Dr. Elizabeth Comen on Women’s Health, Advocacy, and the History of Medicine

In a candid conversation with SEAM founder Amy Cohen Epstein, Dr. Elizabeth Comen—a New York City breast oncologist, author, and medical historian—dives into the realities of women’s health, the gaps in medical research, and the importance of advocacy. Drawing from her recent book, All in Her Head, Dr. Comen discusses how the historical treatment of women in medicine has shaped today’s challenges, from inadequate testing to cultural taboos around health. Join Amy and Dr. Comen as they explore the journey of empowering women through knowledge, empathy, and a deeper understanding of whole-person care.

Amy Cohen Epstein:
Welcome, Dr. Elizabeth Comen. I'm really excited, and I'm going to let you do your whole introduction, bio, and history—anything you want to say or not say. What I am going to say is that we’re mostly going to talk about this book, All in Her Head. When I first got this book, I thought, "All in her head?" I don’t know how many times I’ve literally been told that. Add “blonde” in there—“all in your blonde head”—and it resonates with me and so many women. So, welcome. Thank you. And just give us your goods.

Dr. Elizabeth Comen:
Thank you! Well, where to start? I love to dance, I have three kids, and I’m from outside Boston originally. Do you want the fun part or the academic part?

Amy:
I want all of it.

Dr. Comen:
All right! So, as I said, I love to dance—I grew up doing hip-hop, salsa, all kinds of rhythms. I’ve probably tried every type of exercise out there... [Editor’s Note: Edited for clarity and flow]. Originally, I’m from outside Boston. I went to Harvard and then Harvard Med School, where I majored in the history of science. I’ve dedicated my career to women with breast cancer and am currently a breast oncologist in New York City.

Amy:
And you’re also a medical historian?

Dr. Comen:
Yes. It took me some time to actually own that title. I’ve always been passionate about understanding how medicine connects to history, culture, politics, and religion. My focus is on continuity of care and understanding the lifelong experience of illness for women. For this book, I spent years studying historical texts on women’s healthcare, going back to the ancient Greeks, the Romans, the Egyptians... [Editor’s Note: Details of historical research summarized].

Amy:
So, you’re just a real underachiever! Okay, but truly, your work and passion are amazing. I think that’s the crux of the book—looking at women as whole beings, not just as parts. When did this approach click for you, and is that what drove you down this path?

Dr. Comen:
Yes, actually, going back to college. I was interested in empathy’s role in medicine—how it’s taught, and the mind-body connection. Early in my career at Dana-Farber Cancer Institute, I saw that for women with cancer, their experience went beyond survival; it was also about thriving and maintaining their identity. Seeing how a diagnosis impacted how they felt about themselves and looked in the mirror... [Editor’s Note: Simplified for brevity].

Amy:
That resonates. My mom had cancer and was very focused on finding the right wig; it was her way of fighting what was happening internally. I think I understand now that it gave her confidence.

Dr. Comen:
Absolutely. When I talk to patients, one of their biggest concerns is, “Am I going to lose my hair?” because it signals illness. And until recently, insurance rarely covered treatments like cold capping to prevent hair loss, though it’s a critical quality-of-life issue for many women... [Editor’s Note: Edited to focus on patient impact].

Amy:
I know someone who struggled to get insurance to cover genetic testing for BRCA, despite her family history. It’s frustrating how hard it can be to advocate for yourself.

Dr. Comen:
We’ve made it difficult on many levels. History shows gaps in coverage and support for genetic testing and women’s healthcare in general. It’s a real problem... [Editor’s Note: Condensed historical context].

Amy:
Why do you think women struggle to advocate for themselves in medical settings?

Dr. Comen:
It’s less about being bad at it and more about being conditioned not to have space for it. The book explores how women’s health has been narrowly defined, often focused on reproductive functions rather than broader health needs. This leads to a kind of inherited shame and blame where women apologize for being unwell or in pain. Recognizing these patterns helps us understand that our health is more than “bikini medicine”—it’s a head-to-toe, whole-person approach... [Editor’s Note: Edited for clarity and flow].

Amy:
Exactly. One thing that struck me was that drug dosages are often based on male body types. That’s wild to me.

Dr. Comen:
Yes, it is. A lot of early studies, even on things like aspirin, were done on the “average 70-kilogram white male,” with limited inclusion of women. Only in 1993 did the NIH start requiring the inclusion of women and minorities in clinical trials. And we still know very little about medication effects on pregnant women... [Editor’s Note: Edited for brevity].

Amy:
That lack of information is unnerving. Pregnant women are often so cautious, but we have almost no data on what’s safe for them.

Dr. Comen:
Exactly. Pregnant women are often afraid to seek care out of fear, and we don’t have the information we should. For example, symptoms like shortness of breath might be overlooked as “just pregnancy” rather than checked for other conditions... [Editor’s Note: Edited for focus].

Amy:
The stigma around normal bodily functions is so real. I’m reminded of the notion of “hysteria” and how that term was used against women.

Dr. Comen:
Yes, the word hysteria comes from the Greek word for “womb.” Throughout history, the idea was that the uterus was the source of all our problems. If it wasn’t the uterus, it was estrogen. This belief led to the stigmatization of women’s emotions and health issues... [Editor’s Note: Summarized historical context].

Amy:
It’s absurd to think this was only removed as a diagnosis in the 1980s.

Dr. Comen:
Yes, far too recent. And that legacy affects us today, as women still have to battle the stereotype of being “hysterical” when we advocate for ourselves.

Amy:
It’s frustrating, especially since women have such a unique, resilient biology. Menstruating, for example—it’s powerful, yet it’s often a source of shame.

Dr. Comen:
I couldn’t agree more. Menstruation is powerful, and yet society shames it. Women aren’t encouraged to understand or embrace their normal bodily functions, and this extends to areas like vaginal health... [Editor’s Note: Edited for brevity and clarity].

Amy:
And you cover so much of this in your book, helping women understand their “normal.” It’s truly empowering.

Dr. Comen:
Thank you. I hope it can be part of a broader conversation on women’s health that will shift how we approach care for future generations.

Editor’s Note: This interview has been edited for length and clarity.