Health care wasn’t built with women’s full lives in mind. Between rushed appointments, old-school social norms, and a siloed system, it’s no wonder their needs slip through the cracks. Too often, women are told to wait, calm down, or come back later. But a growing number of providers are calling for something better: care that listens more and assumes less, treating patients—especially women—as equal partners in the process. From prioritizing patients’ insights over politeness to making sense of the messy middle between postpartum and perimenopause, here’s how women and their providers can rebuild the care relationship together—because barriers can’t get broken down until you name them.
Crossing the “Postpartum Cliff”
Prior to “the big change,” a woman’s health is often viewed almost exclusively through the lens of her reproductive organs—from periods and pregnancy to contraception and cancer screenings. That’s why a woman’s OB-GYN becomes her de facto primary care provider well after her childbearing years are behind her. Melissa Hasler, a certified nurse midwife and director of nurse midwives at M Health Fairview, adds that women disengage from the health care system after the chapter of having children quietly closes.
“It’s not necessarily a conscious thing, but our health care system is not set up to support and engage women from before delivery through their perimenopausal years,” she says. “And that gap is hugely consequential for women.” Because pregnancy is so common—and thanks to modern medicine, often treated as routine—we sometimes forget just how brutal it can be on the body. It can leave behind a spectrum of physical effects that linger well after delivery.
“Pregnancy puts us at higher risk for a whole host of things—we’re four to eight times more likely to develop cardiovascular disease,” says Hasler. “These are serious, long-term consequences. And no one is minding the gap.” That transition from childbearing to perimenopause is what Hasler refers to as the “postpartum cliff.”
When you’re confident that your baby days are behind you, ask your OB provider for clear documentation of any pregnancy complications you experienced, details that will help inform how primary care can track and treat your health going forward.
“If there was hypertension during pregnancy, you may need different screening protocols,” she says. “A history of gestational diabetes, an intrauterine pregnancy, placental abruption—any of these factors are correlated with long-term risks for the mother and can give us clues that you may need certain interventions.” Gestational complications are now understood as early indicators of future chronic disease, so a woman’s full reproductive history should be part of her permanent medical records.
However, making the leap from reproductive care to general medicine isn’t always straightforward—nor is it as simple as getting a referral. Not all primary care providers are well-versed in women’s midlife health. Hasler suggests browsing bios of providers online and seeking out key terms in women’s issues—particularly menopause and perimenopause. Ideally, she says, you want someone who openly values equitable care for women and views the provider-patient dynamic as a partnership, not a one-way fix.
Making that switch means letting go of what Hasler calls “kind-keeping”—the urge to be polite at your own expense. “I am here to help you heal—spending an extra five minutes to find additional resources for your condition is not an inconvenience for me.”
“I am here to help you heal—spending an extra five minutes to find additional resources for your condition is not an inconvenience for me.”
—Melissa Hasler, CNM
Small Steps to a Better Doctor Visit
Tips from Melissa Hasler, CNM
Come with a list
“Make a running list in your phone of symptoms or concerns and bring it with.”
Don’t leave with questions
“Ask over and over again until you can walk out saying you understand your diagnosis.”
Be specific
“I want to know when the pain started, where it’s located, and how it feels.”
Don’t go it alone
“Bring a trusted person to help hold you accountable for follow-up. Engaging other people in your care is important.”
Co-Piloting the Conversation
In our younger, impressionable years, we’re taught that being “good” means waiting our turn, letting others lead, and saving questions for last—especially in spaces where we’re not the expert—which is why clinicians are here to remind you that your health is not the place to prioritize politeness over your own instincts.
“Oftentimes when women approach health care, they tend to be more relational—they approach with deference, as in, ‘I’ll let them ask me, and then I’ll bring up my concerns.’ Even in an ER situation, they tend to let the doctor lead the conversation and wait before raising a critical issue,” says Dr. Taj Mustapha, an internal medicine and pediatrics physician and chief equity strategy officer at M Health Fairview. “From an insider’s perspective, I’m here to tell you: It’s okay to interrupt! And to do so as early on as possible!”
Bringing your concerns to the forefront from the get-go could set your visit down an entirely different trajectory. “I want to know things up front so we can have a coherent conversation, so interrupting and re-steering the conversation is incredibly helpful to get patients closer to meeting their needs,” she says. And if it’s not well received? That’s the provider’s problem, Mustapha says—not a “you” problem.
“Don’t let the provider, without your story, drive your time together. Co-piloting the conversation is not the same as fighting over the steering wheel,” she says. “It’s more like ‘Hey, I don’t think we should go left here—let’s go straight instead.’” That could mean being seen for stomach pain and making the provider aware of a snowboarding accident you were in last week. Physicians may not always remember to ask you about recent trauma or accidents, and this could set them down “a completely different diagnostic pathway.”
Of course, knowing what to say is only half the battle—another common barrier is knowing where to say it. Without a dedicated primary care provider (yes, we’re back to this!), women may ask their OB-GYN about a stubborn rash or blurred vision, symptoms that often fall outside their scope. “And if it doesn’t seem serious [to the OB -GYN], she may not make a referral,” says Mustapha. “So the patient leaves feeling like she made a big deal out of nothing, that maybe this nagging issue isn’t a problem after all.”
She continues, “It’s important to make that recognition of, ‘Hey, what’s the type of doctor I’m seeing now? Is this a person who might know something about my condition?’ If you see a new primary care physician and they don’t think anything of your recurrent rash, it’s OK to ask for a referral to a dermatologist.”
Internalized minimization has become a conditioned response for women, but it’s worth trusting that second thought when something just isn’t sitting right.
“From an insider’s perspective, I’m here to tell you: It’s okay to interrupt! And to do so as early on as possible!”
—Dr. Taj Mustapha
Changing the Care Culture
Still, even with effort, the system isn’t built to meet in the middle. And while self-advocacy certainly has a place, so does a health care system that’s actually designed to hear you out. “When I think about what contributes to true disparities for women, I think it is, quite frankly, just listening,” says Mustapha. “Where the system fails is in the interaction of seeking to understand and hear concerns. Medicine is still generally more paternalistic with women. There’s more minimization and more assumptions made and less shared problem-solving together.”
Health care has long been shaped around male bodies and norms. When symptoms get dismissed as “stress” or “hormones” and appointments are rushed or access is uneven, it’s no wonder many women leave feeling unheard.
“Thank god for millennials,” Mustapha adds, “because they’re not taking this. They’re demanding better, and the profession is shifting because of it.” Of course, demanding better only works if the system and its providers step up.
“We have to change the culture,” says Hasler. “It happens by patients and women requiring it. You need to demand this of your provider!” The next generation of care won’t be defined by politeness or pushing through. It will be built on partnership, clarity, and care that treats women not just as patients—but as people who deserve to feel heard, respected, and whole.
Say What You Need to Say
Self-advocacy that sticks, from Dr. Taj Mustapha
“There are key words and ways of talking that will help you be heard. In self-advocating, women can get so frustrated that they fall into the ‘combative’ bucket. But before it gets there, use phrases like ‘I’m really concerned that we might be missing X’ or ‘Can we be sure this isn’t happening?’
“‘Can we be sure’ causes a pause, so it stops the conversation just long enough to think: ‘Well, it’s hard to be 100 percent sure, but here’s why I think we are.’ You provoke that thinking, and sometimes that’s what gets your concerns truly heard.”
At M Health Fairview, wellness for women is well within reach. To learn more, visit mhealthfairview.org/womenshealth.
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