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

These doctor-patient relationships reflect our culture and our society. And women notoriously apologize. And we have absorbed tremendous shame about our bodies. It isn't just people with, you know, poorer access to healthcare. This is some of the most powerful, incredible royalty, literally people that we've seen. And it is this common thread no matter where you're from, no matter what you do, no matter how much money you have, no matter what your resources are. I guarantee you almost all women in a doctor's office will apologize for something about their body. And I think that it's terrible. The views and opinions expressed on unpossed 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 a professional medical advice, diagnosis, or treatment. So let me set the stage for you. I am head down deep into research for my own book, The New Perry Metapause. And I come across a clip on social media where I saw our next guest. Dr. Elizabeth Komen being interviewed about her book, it's all under head. And what I heard her say in this clip left me literally speechless. Hearing another physician speak with such clarity about her own story and her patient stories and about the systemic marginalization of the female experience in medicine was absolutely earth shattering. I immediately ordered the book. When I started reading Dr. Komen's book, I was stunned. She didn't just tell the stories of her patient. She lays bare the history that is shaped medicine itself. The biases, the blind spots, the outright misogyny that still haunt exam rooms today. And what struck me the most is that she wasn't just talking about the past. She showed us how the very structure of modern medicine, the way it was built, brick by brick, still perpetuates those same patterns. I'll be honest. It took me over a decade of practice to realize just how deeply this is embedded in the system. For so long, I thought the gaps were individual. A doctor who didn't listen here, a misdiagnosis there. But the longer I practiced, especially in the space of menopausal women's health, the more I saw that this wasn't about a few bad apples or a rare oversight. This was structural. It was baked into how we were trained, how research is conducted, how curricula are written, how the guidelines are weaponized, and how women are too often dismissed, minimized or told their symptoms are all in their head. That's what makes her message so powerful. Dr. Komen names what so many women have felt but couldn't quite articulate. She connects the dots between history, medical culture, and the lived experiences of patients today. And in doing so, she validates what millions of women know in their bones, that the system is failing them and has been for generations. Today, I am beyond honor to have Dr. Elizabeth Komen here with me. We're going to talk about her groundbreaking book. It's all in her head. What it reveals about medicines past and present, and what it will take to build a future where women's health is valued, respected, and truly seen. I'm Dr. Mary Claire Haver, a board certified obstetrician, gynecologist, and certified menopause practitioner. I'm also an adjunct professor of Stetrics and Gynecology at the University of Texas Medical Branch. Welcome to Unposed, the podcast where we cut through the silence and talk about what it really takes for women to thrive in the second half of life. All right, so Dr. Elizabeth Komen, welcome to Unposed. Thank you so much for having me. I am thrilled to be here. I am so happy you're here. You are one of my top, top, top 10 guests that I wanted on because I'm obsessed with your book. Thank you. Every time I see you on social media or on the New York, you know, reading about you in the New York Times or you on a morning show, I'm like, there she is. That's my girl. I can't wait to meet her. So let's go backwards. Talk to me about where are you from. I am from Brookline, Massachusetts, which is a separate book, Boston. Very nerdy, liberal, granola kind of town. And did you always know you want to be a doctor? I wanted to be a dancer when I was younger. That's the true. Me too. We're an actress. Like, literally, like, placed in drama competitions on a national level. I was traveling all over. I was in plays. I was in a movie. Yeah. Wait, I didn't know this about you. This is amazing. Okay. And then Taylor Hackford, director back in the day, screamed his head off at me and made me realize maybe this wasn't my path. Yeah. And I decided to switch my major to geology of all things. And my undergrad is in geology. Wow. Well, you're always uncovering things. And you're our rock. I also loved science. And my mom is a therapist. My dad is a lawyer. So I kind of grew up in this very questioning household. And I wanted to be an authority in something. And I ended up me dreaming in the history of science in college. Okay. And I sensed with your advice. And so I was really fascinated by not only scientific discovery in the present, but the context within which science and medicine happens, the history, the culture, the stories that we've been told ourselves, and how that plays into discovery and advances. Because we know it doesn't happen in a vacuum. Undergrad degree. Yes. And you get right into med school. Did you take time off? Did you... No, I was always a very type A person. Now I don't know what type I am, but it's all over the place. But I was definitely very focused. In fact, when I was in college, I had worked with breast cancer patients at Dana Farber Cancer Institute, helping them with wigs and breast prostheses as part of a look good feel better program. The same time, my aunt was diagnosed with breast cancer. And I started talking to these experts. And I ended up working in a lab, looking into the external receptor and breast cancer. And I was so fascinated by the biology, but yet I always wanted to get off on the floor where the patients were. Mm-hmm. And I never really wavered in that interest. Okay. So then, where'd you go to med school? So I went to Harvard for undergrad majored in the history of science. Then I went to Harvard for medical school. And then I had to leave preparation age in Boston and spread my wings. And they had better dance classes in New York. So I did my residency at Mount Sinai, and then my training and oncology and my fellowship at Memorial Sloan Kettering Cancer Center. Okay. So you stayed all the way through. All the way through. I never... I became a New Yorker. And now I'm at NYU, which I'm thrilled to be at. And I am co-directing their Minioni Women's Health Collaborative, which is looking at women's health in its entirety. We have a very large audience, okay. Succeeding and watching. And a lot of them are going to be survivors, pre-vivors, been told their high risk. How are they going to beat down your door? How do they find you? Oh, well, you can make an appointment at NYU. Yeah. Okay. Yeah. So... And I'm available as are my colleagues, my amazing colleagues. Thank you. From your undergrad, you knew oncology was your path. Like, zero percent chance I was going into oncology. I wanted a happy field. I wanted a field where I was, you know, surrounded by joy, turns out, OB-GYN is not always joyful. And there's definitely tragedy. But I find it very interesting that you would be drawn to something like that. Because taking care of a cancer patient isn't easy. Yes. I think there were a couple of things that went into it. And it relates to my interest in the humanities and history and literature. Is that oncology is one of those fields that really throws into high relief. What does it mean to be alive? And these big, existential questions. And it makes you kind of dive into the narrative stories of who people are in the experience of illness. And that has always drawn me to medicine. And getting to know women, getting to know their stories, what their passions are. Because when people get diagnosed with cancer or they're living with cancer, their afraid cancer is going to come back, it really brings up what are you living for? And I am drawn to those conversations. I think when I was younger, I never imagined what it would be like to take care of that young mother dying of disease. Or that older woman that has so much to live for. And there is a lot of death and dying in sadness. And I don't think I was fully prepared for that. On the other hand, someone in medical school once asked me, you know, and I had an interest in sports medicine as well. If you were diagnosed with something, who would you want? If you were going to be your doctor, what would you be diagnosed with? And of course, I don't ever want to be diagnosed with breast cancer. But I thought I would not want me operating on me. I would be like, looks good enough. Like, move on. Okay, I thought I could be in the trenches when it really goes down. I just don't think I imagined the burnout that comes from that too. Let's talk about your book a little bit. I understand now because when I started reading it, I thought, she's busy. The, you know, oncology as a profession is not 9 to 5 as much as you want it to be. You know, you're busy. I read that you had three kids on the flap. I'm like, when did she ever have time? Because this isn't an extension, not necessarily of your work. Like, when I wrote the new metapause, I was living it, breathing it, drinking it, researching every single day for my patients because we didn't have anything. Right? But now that you've explained your undergraduate degree and you've always had an interest in this, so did you get any pushback when you... Who did you tell? I'm going to write this book. The truth is, I'm so honored to be here because you are one of the people that has really been such a disruptor and bringing women's health and the issues that we haven't talked about for so long to the forefront to starting this incredible groundswell of people actually caring about women's health. When I wrote this book, I felt that I had to, but I had no inkling that anybody would care at all. And it's opened up this incredible world of meeting people who are so devoted and passionate about closing these gaps in our healthcare system. But I really wrote the book because I felt this hearing these stories from patients that was not just about their diagnosis of breast cancer, but they couldn't find a cardiologist or they were told they were anxious when they had an neurologic disorder or they had a rheumatologic disorder or they had frozen shoulder or they couldn't find an orthopedic doctor? Or they had IBS and were told that, you know, just like eat some more fiber. And I really began to think, well, where does this legacy come from? How do we unpack that? Where and how did it start? And then I just started reading and reading and reading and I went back to college or my college textbooks and we're like, oh my god, there is a legacy here that we have to be informed of. Otherwise, we can talk all we want about what we need to improve, but if we don't know where we came from and where it started, I think we're not going to get where we want to go. Or how it was built into the system. So you have this idea for a book you want to write. And as an author, you typically get an agent, you shop the idea around, what was that process like for you? I was really lucky because I knew an agent at the time and I pitched her the idea. We spoke about it for a long time. The proposal, as you know, it goes a lot of work goes into that and I really spent a year thinking about how did I want to structure this book? And I decided I really wanted to do a walk through women's bodies by organ system. The same way that it really developed in the 19th century, these fields of gastroenterology, cardiology, neurology, and how much we've saddled OB-guines with all of women's health, which is absolutely outrageous. If you're a cardiologist, you're taking care of women. It's a number one killer of women. You are a women's health specialist. Even with a diagnosis of breast cancer. Yes, yes, of course. So I really wanted to walk through each of these specialties to understand the specific gaps that exist in each field. So that took some time to come up with. And then I was really lucky that book went to auction and you know, it's done well. And I'm grateful to be part of this bigger mission. In the intro, I talked about I was, you know, head down, doing deep dives for the new Perry Menopause, which is harder than the new Menopause because we had more research for the Menopause than Perry. Perry is almost like, once you learn how to pronounce it, move on. I heard your voice and I popped up and you were talking about the book, it's all in her head and just that title because that's a recurring theme through every book I've ever written. And I immediately got on Amazon and ordered the book, you know, on my Kindle and started reading. And so in that very, very first in the introduction, you talk about a patient, Ellen. I was with you. I was in the room with you. I could hear the beeping. I could see the rumpled sheets. I could see her sweating. And I thought, oh my god, she gets it. Lake. And it was just so beautiful how you didn't describe her as this inanimate object, laying in a bed with a list of diagnoses and you having to tell her bad news that basically your medical expertise had reached its limit as far as, you know, saving her life. And how are you going to help her? Talk to us. Talk to the listeners about that experience and why you chose to open the book with her story. So it's interesting because it is a story where my editor originally was like, are you sure you want to open with something so negative and sad? And I felt very, I felt that I had to and that it really spoke to the shame and the legacy of that shame that so many women feel. So Ellen made up name. But a real patient was a patient of mine. She was a mother of four. She was incredible. She was living with metastatic breast cancer. So she knew she was going to die of her cancer at some point. But she did well for years and years and years. And every appointment was so joyful because she was pictures of the travel and the mountains that she climbed and the outfits that she wore. And then in a short period of time, she decompensated and became very sick. And I went to see her in the hospital and it was about 18 hours before she died. And I wanted to, you know, say goodbye to her and honor that relationship that we had. I went to hug her and she was having difficulty breathing and she was in incredible distress. And we were trying to comfort her with medication and support because, you know, one thing about oncology is we may not be able to cure everybody but you can always be present for the suffering and you can try to ease that. And I went to give her a hug and, you know, she was thin, she was frail and she was sweating and she said to me, thank you and I'm so sorry for sweating on you. And I thought, my God, this woman has how many words left to say, how many breaths left. And she's choosing to apologize to me for sweating. And it was just such an overwhelming gut wrenching moment where I thought how many women have apologized to me for the most ridiculous things. Let alone on their deathbed. Every time I think it's almost universal if I really think about it, that a disrobed patient, not one sitting across from me. They should usually figure out a way to apologize for something. But in my own exam room, back in the when I was full on generalist OBGYN, they were apologizing in stirrups for hair on their legs or some kind of smell or their toenails weren't painted or, you know, what if there was such shame present over a normal physical human body, doing normal physical human body things. And I'm the one who's about to invade them and they are apologizing to me. They are hiding their underwear, which I still do myself actually. I do it too. At least I want to fold it to make it look nice. We're not disheveled. We're okay, but I read that and I thought almost all of my patients when I've asked them to get undressed for an exam, have apologized for something. Yes. And I think it really speaks to that, again, medicine doesn't happen in a vacuum. These doctor-patient relationships reflect our culture and our society. And women notoriously apologize. And we have absorbed tremendous shame about our bodies. It isn't just people with, you know, poorer access to healthcare. This is some of the most powerful, incredible, royalty, literally people that we've seen. And it is this common thread no matter where you're from, no matter what you do, no matter how much money you have, no matter what your resources are. I guarantee you almost all women in a doctor's office will apologize for something about their body. And I think that, you know, it's terrible. I loved. Also in her description, that you brought shame to the forefront because I think we need to talk about it. And I think we need to empower women that this shouldn't be. My husband does not feel shame when he goes to the doctor, even if he has to have a prostate exam, you know, a trans-rectal prostate exam. He doesn't care. And like, why can't we be that way? But also that you really humanized this woman and you've you really felt compelled to be present with her and describe that connection. And I think I was trained to create some kind of a distance with patients to not get so emotionally attached, you know, unless it was something joyful, I'm there celebrating the birth of the baby or, you know, their engagement or whatever, there's lots of joy in my field. And I just thought that was beautiful. And were you inspired to do that? Was that something you were trained with? No, I think we, you know, trained similarly. But I think this threat of humanity has always been in medicine, but more recently, we've really lost the plot. If you look at, we've lost our trust in science. We've lost our trust in medicine and our healthcare system in these third-party players that infiltrate the doctor, patient relationship, and pull us away from where we want to be. I think we could both agree that almost all doctors go into this caring for humans. And yet we are pulled away from these natural, intuitive senses of how we want to connect. My own daughter has chosen medicine as a field, despite all of the warnings for me, despite watching me, I think it's a testament to you. Almost break from call and administrative burden, watching, you know, all the things. She went in absolutely wide-eyed and she's still choosing. I'm like, there's other ways to make money, you know. You'll have a good living as a physician, but, you know, it comes at a cost. And she's like, this is what I have to do. Yeah, and I think it is a calling for so many of us, but I would love to see medicine and our healthcare system wrap around that calling and bring the patient and doctor to the forefront together. Talk to me a little bit more. Let's go there about this third party. You know, what does that mean? A third party system, you know, this third party system really developed in the last, I'm guessing, 50, 60 years. Yes, I mean, I think, and deeply affects women's healthcare as well. If you look at what gets reimbursed for men's healthcare. So when we say third party, we're talking about insurance. Yeah, and if you look at what gets reimbursed for female specific procedures, you would know better than I. I mean, surgeries for fibroids and endometriosis, some of which are extremely complicated. Comparable surgeries and men often get reimbursed to any time. Yes. Higher. Yes. Lose the surgeon. She's a gynecologic surgeon. I'm a Jocelyn Fitzgerald. Yes. Follow her. Jocelyn Fitzgerald goes through and tabulates what surgeons get paid for female procedures versus the identical procedure in a male. And it is shocking. Female surgeries tend to be a lot more complicated. Number one, because our plumbing is on the inside. Yeah. So for men, testicles are out in the floating in the breeze, penis, everything's out. When you look at yourology versus your organicology, which is basically equivalent, she's looking at those procedures, it's harder to go inside of a body cavity to fix something than to do it on the outside. Yeah, they're getting reimbursed so much more for an identical procedure. Yes. And again, it points to what do we value as a society and how have we devalued women's health? Where do these gaps come from? How do we close them? And what are the financial ramifications of that? And the financial ramifications are not just to who gets reimbursed, but you know that we are the primary caregivers, delivers, and providers of our health care. So even if you don't care about women, if you are not supporting women's health, you're not supporting our society, you're not supporting our economic security, and it has huge ramifications. Perry Menopause is not early Menopause. It is its own distinct biological phase. And it has been largely ignored. My new book, The New Perry Menopause, is about the seven to 10 years before your period stop. 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, Perry Menopause 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 Perry Menopause 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 Perry Menopause is now available for pre-order everywhere books are sold. Learn more and pre-order your copy at thepaslife.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. Integumentary? Yeah, you've got an integumentary. I think this is more the same. I only read in a book and never set out loud. Do you know I think the smartest people can 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 and worse. Yeah. And we developed anesthesia. So before that, you know, surgeons were not, before we had anesthesia, surgeons were these publishers? Yeah, they were just these like, you know, barbarians, right? 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. And 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. 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. And I mean, let's be clear. I'm vain myself. I'm not here without the lip gloss. I got a blow out because you know, it's your podcast and all, right? And my mom likes to joke that her middle name is Veneta. So it's not that I'm opposed to all of these things and the pursuit of aging gracefully, a cape with a little Botox. But I think it's important that women understand where the field came from, where these pressures come from. They're not new. They've been there a long time. And when you look at breast implants, for example, talk about that. I mean, also, there was a medical term, micro-mastia that was developed to say, like, small breasted women are going to feel insecure about their bodies, developing 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. Yeah, in Texas, where you're from. Texas. 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 you 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 LaBia Plasties, it's like, we're going to get there. Yeah, you want to get there now? Yeah, I get that now. Okay, let's go there now. I saw a Somalian patient in her sister, who had both had female circumcisions, which we now call general mutilation. Okay, there's no medical reason to have it. It is a cultural or travel procedure, where you basically, and there's different types, but they go in and basically remove the clitoris, remove the LaBia menorah, and sew the majora together in some configuration. And totally, 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 US. 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. And this is very, very wealthy individuals. So there are still a few surgeons. It's illegal in the US, but it is, or they'll fly back to whatever country and have it done under anesthesia, but basically their genitals are completely medallated. 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, I think she was getting a master's degree or something. And her sister had had this same procedure done, and she was having her current urinary tract infections. So that particular procedure she had had had blocked the exit of the urethra. So it was hitting this 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. You've got a collegeist typically to figure out, should we take it down? What's the best procedure? I mean, it's just, it's just awful. So then when patients come in and start asking me about labiaplasty, later, not from another country, 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 in my girlfriend's house. I mean, I took baths with my friends as little kids, and you know, very... But I didn't ever look at anyone's labia, or realize my 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. But my god, like, now it's labia or 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 there, but not in medical school. Not in medical school, right? There was one little paid model. It's even the doctors. Like, if you have a patient coming to you, you eat 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 four 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. What is bicycle face? Oh, bicycle face. So this is real, okay? So we both love to work out, but I will tell you, and I, when I was researching the history of women and exercise, I just, 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 shaperone, 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. Well, now this shows you that 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. But 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, I mean, I've got, I must do, I'm into peloton, I'm riding it. I'm done with the thing on a peloton, but not that. No, no, no. So it's really remarkable the things that was 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? No, 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 worry that if they lift things and get stronger? That there's a house that I'm going to look like. Am I going to get bulky? Or I, so one of my dearest friends is a physical trainer. And she was always an incredible shape. But then she really got into lifting and weight training. And she has made a career out of it. And I can remember behind her back, the guys in our friend group kind of commenting on, she didn't want to go too far with this because she might start looking. This was, 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. 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 workout more eat less. Your health was tied to your weight. Yeah. And never, never, never, never, never about prevention of osteoporosis or frailty. Oh, I mean, is it any better for no? No, there was no, there still isn't any now. I mean, I have patients that we talk all the time about how important exercises for decreasing breast cancer, you know, 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. So I definitely didn't get any training at all. Let alone what specifically for women would be important, including during pregnancy. Oh, no. So I got, I've got, I didn't want to raise our heart rates above. Oh my God. A certain amount. What was that? I was telling patients to stop running by the fifth month. Yes. 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 through it in the freezer and every night, I treat myself to this giant ice cream cone because I was underweight when I got pregnant. And so they wanted me to gain some weight. And I was like, I got you. And so no one, as long as I wasn't diabetic, I was fine. Yes. You know, eating healthy was like porn. You know, when you see it. Yes. I just can't believe the advice I was giving patients or what I actually did to myself to remain. 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. It 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 and nutrition. So you also cover cardiovascular, digestive, immune system, nervous system. I mean, I was just a fish and water through all this. The endocrine system, of course, reproduction. What were some of your biggest aha moments? There were so many. 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 pre-clampsia during pregnancy, never learn that. I never learned that. I know 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 disease. Microvascular disease that sometimes heart attacks are not just secondary to plaques but can be other things that we're still looking into. Broken heart syndrome, which is traumatic cardiac events after a traumatic life event, like losing a partner or something like that. I didn't realize this was more common. And 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, where did this start? 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 that he wrote about. And they 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. And at the end of each one, he would attribute it to something other than a cardiac problem. Psychological instead of biological. 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. So for our listeners, let's go through, because you might say, the life today, how do men typically present? What are the typical signs of a heart attack versus how a woman, how a woman typically is that? It can be totally different. So classically is what we see in Hollywood, these women are 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 can be indigestion. It can be fatigue. It can be job 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. Women are twice as likely to call an ambulance on their husband having a heart attack. Then 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. A 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. And so much of that is because we don't know what's going on. Because you haven't studied it. And there's an arrogance to medicine. But we don't know what's going on. We blame the patient and say, it must just be you. You're anxious in its 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. 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 autofunding and how the studies are set up. When women have so much of a higher burden of disease. 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. And we've had lots of calls from Fitcher 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, under diagnosed, 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. I'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. This is a big crazy thing. Yeah, because that's what people say about us, right? Throughout history. Do you know what I'm just saying? Do you know what I'm just saying? Oh, 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 time in clinic. And so I walk into Gini 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 charts. So this is the sold I am. This is paper charts. We're four years of residency. So the fourth years would run to this 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 polypectomy, the culpazcopies, 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 Ms. 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. I've gained some weight. I've had 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 consults, you know, and she hadn't been to psych yet. So they centered a gynecology because her periods were a little bit irregular. Go see what you can do. So my upper level comes over. He's in charge of me for the day and he's just picked all 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, she checked her thyroid. It 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 out. 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 whining woman. And actually, she was Caucasian. It was a WWW, a whining 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 and it's stress. 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 in... 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 it's decreasing risk of recurrence, is by decreasing the amount of estrogen that can bind to the estrogen receptor. And 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 a breast cancer and make them effectively menopausal. And on top of that, decrease there any additional production of estrogen that they have. 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 esteridile from the ovary and then the estriol in pregnancy. And that in postmenopause, 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 for survival and decrease your recurrence, we're going to block everything. Everything. 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, open your alive. You're alive. You may be miserable, sex may feel horrible. You may be having these hot flashes, but you're alive. And for so long, for example, even the concept of vaginal estrogen is 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. And that speaks to 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. This is your latest project. It's heavy with information, data, and exactly 36 pages of waffle. But with Acrobat Studio, you can create a PDF space, an AI-powered workspace that turns documents into summaries and insights, and even generates reports or presentations out of it. So you can cut through the waffle, work smarter, and save time. Do that with Acrobat. Learn more and try it out on Adobe.com. There's another quote that I think we should talk about. Even now, the medical system operates from the same presupposition it always did. That a woman's health, her happiness, and even her freedom from pain are all secondary to her biological destiny to become a mother. Tell us what you meant there, and I 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. 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 the lungs in a chest cavity of a female. It was always the male body in anatomical studies, except when you're learning about reproductive function. Then, oh my god, suddenly we have different anatomy, because that's the only anatomy that is valued are reproductive fitness, as opposed to even studying women's pleasure. The crazy anatomy, the seminal, most important anatomical textbook, sometimes didn't even have the clitoris in it. In the 1940s. It was 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. Women figured that out, and we learned that. I'm pretty sure in the cave they were still having a good time. 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 in treatment a lot faster 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. This is what gets debated in society, but you probably know better than anybody else. How 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 how to historic to me that they possibly didn't need. Or maybe they needed it and weren't offered it, because the only option was to try to preserve their fertility. Talk to me about Anne and the vibrator. Anne was this photographer in her 80s with awesome gray hair, always were really vibrant clothing and these big round glasses. And just super dynamic. She had an early stage breast cancer, and I had, I would do it very differently today to be quite honest this was years ago. And I put her on an aromatase inhibitor, which is to decrease the risk of her currents 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 I told her about the side effects, which could be like, joining, decreased in bone density. But I didn't talk to her about decreased libido and pain during sex or anything like that, or vaginal trinus. Did you know that? I did. But I think I just subconsciously was like, well, she was like in her 80s, why does it matter? And I probably would have done the same thing. Yeah. And then vibrant, fun, and came in, met at me. She was like, you have not properly taken care of me, and you didn't ask me about my special friend. And I was like, special friend. I've known Anna Wile, 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 mind. And I was like, I did not. 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. 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. Wait, there was no training of it. But then it was also very agist. Like women of a certain age, not happening. Mm-hmm. 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. I thought I would have been gray here knitting with a grand baby on the left. 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, um, and that there was only one path to it. And certainly for women in 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. She married a man 10 years older, bore him six kids, seven kids. She struggled unrelated, but to struggle 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. 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 and continents. And for a long time, until I started getting into the world of metapause and getting into the history of why this is happening, I really felt like this is old lady disease. Yeah. This is inevitable. This is in my genetics. And I'll just jump off a bridge at about 85, 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? And it's all over at least the most good- Yes, and it points to the devaluing of our cognitive functional for time and the dismissal of women's cognitive health, of our brain health, of our mental health. You know, when 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 a silence for reading more man's novels, for wanting to have more sex and their husband wanted to have, well, whoa, there's a real problem there. Yeah. Right? And the number of women that have died in a silence for seemingly normal questions just being an apostle. Or whatever the mental health changes around the past. So one of the men that founded Horatio Store 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. Okay, 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 Catermanial, so pre-menstrual mania, where she died in Worcester, Massachusetts. These are the people that founded the field 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 McCowney 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. Yeah. Talk about funding. It was McKenzie 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. When 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. Right. And the statistics are simply terrible about how much we invest in men's health versus women's health. Throughout some numbers, because I think it's like one percent of government funding outside of cancer research goes towards women's health. Our pregnancy. When I think if I have the stats right, of a $43 billion budget in 2023, about 10 percent of that went to women's health. So about 45 million. But like just for menopause, it was less than one percent of like point of three percent of all funding went to study a condition that happens to 100 percent 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. You know, I was taught that women tend to sematicize their problems. Yes. 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, they're great men in medicine. Yes. And they're also in the top, I see me front of them. And women too that have been dismissed, right? Like, it's a, it's a, it's a, it's a, it's a systemic problem. It's a systemic problem. You know, it's fascinating. I have a friend. She's a kind of collegeist. 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. There's something that we're missing that we have to work through. It isn't just need that you need to like, calm yourself down. Why have 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. I think social media really, and I'd love to hear your experience. For me. All of my practice. 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 made 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. So right now, I'm like, that's one that's trying to look graceful. But I'm like, hello, hello, hello, 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 I 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 care. 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? We'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. But when I just wrote this book, it was, well, where do you going to go and talk about? And it was wondering about the pushback because you're really critical of the system. Yes. Now you are operating in. I think if 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. And I'm so grateful to be at the Spinyone 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, are like, oh my god, you had the same experience too. It's been incredible. But we need more of them. 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, especially in the academic world, the most arrogant of them all, 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 one to disseminate. It only comes in a medical journal article and you should get that information from your doctor and nowhere else. Yes. 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. Now we're 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. 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 get to pack as much as I can in and 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 are either invited because it was a women's, women in health, the Vanillisian 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. I'm not teaching them. Or month there be 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 are 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 medicine. And it's 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. 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 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 are 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. A lot of the oncology patients, especially in the GYN, oncology, breast oncology, are frustrated by the lack of attention that they're menopausal symptoms. So, mainly not in your clinic. But what would you tell them? If they're in Kansas, or Ohio, or 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 our, 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. They want to have a conversation with their doctor about the risk, 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 is cared. No one is 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. And 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. 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 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. It'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. 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. It's important. Let me jump back to your new position, where you are now, I am where you. 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, some play-sales. It is entirely eye-opening to me. That shall not be named. That shall 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 sub-specialties 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, NYU 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. 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 very skills are not rewarded by the system. In men and women's healthcare, I give an hour and sometimes longer for that first visit. 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 thinking that's my kind of progress. We worked really hard. I have such a great team. Yeah. Oh my god. So thank you. I appreciate that. So here's study. 2020 forced out 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. 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, then their male counterparts. How does that, 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 value 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. Procedural ones, material ones where there's something objective that you can hold on to 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? 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. 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. 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. So I am very optimistic and thrilled that you had me on this show. Awesome. Well, Minipause 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 this base of your life? I know you're lifting weights. I'm, yeah. So I had this back injury and I used to be like a crazy runner. And now I do kettlebells and I string train and I'm working on my pull ups. So I've definitely drank the cool aid with you can tell Von Der Wright I'm in on it. I'm lifting heavy. I don't need a hormonal therapy now. But you know, if I need it, I'll explore it. I 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. We talk about it a lot. Like when we talk about the good things about Minipause 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 Minipause to do this. Yeah. Right. I wish I had known that in my 20s, but I kind of am feeling it now. And 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 can answer your questions. Yeah. 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 so do you know what? Like, where you're here down? It's all going to be okay. Are you scared of Minipause? 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. Well, Dr. Komen, thank you so much for being on on pause. 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 the pauselife.com. If you're loving this podcast, be sure to click follow on your favorite podcast apps 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. We would be so grateful. You can also find full episodes on YouTube at Dr. Mary Claire. Unposed is presented by Odyssey in conjunction with Pod People. I'm your host, Dr. Mary Claire Haver. The views and opinions expressed on unposed 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 a professional medical advice, diagnosis or treatment.