The full account of Marilyn Monroe's substance use — the real medical conditions behind it, the doctors who prescribed freely, and what killed her.
Marilyn Monroe's drug use is routinely presented as evidence of instability or excess. The truth is more precise and more damning: she was a woman with serious, undertreated medical conditions who was given addictive drugs as management tools in an era before adequate mental health or pain treatment existed.
Marilyn Monroe suffered from severe endometriosis — a condition in which tissue similar to the uterine lining grows outside the uterus, causing chronic, often debilitating pain. The condition was not properly diagnosed or treated in the 1950s. Pain management options were barbiturates and opioids. She used them because she was in physical pain — real, chronic, documented pain.
Endometriosis also explains her multiple miscarriages. She had at least three documented miscarriages during her marriage to Arthur Miller. Each one was not just a physical loss — for a woman who desperately wanted to be a mother, each was a psychological catastrophe.
Marilyn Monroe suffered from severe chronic insomnia her entire adult life. Barbiturates — specifically Nembutal — became her sleep medication of choice because nothing else worked. As tolerance built, doses increased. Her doctors prescribed freely.
The clinical terms barely touch what she experienced. She had been abandoned by her mother, abused as a child, bounced between institutions, and then handed a world that consumed her image while refusing to know her. Depression is a rational response to that history. Anxiety is adaptive when you learn young that safety can disappear without warning.
Treatment options in the 1950s: barbiturates, chloral hydrate, and Freudian analysis. Modern antidepressants did not exist. Trauma-informed therapy was decades away.
Two doctors are central to her final year:
The official cause of death: acute barbiturate poisoning. Blood levels of Nembutal were approximately 8 mg/100 ml — at least four times the lethal threshold. Chloral hydrate was also present. The official verdict: "probable suicide."
The circumstances remain contested. The timeline of the evening as described by those present has inconsistencies. Multiple investigators over sixty years have found the evidence ambiguous. Whether the overdose was intentional, accidental, or something else — she was thirty-six years old, and she died alone.
"Sometimes I feel my whole life has been one big rejection."— Marilyn Monroe
With modern medicine: her endometriosis would have been properly diagnosed and treated with surgery and targeted medication. Her depression would have been treated with SSRIs or modern therapy. Her insomnia would have been managed with cognitive behavioural therapy for insomnia (CBTi). Her trauma history would have been addressed directly.
She would very likely be alive. She died not from being Marilyn Monroe, but from being a sick woman in an era that did not know how to help her.