’s a really long waiting list. And I said, but normally when we give that injection, we give add-back hormones at a constant level because a fluctuating level of hormones can trigger endometriosis. But to actually just basically… it’s the same as castrating someone. You’re just basically stopping all hormones in their body. Like what other area of medicine would you stop something that has biologically active roles in the body. It doesn’t make sense. But women are having to do it because they haven’t got a choice. [00:28:10][72.5]

Elinor Cleghorn: [00:28:11] That’s incredible. But yeah, there’s the centring of the womb being the sort of the only important organ and set of related processes in a woman that is kind of, throughout history, really skewed the way that the information that has been gleaned about how women’s bodies work, even though the information is there, it always comes back to the period, it always comes back to the womb. Rather than thinking, okay, what information do we have here that you have someone experiencing, you know, psychological and emotional distress, chronic pain, but what it sort of it all then comes back to this, you know, the womb, this sort of central, central organ, even though the information is there. But that’s that’s, yeah it’s extraordinary. Yeah. Really, really extraordinary to look at it just to look back. [00:28:57][45.8]

Dr Louise Newson: [00:28:57] It is. And it actually it’s all there. So I sometimes, I play lots of mind games, but I think if I was an alien from outer space, knew nothing about women’s history, knew nothing about biology, nothing about physiology or pharmacology. You would just talk to people, wouldn’t you? And if you had lots of people telling you, oh, when I have a period I feel a lot better, or when I’m pregnant, I feel great. You think, well, what’s different then? Well, the only difference is they’ve got high levels of hormones when they’re pregnant. So is it bad that women feel better because they have hormones? Even if we’re not thinking about the health benefits? And actually, I don’t think it is that we feel bad, but we’ve been made to feel that we shouldn’t feel well. And it comes back to the title of your book. [00:29:39][41.8]

Elinor Cleghorn: [00:29:40] But what is it, I wonder? I have a question for you. I wonder, you know, there’s of course, an enormous debate and even stigma and conversation constantly about whether we deserve them, you know, whether we deserve testosterone prescribed on the NHS. You know, I remember there was a furore, I think, a couple of years ago, about women being prescribed testosterone on the NHS. When you look at the numbers compared to the amount of men who are prescribed Viagra on the NHS. Right. And it’s, there’s such turmoil around just the concept of whether hormonal therapies are safe, whether they, you know, that it’s such an inflammatory question like why is it that it’s so, that this medicine, this often lifesaving medicine, is so sort of shrouded in this contention all the time? I mean, I think I know the answer that, you know, it’s because it’s considered the most important thing in the medical kind of vision of women is of reproductive potential rather than our general wellbeing, as you say that word, that it’s so important but so often dismissed that our wellbeing, our ability to think and enjoy our lives and be free of pain. But, you know, this idea of sort of tending to that when our so-called reproductive potential is over. Is that part of the sort of issue that we have, the controversy around this? Because it seems, you know, I would love, like how much…it just seems so important and at the root of so many other chronic conditions and health disorders that, you know, why is it mired in so much… [00:31:24][103.5]

Dr Louise Newson: [00:31:24] Well, I think it’s really interesting… [00:31:25][0.9]

Elinor Cleghorn: [00:31:25] Hysteria. [00:31:25][0.0]

Dr Louise Newson: [00:31:25] Yeah, it is. And I spend a lot of time trying to think of it because someone I was lecturing, some doctors yesterday, they said something about controversial use of testosterone. I thought, hang on, what’s controversial about using testosterone? What is controversial about allowing women to have their own hormone back? I really don’t see a problem, actually. And even if you just look at libido, which can affect, you know, a good 25% of women who are in menopause or have HSDD, hyperactive sexual desire disorder. Bit of a mouthful. If you look at the criteria for diagnosing that, not only do women have to have reduced sexual desire, but they have to be severely psychologically distressed with it, and they have to have had it for at least six months. Now as a caring clinician, am I going to wait until my patient’s severely psychologically distressed when I know there’s a treatment that might or might not help? But it’s a bit like if you came to me with a headache. Paracetamol might or might not help, but we’ll try it and see. Like I don’t really understand whereas if I was a man and I had HSDD, when in fact they don’t have the same diagnostic criteria for a start, but I would just get my credit card out and go and buy some Viagra, which isn’t even a natural hormone. I just think your book has revealed things that hasn’t actually moved on. There’s this paternalistic medicine, there’s this medical gaslighting. Women are not able to be believed, this hierarchy of medicine where people like being in control. And there’s this lack of moving on from…no-one’s challenging the research, which is actually rubbish research anyway. You’re very clear, and you’re absolutely right. The menopause is under-researched, misunderstood and shrouded in misconceptions because people are forgetting basic biology. And that’s partly because a lot of people have been controlling the menopause base, have been gynaecologists who only think about the womb and the ovaries. And that’s because it’s a multi-system disorder that affects every cell in our body. So we need doctors who are used to looking very holistically. So there’s a huge amount that we need to do. But and I’m very grateful for your time, and we could talk for a lot longer, but I really recommend that people read the book, and obviously I read it well, re-read it in one sitting, but I got more out of it than dipping in and out. But anybody can just dip in and out and there’s so much more I want to talk to you about it and I’m very grateful for your time. But before we finish, I just like to end on three, I always ask for three take home tips, but I would like to ask you three things that you think have been the most outrageously sad, actually, and frustrating things that you’ve learned by writing this book. [00:34:09][163.4]

Elinor Cleghorn: [00:34:09] Wow, I would say. Oh, that’s such an interesting question. I think number one. So okay, there’s so many. Number one, I would say the rush to remove parts of women’s bodies in order to cure them of social dysfunctions. So we talked a little bit earlier about the terrible, barbaric clitoridectomy. But the same can be said of ovariotomy and hysterectomy, which were often used indiscriminately, especially in the 19th century as so-called cures for essentially women not toeing the kind of domestic line, not being ideal, you know, Victorian wives and mothers or expressing, you know, desires to live and enjoy their lives that weren’t sort of within the bounds of, you know, acceptable womanhood at the time. So I would say that the sort of rush for surgical solutions for women’s so-called ills was incredibly shocking. And I talk about it quite a lot in the book. You touched a little bit on James Marion Sims. So my second is James Marion Sims, an American gynaecologist from the sort of early mid 19th century who developed one of the models of speculum that is very popular and continues to be used. And he also developed a procedure for vesicovaginal fistula, but he did this by experimenting on enslaved young women without anaesthesia, and they had no choice in the matter because they were not seen as being fully human. That’s incredibly shocking. And, you know, I think by telling the stories of where these medical advances actually come from, like who was involved in producing this knowledge, we can begin to see a different side of history and return some dignity and respect to these women that they were not afforded at the time. So those are two and I think just number three would be that we are still battling so many of these biases, prejudices and stigmas today, even though we have the benefit of hindsight, even though we have the benefit of so much medical information and stories from medicine’s history. One of the things I often say when I’m asked about how I wrote the book is that writing about medicine’s history is brilliant because it’s such a well documented field. I mean, what’s a gift to a person who’s interested in writing medical histories is that there’s an enormous amount of textual material. There are case studies, there are textbooks. And to see the sort of evolution of that over our history really brings home how women were seen, how women were addressed, how they were spoken to, how they were regarded. And then we think about where we are now with continued issues around medical gaslighting, around the diminishment, continual diminishment of women’s pain and other symptoms, all symptoms in fact. And, you know, as you more than well know, the continual kind of battle that we have around being respected and given, you know, the dignity and humanity that we deserve around perimenopause and menopause. You know, this is a full stage in our lives. It’s important, and we should be able to live it with every, you know, bit of vibrancy and health and enjoyment that we can, you know, being able to enjoy our lives and living to the fullest is not, you know, a massive ask. It should be a human right. And it’s so linked, I think, our hormonal health going forward, you know, into our, that sort of latter part of our lives is something that we more than deserve. So yeah, so that’s the third shocking thing that we are still today having to deal with this nonsense that was sort of haunting us, you know, back in the Middle Ages, back in the ancient Greek times. [00:38:10][240.4]

Dr Louise Newson: [00:38:10] Absolutely. I couldn’t agree more. And I couldn’t be more frustrated and more sad by the injustice to women, by not allowing them to have the right treatment is so true and there’s so much we need to do to change that. But thank you so much for your time today. I’ve really enjoyed it. So thank you. [00:38:28][17.1]

Elinor Cleghorn: [00:38:28] Oh thank you Louise for your brilliant questions. It’s real pleasure to talk with you. [00:38:32][4.5]

Dr Louise Newson: [00:38:37] You can find out more about Newson Health Group by visiting and you can download the free balance app on the App Store or Google Play. [00:38:37][0.0]


How medicine has failed women, with author Elinor Cleghorn

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