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Women's Healthcare

We’re Finally Starting to Take Women’s Hormones Seriously

A new wave of books about women's bodies looks set to turn 'that time of the month' from a punchline to properly understood reality.

by Hannah Ewens; illustrated by Kim Cowie
02 July 2019, 8:30am

When Eleanor Morgan approached publishers with an idea for a book investigating the effect of hormones on women’s health, they were “squeamish” about it. “Women, periods, blood, vaginas. It wasn’t an easy sell and I have no doubt because I saw the emails that came from sales departments,” she tells me over the phone. “It was too ‘angry feminist’ – who’s going to read it? I remember thinking, ‘Half the population. Every single woman of reproductive age has some kind of call to a story related to having a womb.’ There is no other reality.” At one point, it looked as though the book might never be published.

Hormonal: A Conversation About Women’s Bodies, Mental Health and Why We Need To Be Heard did happen. You can consider it something of a spiritual follow-up to Morgan’s first non-fiction book Anxiety for Beginners, mixing her personal story with extensive scientific research and expert interviews (full disclosure: Morgan used to work at VICE UK). The book aims to open up new ways of thinking about our hormones, but it’s also part of a wider commercial literature trend catering to women eager to understand their reproductive health. We’ve seen, to name a few, Period by Natalie Byrne and Emma Barnett, Vagina: A Re-education by Lynn Enright, Nadya Okamoto’s polemically titled PERIOD POWER: A Manifesto for the Menstrual Movement and Maisie Hill’s near-identically named Period Power: Harness Your Hormones and Get Your Cycle To Work For You. These come, no doubt, off the back of the prominence of apps like Clue, Eve and Flo that allow women to track their cycles. The sudden prevalence and positioning of these books begs the question: what impact will all of this attention have on women’s healthcare?

Morgan’s story is similar to my own and probably countless others (I was interviewed for the book, in fact): a history of bad PMS pushes you off to a GP armed with information, physical and emotional symptoms bound up with mental health. Subsequently, you test different management methods that backfire, from birth control to hormone replacement therapy gels. In my case, I was referred to a gynaecologist and various treatments spiralled off into other hormonal related tests and diagnoses – ones I wouldn’t have known about if I hadn’t pissed off several doctors and spent months in a rabbit-hole of obsessing over Facebook groups and Google deep dives. In one way, I find it odd that Hormonal struggled to find a home, given the wider discourse I see clattering by on social media. But then, when I consider the frustratingly empty stares I’ve had from GPs when I described my symptoms, the book’s journey to publication isn’t that surprising.

Morgan doesn’t dismiss the existence of PMS and its lesser-known more severe type, Premenstrual Dysphoric Disorder – “it’s real to every single woman who deals with that stuff in their lives.” But she questions the cultural, political and social framework around why they exist, and beyond that, why we treat them as a problem. The reality is that no one knows exactly why women can suffer with PMS or PMDD. It’s usually suggested in layman’s terms by experts that some women may be more “intolerant” to the fluctuations of, or even “allergic” to, their hormones. Still, as Morgan tells me on the phone, our private experiences in our heads can never, ever be 100 percent down to our biology.

“I had to really reassess what those experiences meant: the sadness, the anxiety, that all get worse during the second half of my cycle,” she told me of writing it. “What is and isn’t my biology? Can it really be that hormones equal sadness or bad mood? I had to work out why I find it so difficult to be anxious and sad, on a basic level. The torture comes with trying to maintain mental equilibrium all the time.” Periods and hormones have for centuries been used to symbolise moodiness in women (whose dad hasn't pulled out that tired “that time of the month, eh!” joke?). In trying to combat that sexism, it's possible that women have denied these fluctuations, a situation all the more confused when you consider that many women are generally unaffected by their hormonal cycle.

Are women supportive in theory of “difficult” women, but not when we might be “difficult” ourselves? Are our hormones just a truth serum allowing us to express what we need to when enraged and tearful before our periods? What if the pressure of holding it all together – career, relationships, friends and more – was just as much a contributing problem to our severe PMS as our hormones? As a woman reasonably firm in my own story of my body, I found Hormonal compelling and frustrating for what it challenged in my own ideas about myself.

A book trend seems promising, but if research is dangerously basic and thin on the ground – a problem Morgan highlights – will any popular literature help bring about scientific change? I asked Nick Panay the leading expert in PMS and PMDD in the country. “I think this is important and I believe that the renaissance in management of women’s hormone health issues will be driven by women themselves,” he told me, adding that eventually doctors and politicians will have to listen and act accordingly.

Morgan agrees to a certain extent, keen to highlight the importance of Invisible Women: Exposing Data Bias in a World Designed By Men, Caroline Criado-Perez’s book published in March. Criado-Perez’s book and her own crossover a fair bit, in terms of how the male body is entirely prioritised in medicine. In Morgan’s work as an assistant psychologist, she’s heard Invisible Women talked about seriously by professionals in clinics and in hospitals. “I hope these books are part of a nascent change, but realistically it’s going to take a long time to undo hundreds of years of stigma and the medical profession not prioritising women’s health and therefore hormones. The message has to be: if you’re equipped with knowledge and understanding of how things are that you can ask for better, you can ask for more.”

She raises a simple but valid point. As we saw with an illness like endometriosis, the public became educated about it via celebrities like Lena Dunham and singer Halsey. Literature and press followed, and it seems as though women all over our timelines were finding meaning to the pain they’d long suffered with. With PMDD in particular, so much of the unbearable pain of mental or physical suffering is shared in Facebook groups, and ways to ameliorate it are swapped between women themselves. But with information comes power. Unfortunately, you have to know what you want to ask for it.

The most interesting (and frustrating) of Morgan’s questions lingers: why can’t we allow ourselves to give up the impossible fight for mental equilibrium? I share concerns about the more fun books of this trend, that empower women to see their cycle as a positive thing, a superpower you can harness. This stance could lean into the argument that PMS or PMDD don’t exist, pink-washing over the fact that some women seriously suffer. Although Morgan believes that any information or hope for people is positive, and that everyone should approach their hormones in whatever way works for them, she says this: “If you’re positioning your cycle as something that can work for you, if we package our cycle as something we can make work for us, it’s still how to be a nice woman – while either your insides or minds are raging.”

@hannahrosewens / @teaplz

Eleanor Morgan’s book ‘Hormonal: A Conversation About Women’s Bodies, Mental Health and Why We Need To Be Heard' is out Thursday the 4th of July, 2019.