What is *It's Not Hysteria* about?

*It's Not Hysteria* by Dr. Karen Tang is a comprehensive guide to reproductive health, addressing misunderstood issues like fibroids, endometriosis, pelvic pain, and PCOS. It debunks myths, explains treatment options, and empowers readers to advocate for their care. Combining medical expertise with patient stories, the book critiques systemic gaps in gynecological healthcare while offering inclusive, evidence-based solutions.

Who should read *It's Not Hysteria*?

This book is essential for anyone seeking clarity on reproductive health, including those experiencing pelvic pain, irregular cycles, or fertility concerns. It’s also valuable for allies, healthcare providers, and individuals exploring gender-inclusive care. Dr. Tang’s accessible approach helps readers navigate confusing symptoms and outdated medical practices.

Is *It's Not Hysteria* worth reading?

Yes—*It's Not Hysteria* fills critical gaps in women’s health education, offering actionable advice rarely covered in traditional settings. Endorsed by experts like Megan Ranney and Sharon Stone, it provides frameworks for discussing stigmatized topics with providers and demystifies surgical/non-surgical treatments.

What qualifications does Dr. Karen Tang have?

Dr. Tang is a board-certified gynecologic surgeon with an MD and MPH, specializing in minimally invasive procedures. A social media educator with millions of followers, she merges clinical expertise with public health advocacy to address systemic issues in reproductive care.

How does *It's Not Hysteria* address fibroids and endometriosis?

The book details diagnostic criteria, lifestyle adjustments, and advanced treatments for fibroids (e.g., UAE, myomectomy) and endometriosis (e.g., excision surgery). Dr. Tang emphasizes avoiding unnecessary hysterectomies and highlights pelvic floor therapy as a non-surgical option.

What solutions does the book offer for pelvic pain?

Dr. Tang explores root causes like vulvodynia and vaginismus, advocating for personalized care through physical therapy, nerve blocks, and hormonal treatments. She critiques dismissive attitudes toward pain and provides scripts to help patients insist on thorough evaluations.

How does *It's Not Hysteria* approach gender inclusivity?

The book uses gender-neutral language where applicable, acknowledging diverse reproductive health experiences beyond cisgender women. It addresses LGBTQ+ needs in sexual health screenings and fertility care, emphasizing equitable access.

What critiques does Dr. Tang make about gynecological care?

She highlights biases in pain management, over-reliance on surgeries, and poor provider education on conditions like PCOS. The book calls for systemic reforms, including better tracking of menstrual cycles as vital signs and expanded insurance coverage for pelvic therapies.

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Karen Tang

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Em "It's Not Hysteria", a Dra. Karen Tang desmantela séculos de negligência médica (*medical gaslighting*) com precisão cirúrgica. Sharon Stone a chama de "uma verdadeira dádiva para as mulheres" — mas e se o diagnóstico mais perigoso na saúde não for uma doença, mas sim o descaso da sociedade com a dor feminina?

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Capítulo 1

When Hysteria Was Never the Answer

Have you ever wondered why women's health concerns have been so consistently dismissed throughout history? Picture this: you're experiencing debilitating pain that disrupts your daily life, yet doctor after doctor tells you it's "just stress" or "all in your head." This isn't a rare occurrence-it's the lived reality for millions. Karen Tang's groundbreaking book "It's Not Hysteria" tackles this medical gaslighting head-on, exposing how the ancient Greek concept of the "wandering womb" continues to haunt modern gynecology. Endorsed by celebrities like Padma Lakshmi and praised by medical professionals, this book has become essential reading in women's health circles, offering both validation and empowerment to those navigating a medical system that has historically failed them. As one reviewer put it, "This is the book I wish I'd had twenty years ago when doctors dismissed my endometriosis as anxiety."

Capítulo 2

The Dangerous Legacy of Hysteria in Women's Medicine

Women's bodies and health concerns have been misunderstood and dismissed since the beginning of recorded history. The term "hysteria"-derived from the Greek word for uterus-contains all the judgments about female bodies that have persisted for thousands of years. Ancient Greek physician Hippocrates proposed the "wandering womb" theory, suggesting that many medical problems were caused by the uterus literally moving around the body, supposedly due to lack of sexual activity. While no modern doctor believes this, echoes persist when patients with endometriosis are told to get pregnant as treatment or when women seeking sterilization are told they'll regret it. Through medieval witch trials, 19th century surgical removals of clitorises and ovaries by doctors like Isaac Baker Brown and Robert Battey, to the "rest cures" of neurologist Silas Weir Mitchell that inspired Charlotte Perkins Gilman's "The Yellow Wallpaper," women's symptoms have been consistently misattributed and mistreated. By the late 19th century, Charcot and Freud moved hysteria from a disease of the body to one of the mind, leading to the modern perception that unexplained physical symptoms must be psychological. This history has directly shaped today's medical landscape. Despite medicine's claims of being evidence-based, gender inequality permeates scientific research. Until 1993, when President Clinton mandated inclusion of women and minorities in NIH-funded research, major clinical trials routinely excluded women entirely. The FDA maintained a policy until that same year barring reproductive-age women from early-phase drug trials regardless of their sexual activity or contraception use. Funding disparities remain troubling-conditions affecting primarily women receive significantly less research money than comparable or even rarer conditions. In 2022, the NIH allocated $37 million for smallpox (eradicated in the US since 1949) compared to just $27 million for endometriosis (affecting 10% of women) and $15 million for fibroids (affecting 70-80% of women). Black women face even greater challenges. The foundations of gynecology are steeped in racism. James Marion Sims, considered the "father of gynecology," developed surgical techniques by operating on unanesthetized enslaved Black women-Anarcha, Betsey, and Lucy-with Anarcha enduring thirty experimental procedures. Today, Black women in the U.S. are three times more likely to die in pregnancy or childbirth than white women, regardless of income, education, or insurance status. Without adequate research, doctors remain ignorant of the basic causes of many gynecologic conditions, limiting treatment options to symptom management or organ removal rather than targeting biological causes. The medical system itself creates barriers-overwhelmed OB-GYNs seeing 40-50 patients daily have only 10-30 minutes per appointment, insufficient for complex health issues.

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Capítulo 3

Understanding Your Body: The Anatomy They Never Taught You

Despite being sexually active adults, most people lack basic knowledge of reproductive anatomy. When given anatomy quizzes in a college sexual ethics class, students consistently failed to identify or accurately draw reproductive organs. This knowledge gap reflects a society where sex and reproduction remain so taboo that people old enough to vote, marry, and become parents lack fundamental understanding of their own bodies. Female internal reproductive organs include the ovaries, fallopian tubes, uterus, and vagina. The ovaries release eggs and produce hormones like estrogen, progesterone, and even testosterone. Unlike testicles, ovaries don't produce new eggs-people assigned female at birth are born with all the eggs they'll ever have, with only a few hundred released in a lifetime. The fallopian tubes connect ovaries to the uterus, though not directly attached. Contrary to common belief, fertilization occurs in the tube, not the uterus, and the fertile window after ovulation is only 12-24 hours. The fist-sized uterus can expand enormously during pregnancy and consists of several layers: the outer serosa, the muscular myometrium where fibroids originate, and the endometrium that sheds as menstrual blood. The vagina connects the cervix to outside the body, serving roles in sex, menstruation, and childbirth. Its inner walls feature rugae (folds) allowing expansion, with estrogen receptors maintaining lubrication and elasticity. The vagina hosts a microbiome dominated by Lactobacillus bacteria that produce lactic acid, creating a protective acidic environment. The female external genitalia (vulva) includes the labia minora, labia majora, mons pubis, and clitoral complex. The clitoris is far more extensive than just the visible glans. Beneath the surface, the body of the clitoris splits into two arms (crura) made of erectile tissue similar to a penis shaft, extending up to four inches along the sides of the vagina and urethra. Most of the clitoris is not visible externally, forming a much larger and more complex system than commonly understood. The menstrual cycle is a complex hormonal interplay between brain, ovaries, and uterus. During each cycle, a follicle matures and releases an egg (ovulation), while the uterine lining thickens. Without fertilization, this lining sheds as menstrual blood. The process is controlled by precise hormone signals: GnRH from the hypothalamus triggers the pituitary to release FSH and LH, which stimulate follicle development and ovulation. Normal periods are defined by cycle length (typically 21-45 days), duration (2-7 days of bleeding), and flow volume. Conception occurs when an egg released during ovulation meets sperm in the fallopian tube. Sperm can survive up to five days in the reproductive tract, meaning pregnancy can result from intercourse nearly a week before ovulation.

Capítulo 4

Advocating for Yourself in the Doctor's Office

When dealing with gynecologic problems, it's challenging to articulate your experiences to healthcare providers. The first hurdle is determining whether your symptoms are actually abnormal, especially if you've experienced them since your periods began. Many people suffer for years with severe pain, heavy bleeding, or bowel issues because they've been told these symptoms are normal. The key question isn't whether symptoms are common but whether they disrupt your quality of life, preventing you from working, exercising, or maintaining emotional well-being. Before medical appointments, track your symptoms, period patterns, pain levels, and triggers to communicate effectively with your doctor. Since appointments may be brief (often just 15-20 minutes), organizing your thoughts beforehand is crucial. Track your menstrual history by noting: age when periods started, date of last period, cycle length and regularity, duration of bleeding, flow heaviness, presence of blood clots, breakthrough bleeding, and any associated symptoms like weakness or lightheadedness. Document pain by recording when it started, whether it began with periods or after a specific event, its frequency and duration, triggers that worsen it, quality (sharp, stabbing, burning), impact on your quality of life, and treatments you've already attempted. Note any digestive issues like diarrhea, constipation, painful bowel movements, bloating, nausea, or changes in appetite that might be related to your gynecologic condition. Record urinary symptoms including urgency, frequency, pain, incomplete emptying, or urine leakage. Document any skin irritation, bumps, sores, or changes in vulvar appearance, as well as pain with sex, vaginal dryness, or discharge. Track mood symptoms like depression, anxiety, mood swings, or irritability, noting their frequency, impact on quality of life, and whether they worsen before or during menstruation. Identify concerns about pain with sex, low libido, arousal difficulties, or inability to achieve orgasm. If experiencing pain, specify when it occurs-during arousal, with genital touch, initial or deep penetration, orgasm, or after sex. Clarify pregnancy intentions-whether you want to conceive (and when), never want to become pregnant, or are actively trying (including duration, methods used, and treatments attempted). Prioritize your greatest concerns to focus your healthcare visits effectively. Clarify what you need from your provider-whether diagnosis, treatment options, education about a condition, or reassurance.

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Capítulo 5

Fibroids: The Silent Epidemic Affecting Most Women

Fibroids are extremely common benign tumors of the uterine muscle affecting up to 80 percent of Black women and 70 percent of white women by age fifty. While not everyone experiences symptoms, up to half develop distressing problems including severe pain, heavy bleeding, bloating, pelvic pressure, infertility, or miscarriage. Also called leiomyomas or myomas, fibroids form when uterine muscle cells multiply rapidly, creating genetically identical clones. Stimulated by estrogen and progesterone, they typically begin growing in one's twenties and thirties and often shrink after menopause, though they may not disappear completely. Fibroid symptoms depend on their size, number, and location. Fibroids can press on the bladder, rectum, and bowel, causing pregnancy-like sensations of bloating, urinary frequency, incontinence, and constipation. They can cause frighteningly heavy or prolonged periods, with large clots and pads soaking through in minutes. Beyond severe menstrual pain, fibroids can cause pain throughout the cycle and during sex. When fibroids outgrow their blood supply, they undergo degeneration-cell death that causes extreme pain. A fibroid's location within the uterus largely determines its symptoms. Fibroids are categorized by their position: in the cavity (causing bleeding and fertility issues), within the muscle (causing various symptoms), or on the outer surface (primarily causing bulk symptoms and pain). Black women have three times higher fibroid incidence than white women, with Hispanic women at twice the risk. Black women typically develop larger, faster-growing fibroids with more severe symptoms 10-15 years earlier than white patients. These racial disparities likely stem from complex interactions between genetics, environment, diet, and psychosocial factors like stress. Family history significantly increases fibroid risk, and social patterns emerge when fibroids run in families. Many women believe severe bleeding and pain are normal because female relatives experienced the same symptoms, delaying diagnosis and treatment. Treatment options include medications for bleeding or pain control, and procedures/surgeries to shrink or remove fibroids. Medications include over-the-counter pain relievers like NSAIDs, hormonal medications like birth control, tranexamic acid to slow bleeding, and GnRH agonists and antagonists that can actually shrink fibroids by suppressing ovarian hormones. Surgical options include uterine fibroid embolization (UFE), which blocks blood flow to fibroids causing them to shrink; myomectomy to remove fibroids while preserving the uterus; ultrasound-guided radiofrequency ablation to destroy fibroids with heat energy; and hysterectomy as a definitive treatment. Each approach has different benefits and risks, particularly regarding future fertility.

Capítulo 6

Endometriosis and Adenomyosis: The Invisible Pain Epidemic

Endometriosis and adenomyosis are often invisible conditions with no definitive lab tests or imaging studies, leaving patients told nothing's wrong despite debilitating symptoms. With endometriosis affecting one in ten women and taking seven years on average to diagnose, patients frequently endure multiple specialists and normal test results while suffering extensive physical pain. These conditions occur when endometrium-like tissue grows outside its proper location. In endometriosis, tissue grows outside the uterus-commonly between the uterus and rectum, on bladder or bowel surfaces, pelvic walls, ovaries, diaphragm, or even the belly button. With adenomyosis, tissue grows within the uterine muscle wall (myometrium). Both are extremely common, with endometriosis affecting at least 10% of women and up to 50% of infertile women. Endometriosis and adenomyosis cause pain and symptoms by inflaming surrounding structures, affecting multiple pelvic organs and systems. They commonly cause bowel symptoms like constipation, diarrhea, pain with bowel movements, bloating, nausea, or rectal bleeding. Many patients are initially misdiagnosed with irritable bowel syndrome. They can cause urinary urgency, frequency, burning, or blood in urine, mimicking UTIs without bacterial infection. Pelvic floor muscles surrounding the bladder, vagina, and rectum can become inflamed, causing pain during sex or exercise, and aching radiating down the legs. Inflammation of pelvic nerves can cause burning or shooting pains in the lower back, buttocks, and legs. Both conditions can cause systemic symptoms affecting the entire body, including severe fatigue or migraines. Endometriosis significantly impacts fertility, with up to half of infertility patients having the condition. It can cause fallopian tube scarring, leading to conception difficulties or ectopic pregnancy risk. Both endometriosis and adenomyosis reduce IVF implantation rates and increase miscarriage risk, possibly from endometrial inflammation or egg quality issues. Diagnosis requires surgical confirmation since no definitive lab test or imaging study exists. Tissue must be removed and examined microscopically to confirm the presence of endometrial cells outside the uterine cavity. Early endometriosis often doesn't appear on ultrasound as the disease starts as small flat spots too tiny to detect. The gold standard for endometriosis treatment is excision-surgically cutting out affected tissue. Adenomyosis treatment presents unique challenges, as hysterectomy is typically required for complete disease removal. Medications for endometriosis and adenomyosis only suppress symptoms rather than eliminate the conditions. NSAIDs like ibuprofen and naproxen are recommended for pain control due to the inflammatory nature of these conditions. Hormonal birth control and progesterone pills often improve pain and heavy bleeding by suppressing ovulation and periods. Many patients need more than surgery or medication alone for complete symptom relief. A holistic approach often provides excellent control of all symptoms, including pelvic floor physical therapy, dietary modifications, and mental health interventions to address the mind-body connection.

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Capítulo 7

Polycystic Ovarian Syndrome: Beyond Irregular Periods

PCOS affects 10 percent or more of those assigned female at birth, making it the most common endocrine disorder among women of reproductive age. This complex syndrome can affect appearance, weight, health, fertility, and mood. Despite its prevalence, PCOS remains poorly understood with more questions than answers, causing enormous frustration for sufferers. The condition presents contradictorily-it can cause periods to disappear for months or cause persistent heavy bleeding. Even its name is misleading, as patients don't necessarily have polycystic ovaries to receive the diagnosis. PCOS is a hormone imbalance affecting ovulation and menstruation. As a syndrome rather than a specific disease, it presents as a constellation of problems including menstrual abnormalities, infertility, mood disorders, skin changes (acne and hirsutism), and metabolic issues (high blood pressure, high cholesterol, insulin resistance, diabetes, and obesity). PCOS diagnosis relies on symptoms and physical findings rather than a specific lab test. The current diagnostic framework, known as the Rotterdam criteria, requires at least two of three features: 1) Oligo-ovulation or anovulation, manifesting as infrequent or absent periods; 2) Clinical or biochemical signs of hyperandrogenism, such as acne, excess facial/body hair, or elevated testosterone levels; and 3) Polycystic ovaries, identified by ultrasound showing twenty or more follicles or enlarged ovaries. Being overweight or obese increases PCOS risk, though the relationship is complex. Body fat may contribute to hormone imbalances, but PCOS itself is associated with weight gain and difficulty losing weight, creating a chicken-or-egg situation. For overweight PCOS patients, weight loss can improve or resolve symptoms. However, many people have "lean PCOS," experiencing symptoms despite having normal or low body weight. PCOS patients face higher risks of chronic medical conditions, abnormal bleeding, uterine precancer or cancer, infertility, depression, and anxiety. Without regular periods, PCOS patients can develop excessive endometrial buildup in the uterus. Irregular ovulation means less progesterone production, allowing endometrial cells to grow unchecked, potentially leading to polyps, precancer, or cancer. No direct treatment exists for PCOS since its root cause remains unknown. Management focuses on addressing symptoms through a multidisciplinary team approach involving gynecologists, endocrinologists, fertility specialists, nutritionists, and mental health professionals. Treatment combines various medication types tailored to individual symptoms, including hormonal methods, fertility treatments, dermatologic treatments, and diabetes medications. For those bothered by acne and excess hair, options include spironolactone (which decreases testosterone but risks electrolyte abnormalities), retinoids, antibiotics, and hair removal methods. Birth control containing estrogen helps by suppressing testosterone. For PCOS patients struggling to conceive, fertility specialists prescribe ovulation induction medications like letrozole or clomiphene. Much of PCOS management happens outside medical offices through nutrition, exercise, and stress management-especially important given the increased metabolic risks. For overweight patients, losing just 5-10% of body weight can reverse symptoms and normalize hormone levels. With proper self-care and medical supervision, people with PCOS can regain control of their health and reverse many effects of the condition.

Capítulo 8

The Hidden Connection: Pelvic Floor Dysfunction and Chronic Pain

Pelvic muscle spasm and dysfunction frequently cause pain and bowel/bladder symptoms but are often missed in diagnosis because they don't appear on imaging or lab work. These conditions require specialized pelvic exams to identify. They're especially common among military veterans with chronic pain, people with endometriosis, and those who've given birth. The pelvic floor forms a muscular bowl connecting to the lower back, hips, and legs. These muscles maintain constant tension to support the pelvic organs and prevent prolapse. The levator ani muscle wraps around the vagina, urethra, and rectum like a sling, while obturator muscles stabilize the hip. The interconnected nature of pelvic muscles and nerves means symptoms often appear simultaneously-pain with sex, difficulty urinating, constipation, and chronic pain in the pelvis, lower back, legs, and hips frequently occur together. Pelvic floor spasms manifest as aching, cramping, pressure, or burning sensations, sometimes with sharp, shooting nerve pain radiating to the legs or back. Myofascial pelvic pain creates trigger points that cause severe pain when touched during intercourse, tampon insertion, or exams. Vaginismus involves involuntary muscle spasms during penetration, often creating a cycle where anxiety about pain causes more muscle tension, worsening symptoms. Pelvic floor dysfunction can cause urinary urgency, frequency, difficulty emptying the bladder, and leakage. Both overly weak and overly tense muscles create bladder control problems. Interstitial cystitis (painful bladder syndrome) is strongly associated with pelvic floor dysfunction and can mimic UTI symptoms without showing bacteria in tests. Tight pelvic floor muscles can cause severe constipation, straining, and painful bowel movements. The primary treatment for pelvic floor dysfunction is physical therapy guided by specialized pelvic floor therapists, with medications sometimes used as adjuncts to help relax muscles or reduce pain. Pelvic floor physical therapy goes far beyond simple Kegel exercises, which can actually worsen dysfunction by causing further muscle spasm. Treatment is customized for each patient, combining stretching tight muscles, releasing trigger points, strengthening weak muscles, retraining normal function, and coordinating muscle activity. Therapists may use biofeedback with sensors that provide visual or audio feedback, electrical stimulation to activate muscles, or vaginal weights. Manual release techniques might employ silicone wands to reach painful spots. For vaginismus, graduated dilators help gently stretch and relax the vaginal walls and pelvic muscles. Medications can augment physical therapy but don't replace it. Options include oral gabapentin for nerve pain, certain antidepressants like amitriptyline for pain and bladder/bowel symptoms, and muscle relaxants like cyclobenzaprine for muscle spasm. Vaginal suppositories of these medications or diazepam (Valium) have fewer systemic side effects but must be made by compounding pharmacies.

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Capítulo 9

Sexual Dysfunction: Breaking the Silence

Sexuality varies greatly between individuals, often constrained by religious and cultural factors that prioritize men's pleasure over women's satisfaction. Many people struggle to seek help for sexual health issues due to embarrassment or unawareness of treatment options. While up to 20% of American women report pain during sex and 40% experience other sexual dysfunction issues (particularly during perimenopause and menopause), many receive unhelpful advice like "just relax" or "have wine" from healthcare providers with limited sexual health training. Sexual health involves complex physical, mental, emotional, and social factors, requiring comprehensive care approaches. The main criterion for treatment is the person's level of concern-decreased libido might distress some but be normal for asexual individuals who naturally lack sexual attraction or interest. Healthcare providers use questionnaires covering three main categories: pain with sex, sexual desire/arousal, and orgasm. Key questions about pain include: When does pain occur (with touch, penetration, orgasm, after intercourse)? When did it start (after childbirth, injury, menopause, medication, treatment)? What type of pain is it (sharp, burning, stabbing)? Where is it located (vulva, vaginal opening, walls, deep pelvis)? Sexual health problems fall into four interconnected categories: pain with sex, low libido/desire, difficulty with arousal, and anorgasmia. These issues often influence each other, such as when pain leads to poor libido or inadequate lubrication causes painful intercourse. Pain during sex can involve various pelvic structures beyond just the vagina. Causes include hormonal changes (menopause, testosterone use, birth control), physical or psychosocial trauma leading to vaginismus, neurologic disorders affecting pain processing, endometriosis causing inflammation and scarring, and vulvodynia (chronic vulvar pain without known cause). Low libido, the most common female sexual disorder, can stem from stress, relationship issues, depression, anxiety, body image concerns, hormonal changes, medications, pain, or illness. Arousal problems (mental excitement and physical responses like lubrication) share similar causes plus medical conditions like thyroid disease, diabetes, MS, COVID-19, cancer, and menopause. No single pill effectively treats all sexual disorders due to the complexity of female sexual response. Treatment often requires a multidisciplinary team and may combine sex therapy, improved partner communication, pelvic physical therapy, and sometimes medication or devices like vibrators. Licensed sex therapists with specialized sexual health training help individuals and couples through practical guidance, communication facilitation, cognitive behavioral therapy addressing fears and expectations, and mindfulness training. Pelvic floor PT effectively treats pain during sex by addressing conditions like vaginismus, vulvodynia, menopausal changes, and scar tissue. Therapists release tight muscles and scar tissue, improve nerve pain, and teach patients to use vaginal dilators when needed. Vibrators and vacuum suction devices can enhance clitoral stimulation and genital blood flow. Lubricants are first-line treatments for vaginal dryness, with different types (water-based, silicone-based, oil-based) offering various benefits and drawbacks. While estrogen and testosterone influence female sexual response, hormone treatments generally don't help premenopausal women and show mixed results for postmenopausal women. Vaginal estrogen effectively treats dryness and pain with minimal systemic absorption. Some antidepressants lower libido while others improve it. Flibanserin (Addyi) and bremelanotide (Vyleesi) are FDA-approved treatments for female sexual interest/arousal disorder but have limitations due to side effects and administration requirements.

Capítulo 10

Perimenopause and Menopause: Beyond Hot Flashes

For those suffering from painful menstrual conditions, menopause might seem like salvation. However, while it ends menstruation and often relieves conditions like endometriosis, it introduces new challenges: hot flashes, night sweats, mood swings, pelvic floor dysfunction, and sexual problems. Though women historically were expected to suffer through menopause, today's multibillion-dollar industry offers treatments ranging from hormonal medications to unregulated supplements. Menopause officially occurs after twelve consecutive months without a period due to natural ovarian decline. The transition phase before menopause, called perimenopause, begins years earlier as the ovarian follicle pool depletes and estrogen drops. During this time, ovulation becomes irregular and eventually stops. Symptoms like hot flashes often begin during perimenopause, though some people experience no symptoms at all. Hot flashes-sensations of heat occurring as frequently as hourly-are the most recognized menopausal symptom. These vasomotor symptoms often include sweating, chills, flushing, and palpitations. Their severity ranges from mild to debilitating enough to interfere with work and daily activities. Mood fluctuations are common during menopause, including irritability, tearfulness, depression, and anxiety. Sleep patterns often change, with difficulties falling or staying asleep. Many experience "brain fog"-problems with focus and memory. Declining estrogen and testosterone can reduce libido and arousal and impair orgasm. Sexual problems may also stem from genitourinary syndrome of menopause, including insufficient vaginal lubrication, reduced vulvar blood flow, and pain during intercourse due to vaginal narrowing or tissue fragility. GSM involves pelvic floor weakening, pelvic organ prolapse, and changes to urethral and vaginal tissues, leading to urinary frequency, urgency, UTIs, vaginal dryness, burning, and discharge. Menopause and low estrogen increase risks of serious conditions like cardiovascular disease and stroke. Declining estrogen raises LDL cholesterol levels, making regular health screenings crucial for postmenopausal individuals. Low estrogen also accelerates bone loss, leading to osteoporosis and higher fracture risk. Estrogen-containing menopausal hormone therapy (MHT) most effectively treats vasomotor symptoms and GSM. MHT comes as oral pills, skin patches, and less commonly as topical gels or sprays. In contrast, vaginal estrogen treatments (creams, tablets, or rings) provide localized relief for GSM with minimal systemic absorption. For those with a uterus, estrogen must always be combined with progesterone to prevent uterine cancer risk. While estrogen-containing medications most effectively treat menopausal symptoms, nonhormonal options exist for those who cannot take hormones. Antidepressants like SSRIs and SNRIs are the most effective alternatives to estrogen. Anti-seizure medications like gabapentin and pregabalin can help prevent vasomotor symptoms. In 2023, the FDA approved fezolinetant (Veozah) for moderate to severe menopausal vasomotor symptoms. Complementary and alternative therapies are commonly used when people seek alternatives to medications or prefer natural approaches. Phytoestrogens (plant compounds similar to estrogen) from soy products, flaxseed, legumes, and some produce can be consumed through diet or supplements. Herbal remedies like black cohosh are also used for vasomotor symptoms, though research shows mixed results.

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Capítulo 11

The Path Forward: Reclaiming Women's Health

Gynecologic conditions share a common thread: a profound lack of information and research. While 80% of Black women develop fibroids with devastating symptoms, the root cause remains unknown, preventing effective treatment. Common conditions like diabetes receive continuous research and funding, yet gynecologic issues affecting virtually all women-endometriosis, fibroids, PCOS, PMDD, miscarriage, menopause-see virtually no breakthroughs or new treatments despite causing debilitating physical and emotional distress. This neglect stems from layers of misogyny, racism, and dismissive assumptions about women's bodies. Female health problems are often expected to be tolerated rather than treated as legitimate medical diseases. The more symptoms a patient reports, the more likely they'll be dismissed as "hysterical" despite normal tests, perpetuating cycles of suffering. In medicine, there are rarely definitive right or wrong treatment choices-only what works best for each individual. While cancer treatments follow specific algorithms based on test results, general gynecologic problems don't have fixed treatment pathways. People with identical symptoms may have different healthcare goals and choose entirely different treatment plans. When choosing treatments, consider your primary goals, which might include eliminating pain or abnormal bleeding, resuming normal activities like exercise and sex, relieving gender dysphoria, or preserving fertility for future pregnancy. Consider your relationship with medications, surgical preferences, broader medical context, fertility goals, and practical factors like ease of use, cost, and insurance coverage. It's time to break the cycle of misinformation and stigma. Women and people assigned female at birth deserve to understand their bodies, advocate for proper care, and seek second opinions when necessary. By speaking openly about these taboo topics, joining support groups, lobbying for research funding, and committing to advocacy, we can leave the concept of "hysteria" in the past where it belongs.

★★★★★

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Temas principais em Não é frescura

medical gaslighting
gynecologic health
reproductive anatomy
gender health gap
patient advocacy

Citações de Não é frescura

This isn't a rare occurrence-it's the lived reality for millions.
Women's bodies and health concerns have been misunderstood and dismissed since the beginning of recorded history.
The foundations of gynecology are steeped in racism.
Most of the clitoris is not visible externally.
The key question isn't whether symptoms are common but whether they disrupt your quality of life.

Personagens de Não é frescura

Karen TangAuthor and gynecologist tackling medical gaslighting
James Marion SimsHistorical figure known as the father of gynecology
AnarchaEnslaved Black woman used for medical experiments
Silas Weir MitchellNeurologist known for the restrictive rest cure

Sobre o Autor

Dra. Karen Tang, ginecologista certificada, cirurgiã minimamente invasiva e defensora da saúde reprodutiva, é autora de It’s Not Hysteria: Everything You Need to Know About Your Reproductive Health (But Were Never Told). Médica formada pela Columbia com residência na Harvard Medical School, Tang combina especialidade clínica e visão de saúde pública para abordar dor pélvica, endometriose, miomas e cuidados de afirmação de gênero neste guia de saúde inovador.

Seu trabalho preenche lacunas na educação em saúde da mulher, fundamentado por seus papéis como consultora da Organização Mundial da Saúde e educadora em redes sociais (@KarenTangMD), onde alcança milhões de pessoas através do TikTok, Instagram e YouTube.

A abordagem de Tang, baseada em pesquisas e ao mesmo tempo acessível, rendeu destaques no The Washington Post, NPR e Oprah Daily, além de parcerias com instituições como a Procter & Gamble. Palestrante requisitada sobre saúde LGBTQIA+ e direitos reprodutivos, ela defende o empoderamento das pacientes por meio do diálogo franco.

It’s Not Hysteria, indicado ao Goodreads Choice Awards 2024 na categoria Não Ficção, destila sua década de experiência cirúrgica e advocacia viral em um recurso essencial, desmistificando mitos e destacando condições pouco discutidas. Seus vídeos no TikTok sozinhos ultrapassaram 65 milhões de visualizações, amplificando sua missão de democratizar o conhecimento sobre saúde reprodutiva.

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It's Not You, It's Me

Sara Eckel

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Reclaiming Your Body and Mind

This plan is essential for survivors of maternal narcissism seeking to heal the deep-seated neurological and emotional wounds of their upbringing. It provides a holistic path for those ready to integrate somatic healing with cognitive boundary-setting to reclaim their sense of self.

1 h 36 m•4 Seções

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Unshakable: Stoic Drills for Modern Chaos

In an era of constant digital noise and social volatility, emotional resilience is a survival skill. This plan is designed for high-stress professionals and individuals seeking to regain control over their reactions and mental clarity through practical, ancient wisdom.

2 h 30 m•5 Seções

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Quiet the Panic, Speak Your Truth

This plan is essential for individuals who struggle with physical anxiety or freezing during difficult conversations. It is designed for professionals and individuals looking to bridge the gap between physiological calm and assertive self-expression.

2 h 18 m•3 Seções

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The Female Eunuch: Reclaiming Vitality

This plan is essential for anyone seeking to understand the radical roots of modern feminism and the social construction of gender. It is ideal for students of sociology, gender studies, or readers looking to reclaim their personal autonomy from societal expectations.

1 h 12 m•3 Seções

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Quiet the Noise: A Guide to Clear Thinking

In an era of constant information overload, the ability to regulate your physiological response and mental clarity is a critical skill. This guide is designed for professionals and individuals who feel overwhelmed by anxiety and want to transition from reactive stress to intentional, clear thinking.

1 h 30 m•3 Seções

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Women's wellness channel

This learning plan is designed for women who want to take control of their health and wellbeing through evidence-based knowledge rather than conflicting advice. Whether you're struggling with hormonal imbalances, feeling disconnected from your body, or ready to step into a more confident version of yourself, this comprehensive approach addresses the interconnected aspects of women's wellness that are often overlooked in traditional health education.

5 h 10 m•4 Seções

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Tame Your Speaking Fears

Public speaking anxiety often stems from a physiological hijack that overrides logic. This plan is essential for professionals who want to regain physical control and mental clarity during presentations. It is ideal for anyone looking to transform nervous energy into a confident, service-driven presence.

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The Master Manipulator's Field Guide

In high-stakes environments, psychological safety is often threatened by calculated manipulators. This guide is essential for professionals seeking to identify toxic behaviors and build resilient defenses to protect their careers.

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Criado por ex-alunos da Universidade de Columbia em San Francisco

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Veja mais sobre como o BeFreed é discutido na web

Criado por ex-alunos da Universidade de Columbia em San Francisco

LOVED BY

1,000,000+ curious minds.

4.7

avg rating

1M+ learners

"Instead of endless scrolling, I just hit play on BeFreed. It saves me so much time."

@Moemenn

"I never knew where to start with nonfiction—BeFreed’s book lists turned into podcasts gave me a clear path."

@Chloe, Solo founder, LA

117

"Perfect balance between learning and entertainment. Finished ‘Thinking, Fast and Slow’ on my commute this week."

@Raaaaaachelw

"Crazy how much I learned while walking the dog. BeFreed = small habits → big gains."

@Matt, YC alum

108

"Reading used to feel like a chore. Now it’s just part of my lifestyle."

@Erin, Investment Banking Associate , NYC

254

"Feels effortless compared to reading. I’ve finished 6 books this month already."

@djmikemoore

"BeFreed turned my guilty doomscrolling into something that feels productive and inspiring."

@Pitiful

4.5K

"BeFreed turned my commute into learning time. 20-min podcasts are perfect for finishing books I never had time for."

@SofiaP

"BeFreed replaced my podcast queue. Imagine Spotify for books — that’s it. 🙌"

@Jaded_Falcon

201

"It is great for me to learn something from the book without reading it."

@OojasSalunke

"The themed book list podcasts help me connect ideas across authors—like a guided audio journey."

@Leo, Law Student, UPenn

483

"Makes me feel smarter every time before going to work"

@Cashflowbubu

"Instead of endless scrolling, I just hit play on BeFreed. It saves me so much time."

@Moemenn

"I never knew where to start with nonfiction—BeFreed’s book lists turned into podcasts gave me a clear path."

@Chloe, Solo founder, LA

117

"Perfect balance between learning and entertainment. Finished ‘Thinking, Fast and Slow’ on my commute this week."

@Raaaaaachelw

"Crazy how much I learned while walking the dog. BeFreed = small habits → big gains."

@Matt, YC alum

108

"Reading used to feel like a chore. Now it’s just part of my lifestyle."

@Erin, Investment Banking Associate , NYC

254

"Feels effortless compared to reading. I’ve finished 6 books this month already."

@djmikemoore

"BeFreed turned my guilty doomscrolling into something that feels productive and inspiring."

@Pitiful

4.5K

"BeFreed turned my commute into learning time. 20-min podcasts are perfect for finishing books I never had time for."

@SofiaP

"BeFreed replaced my podcast queue. Imagine Spotify for books — that’s it. 🙌"

@Jaded_Falcon

201

"It is great for me to learn something from the book without reading it."

@OojasSalunke

"The themed book list podcasts help me connect ideas across authors—like a guided audio journey."

@Leo, Law Student, UPenn

483

"Makes me feel smarter every time before going to work"

@Cashflowbubu

"Instead of endless scrolling, I just hit play on BeFreed. It saves me so much time."

@Moemenn

"I never knew where to start with nonfiction—BeFreed’s book lists turned into podcasts gave me a clear path."

@Chloe, Solo founder, LA

117

"Perfect balance between learning and entertainment. Finished ‘Thinking, Fast and Slow’ on my commute this week."

@Raaaaaachelw

"Crazy how much I learned while walking the dog. BeFreed = small habits → big gains."

@Matt, YC alum

108

"Reading used to feel like a chore. Now it’s just part of my lifestyle."

@Erin, Investment Banking Associate , NYC

254

"Feels effortless compared to reading. I’ve finished 6 books this month already."

@djmikemoore

"BeFreed turned my guilty doomscrolling into something that feels productive and inspiring."

@Pitiful

4.5K

"BeFreed turned my commute into learning time. 20-min podcasts are perfect for finishing books I never had time for."

@SofiaP

"BeFreed replaced my podcast queue. Imagine Spotify for books — that’s it. 🙌"

@Jaded_Falcon

201

"It is great for me to learn something from the book without reading it."

@OojasSalunke

"The themed book list podcasts help me connect ideas across authors—like a guided audio journey."

@Leo, Law Student, UPenn

483

"Makes me feel smarter every time before going to work"

@Cashflowbubu

Veja mais sobre como o BeFreed é discutido na web

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Capítulo 9

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Um livro. Muitas maneiras de ouvi-lo.

When Hysteria Was Never the Answer

The Dangerous Legacy of Hysteria in Women's Medicine

Veja cada palavra enquanto a ouve

Understanding Your Body: The Anatomy They Never Taught You

Advocating for Yourself in the Doctor's Office

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Fibroids: The Silent Epidemic Affecting Most Women

Endometriosis and Adenomyosis: The Invisible Pain Epidemic

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Polycystic Ovarian Syndrome: Beyond Irregular Periods

The Hidden Connection: Pelvic Floor Dysfunction and Chronic Pain

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Sexual Dysfunction: Breaking the Silence

Perimenopause and Menopause: Beyond Hot Flashes

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The Path Forward: Reclaiming Women's Health

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What is It's Not Hysteria about?

Who should read It's Not Hysteria?

Is It's Not Hysteria worth reading?

What qualifications does Dr. Karen Tang have?

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1,000,000+ curious minds.

1,000,000+ curious minds.

Um livro. Muitas maneiras de ouvi-lo.

When Hysteria Was Never the Answer

The Dangerous Legacy of Hysteria in Women's Medicine

Veja cada palavra enquanto a ouve

Understanding Your Body: The Anatomy They Never Taught You

Advocating for Yourself in the Doctor's Office

Aproveite ainda mais Não é frescura

Fibroids: The Silent Epidemic Affecting Most Women

Endometriosis and Adenomyosis: The Invisible Pain Epidemic

Veja cada palavra enquanto a ouve

Polycystic Ovarian Syndrome: Beyond Irregular Periods

The Hidden Connection: Pelvic Floor Dysfunction and Chronic Pain

Aproveite ainda mais Não é frescura

Sexual Dysfunction: Breaking the Silence

Perimenopause and Menopause: Beyond Hot Flashes

Veja cada palavra enquanto a ouve

The Path Forward: Reclaiming Women's Health

Você chegou ao fim de Não é frescura

Usuários também gostaram

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