Category: Final Blog Essay

There is little support for widely-held beliefs about depression and sexual decay. The National Institute for MentalHealth in the USA declared that it’s tougher for postmenopausal women because they expect their own climacteric to display the negative aspects they have come to believe it will have, which in some cases has the effect of a self-fulfilling prophecy. There seems to be three groups of climacteric symptoms: those associated with reduced estrogen-production, those which are in connection with socio-cultural factors and finally those which arise from personality characteristics. No doubt the most relevant factors influencing a woman’s quality of life during the menopausal transition are her previous emotional and physical health, her social situation, her experiences of stressful life events (particularly bereavements and separation) as well as her beliefs about menopause.

Menopause is a natural process. Yet, as early as the 1930s, the hot flashes and irritability that accompanied menopause was seen as a threat to the happiness of families and stability of marriages. Blame in a couple’s conflict often shifted entirely onto a middle-aged wife’s changing physiology and her emotional reactions to it. There are various treatments available that focus on symptomatic relief. Vaginal dryness is treated with topical lubricants or estrogens. Medications aimed at reducing the severity and frequencies of hot flashes include venlafaxine and gabapentin. In special circumstances, oral hormone therapy may be prescribed. A case study was done on a total of 71,076 patients with a diagnosis of menopause symptoms or a prescription claim for hormone therapy that were matched to control patients. Healthcare resource utilization and costs during the 6-month follow-up period were compared. In the study published in the Aug. 27 online issue of the journal Menopause, it was found that moderate to severe hot flashes- also known as vasomotor symptoms (VMS) are not treated in most women. It was found that women who experienced hot flashes had 1.5 million more health care visits than women without VMS. Costs for additional health care were $339,559,458. The cost of work lost was another $27,668,410.

Menopausal symptoms have a significant negative impact on a patient’s quality of life and increase health costs among women. In other research, significant correlations between socioeconomic factors and the severity of climacteric symptoms have also been found. Patients with menopausal symptoms were most likely to have depression and anxiety and incurred significantly higher follow-up healthcare costs than those without menopausal symptoms.

While awareness of menopause and women’s health has increased, there are still stigmas toward those who receive mental health treatment. For example, in Korea, the Ministry of Health and Welfare announced the ‘Comprehensive Plan for Mental Health Improvement’ for the purpose of redefining mental patients and conducting regular checkups of mental health across one’s lifespan. However, the rate of utilizing mental health services in South Korea is still significantly low. According to a survey by the Ministry of Health and Welfare in 2012, only 15.3 percent of potential people with mental health concerns sought professional help. The lower rate of people seeking mental health services implied that mental health and counseling fields still face enormous challenges in Korea, including a stigma towards those who receive mental health treatment. The Korean public may still consider he concept of a person being mentally ill and seeking relevant treatment as being taboo.

Hwabyung is one particular Korean mental illness that arises when people are unable to confront their anger as a result of conditions which they perceive to be unfair. The term ‘Han’ is a Korean culture-related sad sentiment related to hard life and social unfairness resulting not only from the tragic collective national history, but also from a traumatic personal life. As a culture-bound syndrome, Hwabyung is a unique affliction which can be triggered by various external events, particularly intra-familiar stressors such as spousal infidelity and conflict with in-laws. Because of the cultural emphasis on familial harmony and peace, expressing anger is not acceptable. Prevalence of Hwabyung exhibits gender differences in that the majority of individuals who experience Hwabyung are middle-aged, menopausal women. These individuals usually are women of low socioeconomic status, live in rural areas, and are among the divorced or separated, smokers and drinkers. They typically typically live in traditional families which stress the value of males while devaluing women. In these families, a woman’s virtue is to quietly bear misfortune and unhappiness while maintaining harmony.

I used the concept of Hwabyung to point out an interesting lexical gap in America. To my understanding, there is no term in the English language that accurately matches this illness. While Hwabyung may not necessarily be a cultural norm in this country, it cannot be denied that American women face a unique menopausal experience marked by its own stigma and oppression. Analyzing different situations menopausal women of varying cultures are placed in brings light to a deeper understanding to the disparities in treatment of women and my own experience as an Asian American who will one day experience menopause.

Women are held to maintain domestic tranquility and sex appeal while fulfilling sexual obligations. To border the dangers of sexual excess would be unthinkable. The social stigma surrounding menopause and the unavailability of treatments to those of the lower class points out that there needs to be an adequate understanding and fulfillment of women’s health care and not merely a matter of individual assistance. The psychological aspects concerned are relevant not only to women themselves, but also because an adequate or inadequate approach to them has consequences on women’s perception of their health needs, their access to health services provided, and their compliance to the treatments prescribed. This is a problem which involves public health policies and strategies designed to take into account the needs of women domestically and internationally.

After years of suffering from ear and sinus infections, loss of hearing, dizziness, and tinnitus, speaking to multiple doctors, and having multiple pointless procedures, I finally had surgery to alleviate my pain and improve my immune system. They put me under for the surgery, which I never thought to question. I didn’t want to experience any more pain than I was already expecting for recovery and I didn’t want to have a memory of being cut open. But of course, I never really had a choice—this was an invasive procedure. Anesthesia has become so common-place that no one bats an eye at it’s use: Cavity? Local anesthetic. Stitches for a deep cut? Local anesthetic. Wisdom teeth removed? General anesthetic. Sinus surgery? General anesthetic. It is automatic. Except for me, it isn’t always the miracle drug-cocktail it is peddled as.

Every time I have to get a local anesthetic, I tense up because I know I have a delayed reaction to it. Typically, the doctor is finishing up their procedure or sometimes I am getting back in my car by the time the numbness finally kicks in. Then, when I have been given general anesthesia, I have lost multiple-hours post-surgery and when I came out of this most recent surgery, I was uncontrollably sobbing for no reason. Each time, without a doubt, no matter the reaction, the nurses tell me that it is a normal side-effect for girls or women my age. However, I always feel as if they are just trying to appease me, to calm my anxiety. I can’t help but wonder how much of what I experience is just me, how much is because I am a woman, and how much falls under medical mismanagement?

After an initial search, I found that the risk of side effects is augmented for females under general anesthesia. Girls are more likely to have PONV (Post-Operative Nausea and Vomiting), more likely to experience intense confusion, and more likely to wake tearful and crying. However, I struggled to find any mention as to why these problems were happening. Countless women on message boards across the internet are asking “why was I crying when I woke up from surgery?” but no one seems to have a complete answer. Some suggested hormonal imbalances post-puberty, but then why aren’t all women experiencing this? And more importantly, why were these reactions not discussed pre-operatively with patients. Given the lack of current work on the issue, I decided to see if the stories of the past could help inform me about our present situation.

Drug use to reduce pain is dated back to 4000 BCE amongst the Sumerian artifacts depicting the use of opium poppy. Throughout the ensuing five thousand years, different herbal and alcoholic mixtures were tested to produce some unconscious or semi-conscious state for medical procedures. Then in the mid-19th century, women were often being given chloroform for pain in childbirth. It became such a popular procedure that Queen Victoria herself was administered chloroform for the births of both Prince Leopold and Princess Beatrice.

As greater understanding of germs and patients’ rights came about, doctors began to use needles or tubes rather than cloth rags soaked in an herbal/alcohol mixture and to monitor their patients heart and respiratory rates before, during, and after surgery. By the mid-20th century anesthetic-use was booming, particularly in the obstetrics field. One of the most prominent, and controversial, uses of anesthetics was for “twilight sleep” births. Women would be given morphine and scopolamine so that they felt less pain and had no memory of the labor. In reality, this procedure often left the mother struggling for consciousness, many thrashing around in pain or in an attempt to subvert the oncoming “sleep”. Due to their memory loss, these women’s qualms were actively being silenced in the name of birthing efficiency. But then, by the mid-1980s, doctors had “perfected” the art of general anesthesia we know today.

All of these innovations were driven by the desire to reduce pain and suffering, but I still kept wondering how pain’s inherently subjective-experience was, and is, taken into account? We tend to err on the side of not feeling anything, rather than risk feeling any discomfort at all. However, this is operating under the assumption that pain is believed to be real. Even though anesthetics are common-place, many women still need to convince their doctor of the problem in the first place, and then when she has complications from the procedure, whether it is the anesthetic or the surgery itself, she is told that what she is experiencing is normal. According to Hoffman and Tarzian (2001), “nurses gave less pain medication to women aged 25 to 54” than to men. Women are also less likely to be given narcotics and more likely to receive sedatives in the hospital because their agitation is more typically associated with anxiety than pain.

With all of this in mind, I couldn’t help but wonder if my discomfort pre- and post-surgery was seen as anxiety rather than pain. It would explain why it took multiple years for my symptoms and pain levels to be taken seriously, and then why, even once I convinced a doctor and got the surgery, I was still left alone in the recovery room crying and sent home with an extremely low dosage of pain medications given the severity of my recovery. This is evident by the few mentions of female-driven innovation, outside of obstetrics, in anesthetic history. The Queen Victoria anecdote is a perfect example; it took her being the highest ruler in the land to receive pain medications for her labor. Furthermore, due to our patriarchal-based history, women’s ailments were treated not because of their suffering as much as to reduce the strain that their suffering put on their husbands or fathers. From the treatment of hysteria to the use of “twilight sleep” births in the early twentieth-century, women have been and are consistently being silenced by medicine, rather than listened to, diagnosed, and treated as men unfailingly are.

I sat in my gynecologist’s patient room in a blue paper gown. “My birth control doesn’t work again,” I blurted out as she walked in. I explained to her, yet again, that I was getting multiple periods each month.

That was August, the fourth time I’ve had to have that conversation about changing medications. But, like the others, it soon stopped working. While it limited me to one cycle a month I felt physically horrible; I couldn’t keep my eyes open for more than a few hours at a time; I had eye-watering migraines; I had overbearing cramps; I gained and dropped weight drastically, sending my body image into a horrible roller coaster. So now, I am about to start my fifth birth control prescription in less than a year and a half. I am not merely changing them based on trends, either. The pills, after a few months, suddenly lose out to my natural hormones.

Why are women the ones who must endure the distressing changes that go along with hormonal birth control methods?

Male hormonal contraceptive methods have been largely unexplored in modern research. However, the latest study on male contraceptive injections proved to be about 96 percent effective. However, it was stopped prematurely –in the phase two of three– due to the drug’s unbearable side effects.

In a study sponsored by the United Nations and the Journal of Clinical Endocrinology and Metabolism, 320 healthy men in monogamous relationships, ages 18-45, were tested with the injections. The shots consisted of synthetic testosterone, similar to how female birth control pills use synthetic estrogen and progestin, to decrease the production of natural sperm. Researchers found that the sperm count in men using the injections dropped significantly, from 15 million/mL to 1 million/mL after just a 24-week period.

Negative side effects experienced by the men in the study included one case of depression, irregular heartbeat, injection site pain, muscle pain, acne and mood swings. (Hmm, sounds familiar!) Twenty men even quit the injections, citing these reasons. However, despite this, more than 75% of the participants said they would still seek this form of male contraception if it were made available.

As women, we are still fighting for the rights to our own bodies. The modern fight lives on in this country in the politics of abortion rights and access to contraception. Methods of birth control have long fallen to women to handle—diaphragms, IUDs, injections, patches, and pills are all made for women.

The FDA approved the first hormonal birth control pill in 1957 for severe menstrual disorders. In 1960 the pill was approved for contraceptive use and within five years, more than 2.3 million women were on the pill. However, it was not until 1972 that a Supreme Court case (Baird v Eisenstadt) legalized birth control for all women, regardless of their marital status (previously, only married women were granted access).

Women’s health journalist Barbara Seaman published a book in 1969 titled The Doctor’s Case Against the Pill. In it, she exposed many of the side effects of the pill, including stroke, depression, blood clots, and heart attack. This was just the beginning of the negative publicity about the pill; by the end of the 1970s, its sales had dropped 24 percent.

Today, about 50 years after Seaman’s book, the list of common side effects for birth control includes nausea, headaches, weight gain, and mood swings. And more severe side effects included blood clots, blurred vision, seizures and heart conditions.

Women have come a long way in the name of reproductive freedom; women have long fought for the right to make decisions about their own bodies. And while there is no greater pride in this history of courage, it must also be recognized as a one-sided burden to comply with an androcentric medical system.

Sparse research on male contraception suggests that there has been scientific interest. Endocrinologist Gregory Pincus, who is credited with the co-creation of the female contraceptive pill, was doing similar research on men in 1957 but it never came to fruition once the pill became a hit. In the 1970s, a non-hormonal drug known as gossypol was tested in China as a male contraceptive and seemingly worked. But the side effects were problematic, ranging from fatigue to paralysis. A Brazilian pharmaceutical company picked it up 20 years later, but the previous side effects, along with infertility, inhibited the drug from hitting the market. In 1998, the WHO recommended that all research on the drug be abandoned. Ten years later, enrollment for this latest study began.

If scientific research is not inhibiting male contraceptive methods, what is?

Science has never been closer to discovering a hormonal contraceptive for men. But on the latest attempt, the study was stopped short due to the symptoms—the very symptoms that women have endured for decades in the name of preventing unwanted pregnancy. But instead of calling men in the study “wimpy” or “weak,” maybe it is time to instead explore the gender disparity in how we politicize contraception and its side effects.

Now if you’ll excuse me, I have to go pick up my new prescription.

Further Reading:

Andy Extance, “A Brief History of Male Birth Control: Clinical Research is Promising but We Still Have A Ways To Go” Medical Daily (2016)

R.E. Fulton, “‘She Looks the Abortionist and the Bad Woman’: Sensation, Physiognomy, and Misogyny in Abortion Disclosure” Nursing Clio (2015)

Gloria Steinem, “If Men Could Menstruate” Outrageous Acts and Everyday Rebellions (1986)

V. Tanner, “Why We Must Stop Calling Menstruation A ‘Women’s Issue‘” The Establishment (2016)