Book Review

Screaming to be Heard

Hormone Connections Women Suspect and Doctors Ignore

by Elizabeth Vliet, M.D.


Review submitted by Cris Bronson


Some decades provide us with landmark documents, people, and textbooks. Like the 70s Joy of Sex and Every Woman's Body, Dr. Vliet's Screaming to be Heard fills an urgent need and takes its place in history as a monumental work.

Like both 70s' books, Dr. Vliet's book arrives at a time when Baby Boomers are entering a new phase of life: Menopause. While it answers and discusses a lot of menopausal issues, Screaming reaches farther and crosses more boundaries. This book recognizes that women are clearly more than their genitalia and reproductive organs.

Why has it taken so many years for a doctor to address the clearly defined needs women have? I can't believe that some male doctors haven't heard and understood women. I find it hard to believe that all male doctors could blatantly ignore the evidence in front of them―educated women who are explicit in describing their physical symptoms, pain and emotions. And yet, for as long as traditional medicine has existed and battled with natural methods of healing, most doctors―both male and female―have ignored women's needs and their statements about their emotions and symptoms.

Screaming isn't just for menopausal women. It is for any woman who has ever had chronic fatigue, migraine headaches, diabetes, thyroid problems―to name only a few issues Dr. Vliet discusses. And as an author Vliet recognizes that the pages between the covers of her book supply limited, but valuable information; thus, she generously refers the reader to various texts, experts and other sources of medical care.

It is this writer's opinion, however, that Dr. Vliet picks up where Joy of Sex and Every Woman's Body left off . . . filling in the gaps, adding new insight and fresh material as well as questioning standard practice which hasn't necessarily worked. Such as using patients on Premarin as the primary source of information for breast cancer studies. Strangely, little or no research has been done (or perhaps it hasn't been published) on the effects of women who take synthetic human estrogen. Why not? Isn't it logical that an estrogen (horse) which fails to match the receptors in human females would cause some kind of problem?

The human race is both male and female, yet the problems afflicting women are largely ignored. John Bobbit's penis is whacked off; the hospital rushes micro surgeons to his rescue. A woman in West Virginia sits gushing blood from her uterus, it flows through her clothing, soaking the seat, a life threatening condition―yet, instead, she is sent home with medicine which makes her problem worse, ultimately facing in surgical castration. Dr. Vliet's book is a wonderful step toward equality in treatment.

Ladies, please read: The first chapter discusses her experience as a physician and her female patients. It goes further and reaches into the controversy surrounding hormone replacement therapy, the facts behind the headlines. The words women do not hear from most physicians. And she sets the stage for potential change. Knowledge is power. Dr. Vliet gives us the information we need as clearly as she can to protect and heal ourselves―and to help guide our doctors.

The second chapter carries these concepts further as an attempt to describe her approach to creating a "holistic approach" to medical care. Including many informative comments about the use of alternative therapies among others.


Chapter three contains an easy-to-understand explanation of hormones. What these chemicals are, what they do, how they interact. She also clearly discusses the menstrual cycle rhythm - it has it's own music and plays a symphony which is not isolated from the rest of the body but instead, works with itharmonizingto create life.

Chapter four discusses the relationship between hormones and the brain. In this section, she includes discussion of:

  1. Mood Changes
  2. The difference between depression, anxiety and dementia created by hormone imbalance versus true psychiatric disorders. (How many of us feel crazy during PMS, or Menopause for that matter? I can raise my hand in both places in different phases of my life.)
  3. Testosterone and progesterone. (How many of us knew we produced these two hormones? Before reading Screaming, I didn't!)

Chapters five and six discuss estrogen and testosterone. And again, in these chapters, Dr. Vliet touches on herbal remedies. As well as suggesting a variety of options. These sections also discuss the difference between Premarin (estrogen from pregnant horses) versus the synthetic human molecule. In this section, she discusses the necessity of using *blood tests and what kinds of tests need evaluation and what the results should be versus therapy where our natural hormones fall short.


The next series of chapters discuss other conditions as these might relate to menopause or how hormonal imbalance may trigger, sustain or cause them. In Chapter 7, she discusses depression. Menopause can cause this ― but so can a number of hormone imbalances. If your doctor gives you antidepressants instead of treating the cause of the depression, you are at risk for physical damage to your body―no matter what the hormone involved is. (In diabetes, we're beginning to understand that even "pre-diabetes" conditions can cause as much or even more damage than insulin dependent diabetes itself. And the list is as long as the list of hormones your body produces.)

Chapter eight gets into Chronic Fatigue Syndrome. To be honest, over the last 7 years, more and more women I know are being diagnosed with these conditions. Why only women? I wondered whether it could be something else―Dr. Vliet clearly illustrates an argument for hormonal imbalance―not sudden, inexplicable muscle weakness! Why give women medications which only treat the symptoms―not the source? Why not treat the source of the problem and GET RID OF THE SYMPTOMS????

Chapter nine discusses Alzheimer's versus menopause and points out the normal, natural memory loss and personality changes women will go through as their hormones shift. It may be natural, but if it means losing our minds or being incorrectly diagnosed with Alzheimer's―I'd rather have the blood work and take hormones. This chapter thoroughly discusses the role the thyroid plays and the role the trio of reproductive hormones (estrogen, testosterone and progesterone) play in mental health as well as sleep disorders, memory, sleeping pills, vitamins and "smart drugs".

In Chapter nine she also discusses the marketing ploys which target women in particular for these various "health aids".

Chapter ten discusses migraines. A lot of women suddenly begin to experience migraines for inexplicable reasons in their late 30s, 40s and 50s. Is it coincidence that these begin just as perimenopause begins and the earnest entry into menopause occurs? Or is this simply a natural side effect of changing hormones? Dr. Vliet illustrates a good case for hormones to be at the root of this condition, too.

Chapter 11 gets into Fibromyalgia and the estrogen component here as well. Again, look around. Ten years ago, how many people did you know who had chronic muscle pain which had no explicable cause? And notice how many of these individuals are women! I have yet to meet a man who has this condition or chronic fatigue syndrome, for that matter.

Chapter 12 discusses Interstitial Cystitis―and other bladder problems. Many of us on the Sans-Uteri List have problematic bladders. Here is a full discussion: cause, effect, therapy and references. Invaluable information for each one of us. The bladder is not part of the reproductive system, yet in a woman's body it is also impacted by dropping estrogen and other hormone levels.

Chapter 13 talks about our hearts and updates the role estrogen plays here, too. Human estrogen is one of the reasons women have much, much fewer heart attacks than men. In menopause we begin to lose this protection. Does Premarin help? Or should you be using a human molecule instead?

Chapter 14 explores the connection between breast cancer and estrogen It discusses the studies which have been done, questions the techniques for the basis of the studies. And she makes suggestions with respect to this as well. In addition, she discusses in detail the risks which you aren't told about as well as the protection you also aren't usually told about from estrogen, testosterone and progesterone. And again, here she also touches lightly upon alternative or supplemental therapies which can be used in addition to traditional medical treatment. (For women who do have cancer of any kind, I strongly recommend A Dietitian's Cancer Story by Diana Dyer, M.S., R.D., CNSD, for further information and reference).

Hormone Replacement Therapy: Fact or Fiction and Advertising

Chapter 15 discusses this with a generous outlook on the therapies available. She clearly discusses the symptoms of dropping hormone levels (not just estrogen). Myths about the side effects and the cloudy areas which surround both lay and medical professionals' knowledge of this area. We are not men; studies which pertain to men do not necessarily cross over at all to women and remain valid. Here again, she discusses herbal remedies - which are safe and effective and which have caused clear, dangerous and life threatening problems―(for those of you seeking herbal advice contact Mary Conley, - Mary is a pharmacist and a fully trained herbalist who grows her own).

Chapter 16 fully discusses advertising as well as self esteem and body image issues.

Patient/Doctor Discussion

Chapter 17 discusses patient/doctor issues. It includes background about what doctors are taught in medical school and suggests techniques for improving this relationship. It discusses the importance of your family history from your doctor's perspective and your own good health. How to find the right doctor and becoming an "activated patient". And more.

What's Wrong:

A Series of Questionnaires to Go Through Before Calling Your Doctor

Chapter 18. This is chock full of detailed questions. This will help you uncover and isolate what needs to be discussed with your physician. It is not meant as self diagnostics, but as a means of arming both you and your doctor with enough knowledge to make a wise diagnosis and select the best therapy for you―what is right for you, may not be right for another patient. The days of trusting your doctor to remember all of it―the information and history pertinent to you, and everything they should know to treat us are long gone. Doctors are as overwhelmed with information as we are. No doctor can be the expert on you―he/she doesn't live in your shoes or feel your pain. They must be responsible for their knowledge and treatment―but you need to be as well informed as possible to provide them with the tools they need from you to do their jobs. This is truly a partnership, not a solo operation. Your doctor is not working in isolation, but is supposed to be working with you.


Chapter 19 Fat to Fit: How to get there and making health life style changes.

Chapter 20―a penny lecture―but worth it's weight in gold - TAKE CHARGE! Do not be a complacent patient. During problematic times, keep a food, exercise and medicine journal. Include your symptoms as a part of the data! ("Memory Minder" and "Diet Minder" are excellent books for keeping track of medicines, food, exercise and health. For more information contact Frances Wilkins).


I have no idea how many times I've suggested this book as essential reading. But essential it is. It should be on the shelf in every woman's home. Before you schedule any surgery, READ THIS BOOK!!!!

If you've subscribed to Sans-Uteri, you will know that none of us believe that hormone replacement therapy is as good as or the same as having your own glands producing the hormones for you. A pill can't change it's dosage, it can't make the other minute hormone products which your ovaries, thyroid, pituitary, or adrenals (or any of the others) do for you second by second every day or your life. If your doctor suggests or insists upon removing your ovaries―but you don't have ovarian cancer or any other life threatening disease affecting your ovaries―REFUSE. If it ain't broke, don't rip it out or throw it away!

You don't need an appointment to get your glands to adjust their hormone levels; working properly they automatically adjust. If your doctor removes healthy glands, you will need an appointment to get the hormones, change the dosages and visits to the pharmacist. Why require anything external to your body until it's absolutely necessary?

This is your body. You and only you live inside it (except when you're making a baby). Your doctor's convenience is absolutely not reason enough to rip your ovaries out. Use common sense. And take the time to think it over. Even most forms of cancer do not require immediate surgical attention. And always, but always, get a second opinion! And lastly, never let a doctor you do not trust touch your body.

You are a precious miracle of life, treasure that gift and treasure yourself!


Visit Dr. Vliet's Website at:



  • Aeron Life Cycles for saliva testing.  It provides a convenient, noninvasive, and private way to assess the effectiveness of health choices relative to hormonal balance. They offer testing for estradiol, estriol, progesterone, testosterone, DHEA, cortisol, total estrogens, total progestins, and melatonin.

    1933 Davis Street

    San Leandro, CA  94577

    (800) 631-7900


  • Great Smoky Diagnostic Laboratory or Geovations

    63 Zillicoa Street

    Asheville, NC  28801

    (800)522-4762 or (828)253-0621


  • ZRT Laboratories, Inc


    Beaverton, OR

    (503) 466-2445

    Provides at home saliva and/or blood spot tests for hormones.  Some states require a prescription and some do not.  Check your local requirements.  Also, check to see what testing your health care provider will rely upon to diagnosis your needs.  If they do not believe or understand saliva test it would be a waste of your time and money.


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