Unique Health Challenges for Women with Nurse Practitioner Sandra Christensen
Why is it still so hard for women to get the healthcare they need and deserve?
Today, I’m beyond thrilled to have a guest who brings both deep expertise and a powerful voice to this conversation. Sandra Christensen is joining me on the podcast, and if you’ve ever felt unheard or dismissed in a medical setting or if you care for women in any way, you’ll want to stick around for this one.
I’ve had the privilege of working with Sandra through the Obesity Medicine Association over the past few years, and every time I hear her speak about the unique challenges women face in healthcare, I walk away with so many insights. From navigating weight stigma to the way women’s symptoms are often overlooked, she brings clarity, compassion, and serious clinical knowledge to the table.
Sandra is a board-certified nurse practitioner, an obesity specialist, and the founder of Integrative Medical Weight Management in Seattle. She’s a Master Fellow of the Obesity Medicine Association, a Fellow of the American Association of Nurse Practitioners, and currently serves as president of the Washington Obesity Society. She’s also an associate editor for Obesity Pillars and author of A Clinician’s Guide to Discussing Obesity with Patients.
In this episode, we’re talking about everything from medical bias to menopause to PCOS—and most importantly, how women can better advocate for themselves in a system that doesn’t always meet them halfway.
Let’s get into it.
The Healthcare Gap Women Still Face
When it comes to getting the care they need, women still face health inequities that are both frustrating and honestly heartbreaking. A lot of us know this from experience or from what we’ve heard, but the actual data? It shows a much deeper problem.
Studies show that when men and women present with the same symptoms, men are more likely to be taken seriously. Women wait longer for diagnoses, get less effective treatment, and often aren’t believed. A man and a woman can walk into the same clinic with the same pain, and the man is more likely to get meds, imaging, and follow-ups. Women are often told they’re fine or get vague labels like “fibromyalgia” without real answers. And it’s even worse for women of color and those in LGBTQ+ communities.
These delays can be dangerous. Women wait longer to receive TPA, a medication used during strokes to dissolve clots. They’re less likely to get statins after a heart attack and more likely to be dismissed when describing serious symptoms. These aren’t opinions. They’re facts.
There’s also this message women get about putting others first. Some providers subtly suggest their family role matters more than their own health. So they push back appointments, skip follow-ups, or don’t start treatment because they’re too busy caring for everyone else.
Unfortunately this plays out frequently. Women often come back from specialist visits without answers. It’s frustrating to have to figure out which referrals will actually take women seriously.
One thing that gives hope is seeing younger women prioritizing their health now. It’s common to hear, “Now that the kids are older, I can finally focus on myself.” But it’s even more powerful when someone with a toddler says, “I want to take care of my health now.” That shift can change everything.
We still have a long way to go in how healthcare treats women and how women are taught to treat themselves. But real change starts with awareness, with being heard, and with care that actually listens.
PCOS Isn’t Just About Fertility
One of the most eye-opening things in women’s health is how often conditions like PCOS, or polycystic ovary syndrome, are totally overlooked or just not taken seriously. It’s not just in the research either; you see it all the time in real life. Even though PCOS affects around 7-10% of women of reproductive age, many people don’t even get diagnosed or get the kind of care they actually need. And that’s a huge deal because PCOS isn’t just about fertility or irregular periods. It’s a lifelong condition that can impact your health in all sorts of ways.
What’s extra-frustrating is that the signs can show up really early (sometimes even before puberty), and still no one catches it. So many women remember their pediatrician kind of casually mentioning it like oh maybe you have PCOS and then nothing ever happens. No tests, no follow-up, not even a real explanation. Maybe metformin gets mentioned, but it’s just sort of thrown out there and never followed up on. It leaves women feeling confused and kind of dismissed.
A lot of times PCOS is seen as just a fertility thing, something to worry about only if you’re trying to have kids. But that’s missing the bigger picture. It’s a metabolic condition that can increase your risk for insulin resistance, type 2 diabetes, heart issues, and even certain cancers. It’s not like it just magically goes away after your 30s. It sticks around and affects your health long-term.
Healthcare providers need to treat PCOS for what it is: a chronic condition that needs real attention. It’s not just about reproductive health. For so many women, just getting a clear yes or no diagnosis instead of some vague response would be a game changer.
Why Obesity Care Shouldn’t Stop During Pregnancy
Pregnancy and obesity is one of those topics that doesn’t get talked about enough. Women with obesity have a higher chance of complications, and their babies can be affected too. That’s why it’s super helpful to focus on health and weight before getting pregnant, like six months to two years if there’s time. It’s not about being perfect, but instead about giving mom and baby the best start.
What’s often forgotten is that care shouldn’t stop once someone’s pregnant. Even if weight loss meds are paused, there’s still so much you can do with food, movement, and habits. Pregnancy brings a lot of changes, and having support throughout really helps.
Regular check-ins also keep things on track and remind people that their health matters. But sadly, a lot of women say they’ve felt humiliated by their doctors just because of their weight. That should never happen. Everyone deserves kind, respectful care especially during pregnancy.
Support is just as important after birth too. Women with obesity are less likely to breastfeed, often because they don’t get enough help. But with the right support, it’s totally possible, and the benefits are real for both mom and baby.
It’s honestly amazing that more people now are speaking up and expecting better care. No one should feel ashamed at the doctor’s office. Pregnancy care should adjust with your needs and always come with respect.
Addressing Breastfeeding Difficulties
Breastfeeding can be one of the most beautiful yet honestly challenging parts of early motherhood. And for women with obesity, there might be a few extra hurdles that people don’t really talk about.
For those who’ve had obesity since their teen years, breast tissue development might not be ideal for milk production, even if their breasts look average or even large. Plus, getting into the right position to breastfeed can be tricky too, especially with larger breasts or a larger body. Sometimes it just takes a little more guidance to get that perfect latch.
That’s where a lactation consultant comes in, and seriously they’re amazing. They help with everything from positioning to figuring out what’s going on with milk supply. And the support isn’t just about feeding the baby. It’s also about protecting mom’s health.
Did you know breastfeeding can lower the risk of heart disease later on? It’s not talked about enough but it’s such a big deal. The benefits go way beyond the newborn stage.
These challenges don’t mean women with obesity can’t breastfeed. They just need the right tools, real support, and a whole lot of encouragement. And honestly, that support can change everything.
Why Menopause Deserves Better Care
Menopause isn’t just a phase to “get through.” It brings real changes that impact both quality of life and long-term health. Women deserve support, not silence.
As hormone levels drop, many women experience weight gain, especially around the midsection, along with a loss of muscle. These shifts increase the risk of insulin resistance, high cholesterol, and heart disease. And it’s not about lifestyle changes or lack of effect; many women gain 10 to 15 pounds despite maintaining healthy habits. Just further proof that it’s all hormonal.
Symptoms like hot flashes, sleep problems, and mood swings can be intense, especially for women with obesity. Vaginal dryness and urinary issues, part of Genitourinary Syndrome of Menopause (GSM), are also common but often ignored. Left untreated, recurrent infections can become serious.
There are effective treatments. Menopause hormone therapy and vaginal estrogen can make a big difference for symptom relief and long-term health, yet many women are told to “just deal with it.” That needs to change.
More practitioners are finally taking menopause seriously. Resources like The Menopause Society can help women find trained, supportive clinicians. Because menopause isn’t just about aging—it’s a major health shift. And women deserve care that reflects that.
Perimenopause and Hormonal Shifts
For many women, the changes start during perimenopause. This is when symptoms like sleep issues, mood swings, and hot flashes can begin, even while periods might still be regular. But because perimenopause hasn’t always been a focus in healthcare, it can be hard to find providers who really know how to help.
Early support makes a difference. Starting hormone therapy sooner has been linked to better heart, bone, and muscle health. The old fear of hormone therapy mostly came from a 2002 study that doesn’t reflect how it’s prescribed today. That misunderstanding left a lot of women untreated, and now we’re seeing more issues like osteoporosis and muscle loss that could’ve been prevented.
Screening often starts too late. Many women don’t get a bone scan until age 65, when the damage is already done. And no, having a higher weight doesn’t automatically mean stronger bones. Fat can build up in places it shouldn’t, weakening tissues instead.
The real issue is that many women still feel ignored when they bring up these symptoms. But it’s not in their heads; there’s research showing that women’s concerns around this time are often dismissed. The good news is there are clinicians who listen, understand, and treat menopause seriously. And every woman deserves that kind of care.
Women’s Health: Time for Better
When it comes to women’s health, one of the most important things to remember is this: trust yourself. If something feels off, it probably is. So many women have been taught to brush things off or wait until it gets really bad before asking for help. But your body knows what’s up, and listening to it is the first step toward getting the care you actually deserve.
The next step is about finding clinicians who believe and support you too. Not the ones who smile and nod, but the ones who actually take your concerns seriously and know how to help. Whether it’s PCOS, perimenopause, or hormone therapy, there’s so much info out there now. So read up, ask questions, and don’t be afraid to look for someone who’s actually trained in menopause or hormone care because that stuff matters.
In all honesty, this should extend beyond medical checkups. It’s about changing how women are treated.
It’s totally valid to feel frustrated or even angry about it. That fire can push you to expect better and stop settling for the bare minimum. Women deserve real care, the kind that’s smart, supportive, and actually pays attention.
This conversation with Sandra is one I hope stays with you because the challenges we covered today are not rare. They're happening to women everywhere, in every stage of life. From PCOS and pregnancy to perimenopause and beyond. These aren't niche issues; they're everyday realities that deserve better care, better listening, and real support.
You deserve health care that takes you seriously at every stage, in every season.
So yes, believe in yourself. Speak up. Stay curious. And never feel bad about asking for the care you know you need.
So go ahead and hit play, and share this episode with those we care about. Let’s keep the conversation going.
More from The Dr. Francavilla Show:
Subscribe to The Dr. Francavilla Show on