From hormonal to normal
Dr. Lotte Gerritsen wants to get rid of the stereotype of the 'hormonal woman'. During her sold-out lecture to UU alumni, the researcher explains why we know so little about women's bodies - and why that is everybody's business.
The room of the UU Sharing Days falls silent when dr. Lotte Gerritsen shows her first slide. The screen is filled with humiliating Google images for the word 'hormonal': hysterical women with messy hair, crying faces, chocolate bars in shaking hands. "This is what the world thinks of with hormones," the Associate Professor of Clinical Psychology tells the full auditorium. "Female and negative, as if hormones are a disease affecting you."
She lets the insulting images sink in before she clicks forward to a graph with men's testosterone spikes after a won soccer match. "But everyone has hormones. Men too." She smiles sarcastically. "Men who demolish an Italian city after a soccer match: fun guys. Women who cry because of stomach ache: weak fuss."
It is a confrontation which sets the standard for her story about a scientific apartheid which is already lasting for centuries.
The wonderfull reality of hormones
Before Gerritsen explains what is going wrong, she first tells what hormones really are. "Hormones are messengers between your body, your brain and your surroundings. A wonderful, dynamic puzzle which ensures you always respond adequately to what's happening."
These reactions are surprisingly different between women and men. "Hormonal fluctuations in women are far more predictable than in men. We have a cycle of 28 days on average." In men, a hormonal cycle lasts only one day, but that cycle responds much more capriciously to external stimuli: winning, losing, stress, success.
"But still, women are labelled as unpredictable," she says.
A man who cries after a soccer match is moved. A woman who cries is called hormonal. Even though the underlying mechanisms - rising and falling hormone levels - are exactly the same.
This double standard became the reason for Gerritsen to investigate why women's hormones are not taken very seriously. What she discovered was shocking: a systematic exclusion of women from medical research, a practice which already persists for centuries.
The four pillars of discrimination
Gerritsen names four causes for why we know so little about women's bodies:
1. Systematic exclusion from studies
"It started with women being systematically excluded from biomedical studies," she explains. "Because that cycle is supposedly too complicated." The cynical logic: women are too complex to research, so let's just ignore them.
2. Women-specific matters labelled as irrelevant
The second problem: everything which is specific to women was labelled as irrelevant. "Cycle, pregnancy, contraception, menopause – of no importance." This attitude came about because the field of expertise was dominated by men for centuries. "It was not relevant for them, of course, so the entire field of expertise was ignored."
3. The 'small man' myth
The third point was the assumption that there was no difference between men and women, biologically speaking. "A woman is a small man, only with a uterus and breasts. Beyond that, they are identical. So separate research is not needed." A medical fiction which has persisted for decades.
4. Self denial by women
However, the fourth point affects her the most: how women have adapted. "Once women were allowed to work, they taught themselves to hide all their women-specific aspects. They behaved like men, denied typical women's problems by 'manning up'." These 'predecessors', we also call them the queen bees - expect the same behaviour from other women. No whining and nagging if you have menstruation problems. Taking out pregnancy leave? Then you're not taking your career seriously. Your child is ill? You figure it out, but that work has to be done today. “Especially women, from whom you'd expect understanding in these kinds of typical women's matters, can be very nasty to each other.”
She even sees that mindset among female doctors. "Patients with menstrual and menopausal complaints are still far too often dismissed with the advice to just go to bed early. Then it will pass on its own."
The result is a medical-knowledge gap to the detriment of half the world population.
The price of ignorance
The consequences of this daily apartheid are visible daily. Gerritsen mentions concrete examples which expose the hypocrisy. "Erectile dysfunctions have actually been researched, there are medicines for that, but the menopause is still nearly unexplored territory."
Even though the complaints can be serious. "There are women who really think they're going crazy, they don't recognise themselves anymore." The period before menopause can already start at age thirty-five and be accompanied by no less than thirty different complaints. "To dismiss them all as psychosomatic is absurd."
There is also a lack of nuanced research into hormonal contraception. Studies may show an increased risk of depression among teenagers, but at the same time, the contraceptive pill can provide emotional stabilisation – less stress, better sleep. "The problem is that women are insufficiently informed on both the pros and cons," Gerritsen explains. "They must be enabled to make an informed decision."
One of her most shocking findings: women do not know their own bodies. Many do not even know how long their cycles last – it varies from 22 to 36 days – let alone how hormones influence their moods.
We all have hormones. All testosterone-associated behaviour is considered normal.
Real change on the horizon
Gerritsen sounds combative about the future. "I just want to get rid of the idea that female hormonality is weird and deviant," she says decisively. "This normalisation should start with recognition that women AND men's behaviours are influenced by hormones."
And there is already more going on than you would think. Her own research shows that pharmacological treatments can be adjusted to the menstrual cycle, with better results. "It can even have an effect on the effectiveness of psychotherapy," she says. "Therapy is emotional learning, and oestrogens are important in generating emotional memories."
There are also upcoming concrete breakthroughs. The training programme for general medical practitioners recently asked her to teach about hormones. "So there actually is interest from the medical world." Research into the female heart already shows that women are not small men - the heart responds differently and needs different medicines.
For the next generation, she sees hopeful signals. Students are less ashamed about their cycles. And the UU reception desks now simply stock menstruation products - inconceivable one generation ago.
Her own husband keeps track of her cycle and recommended doing so to his friends. Their reaction: amazed, but also curious. "Once we know better how the female body works, it will eventually also be better for the men," she concludes. It is time that half of the world population is no longer treated as a medical afterthought.
About Dr. Lotte Gerritsen
Dr. Lotte Gerritsen is an Associate Professor of Clinical Psychology at Utrecht University. In her research, she combines sex hormones and stress hormones, neuroimaging (EEG, MRI) and behavioural data in order to understand individual differences in emotion regulation and stress sensitivity. Her work awarded her, among other things, a Veni fellowship (Dutch Research Council) and a Marie Curie scholarship. She is most proud of the latter, because of the namesake.
Text: Pia de Jong