The Conversation That Never Happens
Why women can have more health information than ever and still not know what to do next
I’ve been thinking a lot lately about a conversation that often never happens.
Not the conversation about one particular disease, treatment, hormone, supplement, or diet.
A much more basic conversation:
“Given everything you know about me, what should I be paying attention to, and what should I do next?”
We live in a time when women have access to more health information than perhaps any generation before us.
We have laboratory tests, wearable data, health apps, genetic information, direct-to-consumer tests such as 23andMe, podcasts, social media, supplements, specialists, and seemingly endless advice about how to live longer and healthier.
Some women know their cholesterol numbers, vitamin D level, bone density, family history, genetic variants, sleep scores, and daily step count.
They may have more data about themselves than ever before.
Yet I keep wondering:
Are women actually becoming more confident about their health decisions?
Or are we simply giving them more information to navigate?
She Went to the Doctor. She Got the Tests. Now What?
Imagine a woman who is trying to do everything “right.”
She schedules her annual physical. She gets her bloodwork. She sees her gynecologist. Maybe she has a mammogram or bone-density scan. Perhaps she undergoes additional testing because of symptoms or family history.
Maybe she has even ordered a consumer genetic test because she wants to understand herself better.
She receives results.
She may even receive recommendations.
And yet she walks away thinking:
What does all of this mean for me?
Which issue should I deal with first?
Does something that happened to me 20 years ago matter now?
How does this result relate to everything else happening in my body?
What should I ask at my next appointment?
And what am I actually supposed to do tomorrow?
This is the gap that increasingly interests me.
It is not necessarily a lack of information.
It is the space between information and action.
What If We Don’t Know What to Ask?
We often tell women to “advocate for yourself.”
I agree. But that advice assumes something important:
You know what to advocate for.
What if you don’t?
Think about how early this can begin.
A teenage girl or young woman may experience menstrual symptoms and simply assume: this is what periods are like.
Years later, perhaps the conversation is about contraception.
Then fertility.
Pregnancy.
Postpartum recovery.
Years after that, sleep changes, body-composition changes, menstrual irregularity, mood changes, bone health, cardiovascular risk, perimenopause, menopause, and healthy aging may enter the picture.
At each stage, she may see a different healthcare professional and have a different conversation.
But who is helping her ask:
Could any of these pieces be connected?
Would a woman know which aspects of her menstrual history deserve attention later?
Would she know that something that happened during pregnancy could provide useful context for her health decades later?
Would she know which aspects of her nutrition, reproductive history, family history, sleep, bone health, medications, supplements, or changing symptoms deserve a conversation?
If a consumer genetic test tells her she carries a particular variant, does she know whether it is clinically meaningful, or whether it should change anything at all?
And does her healthcare professional even know she has that information?
You cannot ask a question you don’t know you need to ask.
And a healthcare professional cannot respond to information that never enters the conversation.
What I’m Hearing from Clinicians
Recently, I’ve had the opportunity to speak with healthcare professionals who work directly with women across different stages of life. Those conversations have made me think even more deeply about what may be missing.
I spoke with Nicole Homan, a Women’s Health Nurse Practitioner whose work spans maternal and reproductive health, clinical strategy, digital health, and care delivery, as well as Renee Fogelberg, MD, FACOG, Dipl. ABOM, an OB-GYN and obesity medicine physician whose work focuses on midlife and menopause care. These conversations brought me back to something I have been thinking about for some time: women can arrive at appointments carrying many pieces of their health story, but those pieces do not always arrive as a coherent picture. Relevant history may be missing. Nutrition and supplement use may not be fully understood or discussed. Women may be confused before an appointment, overwhelmed afterward, or uncertain about what deserves attention between visits.
There can be a significant gap between the importance of nutrition to women’s long-term health and the nutrition expertise and resources readily available within traditional healthcare settings.
That isn’t a criticism of physicians. Nor is it something one clinician, or one appointment, can necessarily solve.
Instead, it raises a systems question:
Are we expecting one healthcare visit and one healthcare professional, to connect more dots than our current system realistically allows?
And perhaps there is an even bigger question:
Who is helping women connect those dots across their lifetime?
The Roadblocks May Start Before the Appointment
The more I think about it, the less I believe there is one single barrier.
Cost matters. A woman may not be able to afford another specialist, additional testing, repeated appointments, or services that insurance doesn’t cover.
Time matters. Both patients and healthcare professionals are trying to address complicated health histories within limited appointments.
Health literacy matters. Having access to a laboratory result, genetic report, or health metric doesn’t necessarily mean knowing what it means, or whether it matters.
Knowing what to ask matters. A woman may sense that something has changed without knowing which questions could uncover what is happening.
Nutrition matters. Yet detailed conversations about diet, supplements, nutrient status, and long-term behavior may not fit neatly into a traditional medical visit.
Fragmentation matters. One healthcare professional may know about her reproductive history. Another sees her laboratory results. Another discusses bone health. Her app knows how she sleeps. Her wearable knows how she moves. Her consumer genetic report contains another set of information.
But who is helping her see the whole picture?
And perhaps something even more fundamental matters:
Are we asking women the right and honest questions?
Not only:
What symptoms are you experiencing?
But also:
When did you first notice something changing?
What has your menstrual health been like throughout your life?
What happened during your pregnancies?
What concerns you most?
What are you afraid might happen?
What have you already tried?
What are you taking, including supplements?
What does your family health history look like?
What information have you gathered on your own?
What have you heard about your health that you aren’t sure you can trust?
And maybe the most important question:
What matters to you right now?
The answers could change the conversation.
A Woman’s Health Story Doesn’t Start at Menopause
This may be one of the most important realizations for me.
Healthcare often organizes women’s lives into stages:
Menstrual Health → Fertility → Pregnancy → Postpartum → Perimenopause → Menopause → Healthy Aging
These stages are useful clinically. But a woman’s health story doesn't reset each time she moves from one stage to another.
It is a continuum.
Her menstrual history doesn't become irrelevant when she becomes pregnant.
Her pregnancy history doesn't disappear after the baby is born.
Her nutrition status doesn't suddenly become important at menopause.
Bone health doesn't begin when she receives an osteoporosis diagnosis.
Cardiometabolic health doesn't begin when a laboratory value crosses a threshold.
And family history or genetic information doesn't automatically determine her future, but it may provide another piece of the picture that deserves context.
More than a moment in time, a lifetime of health is connected.
Yet our healthcare experiences don't always feel that way.
One healthcare professional may know her menstrual and reproductive history. Another may manage her cardiometabolic health. Another may discuss bone health. Her laboratory portal contains years of test results. Her wearable knows how she sleeps and moves. Her 23andMe report may contain genetic information she doesn't fully understand.
Meanwhile, she may be taking supplements, changing her diet, experiencing new symptoms, and reading health information from dozens of sources.
Each piece may tell us something.
But who is helping her see the whole picture?
Different Stages. A Fuller Picture.
Consider how different the conversation might look if we connected the stages.
A young woman experiencing significant menstrual-health issues may think only about getting through this month's symptoms. But could aspects of that history become relevant later?
A woman trying to conceive may be focused understandably on pregnancy. But what can her fertility, nutrition, metabolic health, or medical history tell us about her health beyond pregnancy?
During pregnancy, the primary focus is appropriately on mother and baby. But are there pregnancy-related health events that should remain part of her health story for years or even decades later?
After delivery, attention understandably shifts toward the baby. But who is helping the mother understand what happened to her body and what deserves follow-up?
At perimenopause and menopause, new symptoms and health considerations emerge. But this woman isn't arriving at midlife with a blank medical history.
She is arriving with decades of information.
Menstrual history.
Pregnancies.
Postpartum experiences.
Family history.
Nutrition.
Medications and supplements.
Laboratory trends.
Changes in weight and body composition.
Sleep.
Physical activity.
Bone health.
Cardiometabolic health.
And increasingly, wearable and genetic data.
The question isn't whether every piece predicts what happens next. Most don't.
The question is:
Are we looking at enough of the pieces to ask better questions?
Real Conversations. Brighter Tomorrows.
Perhaps that is what has been missing from some women's healthcare conversations.
Not another data point.
Not another test.
Not another app.
And not another person telling women what they should do.
Maybe we need better ways to help women understand their own health stories well enough to participate meaningfully in the decisions ahead.
That means knowing what information matters.
Knowing what questions to ask.
Knowing which healthcare professional may need to be part of the conversation.
Understanding the options.
And, importantly, understanding what comes next.
Because a healthier tomorrow may begin with a better conversation today.
Information Is Not the Same as Guidance
This distinction has become increasingly important to me.
A woman can have access to her laboratory results, genetic information, and wearable metrics.
That’s data.
She can receive an explanation of what those results mean.
That’s information.
She can learn about several possible approaches.
That’s education.
But she may still be wondering:
“What does all of this mean for me, and what should I do next?”
That is where navigation begins.
Navigation does not mean replacing the healthcare professional.
It doesn’t mean diagnosing a woman.
And it doesn’t mean telling her which medical decision to make.
It means helping her connect her health story, identify what deserves attention, prepare better questions, understand her options, and determine the next appropriate conversation or action.
Maybe We Need to Redefine the Gap
For a long time, I thought one of the biggest unmet needs in women’s health was access to better information.
I’m no longer sure that’s the whole problem.
We certainly need good science.
We need qualified healthcare professionals.
We need better research in women.
We need affordable access to care.
But we may also need something between knowing and doing.
Something that helps a woman connect what happened earlier in her reproductive and menstrual health with what is happening today and think about what may matter decades from now.
Something that helps her walk into an appointment prepared to have a more meaningful conversation and walk out understanding what comes next.
Because scientific knowledge can only help women if it reaches the conversation.
And perhaps we should add:
The conversation can only help if it leads to understanding and action.
So, I’ve started asking a different question:
What are the real roadblocks preventing women from having the healthcare conversations they need?
Cost?
Time?
Not knowing what to ask?
Fragmented healthcare?
Too much information?
Not enough nutrition support?
Having data without knowing what matters?
Or are there questions that women and perhaps healthcare professionals, simply aren’t asking?
I don’t think we should assume we already know the answer.
I think we should start asking women.
Have you ever left a healthcare appointment with test results or recommendations but still weren’t sure what you were supposed to do next?
What was missing from the conversation?
Who is going to help you see the whole picture?
This article is part of Women's Midlife Insights™, inspired by my journey through the Harvard Medical School Women's Health & Wellness – Executive Program and nearly three decades working in nutrition science and dietary supplements.
Evidence should empower—not overwhelm.
For educational purposes and personal reflection only. This article is not medical advice. Individual health concerns and decisions should be discussed with an appropriate healthcare professional.
Selected References & Further Reading:
American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 736: Optimizing Postpartum Care (2018). Obstetrics & Gynecology, 131(5), e140-e150. https://doi.org/10.1097/AOG.0000000000002633.
Bassin, S. R., Al-Nimr, R. I., Allen, K., & Ogrinc, G. (2020). The state of nutrition in medical education in the United States. Nutrition Reviews, 78(9), 764–780. https://doi.org/10.1093/nutrit/nuz100
Dinh-Le, C., Chuang, R., Chokshi, S., & Mann, D. (2019). Wearable health technology and electronic health record integration: Scoping review and future directions. JMIR mHealth and uHealth, 7(9), e12861. https://doi.org/10.2196/12861.
Kilfoyle, K,A., Vitko, M., O'Conor, R., & Bailey, S.C. (2016). Health Literacy and Women's Reproductive Health: A Systematic Review. Journal of Women’s Health, 25(12), 1237-1255. https://doi.org/10.1089/jwh.2016.5810.
Land, V., Parry, R., & Seymour, J. (2017). Communication practices that encourage and constrain shared decision making in health-care encounters: Systematic review of conversation analytic research. Health Expectations, 20(6), 1228–1247. https://doi.org/10.1111/hex.12557.
Parikh, N.I., Gonzalez, J.M., Anderson, C.A.M., Judd, S. E., Rexrode, K. M., Hlatky, M. A., Gunderson, E. P., Stuart, J. J., & Vaidya, D. (2021). Adverse Pregnancy Outcomes and Cardiovascular Disease Risk: Unique Opportunities for Cardiovascular Disease Prevention in Women. Circulation, 143(18), e902–e916. https://doi.org/10.1161/CIR.0000000000000961.
U.S. Food and Drug Administration. (n.d.). Direct-to-Consumer Tests. https://www.fda.gov/medical-devices/in-vitro-diagnostics/direct-consumer-tests.
World Health Organization. (2025). Framework to implement a life course approach in practice. https://www.who.int/publications/i/item/9789240112575.
World Health Organization. (n.d.). Women's health. https://www.who.int/health-topics/women-s-health.