This is a special edition: The 2 Susans monthly newsletter now resides here at MenopauseMenu!
Dr. Susan Baumgaertel and Dr. Susan Vogler will continue sharing their thoughts on a variety of important subjects pertaining to aging and women’s health.
To kick it all off, this month’s focus is on the inclusion of female patients in medical research. Dr. B looks at several “it’s about time” moments that recently caught the public eye, and Dr. V considers where we’ve come from in modern history.
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Susan B:
Here in the U.S., May is National Women’s Health Month. And Mother’s Day starts off National Women’s Health Week.
Why bring this up in June? It’s simple: We need to keep talking about women’s health 365 days a year!
Now, more than ever, women’s health needs to be in the spotlight. Scientific advances over the past number of decades have often put women to the side. It often seems like a struggle to just get women’s basic needs recognized.
Several recent examples bring this to light.
The first is big news in the medical world just last month from the American Urological Association: GSM is finally being recognized as “important” to treat with hormones.
GSM stands for genitourinary syndrome of menopause. During perimenopause and extending into postmenopause, many women experience urinary frequency, changes in consistency of bladder emptying, painful urination, painful intercourse, vaginal dryness and diminished libido.
These conditions are primarily due to a decline in estrogen and androgen levels. Treatment approaches are numerous, but targeted hormone therapy is now the gold standard: vaginal estrogen +/- androgen. It works!
Why did it take so many years—decades, actually—for this to be acknowledged as standard of care? A rhetorical question … sadly, we all know the answer.
A second example is pain management for IUD placement. An IUD is an intrauterine device, typically used for birth control and also used for hormone management in menopausal and postmenopausal women.
If you’ve ever had one, you’ll know it’s not a walk in the park to get it put in. Many/most women experience significant pain. Yet, minimal pain management is offered.
Why?
It’s not because physicians don’t recognize that IUD insertion is painful. It’s that insurance historically won’t cover medications or local anesthetics! Instead, “therapeutic language and verbal analgesia” is recommended.
What does that even mean?
Read the following script taken directly from a recent edition of the American Journal of Obstetrics & Gynecology (AJOG):
“This procedure shouldn’t cause you any harm. Patients may have discomfort, but everyone’s experience is different, and we have ways to help make this more comfortable. We want this go to well for you. If you need a different plan to help with any discomfort, let me know right away. There are three steps where you might have sensation/possible discomfort; we will pause after each step until you let us know that you are ready to continue. You are in control. We can stop at any time. We can reschedule if now is not good for you.”
You may have just snorted your coffee!
And … factors associated with painful IUD procedures include history of trauma, anxiety, fear, anticipation of pain, previous painful IUD, lack of mental preparation, higher emotional reactivity …
Can you imagine if these guidelines were applied to men getting vasectomies? Or prostate biopsies? Or procedures to treat scrotal and testicular cysts?
The AJOG article also lists updated recommendations to follow for IUD placement that include anesthetics: topical cream/spray and/or injected lidocaine to the cervix, and even consideration of an oral medication for anxiety.
Finally! Why has this very basic and very simple approach taken decades?
One more bold example last month was an article from the Journal of the American Medical Association (JAMA), entitled “Experiences of Care and Gaslighting in Patients With Vulvovaginal Disorders.”
It reported on a recent cross-sectional study interviewing female patients who shared common past experiences with gaslighting* and substantial distress that frequently caused them to consider stopping care.
*Medical gaslighting was defined as a patient’s concerns being dismissed without proper evaluation.
Stopping care because of emotional distress and not feeling heard is never okay.
✅ Women’s health matters.
✅ Women of the world matter—all four billion of them.
✅ We must continue to advocate for more awareness and scientific research, in all industries.
Spread the word!
Allium giganteum (giant onion) in Seattle. Photo credit: Dr. Susan Baumgaertel on May 24, 2025.
Susan V:
Women’s Health Research: A Timeline
Women’s health research has made significant advances over the past few decades, underscoring the importance of understanding how aging uniquely affects women. Aging brings about physiological changes in women that influence health outcomes, such as menopause, osteoporosis, cardiovascular disease, and cognitive decline.
Menopause marks a significant hormonal transition that affects various bodily systems, leading to symptoms like hot flashes, mood swings, and increased risk of osteoporosis and heart disease. Women’s health research is essential for understanding these changes and is crucial for developing effective treatments and preventive strategies.
Several decades ago, the advancements in women’s health research were deeply affected by the drug Thalidomide. The congenital disabilities associated with Thalidomide in the 1960s led to an increased concern about the safety of drugs and drug trials during pregnancy.
At the time, home pregnancy tests were not available, so the problem extended to all women capable of becoming pregnant. In 1977, the Federal Drug Administration (FDA) issued a policy that recommended excluding any premenopausal woman capable of becoming pregnant from early-phase drug trials, including those women who were using birth control, had a sterile partner, or abstained from sex.
Thalidomide’s Impact
Originally marketed as a sedative, Thalidomide gained worldwide popularity among pregnant women for its effectiveness in treating morning sickness. Thalidomide was manufactured by a Swiss pharmaceutical company in the early 1950s and introduced to the market by a German company a few years later as a medicine for treating anxiety, insomnia, and morning sickness.
The drug testing conducted for public safety did not establish a lethal dose; therefore, it was assumed it would be nontoxic and safe for human use. Because of its inexpensive cost and widespread availability, Thalidomide became a top-selling medication.
At the same time, physicians started linking thalidomide use in pregnancy with neonatal death and congenital malformations such as limb deformities and cardiac malformations, just to name a few. This devasting event affected thousands of pregnancies and led to a cautious approach to including women in drug development research. Women were excluded from clinical research for many years thereafter.
In 1991, the Women’s Health Initiative (WHI) was established under the leadership of the first female director of the National Institutes of Health (NIH). The WHI aimed to investigate the effects of hormonal therapy, heart and bone disease, and breast and colon cancer.
Two years later, in 1993, the US Congress passed a law requiring the inclusion of women in NIH-sponsored research. A year later, the FDA established the Office of Women’s Health, which promotes the inclusion of women in clinical trials and advances in women’s healthcare.
Despite these advancements, there is still a long way to go. Women’s health research is chronically underfunded. Only a fraction of funding is allocated to women’s health clinical trials, even though women represent more than half of the US population.
Ongoing Challenges and Importance of Inclusion
Advancing women’s health research in the context of aging is vital for improving the quality of life and health outcomes for women worldwide. By understanding the unique challenges women face as they age, medical professionals can offer more effective, personalized care, supporting women in leading healthier, longer lives.
Sources:
Society for Women’s Health Research
The Annual Spring Courtyard Display of Hanging Nasturtiums at the Isabella Stewart Gardner Museum in Boston, MA. Photo credit: Dr. Susan Vogler on April 5, 2025.
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To read our April edition, Stress Awareness, just click here.
📆 Here’s a quick rundown of topics for the next five months:
July: 💉 HPV & shingles vaccines
August: 🦴 Osteoporosis & bone health
September: 🩺 Lipids & cholesterol
October: 🦀 Breast cancer
November: 🧬 Alzheimer’s & other dementias
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📝💬 The 2 Susans would love to hear from you!
Let us know the women’s health & aging topics YOU are curious about. Please also share this newsletter in your network and tag us—we are so grateful.
Susan B: susan@mymdadvocate.com
LinkedIn, myMDadvocate, MenopauseMenu, The Menopause Menu book
Susan V: susan@voglermedical.com
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The 2 Susans newsletter is for informational purposes only. It does not represent medical advice and is not intended as a substitute for professional advice, diagnosis, or treatment. Always consult with your private physician.