When the Life That Fit You No Longer Fits Quite the Same
There is a moment I have seen in women over and over again, and I have known versions of it in my own life. A woman comes to me because she is gaining weight, she isn't sleeping, her body feels more inflamed, and she is more irritable or emotional than she remembers being. She may be eating when she isn't hungry and wondering why the discipline that once came so easily now seems nowhere to be found. Her marriage or partnership may feel different. Her work may no longer be fulfilling in the same way. Her children may need her less, while aging parents may suddenly need her more. She has spent years being the capable one, the caretaker, the professional, the mother, the partner, the organizer, the person who makes sure everyone else is okay, and somewhere in the middle of all of this she begins to wonder, “Do I actually want to keep living my life this way?”
That can be a frightening question, particularly when she has a good life. She may love her family, appreciate her partner, be proud of the career she built, and feel genuinely grateful for many of the choices she has made. Gratitude, however, does not prevent a woman from realizing that something inside her is changing. Sometimes she comes to me assuming the entire experience must be hormonal, and certainly there are very real biological changes occurring during perimenopause and menopause. Sleep can become disrupted, body composition can change, and shifts in metabolism, appetite, mood, energy and inflammation can become part of the picture. Those things deserve to be investigated and treated, but there is another upheaval happening at this stage of life that will never fit neatly onto a laboratory report.
This is often the age when a woman begins taking inventory of the life she has built. She wonders what happened to the things she once wanted to do, who she was before everyone needed something from her, whether she still wants the career she worked so hard to create, and why she suddenly has less tolerance for situations she accommodated for years. She may wonder where her creativity went, why food has become comfort at the end of the day, or why she lies awake exhausted while her mind seems determined to revisit every unresolved question of the last twenty years. Beneath all of those questions may be an even more difficult one: What if I have spent so much of my life becoming who everyone needed me to be that I have lost touch with who I am?
I don't believe we should reduce that experience to hormones, but I don't believe we should separate it completely from the physical transition either. Sometimes the body changes first. Sometimes the circumstances of life change first. Usually, by this age, biology, identity, relationships, purpose, responsibility and desire have become deeply intertwined. Whole-person care has to be large enough to hold all of them.
What If This Isn't a Crisis?
There is another way to understand this season of life. What if some of the disruption isn't evidence that a woman is falling apart, but an invitation to become more fully herself? I don't mean romanticizing menopause or turning genuine suffering into a spiritual lesson. A hot flash is not a spiritual awakening, insomnia is not automatically your soul trying to communicate with you, and depression, anxiety, abnormal bleeding, metabolic changes and other symptoms deserve thoughtful medical evaluation and treatment. We need to respect the biology. But once we have done that, there is still a woman living inside that biology, and she may be asking for something.
This is where my work has increasingly taken me, both professionally and personally, and it is part of what led me to write Anatomy of a Soul's Calling. There comes a time in life when achievement, responsibility and even success may no longer be sufficient answers to the deeper question of whether we are living the life we are actually called to live. That question is very different from asking whether we have done everything correctly. For many women, midlife is the first time they have enough experience to recognize the difference.
I don't think the prize of this stage is getting a woman back to exactly who she was at 35. I want something much richer for her. I want her to become curious about the woman she is becoming now. There can be extraordinary freedom in reaching a point in life where we begin separating what we genuinely value from what we were taught to value, what we truly desire from what we learned we should desire, and the roles we consciously choose from the roles we simply inherited.
Perhaps there is a dream she put down twenty years ago because there was no room for it. Perhaps there is a creative part of her that has been patiently waiting. Maybe there is a conversation she knows she needs to have, a career that needs to change, or a career she still loves but wants to inhabit differently. Maybe her relationship doesn't need to end at all, but the way she participates in that relationship needs to become more honest. This is why I think one of the most useful questions we can ask during this stage isn't, “How do I get back to myself?” It is, “Who am I becoming now?”
We Keep Trying to Fix the Woman Instead of Listening to Her
This is where I believe our conversation about women in midlife becomes far too small. A woman gains weight, so we give her a diet. She can't sleep, so we talk about sleep hygiene. She is anxious, so we discuss anxiety. She is exhausted, so we check her thyroid and hormones. She is emotionally eating, so we tell her to manage her cravings. She begins questioning her work or her relationship, and perhaps she or someone around her dismisses the whole experience as a midlife crisis. Each of those individual issues may deserve attention, but treating them as unrelated problems can cause us to miss the larger pattern.
If a woman is using food every evening to create ten minutes of comfort in a life that contains no space for her, I can give her the most sophisticated nutrition plan in the world and still completely miss the problem. If she is lying awake at three in the morning questioning the direction of her life, I can investigate estrogen, progesterone, glucose, sleep physiology and the other biological contributors that matter, but I also need to leave room for the possibility that there are questions she can no longer silence simply by becoming busier. If her relationship is changing, we need enough wisdom not to blame everything on menopause and enough wisdom not to pretend that the enormous physical and emotional transition she is experiencing has nothing to do with the way she sees herself and her life.
Not everything happening in midlife is hormonal, but hormonal change can alter the context in which long-standing needs, frustrations and desires are experienced. Things that have been quietly tolerated may become harder to tolerate. Dreams that were postponed may become harder to ignore. Roles that once felt meaningful may begin to feel restrictive. A woman who has spent decades accommodating everyone around her may discover that she has less willingness to abandon herself in order to maintain the comfort of everyone else.
This is where emotional eating, disrupted sleep, weight concerns, inflammation, relationships and career questions can become part of a much larger conversation. I don't mean that every physical symptom has a psychological explanation; that would be as reductive as saying every emotional struggle is caused by estrogen. Whole-person care demands more sophistication than either extreme. Biology matters. Psychology matters. Relationships matter. Environment matters. Purpose matters. The story a woman has been telling herself about who she is and what she is allowed to want matters too.
I have lived long enough, practiced medicine long enough and sat with enough women to know that sometimes what first appears to be a problem to eliminate is also an invitation to a larger conversation. The mistake is becoming so focused on getting a woman “back to normal” that nobody stops to ask whether normal is where she wants to go.
The Reckoning Can Become a Reconnection
This is where I believe whole-person care has an opportunity to become something far more expansive. We still practice good medicine. We investigate sleep disruption, metabolic health, inflammation, nutrition, movement and hormonal changes. We address weight concerns without shaming the woman living inside that body. We evaluate symptoms appropriately and treat what needs to be treated. Then we allow the conversation to become larger, because there are questions medicine alone was never designed to answer.
This is where I bring what I think of as the coaching seat, the teaching seat and the visionary seat into whole-person care. The coaching seat allows us to ask what a woman wants now, what she has outgrown and what she has been tolerating. The teaching seat helps her understand what is happening in her body and gives her the information she needs to make choices from a place of knowledge rather than fear. The visionary seat allows us to look beyond symptom management and begin imagining what health is actually for. If we help a woman sleep, restore her energy, improve her metabolic health and feel at home in her body again, what does she want to do with that life?
Those questions can take us into territory that rarely appears on a medical intake form. What dream keeps resurfacing? What part of yourself did you put away because there wasn't room for her? Where are you saying yes when something inside you is saying no? What are you hungry for that has nothing to do with food? What would you create if you stopped assuming it was too late? What would change if you believed your desires deserved to be heard rather than immediately judged?
The authority I bring to those conversations comes from more than my medical training and more than 33 years of clinical practice. It also comes from a life well lived, which does not mean a life perfectly lived. It means a life with successes and mistakes, transitions and losses, dreams realized and dreams reconsidered, and my own periods of reckoning. It comes from the work that ultimately became Anatomy of a Soul's Calling and from understanding personally that a calling is not necessarily one grand purpose we discover once and then spend the rest of our lives fulfilling. Sometimes our calling asks something new of us because we have become someone new.
That is what I mean when I talk about stepping gracefully into a reckoning. Gracefully does not mean painlessly. It doesn't mean without tears, difficult conversations, uncertainty or grief for paths not taken. It certainly doesn't mean quitting your job, leaving your marriage, selling the house and moving to Tuscany because you had a hot flash. Grace, to me, is something much deeper. It is the willingness to meet the truth of your life without immediately running from it and without assuming that every uncomfortable truth requires an impulsive external change.
Sometimes a woman changes everything. Sometimes almost nothing changes externally, but internally the shift is profound. She begins eating because she is hungry rather than because she is depleted. She moves her body because she wants to inhabit it rather than punish it. She protects sleep because she finally understands that her health deserves a place on her own priority list. She establishes boundaries because resentment has been telling her something. She has conversations she has postponed. She reconsiders what success means. She makes room for desire again, and I don't mean only sexual desire, although that matters too. I mean desire for creativity, connection, adventure, contribution, pleasure, purpose and meaning.
Perhaps one of the most important changes is that she stops spending all of her energy asking, “What is wrong with me?” and begins becoming curious about a different question: “What is trying to emerge from me?” That shift doesn't replace medical care. It expands what we believe care can be.
Perimenopause and menopause are biological transitions, and women deserve sophisticated medical care through them. But these transitions are occurring inside a human life, often at a time when that life is ready to be examined. So yes, let's talk about hormones. Let's talk about sleep, inflammation, metabolism, weight, nutrition, movement and physical health. But let's also talk about the dream you haven't mentioned to anyone, the career you may have quietly outgrown, what your relationships need from the woman you are becoming, the parts of yourself you want back, and the parts you are finally ready to leave behind.
Let's talk about your calling, because perhaps the deepest work of this season isn't becoming who you used to be. Perhaps it is becoming more fully who you are. That is the opportunity I see for whole-person care: not simply helping women get through menopause, but helping them become healthy enough, supported enough and connected enough to themselves to decide what they want to carry forward into the life that comes next.
I reckon that it’s time for a reckoning, I reckon. Happy trails,
Mary Louder, DO