Dr Karen Tang, 45, is not your average gynaecological surgeon. She’s a social media sensation, for one (she has over 450K followers on TikTok) and with her educational, myth-busting posts around reproductive health issues, is on a mission to “create a revolution for how people understand their bodies and their choices”.

This is the aim of her debut book, which came out last month, It’s Not Hysteria: Everything You Need to Know about Your Reproductive Health (But Were Never Told); to guide and empower the millions of people around the world suffering with menopause, pelvic pain, abnormal periods, sexual dysfunction, infertility, and other gynaecological problems.

The book is already amassing rave reviews for its empathetic tone and accessible information.  Each chapter is packed with useful facts and take-home points as well as potential treatments and solutions, arming women and people assigned female at birth with the knowledge they need to take control of their health.

“Countless books have been written about dieting, weight loss and preventing cancer, but there are not nearly enough books about period problems, pelvic pain, sexual health and fertility issues,” she says. “These gynaecologic problems affect more than half the population, but we don’t talk about them.”

The US cover of ‘It’s Not Hysteria’.

Over her 14-year career practicing medicine, Karen, who’s based in Philadelphia, has heard countless stories from people “who have felt frustrated, overwhelmed, unheard”, and not getting access to the solutions they need. Too many women are being left without answers, forced to struggle on and endure painful symptoms that often interfere with daily life.

Shame and embarrassment is a major problem in reproductive health, with stigma surrounding periods, sexual health, menopause, infertility, vaginal and urinary conditions and more, tightly linked to the other key issue: that women’s health issues “have been universally understudied and underfunded.”

The lack of funding in women’s health research

One of the most shocking aspects of her research, when writing the book, was the stark disparity in funding for women’s health research. In 2022, for example, the NIH (the National Institute of Health; the main funder of medical research in the world) allocated $37m for research on smallpox, she tells ITN Business, “a disease that was completely eradicated in the 1940s and doesn’t affect any human beings”, while only $27m went into research on endometriosis, which affects 10% of women; and $15m for fibroids — which affects 70% of white women and 80% of black women.

“Conditions like diabetes — which affect the same percentage of the population of women as endometriosis — gets orders of magnitude more funding.” The medical profession determines which areas get funding and research. “With smallpox, it’s presumably to do with National Defence,” says Karen, (it has resurfaced as a possible agent of bioterrorism), and yet endometriosis and fibroids today causes suffering to millions of people. “The quality of life of women and people assigned female at birth does not seem to be as worthy of research.”

The link between endocrine disruptors and the risk of problems like fibroids, as well as several cancers, is of growing concern as more studies emerge. “Phthalates (a known endocrine disruptor), which can be found in certain hair products like hair straighteners, are used more commonly by black women, and these significantly increase the risk of both fibroids and uterine cancer,” says Karen. They’ve also been linked to breast cancer.

“There are societal pressures on black women to have straight as opposed to natural hair, and that can actually manifest as potential health risks.”

Our first step to change needs to be recognising the severity of these disparities in funding, research and overall attention for women’s health problems, Karen says. 

“We need to advocate for more funding and research for women’s health issues. For so many women’s health problems, we don’t have answers as to what the cause is; how to prevent it; and how to more accurately diagnose it — which leads to delays in care.”

“As individual medical providers, we also need to recognise our own potential biases. And if a patient is explaining that they have significant concerns, working with them to uncover what could be going on, rather than simply telling them that everyone has terrible periods or everyone goes through menopause — work with them to find a solution, and to address their concerns.”

Talking about women’s health 

What’s most important in driving change, is that we’re talking about women’s health and gynecologic issues.

“So often there’s a sense that anything to do with periods, sex, fertility, menopause, is taboo or embarrassing…  people feel too embarrassed to bring up their problems with partners, family, parents or even their doctors. But women’s health is just like any other aspect of health. We should be able to talk freely about it, just as if we talk about high blood pressure or diabetes.”

“It’s like the Emperor’s new clothes; we don’t realise until the point we’re sharing these things that almost everybody around us is going through very similar things. Which can lead to people feeling very isolated… it also leads to people not getting the care that they need.”

Karen’s hope is that It’s Not Hysteria is shared widely; with friends, through book clubs; from parents to daughters — and that more and more conversations will be opened up around these common issues.

The history of women’s health

In the book, there’s also a chapter on the history of women’s health, which provides crucial context for understanding why things are how they are; with patriarchy and racism inherent in our formal medical systems.

“Holding the fallacies and mistakes of the past up for scrutiny can illuminate the ways in which healthcare systems must change in the present,” she says — and it’s important we understand how racism, both historically and in the present, has implications for our current day disparity in maternal mortality. 

“Black women are four times more likely to die in childbirth than white women in the UK; the fact that black women’s pain is not taken as seriously; these all have historical roots,” Karen says, adding that further reading, of books such as Unwell Women (Elinor Cleghorn) and Pain and Prejudice (Gabrielle Jackson), can help deepen our understanding of the role that history plays. 

Today, what’s encouraging is the rise of “really strong advocacy groups” that are promoting awareness, and lobbying for increased funding for research on conditions like endometriosis, infertility and menopause. As a society, we’re also starting to feel more confident about talking about sexual and reproductive health, she says.

“I do have a lot of optimism that speaking out, advocating for women’s health issues and reproductive health issues is going to make a significant difference. We all have to speak out and use our voices together.”

LISTEN TO OUR PODCAST: Dr Karen Tang features in our Women’s Health: The Future We Deserve podcast. Take a listen here.

Key topics of the book

Karen covers all the main topics of reproductive health in her book, with information on:

  • Fibroids (benign tumours of the uterine muscle)
  • Infertility 
  • Pelvic floor issues
  • PCOS (polycystic ovary syndrome)
  • Ovarian cysts
  • Endometriosis (which is often misdiagnosed as IBS)
  • Vulvovaginal problems
  • Prolapse
  • Incontinence
  • Gender diversity
  • Intersex
  • Birth control
  • Hysterectomies
  • Abortion
  • Cancer
  • Epidurals (which can cut risk of complications in labour by 35%)

And more…  as well as chapters that offer guidance on how to communicate with our medical practitioners, and questions for self-assessment.

‘It’s Not Hysteria: Everything You Need to Know about Your Reproductive Health (But Were Never Told)’ is available now and published by Penguin UK and Flatiron Books (US).

 

Explore more on women’s health in our Women’s Health: The Future We Deserve programme.