Dr. Donna Adams-Pickett on Menopause, Misdiagnosis, and Women’s Health

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2026/03/27

Dr. Donna Adams-Pickett is a physician and women’s health advocate focused on evidence-based, individualized care across the lifespan. In this interview, she emphasizes the frequent dismissal of midlife women in clinical settings, especially when symptoms are subtle, overlapping, or poorly contextualized. She highlights delays in diagnosing perimenopause, menopause, cardiovascular disease, cancers, infertility, and fibroids, with particular attention to the credibility bias faced by Black women. Adams-Pickett argues for stronger clinician education on sex-specific presentation, careful counselling on hormone therapy, and practical patient self-advocacy. Her perspective centers on clearer communication, prevention, continuity of care, and better outcomes for all women everywhere.

In this interview, Scott Douglas Jacobsen speaks with Dr. Donna Adams-Pickett about the systematic dismissal of midlife women in medicine. Adams-Pickett explains how delayed diagnoses, credibility bias, and poor clinical education can leave women unheard, misdiagnosed, or undertreated, especially Black women. She distinguishes normal aging from poorly contextualized hormonal transition, addresses fibroids, infertility, miscarriage, and myths about hormone therapy, and outlines practical self-advocacy during appointments. The discussion stresses sex-specific differences in disease presentation, the need for individualized, evidence-based care, and the importance of continuity, clear communication, and informed support from families, clinicians, and communities for healthier outcomes across the lifespan overall.

Scott Douglas Jacobsen: To begin, I have seen many reports suggesting that clinical “best practice” standards in the United States are often developed from research populations that do not fully reflect the diversity of the patients being treated. Midlife women also face persistent misconceptions about perimenopause and menopause, and better evidence and better clinical education can help correct them. What are the clear signs that midlife women are being systematically dismissed in clinical settings?

Dr. Donna Adams-Pickett: One clear sign is delayed recognition or diagnosis of important conditions. That can include delays in identifying perimenopause or menopause as the driver of symptoms, as well as delays in diagnosing serious illnesses such as certain cancers and cardiovascular disease.

Jacobsen: A woman I know had ovarian cancer. Her general practitioner repeatedly dismissed her until it was finally diagnosed at an advanced stage. She survived after a large tumour was removed. When you mention cancers, I think of life-threatening conditions. What about perimenopause and menopause?

Adams-Pickett: Many symptoms can sound nonspecific to a clinician, but they are meaningful to the individual because they represent a change from that person’s baseline. Clinical training often emphasizes classic, clearly defined symptom patterns. In midlife, however, people may present with subtler changes—such as unexplained weight gain, thinning hair, sleep disruption, mood changes, or a general sense of not feeling like themselves. These shifts can be part of perimenopause, but they can also overlap with other conditions. The problem is that such changes are sometimes minimized rather than assessed carefully and in context.

Jacobsen: Why are Black women, in particular, misdiagnosed or undertreated?

Adams-Pickett: Black women often face credibility bias in clinical encounters. Their reports of symptoms may be discounted, or providers may assume they are misinformed rather than engaging seriously with what is being described. Assumptions about education, health literacy, or pain tolerance can interfere with appropriate evaluation. The result can be delayed testing, delayed referral, or delayed diagnosis.

Jacobsen: How do you distinguish normal aging from a hormonal imbalance that requires further investigation?

Adams-Pickett: Normal aging includes hormonal change. Ovarian hormone levels decline over time, particularly during perimenopause and menopause. Women are born with a finite number of eggs, and both the number of eggs and ovarian function decrease with age. As ovarian activity declines, estrogen and progesterone levels fluctuate and eventually fall. The problem is not that this process occurs, but that it is often not explained clearly. Patients are told to expect gray hair or joint stiffness, yet changes in sleep, temperature regulation, mood, metabolism, and body composition are rarely framed as expected consequences of hormonal transition. When these changes are not contextualized, women may feel dismissed rather than informed.

Regarding fibroids, uterine fibroids are common across populations. By age 50, studies suggest that up to 70–80% of women will have fibroids detectable by imaging, with higher rates reported among Black women and often earlier onset and more severe symptoms. Prevalence estimates vary globally, and differences may reflect genetics, environmental exposures, diet, body weight, vitamin D status, and access to imaging rather than a single cause. It is inaccurate to attribute fibroids solely to one factor, such as dietary hormones. In the United States, the use of added hormones in poultry production has been banned for decades, and milk from treated cows generally contains hormone levels lower than endogenous human levels. However, broader environmental and lifestyle factors—including endocrine-disrupting chemicals, obesity rates, and reproductive patterns—are areas of ongoing research.

Jacobsen: What would need to change in consumption patterns or production practices in the United States to reduce fibroid prevalence?

Adams-Pickett: There is no single dietary switch that eliminates the risk of fibroids. Evidence supports maintaining a healthy body weight, increasing fruit and vegetable intake, limiting consumption of highly processed foods, ensuring adequate vitamin D intake, and reducing exposure to known endocrine disruptors where possible. Public health measures would focus less on one product and more on overall metabolic health, environmental regulation, and equitable access to preventive care and early evaluation.

Jacobsen: What are effective questions women can ask during an appointment to advocate for themselves?

Adams-Pickett: One of the most effective questions a patient can ask is: “You know my history. Based on me as an individual, what should we focus on today?” That shifts the encounter from a routine checklist to personalized care. Patients are not monolithic. Differences in genetics, history, environment, and lived experience matter. Framing the question around personal risk and longevity encourages the clinician to think beyond the chart and tailor the visit to the person in front of them.

Jacobsen: At what age range should women begin asking more targeted questions based on known risk patterns?

Adams-Pickett: Preventive care should begin in early adulthood and continue across the lifespan, but conversations often need to become more detailed in the late 30s and 40s, when cardiometabolic risk, perimenopausal changes, and certain gynecologic conditions become more common. The idea that one annual visit is sufficient for everyone is outdated. Screening intervals, such as cervical cancer screening every three to five years depending on age and testing method, do not replace broader health evaluations. Women benefit from regular follow-up with primary care providers and, when appropriate, with gynecologists and other specialists. Subtle physiologic changes are easier to identify when there is consistent clinical contact.

Jacobsen: In medical education and clinical culture, what are the common failures regarding women’s health?

Adams-Pickett: A major gap is insufficient emphasis on sex-specific differences in disease presentation. Cardiovascular disease is a clear example. While chest pain is common, women may also present with symptoms such as shortness of breath, nausea, fatigue, or upper back discomfort. Without training that highlights these variations, clinicians may miss or delay diagnosis. Culturally, time pressure and cognitive bias can also reduce individualized assessment.

Jacobsen: What myths continue to cause harm?

Adams-Pickett: One persistent myth is that menopausal hormone therapy is uniformly unsafe. The evidence is more nuanced. For appropriately selected patients, initiated near the onset of menopause and without contraindications, hormone therapy can effectively treat vasomotor symptoms and prevent bone loss. Risks and benefits vary by age, timing, formulation, and personal medical history. It is inaccurate to claim it universally increases cancer risk, but it is also inaccurate to describe it as risk-free. Careful, individualized counselling is essential.

For my community, another damaging myth is the idea that African-American women are uniformly highly fertile. In reality, Black women in the United States experience disproportionately high rates of infertility. Many are surprised to hear that. Higher rates of fibroids and polycystic ovary syndrome, along with delayed access to reproductive care and higher rates of untreated tubal disease, all contribute. Some women delay attempting pregnancy because they assume conception will be easy whenever they choose. Later, they may face difficulty conceiving or carrying a pregnancy to term.

Jacobsen: Psychologically, what happens when miscarriages occur?

Adams-Pickett: There is a strong cultural expectation that pregnancy should naturally result in birth. When a loss occurs, many patients feel that they are at fault or that something is wrong with them. Clinically, however, miscarriage is common. Estimates suggest that about 10–20% of recognized pregnancies end in miscarriage, and the true number may be higher when very early losses are included. Experiencing a loss does not mean a person cannot go on to have a healthy pregnancy. Still, the emotional impact can be profound, especially with recurrent losses.

Jacobsen: If a woman leaves an appointment feeling unheard, what practical steps can she take to protect her health and secure better care?

Adams-Pickett: Preparation matters. Patients should write down concerns in advance, note when symptoms began, and clarify what they want addressed during the visit. At the start of the appointment, they can ask for time to discuss their concerns before the physical exam. Before the visit ends, they should confirm that their main questions were answered and ask about next steps, follow-up, or additional testing if needed. If concerns remain unresolved, seeking a second opinion is reasonable. Clear documentation, follow-up appointments, and continuity of care improve outcomes.

Jacobsen: Any final thoughts?

Adams-Pickett: Women deserve evidence-based, individualized care. Many physiologic changes across the lifespan are normal, but normal does not mean insignificant. Clear communication, clinician education on sex-specific differences, and patient self-advocacy all help close the gap between symptoms and appropriate treatment.

My final thought is that I am encouraged to see more men becoming engaged in the reproductive education of the women in their lives. Everyone has a mother, a partner, a daughter, or a sister. Greater understanding fosters empathy. When men are informed about hormonal changes, fertility challenges, and midlife health transitions, it strengthens support systems and improves health conversations within families and communities.

Jacobsen: Thank you very much for your time today. I appreciate your expertise.

Last updated May 3, 2025. These terms govern all In-Sight Publishing content—past, present, and future—and supersede any prior notices.  In-Sight Publishing by Scott  Douglas  Jacobsen is licensed under a Creative Commons BY‑NC‑ND 4.0; © In-Sight Publishing by Scott  Douglas  Jacobsen 2012–Present. All trademarks, performances, databases & branding are owned by their rights holders; no use without permission. Unauthorized copying, modification, framing or public communication is prohibited. External links are not endorsed. Cookies & tracking require consent, and data processing complies with PIPEDA & GDPR; no data from children < 13 (COPPA). Content meets WCAG 2.1 AA under the Accessible Canada Act & is preserved in open archival formats with backups. Excerpts & links require full credit & hyperlink; limited quoting under fair-dealing & fair-use. All content is informational; no liability for errors or omissions: Feedback welcome, and verified errors corrected promptly. For permissions or DMCA notices, email: scott.jacobsen2025@gmail.com. Site use is governed by BC laws; content is “as‑is,” liability limited, users indemnify us; moral, performers’ & database sui generis rights reserved.