A Terrible Strength: How Medical Bias Is Costing Women Their Lives with Dr. Kemi Doll | 408

Summary

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Podcast Summary:

This Is Woman's Work with Nicole Kalil | Episode 408
Title: A Terrible Strength: How Medical Bias Is Costing Women Their Lives with Dr. Kemi Doll
Date: May 4, 2026
Host: Nicole Kalil
Guest: Dr. Kemi Doll, MD, MS – Double board-certified gynecologic oncologist, OBGYN, Professor at UW, Founding Director of the Grace Center, Author of A Terrible Strength

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Episode Overview

This episode features a crucial, candid discussion between host Nicole Kalil and Dr. Kemi Doll about the systemic medical bias in gynecologic care, particularly as it affects Black women. Together, they dissect why women’s health—especially “womb health”—is consistently underfunded, undervalued, and overlooked, and why progress in women’s health cannot be measured by the experiences of the most privileged. The conversation challenges listeners to move from passive awareness to committed advocacy for themselves and all women, stressing that true “woman’s work” means demanding equitable healthcare for every woman, especially those most marginalized by the system.

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Key Discussion Points & Insights

1. Setting the Stage: Why the System is Broken (03:50–09:52)

• Women’s health is not equally broken for all: Nicole stresses that medical inequality persists—Black women face far higher rates of denial, late diagnoses, and death from treatable conditions.
• Misplaced benchmarks of progress: Using the experience of (affluent) white women as the standard for women’s health is misleading and erases disparities.
• Nicole (05:08):

  “We cannot look at the experiences of white women, especially rich white women, and use that as the benchmark for what’s working or whether progress is being made or not.”

• The definition of “woman’s work” must include fighting for equitable healthcare.

2. The Structural Crisis in Womb Health (06:21–09:52)

• Dr. Doll outlines four systemic layers:
  1. Research is underfunded: Less than 1% of NIH’s budget goes to fibroids, a condition affecting 70–80% of women.
  2. Medical education is lacking: Reproductive health is siloed in short curriculum blocks; most doctors are under-trained on basic gynecologic health unless they specialize.
  3. Insurance undervalues gynecologic care: Many essential treatments for women are arbitrarily deemed “optional” or under-covered.
  4. Cultural messaging silences and devalues womb health: From a young age, girls are taught to hide and minimize their reproductive health needs.
• Dr. Doll (08:09):

  “We don’t put dollars and effort into researching womb conditions that are not pregnancy-related... physicians, when they get out and start training, don’t have to have basic knowledge of our wombs...”

3. The Myth of Acceptable Suffering (11:23–13:40)

• Passivity is a learned myth: Societal messages tell women to accept pain, anemia, and reproductive distress as “normal.”
• Change comes when women collectively reject the status quo.
• Dr. Doll (12:09):

  “If I accepted all the messages...we would make nothing real in the world. ...those ideas that we can’t expect more...is just part of the oppression, honestly, that keeps us thinking it’s reasonable to be anemic.”

4. ‘A Terrible Strength’: How ‘Strength’ is Weaponized (14:09–16:15)

• Endurance becomes invisibility: The idea that Black women are especially “strong” leads to their symptoms and pain being even more ignored.
• Endurance, while a source of pride, blocks access to care and compassion.
• Dr. Doll (15:08):

  “When you’re perceived to be so strong, you are not perceived to be vulnerable or in need of care...the very ability to endure is killing us.”

5. Collaboration & Collective Advocacy (16:15–19:20)

• All women have a role: Solidarity, education, and shared advocacy raise the standard for everyone—not just marginalized groups.
• Knowledge is power: Understanding basic reproductive physiology empowers women to ask better questions, demand better care, and hold systems accountable.
• Dr. Doll (18:19):

  “If Black women are the intersection where we are vulnerable to all of the overlapping vulnerabilities...if we’re behind and saying this is unacceptable for Black women, everybody improves, right?”

6. Health Trends & Wellness ‘Grift’—Navigating Fact vs. Fad (22:13–26:38)

• Knowledge protects against misinformation: Dr. Doll cautions listeners to watch for “clickbait” wellness schemes, one-size-fits-all protocols, and stealthy diet-culture repackaged as “health.”
• Dr. Doll (25:55):

  “Womb health is not about clicks. Everybody is not supposed to be on the same protocol...It is always personalized.”

7. Our Health Is Not Enough: Societal Pressures and Internalization (27:14–32:10)

• Women's health is marketed as secondary: Even crucial interventions are often justified by aesthetic side effects (e.g., “reduces belly fat”) instead of genuine wellbeing.
• Internalized priorities: Many women absorb the message that self-advocacy for health is less important than outward appearance.
• Dr. Doll (27:14):

  “Our health is not enough. Because it’s not enough to say...your risk of uterine cancer increases five-fold...but that’s not the message. The message is your glowing skin and your hair.”

• Nicole (29:14):

  “Somewhere along the way, I think so many of us—I know I did—bought into the lie that our health isn’t enough.”

8. Shifting from Outside-In to Inside-Out Wellness (31:12–34:04)

• Prioritizing health for itself: Nicole and Dr. Doll urge women to prioritize true wellness from the inside out, rather than as a path to meet external standards.
• Women know how to do this at work, but not for their health—time to apply that confidence and clarity to womb care.

9. The Reality of Silent Suffering (34:04–36:10)

• Suffering is normalized: Women routinely work, parent, and succeed while experiencing debilitating reproductive health symptoms.
• Dr. Doll (33:54):

  “What could you do with a full tank of blood?...You don’t recognize how much better it could be.”

10. Medical Dismissal: When One Group Suffers, All Are At Risk (36:28–39:29)

• Bias harms everyone: Medical systems that normalize ignoring Black women’s suffering eventually erode care for all women.
• Black womb crisis specifics:
  • 1 in 3 Black women with heavy periods are clinically anemic right now.
  • Black women get fibroids more, younger, larger, and more symptomatically.
  • Black women are twice as likely to die from uterine cancer as white women, despite early detection being highly treatable.
• Dr. Doll (37:13):

  “Anytime we try to move forward and make progress and just leave a whole group behind, it never works. What’s happening with the black womb crisis...is the tip of the iceberg of what black women deal with...”

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Notable Quotes & Memorable Moments

• Nicole (04:26):

  “Our health, our autonomy, and being believed—those are the hills I’m willing to die on. And if redefining woman’s work means anything, it has to include that.”

• Dr. Kemi Doll (15:08):

  “It’s a terrible strength because the very ability to endure is killing us.”

• Dr. Doll (27:14):

  “Our health is not enough, Nicole.”

• Nicole (29:14):

  “Somewhere along the way, I think so many of us...bought into the lie that our health isn’t enough.”

• Dr. Doll (37:13):

  “Anytime we try to move forward and make progress and just leave a whole group behind, it never works. It never works.”

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Timestamps for Important Segments

• 00:00–03:50 – Introduction, show framing, and Nicole’s perspective on tolerating inequities
• 06:21–09:52 – Dr. Doll lays out the systemic crisis in gynecologic care
• 13:40–16:15 – The burden of ‘terrible strength’ for Black women
• 16:15–19:20 – How all women can advance womb health advocacy
• 22:13–26:38 – Navigating wellness trends and misinformation
• 27:14–32:10 – Why women’s health is marketed incorrectly and how to reprioritize it
• 36:28–39:29 – Medical dismissal, the Black womb crisis, and why it matters for everyone

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Conclusion & Call to Action

Nicole and Dr. Doll emphasize that true progress in women’s health—and in “woman’s work”—requires acknowledging and actively addressing the specific, systemic biases harming women, especially Black women. Individual advocacy is vital, but collective change is only possible when every woman’s needs are seen, believed, and prioritized.

Nicole’s Call to Action (39:01):
Buy Dr. Kemi Doll’s book A Terrible Strength for yourself, a woman you love, and someone who influences your health decisions—so knowledge and advocacy can ripple outward.

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For More from Dr. Kemi Doll

• Book: A Terrible Strength: The Hidden Crisis of the Black Womb and Your Survival Guide to Healing
• Instagram and Website: [Links in episode show notes]

Final Thought:

“We don’t get to claim progress for women while some of us are still being dismissed, denied, and dying from things that we know how to treat. And we don’t get to call it woman’s work until it works for all of us.” — Nicole (40:27)

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Transcript

[A]

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That's upwork.com upwork.com Are you the friend or family member who ends up planning every trip like you're out there, spreadsheeting and comparing hotels, organizing the itinerary, locating the best restaurants like you're a trained food critic, and booking all the epic experiences? Yeah, I bet you are. So here's my question. Why are you not getting paid to do it? Because you're exactly who Fora is built for. As a FORA Advisor, your subscription gives you access to best in class training, powerful booking technology, and a vibrant global community of experts and fellow advisors who share real insider knowledge to help you launch and grow your own travel business with confidence. With access to more than 7,000 preferred travel partners from iconic brands to boutique hotels, you can unlock VIP perks like upgrades, upgrades, resort credits, and late checkout, giving you and your clients the kind of elevated travel experiences that regular travelers simply don't get. So why not turn your passion for travel and epic planning skills into a fulfilling business with fora? Become a fora advisor today at foratravel.com woman that's f o r a travel.com woman and make sure to tell them that I sent you foratravel.com woman. I am Nicole Kahlil, and you're listening to the this Is Woman's Work podcast. We're together. We're redefining what it means, what it looks and feels like to be doing woman's work in the world today. And if we're serious about redefining it. If this isn't just talk, if it's more than just A cute tagline, then we need to acknowledge that it's complex and we're not all on the same page. And maybe we don't need to be on everything, but we do need to get clear about what we refuse to tolerate. And listen. I know we have different perspectives, and we all have things that just don't compute. Perspectives that don't just challenge us. They flat out do not make sense to us. Some of them are trivial, like how tamales aren't a Christmas Day staple in every household, which just feels wrong to me. And there are some that are not trivial at all, like how any woman could vote for Donald Trump. I just can't make sense of it. I intellectually can understand that people have different experiences, different influences, different priorities and different information streams. I can understand the context, the influences, the arguments, and still not agree, still not see it, still not want to. And then there are perspectives that I won't ever fully understand because I haven't lived them. And the work isn't to debate or interpret or even relate. It's to listen, to believe and to witness. And this topic is both. I don't know what it is to be a black woman. I don't know what it is to be a black woman navigating pain in a health care system that has a long documented history of ignoring it, minimizing it and denying it. I can never fully understand because I have not lived that experience. But what I can also not understand is how anyone, especially anyone who claims to advocate for women, isn't outraged by it. Because every once in a while I catch myself thinking, well, we've made progress. Maybe we're in a different place. Maybe I'm just seeing inequality because I'm looking for it. And then I look at the data, the stories, the lived experiences of black women when it comes to gynecological health. And I have all the evidence I need to know that we are not even close. Most of us agree women's health is broken, but we need to be clear. Women's health isn't equally broken for all of us. We cannot look at the experiences of white women, especially rich white women, and use that as the benchmark for what's working or whether progress is being made or not. And we can't look at black women being systemically denied care, believed less, diagnosed later, and dying at higher rates from conditions we know how to treat and think anything other than this. We still have a fuck ton of work to do. Not performative work, not convenient work, real work. Because our health, our Autonomy and being believed, those are the hills I'm willing to die on. And if redefining woman's work means anything, it has to include that. So if you're with me, not in theory, but in commitment, two women, we're going to get into it. Today we're joined by Dr. Kemi Dahl, a physician, surgeon, researcher and advocate working in the intersection of health, justice, reproductive equity and gynecological cancer. She's a professor at the University of Washington, a double board certified gynecologic oncologist and obgyn, the founding director of the Grace center, and the author of A Terrible Strength, the hidden crisis of the Black Womb and your survival guide to healing. Dr. Kimmy, thank you for being a guest. And I'd like to start by asking you to explain the systemic crisis happening in gynecology and what you call womb health and why that experience is not equal for all women.

[B]

Nicole, thank you so much for having me on the show. From that intro alone, I know we're going to be friends. I feel like I was just nodding and putting my fist up all of the ways. But I, I truly appreciate being here because, you know, my entire perspective on this is that it's not, it's not a niche issue and, and it completely intersects with, with women's work, with what we, how we are show up in the world and our livelihood and how we are able to express this energy that we have and whatever we want to do here on the planet together. So I'm just really, really happy to be here. The gynecologic crisis, as I think of it, is absolutely systemic. It's, it's really important to understand in this world of like wellness and individual agency, which all matters, that we are here because there are multiple layers of influence that have gotten us here to feeling like we're the only ones who can save ourselves in terms of womb health. So for me, the way I think of it is it starts with the fact that we really devalue women outside of their ability to reproduce and to get pregnant. And when I say we, I mean medicine. I mean the biomedical industrial complex. I mean that less than 1% of the NIH research budget goes to researching a condition that 70 to 80% of women have, which is fibroids. So when I think about the systemic issues, I think one, we don't put dollars and effort into researching womb conditions that are not pregnancy related. Number two, in medical education and training, we literally silo reproductive health, anatomy, physiology, knowledge to like single blocks, maybe three weeks, maybe Maybe two weeks, maybe one week of. Of information to students. Meanwhile, it affects everybody system. Meanwhile, it's just as important as the heart, the lungs, the brain, everything. But even in medical training, we act like it's a niche issue, which means that physicians, when they get out and they start training, they don't have to have basic knowledge, basic knowledge of our wounds and how what happens affects them and how the symptoms can show up and what they can look like. So that's another layer of issue. A third layer is our insurance companies and what we consider to be optional or not. Most cardiac care that you need for your heart, covered, lungs covered, kidneys covered. Like you're not fighting for that when it gets to the womb. It's ridiculous. It's ridiculous. What is considered optional, what is considered appropriate, et cetera. Why is gynecologic care one of the things that we get to. That gets to be kind of adjusted or played around with, with the numbers? It's another level of devaluing. And I think, lastly, I would just say on a very individual, like a really personal level, I think that we teach young children, I think that we teach young girls, the first thing that they learn about their period is how to cover it up. The first thing they learn is success, is that nobody knows this is happening. And so when you do that, when that's the message that the young girls get, and then you get older and older, and that message doesn't really change, then we all also devalue our own womb health. We also think of it as something that's below the belt, something that we're just managing until it becomes a crisis. And unfortunately, that's what I see in my world, which is that people are coming in way too late. They're coming in with severe symptoms. They're coming in when there are very few options. And my whole goal is to change that for all women in this country.

[A]

Okay. My brain is pinging all over the place. So, okay, I. I think it's important that we really hone in on what we're talking about here. First of all, we are half the population.

[B]

Correct.

[A]

As women. The idea that there isn't money for this is ridiculous. The amount of money that's been spent on Viagra research.

[B]

Correct.

[A]

Could cover. I mean, and I think what I'm hearing that you're saying is all of our focus is on our reproductive, like our ability to get pregnant and deliver a child when it comes to our womb. But there's so much more to it. You mentioned fibroids. I Had a guest on who talked about endometriosis.

[B]

Yes.

[A]

Pms, just in general, pcos, hormones, menopause. I mean, there is the idea that this is so under researched, under taught, under informed. It's crazy to me because you'd think there'd be a ton of money there, even if it wasn't the right thing to do. You would think some people would come along and be like, there's a ton of money to be made here if we could fix this problem for women. So, okay, I'm gonna go down a rabbit hole, but I guess my question is, what would you say to who is like, well, you know, there isn't the money, or we can't expect our doctors to know everything or, I don't know, there's like some things that we say to kind of dismiss this issue that I can't wrap my head around.

[B]

Yeah. I think it comes from just. I understand that when we talk about those statistics, it does feel. The scope feels too big. And I do think that we. We naturally, as humans. Right. We go to like, well, I can't do anything about this. Like, I can't. And so I appreciate that. I do. But also, we've only ever moved the needle on anything important because we just decide this is absolutely unacceptable and we're not doing this anymore. And so it's why I start with us as individuals, despite the fact that this is a systemic issue. Because, like, when women demanded better care, we got the patient's bill of rights. Like, we. There are ways that we have changed how we interact with the medical system. I want women to say, listen, I am done with this idea that my womb health is secondary. I'm done with this idea that because you're not an OB gyn, you literally cannot comment at all in any way, shape or form about an organ in the body, despite the fact that you are a board certified, whatever doctor number three is, that I am going to divest from the idea that suffering is just part of my womb health. Like, that is just. That's just what I have to accept. There's a lot of messages we get about. Around that. So when somebody says there's not just money, I think that's what you were saying. Right. Like, what. What do you say when it's like, oh, this is. We can't expect this from doctors. We can't. I say, if I live my life this way, I would not be sitting and talking to Nicole right now. If I live my life in a way that just accepted the messages given to me. Medicine is not for you. You're a black woman. Are you sure that you want to shoot that high? Are you sure you can be a researcher? Can you really do all of these things? You want to be a mom? Can you really do this? If I accepted all of the messages that constantly. That constantly we're told, then, you know, we would make nothing real in the world. I wouldn't be able to talk to you. So all I want people to acknowledge and maybe to recognize is that that is just part of the myth. Those ideas that we can't expect more from our doctors, that we can't expect more from the nih, that we can't expect more is just part of the oppression. Honestly, that keeps us thinking that it's reasonable to be anemic. That keeps us thinking that it's reasonable to not care about womb health other than getting pregnant, contraception and sexually transmitted infections until we reach 51 and we have menopausal symptoms. That is not the reality, but it's the narrative, and I want to change that, because womb health lasts a lifetime.

[A]

Okay? Your book is called A Terrible Strength, and I know you didn't pick that by accident. I want to talk about this thing where we focus on the. And I'm just going to put in air quotes, the strength of women. And I do believe we are emotionally, mentally, the strongest gender. But listen,

[B]

No argument.

[A]

We may not be able to lift heavier, but, I mean, we do push humans out of our bodies. So even the physical thing, anyway. But you're honing in, especially on black women. And I do think there is a narrative of how strong black women are. And I will be honest, I subscribe to that narrative. I sometimes I'm like, how do you even live in this world, in this country, in this time, and not want to just go around punching people in the face? So my question is, how does this perceived strength work against women, Black women specifically, as it relates to our womb health?

[B]

Yeah, I understand that it, like, is a little bit odd of a phrase, the idea of a terrible strength, but it is very intentional because I think it's really important to honor that Black women are incredibly strong. That that is not a myth. We are strong. We have to be in order to navigate this society and certainly to achieve, you know, to make. To make meaning of our lives and all of those things. And so the reason why it's called a terrible strength, though, is that when you are so strong, when you are perceived to be so strong, you are not perceived to be vulnerable or to be in need of care, support or help. And when it comes to the womb, that translates to black women being able to endure the unimaginable in terms of symptoms and suffering and pain and bleeding and in my world, cancer and progression with nobody stepping back to say, whoa, whoa, whoa, whoa, whoa, this is not normal. This is not okay. So it's a terrible strength because the very ability to endure is killing us. And what I want so much for black women and for any woman who feels like her, go to Tool for dealing with her womb, health, whatever it is, is endurance. I want to transfer all of that energy of endurance into advocacy, personal self advocacy agency and demanding better of your life.

[A]

What part do all women play in that? Because while it is individual and as a black woman going to a doctor, not settling for less demanding, requiring to be taken seriously, I would imagine is the assignment. And if they're the only ones doing it, yeah. Isn't there the potential that they get even more dismissed or even more denied? And so where do we all need to play this the part?

[B]

Yeah, I think. Thank you for asking this, because I think actually, you know, I think we. We understand that there is inherent risk in walking to a room that's not built for you or walking into an environment where you're supposed to be a certain way and you choose to show up in your full or whatever. I think we all have that feeling of like, yeah, there's a risk there. So I don't say lightly when I say I want black women and all women. I want us to walk in and demand better care, et cetera. Part of the reason why I wrote my book is because I want to give you the tools to do that. Well, and one of those tools is knowledge, Nicole. One of those tools, if was when you actually understand the underlying physiology of these conditions, when you actually understand why we do certain tests and what those tests mean and what the labs are. You are now. You're now having a conversation on a different level. It's not just, help me, help me, it's I can be in conversation with you about what the steps are. And now I can ask you more pointed questions that create accountability. So one thing that all women need to do is have this knowledge so that you can also be an ally and supporter. When a woman is asking for an ultrasound or. Or asking for a test, that's like, no, this makes sense. It doesn't. We need to look into this. We need to look into this further. The second thing is that black women have a history of galvanizing everybody. You Know what I'm saying? When you look at the fight for democracy, when you look at the fight for the vote, when you think I mean. So I would say that we can pull on our own history to say, listen, when we all demand better. If black women are the intersection where we are, we are vulnerable to all of the overlapping vulnerabilities, as I think of it, right? The racism, the sexism, the xenophobia to some extent, like all those things, if we're behind and saying this is unacceptable for black women, everybody, everybody improves, right? Because you are closing all of the gaps in which people can fall through the cracks. So I would say all of us having the knowledge will elevate all of our abilities to advocate and especially black women's abilities to advocate. I would say the bottom line is when you think about the numbers, they're just a lot more non black women than there are black women in this country, right? So, like, the bottom line is I'm a numbers girl, too. I'm like, if all of y' all are going into the office being like, listen, we're not doing this anymore. I need to understand what the steps are. I need to understand what the treatments are. I want better for myself. Then we're now creating a new environmental norm. And that is helpful too, because me as a black woman, there's not as big of a gap for me to close.

[A]

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[B]

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[C]

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[B]

I used to dread.

[C]

Hi, I'm Katie Ferraro, College nutrition professor and dietitian specializing in baby Led Weaning and I host the Baby Led Weaning Made Easy podcast. Each week we cover evidence based safe infant feeding practices for parents and caregivers of babies who are 6 to 12 months of age. So if you're confused by all the conflicting info you hear about starting solid foods, or you want easy, actionable tips on how to safely prep food for your baby or introduce allergenic foods or figure out when to drop a milk feed, we cover all that and more, plus interviews with the world's leading feeding experts in two new episodes each week. Search Baby Led Weaning Wherever you listen to podcasts and happy feeding,

[A]

what are your thoughts? Because I do think this desire to increase our knowledge to grab hold of things that seem like they can't be explained or being dismissed. Like I, you know, struggled with perimenopause for many, many years where it was just sort of chalked up to like, that's part of aging. And I'm like no, no, absolutely not. But I could not find the medical professional or the doctor or the resource that helped me get the answers for many, many years. And so my question is, any advice or any thoughts about sort of the health and wellness trends that are taking over? I on one hand admire the like, discover and become knowledgeable, and on the other hand it starts feeling really grifty and Nicole. Disgusting. And how do we navigate this? Sort of like we want to be responsible, we're not settling for less. And there is an abundant amount of misinformation and bullshit out there and it gets really confusing.

[B]

Yes. So first of all, I appreciate this because I actually wrote like my book starts with a letter and like my whole point of that letter is saying like, we're not going to do the us versus them. Yes, I'm a double board certified gynecologic oncologist. Yes, I'm a scientist. All this, I have no interest in the demonization of the us versus wellness versus them because it's not helpful because of what you just said. People are just looking for ways to make their life better individual. So it, we're not, it's not helpful to start to demonize, like where they might have found information that they thought was helpful, etc. What we actually need to do is I think, create another level of common knowledge that is like unassailable. Let's all agree on how these organs work, what things impact what, and then we can move forward. So I'm going to answer your question in a little bit of a roundabout way. One of the one, the four conditions that my book focuses on is heavy bleeding, endometriosis, fibroids, and uterine cancer. And when you say those, when I say those, people are like, I don't like, what is the connection? And I'm like, exactly. When you understand how all of those are connected, you are operating with a different level of understanding of the reproductive system that will help you avoid the grifters because you have a different level of understanding the cause and effect and how these things work. And some of the phrases no longer hold the same power. So one thing is, I think when we're just a little bit more informed, which is possible, it's doable, then we can be better consumers. Number two is I think they're honestly, they're kind of two different camps in the wellness world. There are people who are genuinely trying to fill the gap that western medicine has left. All of the terrible experiences like you had trying to get help, being dismissed, told that it's just aging right. And they might not have the right information, frankly. And so my book is for them, like, please read this so that you are better informed. And then there's the actual grifters who know better and they're just out to make money. Okay, the, the things that I look out for that I tell people to look out for is things that sound like click Bait. Like, we're all on the same protocol doing the same thing. Like, we're the cool girls. Womb Health is not about clicks. Everybody is not supposed to be on the same protocol. Everybody's not supposed to be on the same hormone therapy regimen. Every. Like, that is not how this works. So one, when you start to get that kind of energy of like, oh, you're not on this supplement. What's wrong with you? I back off because I'm like, that's not ever how medicine has worked. It is always personalized. Number two is if you can control, replace what you're hearing with diet, culture, language, pause. I get really concerned about that. I'm like, if it's easy for you to. If we used to say low fat and now we're just saying protein. If we used to say skinny and thin and now we're just saying, I don't know, toned and like, just take a pause because it sounds a lot of. It sounds to me like the same body optimization, diet culture stuff wrapped up in something different. And I don't like that either. Because that, I mean, because of all the reasons, right? Because it. Underlying that is about shame. It's about, you know, the male gaze, frankly. So those are the two kind of vibey things that I look out for. The idea that we all have to be on the same protocol doing the same things and whether I can basically just replace these words with diet language and it sounds the same.

[A]

It's amazing to me how often anything reproductive or like hrt, the things you hear is it reduces belly fat and going in and belly fat. Oh my gosh. I'm like, shut the fuck up. I just want to feel like a normal, functioning, healthy, healthy human who can live a good life for as long as humanly possible.

[B]

Correct?

[A]

If it comes with some great skin, fine, fine. You know, but like, why do we always have to package that as the priority for anything that I can tell you why.

[B]

Nicole, you know what? Okay. I'm so glad you. You know why? Because our health is not enough. Because it's not enough to say, you know what? During the perimenopause years is the, is the by far right, the. The time in your life where your risk of uterine cancer increases like five fold. Uterine cancer is the number one rising cancer in the United States. It's going to be second only only to breast cancer by 2030. It's more common than colon cancer already. So I'm sitting here thinking we're talking about perimenopause and menopause but somehow people's like, literally your life, like the fact that you're about to enter into this world and we have a problem with uterine cancer. And all of my colleagues know it. We know that this thing is rising every year and women are dying and the mortality rate is going up. But that's not the message. The message is you're glowing skin in your hair. Why? Because your health is not enough, Nicole. It's not about. And so that's. I hope I'm not like, getting too deep or political, but I do think about that a lot. And that's why uterine cancer is in my book. And I'm like, listen, I'm not trying to scare people, but don't you. Wouldn't you, Nicole, want to know that part of what is happening in your body is this transition? And part of what's happening in our society is rising rates of womb cancer? And wouldn't that be something important that you'd want to think about as you enter your perimenopause and menopausal years? Why does that not lead the conversation?

[A]

Yeah, I literally teared up when you said that because I know, like, I heard something true. Our health is not enough. And I think the part that gets me is our health is not enough in society. Our health is not enough on social media. Our health is not enough to garner the male gaze. The list goes on. But the part that really makes me sad is we've gotten to the point because of our conditioning and our experience that our health is not enough to us.

[B]

Yes, exactly.

[A]

And that breaks my heart because what could be more important, like, who cares about how your skin looks or your belly if you're living your day to day feeling unhealthy physically, mentally, emotionally, Somewhere along the way, I think so many of us I know I did bought into the lie that our health isn't enough.

[B]

Yeah. I think that, you know, we are products of our culture and our society. And so, like, you know, I think we certainly aren't born thinking this way, but we are pro, you know, we, we live in this, in this society too. And it's not like I don't care how my skin looks. It's not like I don't care, you know, like, I understand also the privileges that come with, with fitting in to some extent. Right. To what is ideal. And I do think it goes back to what I want to share with people, is that your gynecologic health lasts a lifetime. But if you're taught from the beginning that it's only one thing or one or two things. It does make sense to me that we wouldn't lead a conversation about reproductive health with actual reproductive health, which is basically what we're talking about. Like right in perimenopause menopause, like the transition of like this is a conversation about your ovaries, your uterus, your tubes, like. Right. Your reproductive organs and reproductive health. That conversation is led by skin, body size, muscle appearance, hair, fullness in the depths of my heart. And like, what I am all about is reclaiming a full humanity for women to say that. No, no, no, no, no, we, it's not like those things don't matter at all. I'm always like, you can have both, but like, they don't matter at all. But like, but can we think about what participation in this, in this dialogue is doing to us when it's not focused on the actual, like the actual, our actual health from top to bottom?

[A]

I don't know if this is going to resonate. I feel like I'm purposely consciously trying to shift to an inside out model versus an outside in. Because you're right, I like having good skin or great hair. And I mean, if, if, if I'm healthy and that reduces my belly fat. Amazing.

[B]

We'll take it.

[A]

Yeah. Not upset about it. But it's this focus on that first and then hopefully, fingers crossed, I'll be healthy on the other side of it versus if I hone in on the things that make me healthy. If I care about my womb health, if I care about my heart health, if I care about feeling good inside of this body, those things can and potentially will happen and that'll be great. Like you said, we can have both. I think it's the order in which I prioritize that I'm really trying to shift.

[B]

Yes. And I offer that we know how to do this in other arenas because we do this when we are trying to be successful in the workplace. And we realize, you know what, I have to care more about how I feel about my work. I have to create my own standards of quality. I have to do that before I give so much power to the external validation of this person or this CEO or this. Right. We do know how to do that as women. That's why I try to remind people you have probably done that in other areas. You have figured out how to go inside out. And it was scary at the beginning, but then you were like, see, it's fine. Actually, my inner confidence mattered more than what this person thought of me. And I Still got the promotion, so we know how to do it. So what I say is that I actually think this arena of womb conditions that don't have anything to do with pregnancy, I think that this is an arena where we still allow for suffering and silencing and all of that, because we're taught to do that right? And we succeed despite. And I'm sitting here thinking, for example, I saw a woman in clinic once who came in for a pap smear, and she had. Her blood level was so low, it would have resulted in, like, an emergency. Like, if she was in the hospital, she would been, like, rushed for a blood transfusion because it was, like, dangerously low. And she was just living her life, Nicole. And I am like, oh, my God, like, you have to come in. She laughed at me. She was like, this is. We have strong periods in my family. It's fine, et cetera. And my thought was, what could you do with a full tank of blood? Do you know what you're capable of? Because we already. I already know what this means. This means that you're cognitively slow. This means that you have brain fog. This means, like, I know physiologically what this is doing to you. So what I think about and what I want to offer is that the inside out here works the same way. Is that what if you. Your norm, that you have just decided is, like, this is how it's got to be. You just. You don't recognize how much better it could be.

[A]

What would be possible? What opportunities would we create? What potential would we. If we didn't accept, fill in the blank, pain, heavy bleeding, endometriosis as just something we're supposed to deal with. To deal with silently, by the way.

[B]

Exactly. Quietly. Yeah. Nobody wants to hear all that quietly. I remember taking physics exams while, like, literally hemorrhaging, you know, and it never occurred to me, right, that this is. It could be better. I was just like, well, this is what I have to deal with, right? Like, I'm sitting here thinking, like, that's. That's crazy, but that is. Norm. How many women have you heard like, oh, I am doubled over in pain, almost cannot stand up straight, but I'm going to this board meeting.

[A]

Or I am, like, having hot flash after hot flash. I'm literally sweating through my clothes, and I'm still going to show up to the board meeting and deliver, you know, a plus quality work?

[B]

Oh, of course. That's never in question. Like, that's the thing is that we're. That's never in question. I just. I Want to elevate our womb health to the same level. I want to say that's great. Have your work quality never be in question. And let's also have the quality of our own understanding of what's going on with our womb and our womb health and our treatment and our demand for good conditions be the same. So that's on the same level of we will not accept. And there are. The thing is, there are amazing doctors out there. There are amazing people who want to help you. A lot of them are not on social media, which is why I talk in the book. Like, if you want to find out how doctored how, like, we find who to go to. We don't scroll. We're not Googling like, it is about network. Like, it's about these other things. So it's like, I think there it kind of goes back to that question you had about, like, what do we do with the wellness of it all? And, like, the menopause gold rush of it all. And it's like maybe reminding us that, like, good quality care is. Is. Is not necessarily something that's online. And, like, the best doctor you can imagine does not necessarily have an Instagram page of 2 million followers. And so there are ways to find these practice these heroes, as I call them, because they're my colleagues. So I know that they're out there.

[A]

Okay, my last question is around. And thank you for saying that. It confirms my underlying belief that social media is just a cesspool.

[B]

But. Okay. And I'm actively on it to. To. To make sure that we're clear about my own hypocrisy here. Yes, continue.

[A]

And I do scroll and I do get caught up, and there are a few amazing people that I follow that do absolutely make a difference. So, yes, I say that as a general statement, even though I am on there. Okay, so my last question is around something you say, which is that when medicine learns to overlook suffering in one group, it builds the habit of dismissing literally everybody. So I want to make sure I frame this in a way that works in that this impacts all of us as women. And we as women, cannot move forward without focusing on and addressing the black womb crisis.

[B]

Yeah. Thank you for bringing us back here. So this is true. Anytime we try to move forward and make progress and just leave a whole group behind, it never works. It never works.

[A]

Never can, never should.

[B]

It never can, never should. What's happening with the black womb Crisis is that 1 in 3 black women with heavy periods is walking around clinically anemic right now. Right now, walking around without enough oxygen carrying capacity in their blood. One in three. What's happening right now is that black women with fibroids are getting fibroids earlier, they're growing larger, they're more symptomatic, they pull them from the workforce. They also cause anemia and incredible amounts of also body dysmorphia and suffering and things that just are not spoken about. What's also happening is womb cancers which are on the rise, but most so in black women. And black women actually have double the mortality rate, so they're twice as likely to die after this, this cancer which when detected early is curable. And so when I look at that, what I see is a group of women who have been told directly and indirectly that your life does not matter, your womb health does not matter. From the time you get your first period to the time you draw your last breath, we don't care. And if you've heard about the maternal mortality crisis, if you've heard about, if you've seen the horrible videos of people being treated terribly online, I told people that is the tip of the iceberg of what black women deal with when they are trying to access basic gynecologic care. And so my mission is to shine such a light on that and use what is happening to black women as a way to teach all of us what actual high quality, great gynecologic care looks like. To teach all of us how to understand these conditions so that we can assess and be aware of them in ourselves. And then teach all of us how to go to board certified trained clinicians and have quality interactions so that we get what we need out of it.

[A]

I could ask you 1 million more questions, but thank you for being here. Thank you for doing this work. Thank you for sharing it with us. Thank you for writing this book. I mean so many thank yous. So I'm going to invite you, our listener, to order the book. It's called A Terrible Strength. Buy it on Amazon or wherever it is you buy books or let's just keep our local bookstores in business. So go there and I'm going to encourage you to buy three copies. One for you, one for a woman you love, and one for whoever ever it is that you're paying attention to when it comes to women's health. Hopefully your doctor, but if not that, an influencer, I don't care. Whoever you're paying attention to, get it for them. And if you're looking for more of Dr. Kimmy's work, you can find her on Instagram or on her website at kimmidahl. We're gonna put all the links, all the ways to find and follow her in show notes. I would absolutely encourage you to do that, Dr. Kimmy. Thank you.

[B]

Thank you so much, Nicole. It's been a pleasure.

[A]

The pleasure was all mine. All right, friend. We don't get to claim progress for women while some of us are still being dismissed, denied, and dying from things that we know how to treat. And we don't get to call it woman's work until it works for all of us, which means that we are not done. Pay attention. Speak up. Demand better. Yes, for you individually, but also for women collectively, because that is woman's work.