Expert Insights: Common Misconceptions in Women's Health

Written by Melissa Schenkman, MPH, MSJ

In this exclusive Q&A, family medicine physician Dr. Jessica Gray tackles the most persistent myths and misunderstandings about millennial women's health. From hormonal concerns to bone health and fertility testing, get evidence-based answers to questions you might be afraid to ask.

Many women are told their symptoms are "just hormonal." When should women be skeptical of this explanation?

Dr. Gray: One of the interesting things I wasn't exactly prepared for when I came into practice was how many women come to me saying, "I know something is wrong with me. I've been to four different doctors already. They just tell me it's my hormones." They'll ask me to run labs for all their hormones.

The reality is that we have many hormones in our body doing many things, and we don't even have labs for some of these hormone levels. Someone may have told them repeatedly that their ache, pain, or fatigue must be hormone-related. Some patients have even been put on hormone replacement therapies at a young age without being told the risks.

We need to delve much deeper. Often, there are underlying issues that aren't hormonally related. There may be mental health aspects like anxiety, depression, or OCD behaviors. Sometimes there's an underlying eating disorder. Other times, it's not about estrogen and progesterone but rather insulin or a pre-diabetic state.

So many times, we want to look at the much bigger picture rather than just labeling things as, "Well, you're a woman, so if you've got complaints about fatigue, it's probably your hormones."

How can women combat misinformation about hormonal health?

We've got to be careful with social media, especially in the age of TikTok—although it was just as bad with Dr. Google and Instagram. With everything so readily available at your fingertips, you can literally search for something completely made up and probably find someone somewhere who wrote a blog post supporting it.

You can really find the answer you're looking for, not necessarily the correct answer. We need to be careful not to continue propagating misinformation by saying, "Yes, it's just your hormones" or "You need to do this liver cleanse."

We need more people on social media with backgrounds in women's health, primary care, or OB-GYN sharing reputable information. Unfortunately, anyone can claim they're a medical expert online and start telling you about liver cleanses that will supposedly cure all your ailments.

As a physician who knows what she's talking about, it's hard to combat medical misinformation. Sometimes these concepts are so physiologically impossible that it's difficult to form a coherent argument against them.

When should women start worrying about bone health, and do we all need calcium supplements?

This is interesting because recent research has challenged some common assumptions. First, let me clarify: osteoporosis is a thinning of the bones that increases fracture risk—it's not the same as osteoarthritis, which causes joint pain.

For the average woman, we don't typically start screening for osteoporosis until age 65 or two years after menopause. You don't need to worry about it in your twenties and thirties, and even in your forties, it's not a major concern for most women.

Many women ask if they need to take calcium and vitamin D supplements. The most recent studies have actually gone against our previous idea that everyone should take these for prevention. While they can help prevent progression if you already have osteopenia (early bone thinning), they haven't been proven as helpful for prevention in healthy younger women.

What does help with prevention are weight-bearing exercises, not smoking, and staying physically fit. If you do develop osteopenia or osteoporosis, your biggest risk is falling, so we focus on balance and strength.

I don't routinely advise 30- or 40-year-olds to take calcium supplements specifically for bone density. That said, vitamin D deficiency is common, so if you have a diagnosed deficiency, you should take supplements as prescribed.

With more women delaying childbearing, should we all be getting fertility testing? What do those tests actually tell us?

When it comes to fertility, there's a lot of confusion about testing. The anti-Müllerian hormone (AMH) test has become popular, but it's important to understand what it actually measures.

AMH gives you an idea of your ovarian reserve—the quantity of eggs you have left. It doesn't tell you anything about the quality of those eggs or your ability to conceive right now. Think of it like looking in your refrigerator to count how many eggs are left in the carton without knowing if they're still good.

A high AMH level might be reassuring, showing you have many eggs remaining. A low level might indicate fewer eggs, which could potentially mean decreased fertility, but it's not definitive. Some women with low AMH levels conceive without any issues, while others with high levels struggle.

The test can be helpful information, but it's just one piece of a much bigger fertility picture. Age remains the most significant factor affecting both egg quantity and quality. For women considering egg freezing or concerned about future fertility, having this conversation with your doctor in your early 30s rather than late 30s gives you more options.

How much protein should women actually be consuming? Is there a magic number?

Everyone seems concerned about protein intake lately. "I've got to make sure my protein intake is where it needs to be." But there isn't a specific number I can give that works for everyone.

For me personally, I'm a vegetarian—I've been one for 20 years—so I can't simply rely on lean proteins from meat products. When patients are trying to lose weight, depending on their overall health, we may focus on factors beyond just protein.

For someone who's pre-diabetic, we're going to be more concerned about carbohydrates and sugar balance than specific protein grams. When discussing insulin resistance, I use a three-pronged approach: medications, diet, and exercise. For diet, we first look at sugar intake—sodas, candy, cookies, cake. Then we look at carbohydrates, which are usually the bigger problem.

Our society consumes way too many carbs. That food pyramid with carbs at the bottom has created a triangle that's much too flat. We need to improve that ratio rather than obsessing over a specific protein number.

I don't give people a target number of protein grams. Instead, I recommend using apps like MyFitnessPal to log everything you eat and drink for a week, not to diet, but to see patterns. Look retrospectively at where your diet was imbalanced. This approach works better than saying you should have X grams of protein daily, which can lead people to start eating bacon all day.

What do you see as the most pressing issues in women's health today?

Mental health is definitely at the top of the list. We're seeing unprecedented levels of anxiety and depression, particularly in younger populations. The pandemic exacerbated existing issues and created new ones.

Many patients come in with physical symptoms—fatigue, aches, digestive issues—that have underlying mental health components. In our practice, we're seeing eating disorders that weren't previously diagnosed, along with anxiety and depression manifesting as physical symptoms.

The challenge is that mental health resources are stretched thin across the country. As primary care physicians, we're often the first line of defense, helping patients navigate both their physical symptoms and the mental health aspects contributing to their overall well-being.

I encourage women to be open with their healthcare providers about mental health concerns. These aren't separate from your physical health—they're intrinsically connected.

Want to hear more from Dr. Jessica Gray, check out the YMyHealth podcast!