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From hysteria to empowerment

Yale Medicine Magazine, Spring 2024 (Issue 172) Women's Health Special Report
by Isabella Backman


Women's health through the ages.

In ancient Greece, physicians practicing in the Hippocratic tradition commonly diagnosed women suffering with such vague symptoms as pain, heavy menstrual bleeding, depression, anxiety, and fatigue—and even infertility—with “hysteria,” a term derived from hystera, the Greek word for uterus. The physicians posited that their patients developed hysteria because they were not fulfilling their womanly duty to marry and bear children, which caused the uterus to become displaced and wander around the body. The cure, the doctors advised, was to get married and have children quickly.

Throughout history, medical treatments for these “female problems” ranged from hanging women upside down and shaking them to return the uterus to its rightful place to putting leeches in the vagina to giving suppositories of bull urine. Women were accused of madness, witchcraft, or demonic possession, and forced to undergo exorcisms, burned as witches, or confined in mental institutions.

Stories of misdiagnosis and mistreatment aren’t just curiosities of ancient and medieval history. Longstanding claims that Victorian-era doctors performed “pelvic massage,” in which they stimulated female patients until they reached orgasm, as a treatment for hysteria have now been called into question. However, neurologist Silas Weir Mitchell’s 19th-century rest cure, which included six to eight weeks of forced bed rest and isolation, was often prescribed for hysteria.

“For centuries, hysteria has served as a dramatic medical metaphor for everything that men found mysterious or unmanageable in the opposite sex,” wrote Mark Micale, PhD, a former assistant professor of history at Yale and professor emeritus of history at the University of Illinois Urbana-Champaign, in a 1989 article published in History of Science.

Feminism and women’s health advocacy

But in the mid-19th and 20th centuries, change was brewing. In 1848, the so-called “first wave” of feminism emerged with the women’s rights agenda promulgated at the Seneca Falls Convention. A year later, Elizabeth Blackwell, who was born in England and moved with her family to Cincinnati, became the first woman in the United States to graduate from medical school, earning her diploma fromthe Geneva Medical College after being rejected by 29 other medical schools. Several decades later, Mary Ware Dennett, who had once been prosecuted for mailing a pamphlet that she had written for her sons titled The Sex Side of Life, founded the National Birth Control League, an organization that advocated legalization of contraception.

The 1960s and 1970s gave rise to the “second wave” of feminism, ushered in by the Women’s Health Movement, which largely focused on reproductive health. The groundbreaking book Our Bodies, Ourselves (1970) covered topics that were considered taboo at the time, including contraception, women’s sexuality, and post-partum depression.

Feminist health advocacy was strengthened when the Supreme Court’s 1973 landmark Roe v. Wade ruling granted American women the constitutional right to abortion. Two years later, a protest at the U.S. Food and Drug Administration’s (FDA) headquarters—in which women demanded accurate information about the risks of birth control pills—led to the birth of the National Women’s Health Network, which remains a driving force in women’s health advocacy today.

The 20th century also saw the development of products that dramatically improved women’s quality of life. Menstrual pads reached the market in the 1920s, while tampons grew in popularity a few decades later. Birth control pills and intrauterine devices (IUDs) became available shortly thereafter.

Women's health: more than reproductive medicine

Recent years have also brought new challenges. Although the longstanding stigma around menstruation has largely dissipated, many women still feel shame around talking openly about their periods. Activists continue to challenge these attitudes as well as those related to other historically taboo subjects through such movements as #MeToo, which has empowered women around the world to speak out against sexual violence.

Most recently, state-level bans following the overturning of Roe v. Wade in 2022 are hindering many women’s access to safe abortions, and new legal risks to doctors are putting women’s lives in danger as they encounter delays in getting care for complications during pregnancy. Researchers are monitoring the long-term effects on public health in the post-Roe era.

There is also growing recognition of the many health disparities that affect women. Today, women still suffer from autoimmune diseases, chronic pain syndromes, and disability at higher rates than their male counterparts, but these conditions attract less funding for medical research.

Women are also significantly underrepresented in clinical trials and research. A 2021 study published in JAMA Network Open that examined over 20,000 clinical trials between 2000 and 2020 reported that women were underrepresented in clinical trials in a range of areas including cardiology, oncology, neurology, immunology, and hematology.

Women’s health at Yale

Researchers and clinicians at Yale School of Medicine (YSM) have been at the forefront of groundbreaking innovations in women’shealth. As early as 1822, Nathan Smith, MD, YSM’s first professor of materia medica and surgery, developed an improved method of oophorectomy—the surgical removal of one or both ovaries used to treat such conditions as ovarian cancer and endometriosis—a condition now more deeply understood than ever before, thanks in large part to Yale-led research. YSM’s Department of Obstetrics, Gynecology and Reproductive Sciences was also home of the first fetal echocardiography, obstetrical ultrasound, and fetal blood sampling and transfusion procedures, contributing to today’s overall clinical excellence.

In cardiovascular medicine, YSM specialists are identifying innovative techniques to diagnose heart disease so that fewer women are overlooked, supporting women with cardiovascular risk factors and heart disease throughout their pregnancies in YSM’s growing cardio-obstetrics program, and transforming post-partum hypertension care through a novel cardiology clinic that provides new mothers with cardiovascular risk assessment and management.

The Yale Cancer Center (YCC), now in its 50th year, is continuing its tradition of breakthrough research and innovative treatment that includes a dedicated focus on breast cancer. Along with that, YCC has launched a new program to eliminate disparities based on gender identification, race, sexual orientation, and other factors that affect women’s cancer diagnoses and outcomes.

Women’s Health Research at Yale (WHRY), founded 25 years ago by Carolyn Mazure, PhD, has launched over 110 studies dedicated to women’s health across a wide range of specialties, including cardiovascular disease, cancer, autism, obesity, and addictive behaviors. (To read about Mazure’s newest role, see "Mazure chairs new White House initiative.")

Ongoing research in these and other areas is leading the way to new insights into female biology that will help women live longer, healthier lives.

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