Hormones, Health & Power: OB-GYN Dr. Jessica Shepherd on Being Heard in Midlife
Rosie Acosta talks with her own doctor, OB-GYN and menopause expert Dr. Jessica Shepherd, about why so many women feel invisible in the exam room, what hormone therapy is and isn’t, and how to reclaim your voice in your own care.
Why are women taught to distance themselves from their bodies just when their bodies need them most?
Many women arrive at midlife after years of putting everyone else first. When perimenopause begins, the signals their bodies send are easy to dismiss—by themselves and, too often, by the healthcare system.
In this episode, Rosie Acosta sits down with Dr. Jessica Shepherd, an OB-GYN, menopause expert and Rosie’s own doctor, to talk about the “humanistic side” of healthcare: why so many women feel invisible in the exam room, and how the disconnect between mind and body is often rooted in years of social conditioning.
Rosie shares her own difficult journey through early perimenopause, and Dr. Shepherd explains her mission to restore the connection between patients and providers. Together they discuss hormone therapy, the difference between birth control and menopausal hormone therapy, health disparities, and the emotional side of the transition.
The episode is a call to reclaim your agency in midlife, with both scientific clarity and radical self-compassion.
Ideas explored in this conversation
- Medical training can push doctors to focus on data points rather than the person in front of them.
- Women are often socially conditioned to ignore their own physical needs, and that silence has a cost.
- Birth control and menopausal hormone therapy are different treatments used for different purposes.
- The short, transactional appointment model can fail women’s mental and physical health.
- Your personal story is one of the most important tools in understanding your hormone health.
- Ignoring the physical shifts of perimenopause can change how you perceive yourself and your life.
- The dismissal of women’s pain is a systemic issue, and health disparities affect some women more than others.
- Advocating for yourself is an act of self-compassion, not difficulty.
Why so many women feel invisible in the exam room
Dr. Shepherd describes how medical training and short appointment times can push care toward lab values and checklists. When a visit lasts only a few minutes, there is little room for the story behind the symptoms—and in perimenopause, that story often matters most.
Rosie and Dr. Shepherd talk about how this dynamic leaves many women feeling unheard, and how empathy and genuine connection change the quality of care. Dr. Shepherd’s mission is to restore that connection between patient and provider.
Your story is one of your most important health tools
A central idea in this episode is that the way you describe what you are experiencing can guide better care. Coming prepared helps make the most of limited appointment time.
Consider sharing with your provider:
- When your symptoms started and how they have changed
- Changes in your menstrual cycle
- Sleep, mood, anxiety or irritability patterns
- Physical symptoms such as hot flashes, night sweats or joint pain
- Any hormonal birth control or other medications you take
- How symptoms are affecting your work, relationships and daily life
Questions you may ask:
- Could these symptoms be related to perimenopause?
- What treatment options are appropriate for me, including hormonal and non-hormonal options?
- What are the benefits and risks of each option for my health history?
- When should I follow up if things don’t improve?
Birth control and hormone therapy are not the same thing
In the episode, Dr. Shepherd explains the difference between the effects of hormonal birth control and menopausal hormone therapy—a distinction many women are never clearly taught.
According to the U.S. Office on Women’s Health, low-dose hormonal birth control may help with symptoms in the years leading up to your final period. Menopausal hormone therapy can help treat symptoms during perimenopause, menopause and after menopause, but it can raise the risk of blood clots, stroke and some cancers. Treatment recommendations depend on a full evaluation of your health and your own choices.
The conversation also touches on estrogen and aging, the role of the FDA in how hormone therapy is regulated, and long-term health risks for women. Whether any hormonal treatment is right for you is a decision to make with a qualified healthcare provider.
Disparities in women’s health
Rosie and Dr. Shepherd discuss how healthcare disparities affect women’s health, including what public health researchers call the “weathering” effect—the idea that the cumulative stress of discrimination and hardship can take a physical toll over time—and its impact on Black women.
It is part of a larger point the episode makes: the dismissal of women’s pain is not an individual failing but a systemic issue, and advocating for yourself matters even more when the system has not always listened.
The emotional journey of menopause
The conversation closes on the emotional side of the transition—how perimenopause can change how you see yourself, and how women can support one another through midlife. Rosie brings her own experience of early perimenopause to that conversation, and the message is one of agency and self-compassion.
Timestamps
Explore the conversation
Questions explored in this episode
Why do so many women feel dismissed by their doctors in midlife?
Short appointments, medical training that emphasizes data points over the whole person, and social conditioning that teaches women to downplay their needs can all leave women feeling unheard. Coming prepared with your history and questions can help you advocate for yourself.
What is the difference between birth control and hormone therapy?
They are different treatments used for different purposes. According to the U.S. Office on Women’s Health, low-dose hormonal birth control may help with symptoms in the years leading up to your final period, while menopausal hormone therapy can help treat symptoms during perimenopause, menopause and after menopause. A healthcare provider can explain which, if either, fits your situation.
Is hormone therapy safe?
Like all medicines, menopausal hormone therapy has benefits and risks. The U.S. Office on Women’s Health notes it can raise the risk of blood clots, stroke and some cancers, and that treatment recommendations depend on a full evaluation of your health. Discuss your personal risks with a qualified provider.
How can I prepare for a perimenopause or menopause appointment?
Note when symptoms began, changes in your cycle, sleep and mood patterns, physical symptoms, current medications including birth control, and how symptoms affect daily life. Bring questions about hormonal and non-hormonal options and their risks and benefits.
What is the weathering effect?
Weathering is a term public health researchers use to describe how the cumulative stress of discrimination and hardship may take a physical toll over time. In this episode, Rosie and Dr. Shepherd discuss its impact on Black women’s health.
Who is Dr. Jessica Shepherd?
Dr. Jessica Shepherd is an OB-GYN and menopause expert focused on restoring the connection between patients and providers. She is also Rosie Acosta’s own doctor.
You deserve to be heard—by your doctors and by yourself.
Rosie offers mental health coaching grounded in mindfulness, self-compassion and practical tools for the emotional side of perimenopause and midlife change. Coaching complements—never replaces—care from your healthcare providers, and is available in English and Spanish.
This page summarizes topics discussed in the episode and is intended for educational purposes. It does not provide medical or mental-health advice, diagnosis or treatment. Seek qualified professional care for persistent, severe or concerning symptoms.