Transcript for:
Lecture on Women's Health and Menstruation Myths

menstruation comes with many myths period blood is dirty tampons are toxic you can sink your cycle the pill is evil a lot of the birth birth control disinformation is funded by right-wing groups these are the people that want to take away your right to vote your right to have an abortion they have an investment in keeping women in poverty Dr Jen Gunter is a leading figure and mythbuster in this space you don't know if anyone's telling you the truth online if your period stops because of these extreme diet changes that's a medical condition called hypothalamic Amara which puts you at risk for osteoporosis and she's sharing the science of what we do currently know about women's health and what we're still missing there's a gross misunderstanding amongst society and Physicians about like how painful period should be women's pain and women's suffering has just been ignored I'm Dr Curran an NHS surgeon and in this podcast we cut through the BS of Modern Health advice and tackle the biggest issues in science health and Medicine women have historically been left out of a lot of clinical trials the taboo and discomfort surrounding periods has also led to massive underreporting and limited interest from researchers three in four women experience PMS symptoms many have Painful periods one in 10 women have endometriosis the list goes on but how much do we actually know about female health and menstruation and how big is our knowledge Gap Jen Gunter is an OBGYN pain medicine physician and Champion for raising awareness about with Women's Health there is so much misinformation that's just been apparent since I've been on social media I've been making videos on YouTube and online since 2012 and I've seen a spike in stuff more recently since the pandemic since more people have been on short format social media platforms like Tik Tok and Instagram reals now especially and you know you're an expert on obstetrics in Gynecology and women's health and especially in that field and in that Niche there also seems to be some pretty dangerous stuff online and I'm thinking back to when I was a you know a young kid I'm from India and I used to go and visit family in India on holidays and I remember this one time we were visiting this temple in the south of India me my mom and my dad and me and my dad went inside we took our shoes off and we went to on tle and my mom was waiting outside and I wondered why she was waiting outside and you know it turned out she was on her period and she couldn't go inside the temple and I always thought that was very strange and I never really explored past that superficial stage and then over the years I was just interested why at every religious function my mom sort of held back when she was in India held back from kind of joining the main you know function or religious Festival religious right that was happening and digging deep into it there's a lot of deep-seated cultural and religious undertones to this taboo around menstruation and even in some parts of India the women are secluded and isolated and living in mud huts and I just found that so strange in your opinion and in your practice what do you think is the full consequence of those sort of taboos and stigma when it comes to menstruation yeah I mean unfortunately this idea that you know menstruation is dirty and toxic and women need to be sequestered is fairly cross-cultural so you know we we see it in throughout history we see it in many cultures and in many religions so it's very unfortunate it's very damaging I mean you're telling somebody that their basic biology is dirty and in the scope of religion you're telling them that they're less worthy of you know the benefit of God or the gods you're they're less worthy of achieving righteousness or Holiness or you know whatever in the in the context of that religion is the important thing to attain you know it's it's a very damaging message so I think you know what's the impact on a young girl who that's what she sees her whole life right her she sees her mother being excluded does that make you then think less of yourself as you grow up does it make you question less it's a very effective weapon of control and I guess you see that same thing that dogma of you know blood is dirty or menstrual blood is dirty when you see these myths like women can't have sex on period for example and you know there is some evidence that physiologically it may provide analgesic benefits for example if a woman does have intercourse on a period for example yeah I mean there are so many different ways that this kind of myth can can end up harming people and you know there's all these offshoots so for example the idea that you know having sex on your period is somehow dangerous to men I always think so who does that myth benefit you know the the does the myth benefit you know the woman or the man obviously benefits the man to sort of you know say that your partner is dirty and and has to conform to whatever timing that suits your needs there was a paper is so awful you know some of the awful stuff that gets published um you know that I found when I was writing my book blood that actually was a group of male Physicians trying to explain you know their biological reason why they felt that avoiding sex when a woman was menstrating was important and it was just so offensive and you know I I I should pull that up and and write something nasty about it why do you think there is such a lack of research historically and even now even though there's more awareness about women's health compared to say a few decades ago why is there still a significant lack of research and still inequalities when it comes to trial recruitment Medical Research Medical advancements for gynecological conditions in literature you know obviously a lot of it is you know historically you know it didn't interest the people who were in charge of medicine or if it did it didn't interest them very much you also have to understand that you know hormones weren't discovered until you know the early 1900s but of course you can say the same thing about thyroid hormone right but you know we seem to know a lot about that so I think you know it's a combination of misogyny and not not having women in medicine to be representative to say well hey you know what I think that might be like an important subject I mean it's the same thing you know with all aspects of medicine but OBGYN is you know I think the worst so you know at least you learn when you only have men in trials for example about heart disease at least you're learning something about heart disease right maybe it's not the best for women but at least you're learning something whereas if you're not studying painful periods then you're learning nothing about that subject so that's also another thing I'm sorry that's my cat who has this toy called springy and um I guess she's found springy I don't know if you can hear her yeah I was wondering what that was um so with regards to research is there anything exciting legitimate evidence-based that's actually coming out in the field of women's health research that would be of interest something that is actionable oh yeah I mean so I would say just as you mentioned earlier that the last you know decade or so we've seen a real swing things are definitely we you know there's tons of papers coming out all the time with you know looking at different aspects of Women's Healthcare and I would say that you know we've had quite a lot of good research for pregnancy healthare I mean obviously they can always be more but it's also kind of a an interesting statement that pregnancy was seem to be the most you know we were caring more about women's lives as you know being pregnant than not being pregnant so but yeah there's definitely there's been a lot of great research and you know fun has to come and I think as you you know we all know that without basic science research funding at a government level then you know that tells universities that certain subjects aren't important then they don't recruit professors that tells drug companies that those those subjects aren't important so this whole putting government money behind it is I think a really important thing we just had a a law passed in the US very recently or a a statement from President Biden that there was going to be this you know large amount of money shifted over to women's health I think it's also important to mention there's one thing that never gets brought up in this conversation and while I don't like to make excuses for the patriarchy it is a important historical point you know when the theide tragedy was realized right that basically halted all clinical trials of medications on women because the whole fear was when are we going to have the next alomide you know that the the concept that a drug could cause that much Carnage I don't think had ever occurred Ur to people before and that much Carnage like that you see right away things like Dees which is another drug that caused problems that wasn't seen for you know years later but so this kind of like and it wasn't as physically apparent or you know so that really dropped all women out of clinical trials because it wasn't safe now obviously you and I know that intelligent researchers can absolutely find ways around that there are of course women who are willing to not be sexually active there are women who've had two allegations there's women who partner with women right so so there's all kinds of ways around that and so I think it became a very easy out and it's also cheaper for companies right if you don't have to worry about physiology that changes all the time so this thing that was done out of you know fear and oh my gosh we didn't realize this was a possibility became I think a great excuse for the patriarchy when it comes to a lot of research you know there's good and bad research and you know in my research days my tutor always used to say [ __ ] in [ __ ] out you know if you put rubbish in you're still going to get rubbish out whether it's a randomized control trial or a metaanalysis if if the initial data is awful your outcomes and results will be awful as well and you see a lot of research that a lot of podcasters and influencers site that it's just maybe correlative evidence and you know one of these myths that you hear about you know periods and women's health is this whole idea of menstrual cycles sinking and there's even some evidence or not evidence or some letters published about that surely there's no physiological evidence to suggest that's even a plausible thing yeah so you earlier you mentioned you know the impact of short form reels on disinformation and I think it's this kind of thing where that has it's all of a sudden become a thing all over again and I I thought Oh I thought I thought we were done with this like 20 years ago so yeah there's absolutely no byw olical plausible explanation for cycle syncing at all I mean that's if you understand how the menstrual cycle works you you would say okay well that's not possible no one ever says well you know my hormones are going to you know I've got something in The Ether that I'm going to send to you and affect your thyroid why is it always reproductive hormones right so there's that but this was actually studied so there was a a clinical Tri not a clinical trial there was a study published in the 80s that gave Credence to the idea that was kind of the first go around and you know it wouldn't I think have passed further discussion nowadays standards were different right you know when you go back and read old studies from you know the early you know the late 70s early 80s you think oh well okay things have changed a little bit and and people looked at it several groups of researchers I think it's three different groups of researchers right so when one person says one thing and another person says another thing you think ooh you know whose methods are right but then you've got one 2 3 maybe there's more than that but there's three that I can remember so absolutely and there's no physiologic basis so it's but it and the other thing I always tell people about this myth is it's actually quite patriarchal because it tells you that or the the central position is that women don't have you know they can't control their own bodies they need other other women to control them like no one ever says that about men so I mean I find it fascinating like you know beyond those sort of simple myths like that and then we get on to you know an overlapping myth between women's health and nutrition and that seems to be a recurring theme that I see where holistic practitioners or functional practitioners claim that a certain change in the diet or a complete overhaul of some sort of diet or even a specific food group or specific food can actually in some way impart some change in blood flow menstrual flow or something like that and you know as someone who's a GI surgeon myself I know that food certainly has a role to play in gut health and general lifestyle for sure and we are increasing understanding that food can have a role to play in the microbiome but to go and say that a certain food or food group or type of nutrition can completely stop a period and change female hormones seems bizarre but people still buy into this and I wonder if it's just some sort of confirmation bias or anecdotal bias they've done something and by coincidence they've noticed a change in their period and they said yes this is the truth you can do this well I think yes I absolutely agree with you and I think that if you look at the two of the the worst areas of misinformation or disinformation online it would be reproductive health and nutrition so you've got like this perfect overlap right and food makes great videos and reals and it's truthy it sounds like it should be right so that's part of the issue is truthy stuff is really sticky so there's two points to this so one is the menstrual cycle is actually quite IR regular normally so there's a 7day swing cycle to cycle so if normally you could your you could have a cycle that's 32 days and then a cycle that's 28 and a cycle that's 25 it could lead you to make false conclusions that your cycle is changing from what you're doing also we all have recall bias and we only remember the times that we that you know we get our confirmation and the times that we don't right I mean that's just human nature but the other thing I always say to people is just use common sense if there was a single food or a couple of foods or specific diet that was Supreme for the menstrual cycle it would also be Supreme for fertility and so then we would see pregnancy rates different in the areas that ancestrally had that diet and we don't think about your The ancestral diet from where your family is from the is going to be be completely different to the ancestral diet from someone from Iceland or my family is from the UK or the ancestral diet of somebody from the UK so think about those three diets completely different and yet populations flourished and so humans are incredible omnivores our whole system evolved to be able to live in extremes because in every one of these climates where humans have lived there's extremes of cold extremes of heat extremes of flood so you can't there's not going to be you know asai berries all year round wherever you're from if that's one of your Foods they're going to be there for three months and gone or two months right so all these natural foods that that grow in areas where humans have lived they're they're generally not there all year round so so you know you think that that food is seasonal so of course we have to adapt so this idea that there's a single food or a single diet that supports fertility in a way is is really a bizarre conclusion when you think about how freaking adaptable humans have been you know you just think about all the things they've made alcohol from you know I mean it's just in Crazy they'll humans will eat and you know we'll you know we'll eat so many different things and and thrive in so many different ways so do you think it's plausible that potentially these people who claim that certain diets can stop your period are essentially for example example someone who's going raw vegan or carnivore or having some degree of restrictive diet is actually resulting in stress on the body and some you know range of vitamin and nutritional deficiencies and that is causing some amenorrhea because of that stress on the body and then they're accounting that to that food oh absolutely so it's a really important point and I'm glad you brought it up calorie severe calorie deficiency will stop your menstration and it's more than the weight loss because they've actually done studies with bariatric surgery and when you have bariatric surgery your calories drop immediately and you know the weight loss takes a a you know a little bit long you know you don't have you don't you're not losing 60 pounds in the first four weeks right so what happens is There's A disruption in the menstrual cycle with very very rapidly because of the severe calorie restriction if people aren't able to meet the calorie needs that they have so yes so if you're someone who's going on some raw diet where you're getting 800 calories a day your menstruation may stop quite quickly but that is your body's response essentially to starvation because if you think about it historically it wouldn't be very good to get pregnant when there's no food resources available because pregnancy is the most metabolically demanding thing a human can do pregnancy and breastfeeding you need to have nutrition and you know same with you know these carnivore diets and other types of things and also I always say you don't know if anyone's telling you the truth online so there's also that but one other point I want to make is if your period stops because of these extreme diet changes that's a medical condition called hypothalamic amenorrhea which puts you at risk for osteoporosis and if you're 20 years old this is when you're building your Peak bone mass so this kind of restrictive diet um which you know not only might affect the calcium you're intaking but even worse when you're not menstruating like that you're not producing estrogen so you don't have that important thing for building bone so you may very well be increasing yourist dramatically for osteoporosis later in life so it's that kind of sever calorie restriction or potentially even OV exercise which I guess is why physiologically some Elite professional athletes female athletes might experience that hypothalamic a inara because of uh significantly lowered essential body fat content so the you know lack of fat means reduced estrogen production presumably uh and I guess any sort of stress on the body like that overworking overtraining lack of sleep calorie restriction is just basically plummeting your estrogen similar to how I guess you would see in menopause where you also experience that osteoporosis risk with a you know complete dumping of those um you know estrogen and progesterone yeah so with athletes it actually has a name it's called relative energy deficiency of sports or Reds and we used to call it the female athletic Triad um apparently it can happen to men too but I don't know anything about that because I never read about that part I always I always ignore that part of the paper CU like I'm not I'm not interested so yeah absolutely relative energy deficiency of sports and it's a real big issue because not only are there often calorie restrictions in certain Sports not all but there is Extreme putting out of energy right so it's all an energy it's an all energy balance right you have your calories that you take in in your calories that you burn so you have somebody burning this incredible amount of calorie and maybe not taking in enough and so what happens is while you don't have much fat and that might be part of it the bigger issue is your ovaries literally shut down now it's reversible but they stop producing estrogen you stop having the signals from your brain so you know thinking back to the menstrual cycle it's hormones from your brain that trigger the uh the follicles and the ovaries to each cycle produce estrogen so that trigger is gone there's no message so the follicles are just hanging out not producing you know any significant amounts of estrogen and the longer this goes on the lower and lower the estrogen production gets to be so yeah it's significant and then if you add the fact that there's this physical strain on the body you know you're risking yourself for stress fractures and then they may not heal and so this is actually the reason why it's important to know if women are still menstrating when they're par participating in high level Athletics um or you know have a way to you know figure out because you don't want to have that effect and then have these consequences later in life so it's important I mean a lot of athletes don't know about well I shouldn't say a lot but but some don't know especially more at the junior level and another issue is of course if you're an athlete and this is something that you know you're looking for a sports scholarship or something like that then you know then you're potentially risking your health which you know we see in a lot of you know obviously it wouldn't be just restricted to women and and and hypothalamic and Mana I'm sure there's other ways that some athlet some Athletics have impact negative impacts as well or extreme ones but yeah so Reds it's a real condition and so seeing something like that glorified on social media is super harmful yeah I guess you mentioned all of those risks there which a lot of people may not be aware of with the lack of bone density and increased risk of fractures I guess having a period is a very energy intensive process for your body so it's your body saying hang on I don't have enough calories I'm just going to turn everything off and I guess for some women who typically would expected to have Painful periods that they might think wow it's a blessing in disguise I'm training more and I'm cutting my calories and I don't have a period anymore but actually those Insidious risks remain and what I wanted to ask as well is that you know about this pre rual syndrome and I guess there is this myth which perpetuates that it's all in your head or it's not a real thing but you know there's still a significant proportion of women who experience at least one or more PMS type symptoms like irritability fatigue mood fluctuations um so it is a real thing and but what can be done about that if anything yeah so PMS um P so there's PMS type symptoms there's actual PMS and then there's pmdd which is premenstrual dysphoric disorder and just think about that like as a spectrum so about 80% of women have like one or two symptoms that you know might be like a little bit bothersome but are not a major quality of life impact you know bloating is a really common one uh irritability food cravings want I have more chocolate that type of thing so and yeah and in multiple studies chocolate is actually one of the things that people crave and I'm like well it feel it tastes good I mean you like no one's going to be I really want to have more you know uh carrots I mean it's not something most people say then there's PMS which affects about 20% of the population or 10% you know depending on the study that you look at and that's uh where there's an impact perhaps on your quality of life and activities of daily living but you can still go about your business but boy you wish it wasn't there you know kind of a bigger level of impact and then there's pmdd which is affects about you know 2% of the population and that's got a far higher percentage of depressive type of symptoms and so some women can have you know severe depression triggered you know each cycle some can have Suicidal Thoughts you know so it's heavier on the depression aspect of things and so to sort of think about it as a spectrum now we don't actually know if it's a spectrum or they're three you know separate you know things because lots of different things can have similar symptoms but but yeah and there are treatments so you know exercise can make some people feel better you know know in medicine I know we always say exercise helps most things and it really does um exercise is great for depression it's great for all those you know for lots of different things U figuring out what foods might trigger you may make your bowel feel worse your bloating feel worse so some people might feel better you know maybe following more of like a a FODMAP type diet you know during their you know their ludal phase and that's the thing with with PMS pmdd and premenstrual symptoms they can only occur after ovulation because they're related to production of progesterone so if you have them like on day five of your cycle that's not what it is it's something else so it's just important for people to know that it's only triggered by after ovulation and then uh anti-depressants are actually really very effective for the depressive type symptoms and you can even take them with ovulation you don't have to take them the whole cycle so you're just taking them when you need it and the birth control pill that suppresses ovulation and keeps your hormone levels steady also can be very effective for uh lots of different symptoms as well not as much for the GI symptoms but for some of the other symptoms the irritability and um feeling unwell and sleep disturbance and it just depends on which one someone wants to try to see and what the birth control pill does because it's not just about the progesterone it's like the change in level that so a lot of these menstrually related conditions are related to the change not the actual level and so the birth control pill gives you a steady level each month and you can take it in such a way so you don't have a period so then you've eliminated all the hormonal fluctuations so would you say that given such a large proportion of women have PMS pmdd or anything on that spectrum and even PMS like symptoms that actually it is essentially a normal and expected part of menstruation well I think in certainly in in our society it's a the premenstrual symptoms are very common and they they're very common part of the experience what things were like ancestrally we don't know right so we don't know if if it was like this 10,000 years ago you know we don't know how much of external pressures in society also amplify and that doesn't mean it's in your head at all it means that there's a strong mindbody connection right and so I think that yeah right now in our time in society it absolutely is a very common occurrence and I don't think we really understand why I'm not sure there's been a lot of studies that look at different sort of cultural experiences with PMS and one of the problems with researching it is in some cultures women aren't allowed to express these kinds of symptoms right so if if it's not in your cultural language that doesn't necessarily mean those symptoms don't exist that could also be that those symptoms have you've been told for Millennia that those symptoms aren't important so there's never been a language that developed to describe it so it becomes very you know complex to discuss I mean we know from from some research from Japan for example that that historically they don't have a good word for hot flashes in menopause interesting now one explanation is well women in Japan don't have hot flashes so they didn't need to develop a word the other explanation is well no they do but the oppressive nature of patriarchal society meant that talking about your body in that way expressing that was not allowed and so you didn't develop the language and it's interesting that once sort of the western word hot flashes sort of entered into the Lexicon that you know there's been more reporting these are the difficult things for researchers to tease out is more reporting related to to having the language so now you can actually report the symptoms so it gets very fascinating on a cultural level and I would say that certainly and I think the the areas where PMs has been studied it seems pretty similar across the board so I would say that in places maybe where it's not discussed maybe there just isn't hasn't been a space allowed for it and that's one of the tricky parts of women's health research if you've never allowed women to have those conversations you don't you don't really know so I would say that yes that's a very long-winded way of answering your question is saying yes I think that PMS PMS type symptoms are a very Universal experience they're probably part of the normal uh aspect of the menstrual cycle that you know PMS uh the way to impact your quality of life is also unfortunately something that affects quite a lot of people and pmdd is also less common but affects a lot of people it's interesting you mention about how society and culture and the societal Norms shape our understanding and expectation of women's health and I found this particularly when it comes to period pain I remember when I was just starting out in surgery many years ago I saw a young women uh with lower abdominal pain uh lower abdominal pelvic pain and the family doctor had referred us this patient uh with the diagnosis of suspected appendicitis this patient's Bloods were normal uh we got an ultrasound scan of tummy and pelvis they were also normal patient had persistent pain um and my boss the consultant at the time had said you know it's probably period related pain uh you know M Schmutz or something like that you know midcycle pain and discharged the patient um and the patient was still in pain when they were discharged the patient represented a few days later with the exact same thing repeat Bloods were done again completely normal blood test a repeat ultrasound was done in fact this time a CT scan was done again everything was just normal but Norm doesn't mean as we both know that everything's you know hunky dory and it wasn't until another consultant came along and said you know what she's had pain now for over a week let's just do a diagnostic laparoscopy to see what's going on and they we did a diagnostic laparoscopy and found significant endometriosis you know throughout just caking the pelvis and the bowel as well which is really just shocking to see uh that this perfectly in a healthy young women with you know this chronic pain had had this and that and one thing in the history that no one really picked up on and it just struck me thinking back to all those years ago that she did mention that she had significantly painful periods when this person had said she had painful periods that was almost like a collective shrug with all the surgeons like okay that's normal you know painful periods okay whatever next what about your appetite this this and it was almost neglected and it was a systemic failure of of the entire surgical team to actually acknowledge at that time that excessively painful periods which are debilitating are not normal and actually that should have been a cue for us to involve the gynecologist involve you know other Specialties to actually investigate whoa hang on it's not anything surgical it's actually gynecological or at least could be and do you think that that societal expectation that yeah periods are meant to be painful is harmful and actually is that the reason why we're not picking up in a faster you know period of time things like endometriosis things like fibroids and adenomiosis all of these chronic gynecological conditions yeah I mean I think that that you know we do a bad job in medicine I think with persistent pain conditions to begin with and then you add how we treat women with pain and then you add how we treat the menstrual cycles so it's not really a shocker I think that there's a gross misunderstanding amongst society and Physicians about like how painful periods should be and that if you're unable to walk around and do what you need to do after popping you know an ibuprofen then then your period pain is too painful and you know you and I know that I don't get to decide what's too painful for you and you don't get to decide what's too painful for me we just you know people use their own scales basically and so there are lots of clues that can help us understand if we think this is regular painful periods or due to something else so we call that primary disys Menara or secondary Dysa when it's due to something else like endometriosis and so one of the big Clues is pain periods that have always been painful since the first period that is a really big red flag for endometriosis versus painful periods that developed after several years because painful periods like regular painful periods are related to prostaglandins they're completely prostag glandon driven phenomenon so if you don't ovulate you don't actually get prostag gland in that menstrual cycle though the first year or two your menstrual cycle is almost all an ovulatory so the bleeding is not related to withdrawal or progesterone so it's rare to see serious pain in the first few years and so if your period started at age 12 and you told me that your period started to get painful around age 16 I'd be like that fits within the normal spec now you still could have endometriosis and it doesn't mean your pain doesn't need to be treated versus someone who says I got per age 12 and they've been awful from the get-go that's a much bigger red flag for enetri trios but again as we all know people can present in all different kinds of ways and the great thing about averages in medicine is they don't apply you know there's no like one average patient so but those are kind of the general stories that that take you along and then there's physical findings that increase your risk of you know thinking someone has endometriosis but basically if you have Painful periods that are affecting your quality of life and they're not controlled with a couple of different uh medications you know appropriate Trials of medications then investigation for endometriosis is absolutely warranted and there are some people who are resistant to non-al anti-inflammatories so that's always important to point out that about 90% of people with primary dys Menara whether it's not due to endometriosis just won't respond to incets and we don't understand why then um you know we can put people on birth control pills to stop them ovulating so we can do things to take prostag lanin away we can give you the hormone progest the progestins which are the synthetic forms of progesterone that thins out the lining there's less prostate glan and production so we can work on it that way but yeah I would so I would tell people that if you've gone six to n months with therapy for your painful periods and you have not made any progress then it wouldn't matter how early it started then that's the the time to start considering endometriosis and is that something that we need to do surgically to look surgically and some people just want to try more medications geared to endometriosis you know without surgery and both are fine you know it's surgery can be helpful for a lots of people but lots of people can also have surgery and it not improve their pain because there's many things about endometriosis that we don't really understand people can have severe disease like the patient that you describe and have no symptoms and people can have minor disease where we look and there's a few specs and they can have severe pain and there can be all these permutations and combinations in between so we don't know if these people have two different diseases right or if they have a spectrum of the disease and I think a really good example is you know if I do an MRI on 100 people 90 of them are going to 60 of them are going to have some problems with their back they have any pain so you know there's you know you have to link the physical presence of lesions with pain and we still don't understand you know is this a widespread inflammatory condition and so some people have different genes that are triggering more inflammation triggering more pain response and so it's less about the physical burden and more about what's kind of happening genetically or is it something else and this is one of the things that you know if you look at funding for endometriosis research and the impact it has on women it's absolutely devastating and the example I give is you know when I started Medical School a long time ago I was in the 1980s the only thing we had for Crohn's disease was basically steroids right that's all you had you had steroids and you people were getting admitted all the time res sections that you know people were like malnourished it was terrible and then because of investment in research we now have all these biologics we have all these other drugs and you see people with inflammatory bowel disease living lives that that you couldn't have imagined in the 1980s and Crohn's disease affects you know significantly fewer people than endometriosis and you can see that same kind of Devastation from endometriosis so the only example the only explanation for the societal investment in Crohn's disease and the the lack of the similar investment in endometriosis can be the fact that women's pain and women's suffering has just been ignored and it's interesting about endometriosis I mean given that one in 10 women you know potentially suffer with endometriosis that we still don't even have an underpinning as to what the itology is like you mentioned in part inflammatory is there some autoimmune component clearly some potential genetic component and I know there was um I think a a you know I should caveat with saying a deeply flawed study I think last year very small study which suggested that maybe even a bacteria was involved or associated in some way uh with that I mean you know where is the research going with endometriosis and why are we so far away from understanding what is going on because you think that if you could actually understand what are the causitive factors we could then begin to develop treatments Beyond just okay we're gonna cut this out or we're gonna just do you know this surgery and see if it helps the symptoms yeah so I think it's it's a real systematic issue so first of all you have a lack of appreciation amongst say researchers that this is a condition to study you can't get grants you have a condition that affects women and so those those grants are probably less likely to get funded than um than other grants then you have the way that medicine treats people who are in medicine so if you look at a general surgeon and a obgy doing a laparoscopy and this in the United States and in Canada I don't know what it would be the same in the UK but I'm sure it's probably similar if you do the same laparoscopy you'll get reimbursed less as an OBGYN wow if I do a vver biopsy and a urologist does a scrotal biopsy we both use the same punch tool the same amount of anesthetic and the tissues are homologous the urologist gets paid more money interesting so you look at the pipeline to how people get funding to do research so in universities right I'm sure it's the same in the UK it might not be but where I live you have to pay for your own research time right so you if you work five days a week at the hos at the at the University and you're seeing patients you have to see enough patients in whatever 4 days 3 days 2 days whatever it is to then pay for your other time so you can work in a ABB so you can uh do research and it's a lot harder to pay for your time if you get paid less per procedure so you know OBG also historically has been you know we've had to run from clinics to go to deliveries and go back so the whole way everything has been run has made it very very difficult to have these kind of how do you how do you cover labor and delivery how do you cover a full Gynecology practice and how do you also then devote time to research these things become it becomes harder and harder you know there's been less I think investment in you know in it at all different levels and then if you add the fact that there's glass ceilings even though most obj in the United States are women now they still are men men are more likely to be chairs Deans are more likely to be chairs and these are the people who decide like what's what's important how am I going to if I'm the dean and I want to give a new researcher money to get them on the way am I more likely to fund someone who's not studying Women's Health cuz oh how important are painful periods so you look at all of those systematic things and you can understand why we're where we are and you know tying in a lot of the things that we've spoken about the disinformation the the research and the inequalities in research and we were just talking about the pill the or conceptive pill or the birth control pill I mean over the last few years in social media I've seen an increasing I guess vitrio and volatility towards the birth control pill and you know people demonizing in such a way and and I understand in some senses that people don't want to necessarily put hormones in their body and there may be you know some Physicians who don't adequately explain the full gamut of risks of the birth control pill Etc but clearly they have an important role to play in a woman's life and I mean even just looking at the research and I I've seen similarities between HRT for example and you know the risks of breast cancer or uh you know blood clot risk with HRT in the research and also with the birth control pill and you see the thing where people cling on to what they want to cling on to and they demonize the one thing that you know pops up in the research or in the abstract okay the birth control pill increases the risk of breast cancer but then they forget to mention all the other benefits of quality of life and improving pain treating acne lowering the risk of endometrial cancer and ovarian cancer and it always seems to be that they literally emphasize the the relative risk which is the big juicy number that they can say it increases your breast cancer risk by this big percent and they never then focus on the absolute risk where it's actually a minuscule risk where it's maybe one in several dozen thousands of patients might be at increased risk of a cancer or a blood clot if they're on this medication what do you think that sort of I guess stigma and misinformation has on you know women choosing and deciding whether they should go on birth control or continue to be on birth control yeah I mean your point about people not understanding relative risk and absolute risk you know it's really it's very Salient and I would also say that in the United States a lot of the birth birth control disinformation is funded by right-wing uh groups so it's important for people to understand that um these are the people that want to take away your right to vote your right to have an abortion um they they have an investment in keeping women in poverty and the birth control pill I think is responsible for in the United States 40% of the academ of the um Financial gains women have had since the 1960s so that's obviously threatening to people who who you know want to keep women from um being you know in positions of power so yeah if you look at the risk of breast cancer for someone under the age of 35 I I may have the number off a little bit but it's about like one in 50,000 wow so if you're increasing the risk by 30% you're going from 1 in 50,000 to 1.3 in 50,000 right so that number people hear that and they're like what are you even talking about no one ever none of these anti- birth control pill Crusaders ever discuss the Carnage of pregnancy if pregnancy were a drug it would never get approved it should would have the big yeah biggest blackbox warning I mean oh this this condition can give you fecal incontinence right this condition can give you urer incontinence this condition has a risk of giving you a blood clot of four to 60 in 10,000 right this condition can kill you so people never have the full ethical conversation especially on social media and as we all know reals and Tik Tok is all about fear fear feeds that algorithm and you want you're more likely to watch a video to the end if it frightens you than otherwise so it's really frightening how good those algorithms are too so I would say that you know there are we can hold space for two things to be true which you know social media is not good for so one truth can be that women are not listened to in the office and that they come in with a medical condition a medical condition that can actually be treated by the pill and they don't get that medical condition explained to them and how the pill works for that condition and so they think that they've been fobbed off with the pill and rightly so if no one explained it to you then of course you think you've been fobbed off and the pill can also be a fantastic treatment for many conditions and it can also be true that we don't have enough research to look into other things right but one one big example that I'll give is polycystic ovarian syndrome so one of the most evidence-based treatments for it is the estrogen containing birth control pill because the irregularity in the cycle is something that increases people's risk for endometrial cancer it obviously causes all kinds of other issues the hormonal disturbance at the level of the ovaries increases androgen produ ction for many women and so the estrogen containing birth control pill can counteract that that increase in androgens that has all of those negative effects on the body and the progestin will stop their risk of endometrial cancer and so we see these predatory naturopaths and holistic whoever holistic nutritionists and many Physicians I will add to boot who then tell people oh well there's a root cause of polycystic ovarian syndrome and my diet SL supplement is what's going to help help you ovulate and the thing is nobody understands what the root cause of polycystic ovarian syndrome is and it's unlikely the single one there's lots of theories and there's lots of things that are involved uh but there isn't a single root thing and you know what if there were don't you think Pharma would have been all over that this condition affects 10% of people if we had that knowledge of polycystic ovarian syndrome farm would be a way to the races right the the problem is is that we don't have a great medical understanding of the actual ideology we have lot lots of great hypotheses but we don't know for sure and again it could be different for different women there could actually be maybe four different types that have you know different causes so you have someone who steps in and says I'm going to give you my diet I'm going to give you my supplement and I'm going to make you better and what happens is weight can make polycystic ovarian syndrome worse it is not a cause absolutely but people who carry more fat tend to have more symptoms and if you're following a diet that also helps you lose weight as part of it then you will see an improvement in your symptoms and that might be falsely attributed to the asai berries in the diet or falsely attributed to the supplements that you're taking um also when you're taking advice from someone maybe you're going out and exercising more and that can reduce your insulin resistance so and it's true that doctors don't talk enough about these things in the office they don't talk about the benefits of exercise for insulin resistance they don't talk about the fact that you know even a small amount of weight loss can be beneficial for those who are overweight now there's all different kinds of treatments for PCOS and people do not have to feel that they need to go on a diet right there are people who there have been so much marginalization it's really important that we offer people treatment in a way that they feel that they can come in and they can be heard and a treatment that they can do but it's so you it's easy to see when when medicine says ooh it's like complex and doctors aren't explaining it so when someone comes to me and can I explain to them how the birth control pill works for polycystic ovarian syndrome they're like oh my gosh like I want that medication but that's you know a big difference in someone saying oh here take the pill yeah and and I think a lot of this stems from this you know naturalistic fallacy where people believe that just because it's natural it's safe I mean asbestos is natural and just because it's synthetic it must be bad and we know that nowadays penicillin is synthetically manufactured you know in Laboratories and factories so this extends Beyond just the birth control pillar because you know we can still women produce estrogen in their bodies and you know excessively high level of estrogen can also have the same negative consequences and side effects as you know the birth control pil has and I think this extends even to recently I've heard more and more you know murmurings about this is you know the forever chemicals in tampons and how tampons are toxic um what do you what do you think about all of this well I I think there's never been a good study that has shown that there are and that that there's consequences so I would say that we have no safety signals in the literature from tampon use right yeah and there have actually been a couple of studies looking at menual product use and endometriosis and endometriosis is actually a condition that we think might be possibly triggered by forever chemicals or be have a relation to that we don't know for sure but there's kind of a hypothesis there or that it could be part of it for some people there's no safety signal you know the forever chemicals in your water are the bigger issue and I think that that's also important when people people get worked up about something that there's no safety signal for no that doesn't mean we shouldn't study it of course we should but the idea that this is something that people should be worried about is not born by anything in the literature and if forever chemicals are a big deal you know what there's the massive sources are not from that right so do you want to go to the source that's giving you 99% of the burden or do you want to go to the source that's giving you less than 1% of the burden if you want to improve your quality of life right so I think it's important to understand that there isn't a way these chemicals are being added is it possible that the manufacturing process adds them sure someone needs to look at it people don't get worked up about diapers though that tend to be made in exactly the same way why aren't we worried about putting forever chemicals against the skin of babies how come that doesn't become reals on Tik toks toil Pap right because scaring women about reproductive Health makes copy right so I think that's a really and that's a very sort of you know ingrained idea that you know if for since the beginning of time your worth has been valued as a breeder you know those messages are culturally important to us whether we even ever care about being pregnant or not you know we we're all products of the society that we live in right so I think that we don't we've never seen our production in fertility from people use tampons we've never seen we don't see an increased risk of menstrual pain in fact one of the studies that looked at endometriosis found that tampon use was associated with a lower risk of endometriosis now I'm not telling you there's a cause and effect there's actually a great example people who have Painful periods are less likely to put a tampon in because it can be painful right but so that's a great example about how just because you find an association doesn't mean that there's a cause and effect so I would say that scaring women before you have quality research is no better than than not studying them because you're worried you have the next lamide and you're not bothering to follow it through you know that's how I feel about it and again Water Supplies huge issue you know people get all worked up there was a big thing about a year ago two years ago in the states about the period underwear and that they might have forever chemicals well if they do they're bound on the underwear or they've been washed away it's one of the two they're not getting into your body that's on all kinds of clothing how come people are only concerned about period underwear what about yoga pants that cover your whole legs right what about athletic wear what about athletic underwear that men wear what what about that why why is it only matter for women's vulvas right so those are the kind of things that I'm like huh why are you only interested in that and again it doesn't make sense that that would be a you know a significant issue considering all of the other ways that we're exposed to these chemicals right and I see this there's a huge uptick nowadays it seems to be the new thing that everyone is jumping on especially pseudo scientists and charlatans and people who want to sell things is around the topic of gut health and the microbiome and naturally that then has its own you know spider webs which spring off into different directions and people then start to sell supplements not just for gut health but for the vaginal microbiome as well and there's this whole you know seemingly fraudulent industry that's you know propped up overnight almost it seems although you know I suspect it's been there for many years where people are selling probiotics for the vagina or they're selling some sort of you know feminine hygiene products and things which help you deod deodorize inside or other sort of antiseptics for the insides I mean surely nothing should be inserted in that way or cleansed on the inside and our products shouldn't typically just be placed inside for you know hygiene purposes in that way well hygiene sex you know those are the you know those are you know you there's all kind of fun sex toys and things like that to use too so I would say that for um the hygiene business that is all based on 100% lie right I'm complete Mis understanding of how the body works and study after study Associates using so-called feminine hygiene products with negative Health outcomes so you don't want to use wipes you don't want to use sprays you don't want to use things that are meant to deodorize you don't want to use Sen products all of those things are just garbage so then when we look at probiotics I would say that they're all garbage too uh this is I'm sure this is the same for gut health is that we don't know we don't know about the microbiome we are like adventurers who are are standing on the shore of a Brave New World and we we do not speak the language we do not understand what is going on we don't understand the change in the seasons the change that we it's like a whole new world it's like us stepping on a different planet we don't understand like the vaginal microbiome if I sample it in the morning in the afternoon in the evening it's different what does that mean having one te you know and there's companies that sell tests for the microbiome which are like you know we have no way to interpret them I'm like okay and we have no way to replace it and we don't even know what we should be replacing what we do know is that disturbances in the microbiome certain disturbances are associated with negative Health that's the best that we have it's like learning a language and you know we know like 10 keywords so you can like you know not die on the streets of Paris you that like that's kind of what we know when it comes to the microbiome we don't know everything else that we need to know about functioning in that language so the idea that based on that limited knowledge we can fix these complex medical conditions is absolutely absurd there's actually been quite a lot of research in the vaginal microbiome interestingly enough and part of it is because disturbances in the microbiome are associated with transmission of H HIV so you know there's there has there has been you know from the GetGo a pretty um robust for you know for this area of medicine I would say interest in understanding the microbiome because you know there there was you know a belief and there still is a belief that with a you know with a more robust microbiome we could protect more women from HIV if they are exposed right or garhe CL I don't think I don't know if CIA has been associated with it but goria has and then of course there's a condition called bacterial vaginosis which impacts many women and it's a disbiosis of the of the vagina but we have very little understanding and part of this is because it's so freaking complex right how do you study a moving Target that you can't even really recreate the environment in a lab you can do your best with modeling you can do other things and so we also don't know the negative ramifications of taking probiotics right so obviously if you're immunosuppressed there are certain risks associated with it but I don't know what's in your probiotic like is it dirt that someone scooped from the backyard in the United States it certainly could be uh what are the consequences of taking you know these probiotics I mean for most of them they don't contain enough to do anything anyway and I think what a lot of consumers are unaware in the US anyway that the labeling is often incorrect so I would say that getting appropriate probiotic formulations to help people is an Undiscovered area of medicine there's people working on it and we could certainly cause more harm than good by throwing things at it that we don't understand especially things that are potentially contaminated and it's hard to be on the Leading Edge of research we all want um to have all the science for us but this is a situation where I mean my specialty is seeing people with chronic vaginal infections that's what I do every single day after I get off this I'm going to go to the clinic and I'm going to see you know probably two-thirds of my patients today will have disturbances with their vaginal microbiome so it's a very easy population to Target because we don't have a lot of good re good treatments we have a lot of research we have good treatments so you can see how people are so frustrated and they end up going in the other ways but we need to wait for the science because we can we can often do more harm than good and every single one yeah every single person I see probably or 80% will be on probiotics when they come to see me and I'm like you know so my example I give people is when I first started in uh medicine you know working as a clinician in the 1990s probiotics weren't really a thing and they really kind of started to become a big thing in the 2000s and then on to now I still see the same volume of people with the problems right from before and after these things became commonplace it's just now everybody who comes to see me is taking probiotics and obviously if you're coming to see me you're not any better I mean you know obviously that's not like our research study but just to give you an idea you know that we haven't seen any massive change and we know for example for yeast infections probiotics probably have zero impact might they for bacterial genosis maybe we need studies I think similarly I mean the same thing is reflected in the world of gut health as well there's a very narrow range of conditions for which there is some evidence and even it's not very strong you know post rectal cancer surgery in infectious uh diarrhea post antibiotics various things like that but it's an extremely narrow range of conditions I'm not saying in the future that if we know more about the microbiome and how it influences and how it can interact with ious other medications and autoimmune conditions and diseases we won't in 20 years time have some sort of personalized treatment plan based on the microbiome that does remain in the realm of possibility but certainly now this kind of degree of precision medicine with the microbiome doesn't exist and I can totally agree whoever is trying to sell you probiotic or postbiotic or Prebiotic related supplements to improve or cure some disease is likely you know straight out lying to you or you know significantly bending the truth and you know mixing some molecules of Truth you know trying to sell something so yeah I mean it's it's uh no surprise that in those patients you've described with chronic vaginal dpos who are desperate for something would reach to you know would clutch at stws and think like you know what it's not going to harm me let me just try it so I guess that's where you know people are really exploiting the fears of you know those people and um and I think you know I just want to say what you do online to debunk those myths each and every one your online blog as well as your books as well do a fantastic basically public service to do all of that and I've love speaking to you today so thank you so much Dr Jen gun well thank you so much for having me this was a lot of fun thank you in the confusing and often impenetrable world of female Health hopefully you've come away with some useful information about the realities of what we do know and what you can stop worrying about if you've got any thoughts questions or guest suggestions drop me a comment below in the next podcast episode I'll be chatting to obesity expert Dr Andre aosta and I'll be speaking about all things as zic why some people find it harder to stay slim and how close we are to finding a real solution for excess weight gain subscribe so you don't miss that and the weekly Dr curent explores podcast every Friday otherwise I will see you naughty Nuggets next week