The Quiet Transition

Ongoing conversations, especially in midlife and during the menopause transition, can be very useful in avoiding and resolving misunderstandings. The variable nature of hormones, family pressures and external stressors can create an atmosphere where misunderstandings can happen.

What follows are some suggestions based on my own experiences and conversations with psychologists and therapists about the type of helpful conversations that couples can have during this challenging time.

Before any of these conversations can happen, it’s important to ensure that they take place in an environment that supports them, somewhere quiet, away from distractions, not immediately after a conflict or disagreement, preferably not at the end of the day when you’re both tired and patience may be running thin.

What’s Going On?

An open conversation about what is actually happening, physically, emotionally and mentally is a great starting point. Not just for the woman experiencing the menopause transition but for both partners. Midlife and the menopause transition don’t happen in isolation. It happens as part of a broader system, home life, work life, family life, community etc. It shows up in all these places and all these places have an impact on what is going on.

Establishing a clear understanding of each other’s perspectives can bring some surprising revelations. Partners might notice changes in communication, affection and behavior and be confused by what is contributing to them.

Discussing what is happening, when symptoms or feelings occur, and how severely they affect daily life can help couples understand each other’s experiences. Neither can have the lived experience of the other, but listening to it being described and being willing to believe that this is a real experience, even if it doesn’t necessarily align with expectations or perception is a major step toward becoming a team.

Conversation Starter: What have you noticed changing, and how has it affected you?

What Are We Both Feeling?

This conversation can naturally lead from the previous one. The focus here is less on symptoms and physiology of the menopause transition or midlife stressors but rather how those influence the way each partner shows up for themselves and for each other.

This conversation does require some looking inward. Being honest with oneself before being able to accurately describe what is being felt, this was a particular challenge in my own relationship. I was used to talking about feelings and emotions having spent much of my adult life in therapy. My wife was not. It took us some time to find a way of communicating that worked for us. It can be especially challenging when finding the right words for describing an emotion is difficult, which it can be under normal circumstances. Adding in the pressure of midlife and the menopause transition and it can be doubly so. It may take time to develop a shared language for describing what each of you is experiencing. It is important to remember that being able to identify an emotion, being willing to share it, and having the language to describe it are three different things. Even when you’ve developed that shared language, one partner may need more time to find the words, or may communicate differently.

Conversation Starter: Is there anything you’ve been finding difficult to put into words?

What Helps, and What Doesn’t?

A partner might have to get used to the answer “I don’t know” when asking “How can I help?” Pressing for an answer because of the desire to make things better often makes things worse. At times a person experiencing symptoms genuinely doesn’t know what would help. Something that helped yesterday won’t help today. And sometimes they don’t want to be responsible for identifying and organising every possible solution.

From conversations with couples and my own experience, I’ve learned that listening is often the best place to start. Sometimes being heard is what matters most. From there practical changes can be made. Taking responsibility to prepare a meal when the other person is exhausted for example. And sometimes, it’s necessary to understand that quiet time alone is all that is needed.

Offering assistance and not feeling rejected when it is turned down is a good goal to aim for.

Conversation Starter: What could we try that might make things easier?

What Needs to Change?

This is a conversation about renegotiation. By the time a couple reaches midlife they may have been together for several years, perhaps even decades. Routines have been established. The division of labor assigned. The relationship may have operated successfully, almost on autopilot. Not necessarily because those arrangements were openly discussed, but because they became established habits. I’ve written about who carries the load in midlife:

Midlife arrives and with it changes like the menopause transition, employment stress, children growing and perhaps leaving home, parents aging and needing more care. All of these can mean that the way things have operated in the past is not how they can continue to operate. Recognizing this can open the door to reconsidering arrangements that no longer work for both partners. What that looks like is going to vary from couple to couple.

I’ve written here about Who Carries the Load in Midlife. There is work being done that might have been invisible to one partner. Until they get to see the whole picture it would be hard for them to take on that work. For example, one partner might be doing the grocery shopping, while the other partner continues to plan meals, check supplies and write the list. It is one thing to recognize that the work is being done. It is another to take responsibility for it. That’s part of the conversation that could be had.

Conversation Starter: Is the way we’re dividing things up still working for both of us?

Not Everything Is Hormones

There can be a temptation to reduce a woman’s midlife experience to hormones. Perimenopause arrives, and with it an array of physiological symptoms.

The menopause transition can be unfamiliar territory for both partners, although their experiences of it are very different. The symptoms she experiences may vary from day to day or year to year. Just as you have come to terms with one set of experiences they can change.

But attributing everything to hormones can be misleading, both medically and emotionally. Other medical and emotional factors can contribute. Some medical conditions produce symptoms similar to those associated with the menopause transition and may go untreated if everything is automatically attributed to hormones. I’ve written in more detail about that:

A woman can be experiencing perimenopause and also be frustrated about something entirely unrelated. A partner who automatically attributes her frustration to hormones may overlook a legitimate concern.

And sometimes a bad day is just that, a bad day.

Conversation Starter: Are we assuming menopause is responsible for something we haven’t really talked about?

These aren’t conversations to have once and consider finished. What matters today may be different six months from now, and what helped last month might no longer be useful.

What conversations have you had that helped?

Want to add to the conversation. Leave a comment. I reply to them all.

Leave a comment

If you found this post helpful, consider sharing it with someone who might also find it helpful.

This substack runs on copious amounts of tea. If you’d like to support it, you could always buy me a cuppa.

Buy Me A Cuppa

Subscribe now

The Midlife Brief

Simon Salt — Fri, 16 Oct 2026 13:25:35 GMT

Hi,

I’m sharing the posts that I found most interesting and helpful this week.

Some are menopause specific, others are more midlife focused. All have been posts that made my “saved” list.

Let me know if you’ve saved posts and if you think I would find them helpful.

Menopause Transition

HOT FLASH! The Newsletter

What If Menopause Awareness Started Before Menopause?

NEW! Menopause Minute: Last Week in 60 Seconds…

14 days ago · 4 likes · 4 comments · Changing with the Change

Mint Menopause

Does Mindset Matter in Menopause?

I am probably not supposed to say this in an article about menopause, but in many ways menopause has been one of the best things that has happened to me…

13 days ago · 1 like · Esther Walton

Growing into Joy

Menopause: A cautionary tale...

Doors to The Joy Retreat Barbados are now open …

11 days ago · 15 likes · 1 comment · Karen Arthur

Truth in Beauty by Mukti

Menopause Face: When your skin suddenly changes

Following my last post about why I changed my mind about HRT, I wanted to talk about something else I wasn’t adequately prepared for.Thanks for reading! Subscribe for free to receive new posts and support my work…

13 days ago · 4 likes · Truth in Beauty by Mukti

If you find The Midlife Brief useful, please share it with others.

Midlife

Midlife Sparkles ✨

7 Things Midlife Dating Taught Me About Myself

I met my ex-husband in 1996, when I was just about to turn 24. Behind me was a very fragmented dating history, where short relationships, or something like relationships, followed one another. First came the fumbling stumbles of my teenage years, then the whirl of student life and the fervour of youth…

12 days ago · 4 likes · Sanna Walle ✨ Midlife Sparkles

The Midlife Trailblazer

Have You Kept Enough in the Tank for the Way Home?

I’ve spent much of my life learning how to climb. But being home in Canada these last couple weeks (and this photo of my 98-year-old Grandma) has me thinking about the descent, the people holding my rope and whether I’ve left enough in the tank for the journey home…

15 days ago · 2 likes · Melissa Westgate

Life Examined

The Midlife Exhale

13 days ago · 31 likes · 6 comments · Jonathan Bastian

Healthy With Nicole

The Real Reason Women Gain Weight In Midlife

When I turned 45 something happened in me. I stopped sleeping, had no energy as a result and felt anxious and shaky much of the time. Like most women, when the scale when up I took action. I started working out more. I took more pilates classes, lifted weights 3x per week, ran when I could, walked as much as possible and cut back on my calories. The cla…

13 days ago · 4 likes · 1 comment · Nicole Carter

If you found this collection of articles interesting please share it with others that you think would benefit from reading it.

This Substack runs on copious amounts of tea. If you enjoyed this post you can always show that by buying me a cuppa.

Buy Me A Cuppa

Why We Stay

Simon Salt — Tue, 13 Oct 2026 13:25:49 GMT

Photo by Samuel Regan-Asante on Unsplash

I recently read a note from that said “Women don’t always stay because the marriage is good”. That got me thinking, why do we stay? Not just women but men as well. Especially in midlife when stress is on the rise, hormones are fluctuating, and nothing seems to be quite as it was. I should preface this by saying I am not a marriage guidance counselor or couples therapist, and what follows is my own interpretation of research I have found.

Women are often cited as staying in an unhappy marriage because of various barriers to them leaving. Finances, health, children, and other obligations can all be reasons that they stay rather than leave.

A longitudinal study by Rosenfeld (2018) showed that women wanted 69% of divorces. Men and women were about equally likely to want the breakup in unmarried heterosexual relationships. Married women reported lower relationship quality than married men. This tends to indicate that gender differences in divorce initiation cannot simply be attributed to men being inherently less willing to end romantic relationships. It should be noted that the Rosenfeld study was not specific to midlife.

The Rewards of Staying, the Costs of Leaving

What about the rewards to staying or the barriers to leaving? Previti and Amato (2003) found that people only focusing on barriers were relatively unhappy and more likely to contemplate divorce. They were also more likely to divorce over the following 14 years than those reporting only rewards. So it’s conceivable that someone might be in an unhappy marriage but feel constrained by the barriers to actually leaving. Tran et al (2019) found that satisfaction, investments and perceived alternatives were all associated with commitment. Implying that the more satisfied someone was the more likely they were to stay, but it goes beyond that, they also included investments and perceived alternatives.

Investments of emotions, time, money, and labor are all considerations. The “Sweat Equity of Marriage” if you like. The more a person has invested in a marriage, the more they are likely to see barriers to leaving. And the perceived alternatives. Single life, dating, finances, living conditions, access to children. All these can be barriers that constrain a person to stay in an unhappy marriage.

Why Men Stay

What about men specifically, why do they stay? Studies show that, especially around gray divorce, two-thirds of divorces are initiated by women. The stereotype of a man leaving his wife for a younger woman and turning his back on years of commitment is challenged by a 2004 study reported by AARP. They found 58 percent of men, compared with only 37 percent of women, cited their children as the top reason they postponed a divorce for five years or longer. They also found that men were more likely to be caught off-guard by their divorce, with 26 percent of men saying they “never saw it coming,” compared to only 14 percent of women. Kalmijn and Poortman (2006) support this idea of men weighing the social cost of divorce when making decisions. They found, when studying Dutch marriages and divorce, that men appeared to give greater weight to the social costs of divorce, especially the risk of losing contact with their children. They also acknowledged that the determinants of men’s divorce decisions were less clear than those of women’s.

Knowing When to Leave

The research gives us some insight into why people stay, but much less evidence about why dissatisfied men weigh their reasons for staying. Especially later in life. This could lead us to a false conclusion that men are oblivious to issues in the marriage. Knowing a marriage has problems, believing those problems justify divorce, and being prepared to act on that belief are three very different things.

Why we stay married when we are aware that the marriage isn’t good could reflect an active commitment, a calculation about the consequences of leaving, a hope that things will improve, or simply an acceptance of circumstances.

Perhaps we should be just as curious as to why someone stays as we are about why someone leaves.

Want to add to the conversation. Leave a comment. I reply to them all.

Leave a comment

If you found this post helpful, consider sharing it with someone who might also find it helpful.

This substack runs on copious amounts of tea. If you’d like to support it, you could always buy me a cuppa.

Buy Me A Cuppa

Subscribe now

The Midlife Brief

Simon Salt — Fri, 09 Oct 2026 13:24:41 GMT

Hi,

I’m sharing the posts that I found most interesting and helpful this week.

Some are menopause specific, others are more midlife focused. All have been posts that made my “saved” list.

Let me know if you’ve saved posts and if you think I would find them helpful.

Menopause Transition

Her Explained

Is This Perimenopause?

I think a lot of women still expect perimenopause to announce itself pretty clearly. Your periods get irregular, you start having hot flashes, and eventually your period stops. Sometimes it does look like that. But often the beginning is much less obvious. I see this…

15 days ago · 4 likes · 3 comments · Her Explained

♡Liz Farr♡

THE PERIMENOPAUSE LIE

You’re 42. You’re exhausted. Your belly is changing. Your sleep is fucked. Your libido either fluctuates or has completely disappeared. Your period is doing strange things. You feel anxious, flat, irritable or completely unlike yourself. You can't lose the weight you used to lose easily. You wake up tired. You crave sugar. You don't feel sexy. You don't…

14 days ago · ♡Liz Farr♡

Jamie Jensen

What Killer Whales Taught Me About Perimenopause

Last month, I turned forty-three…

14 days ago · 9 likes · 4 comments · Jamie Jensen

Tracy's Substack

Perimenopause & Sleep: What You Can Do

Perimenopause brings many changes to the body and sleep can be one of the areas affected. It can be a vicious cycle too, that can appear to be difficult to come out of. But there is hope…

15 days ago · 1 like · Tracy The Sleep Coach

If you find The Midlife Brief useful, please share it with others.

Midlife

The Midlife Leap

What Practical Magic 2 Got Right About Midlife

How many versions of ourselves can we become before we realize they were all us…

17 days ago · 3 likes · 2 comments · The Midlife Leap

Midlife Remix

Is Anything Ever Good Enough?

If your team is capable but keeps waiting for you to tell them what to do, it may be because they’re working under the same standard you hold yourself to, one where nothing is ever good enough. I know because I led that way at Kasina, the first company I started, and it took me years to see where it came from…

16 days ago · 4 likes · 2 comments · Midlife Remix

The Midlife Field Guide

I Tried to “Win” at Midlife and Failed. (Phew!)

Welcome to the Midlife Field Guide…

17 days ago · 14 likes · 19 comments · Steve Pratt

Midlife Muscle Movement

Wait...I Have to Keep Doing This? The F It Syndrome.

Nobody says “F it” in Week 1…

16 days ago · 1 comment · Ami l Midlife Muscle Mentor

If you found this collection of articles interesting please share it with others that you think would benefit from reading it.

This Substack runs on copious amounts of tea. If you enjoyed this post you can always show that by buying me a cuppa.

Buy Me A Cuppa

Does Menopause Awareness Actually Work?

Simon Salt — Tue, 06 Oct 2026 13:25:19 GMT

Photo by Mika Ruusunen on Unsplash

October is Menopause Awareness Month, which also has International Menopause Society’s World Menopause Day (October 18th). The origins of the actual declaration of October becoming Menopause Awareness Month are a little muddy but suffice to say it shares the month with many other health awareness days and months. These include Breast Cancer Awareness Month, Health Literacy Month, National ADHD Awareness Month, National Physical Therapy Month.

It’s easy to see why menopause can get lost in the mix.

My question is, do awareness days and months actually raise awareness?

Declaring October Menopause Awareness month or even October 18th as World Menopause Day is not the hard part. The hard part is finding if it makes a difference to the women it is supposed to reach.

Does Awareness Lead to Change?

A 2021 systematic review examined 73 quantitative studies evaluating health awareness days, weeks and months. The review found that there was an increase in online activity during those awareness periods, searches etc but evidence of changes in knowledge, behaviour and health outcomes was much less clear.

Let’s think of this as a continuum:

Attention → information seeking → knowledge → behaviour → outcomes

Awareness campaigns seem to be good at grabbing attention and creating information seeking but the impact appears less clear beyond that.

Rhode 2023 says “there is not sufficient evidence to show that they [awareness campaigns] change health behavior by leading to individuals seeking out screenings, diagnosis, or treatment.”

Menopause is much more visible than it was even a few years ago. October produces more articles, podcasts, events, workplace events, and social media. World Menopause Day on October 18th is likely to produce a boost to all of that.

I believe strongly in raising awareness - I wouldn’t write this newsletter, appear on panels or present at conferences if I didn’t. All this increased attention is a good thing. I would argue that we have a long way to go from Attention, and even information seeking to seeing outcomes change.

Information Is Arriving Too Late?

Harper et al 2022 stated that 60.8% of women surveyed reported being not informed at all about perimenopause/menopause before 40. Only 12.3% sought information before symptoms. 68.2% began looking as symptoms started. In a 2018 US study of 1,611 perimenopausal and postmenopausal women aged 40 and older, 65% of those who answered a question about preparedness said they had not felt prepared for menopause.

Women are seeking the information they need but it appears they are doing so after something has changed for them. That’s reactive information seeking not preparedness.

Someone can be aware of the menopause transition. They can know symptoms like hot flashes or brain fog are associated with it. They can even know that October is Menopause Awareness Month but none of that means they understand the menopause transition well enough to recognize what is happening to themselves, a partner, a co-worker or a patient.

What Would Success Look Like?

This creates a question. Who is Menopause Awareness aimed at? Is it women who are premenopausal (those who haven’t reached perimenopause but are approaching it), perimenopausal women, post menopausal women, workplaces, partners, families, healthcare professionals? Because all of these categories have different needs for different information. That information exists, but the evidence shows it isn’t always reaching women before they need it. Whether it is reaching others in their lives is another question.

A male partner might see something mentioned online about Menopause Awareness and not see the connection between that and his changing relationship. A manager might see mention of hot flashes and not connect it to the environment his employees operate in.

Coming back to the question at the beginning - do awareness months actually raise awareness? I think that depends very greatly on how you measure that. Does the volume of content produced during October equal awareness raising? Perhaps better measures would be whether more women recognise possible symptoms before experiencing them, know where to find reliable information, feel prepared for the transition, understand when medical advice may be appropriate, and whether partners, families and workplaces better understand how this transition affects them too.

Ultimately the question is, if Menopause Awareness Month is successful, what should be different on November 1?

As part of my own awareness raising in October I’m presenting at the Global Meno Educa-THON event online on October 16th (10am Central US) - you can attend for free via zoom.

Want to add to the conversation. Leave a comment. I reply to them all.

Leave a comment

If you found this post helpful, consider sharing it with someone who might also find it helpful.

This substack runs on copious amounts of tea. If you’d like to support it, you could always buy me a cuppa.

Buy Me A Cuppa

Subscribe now

The Midlife Brief

Simon Salt — Fri, 02 Oct 2026 13:25:13 GMT

Hi,

I’m sharing the posts that I found most interesting and helpful this week.

Some are menopause specific, others are more midlife focused. All have been posts that made my “saved” list.

Let me know if you’ve saved posts and if you think I would find them helpful.

Menopause Transition

MenoWiser - Because you’re not crazy

Menopause Awareness Month: De gezondheidswinst van hormoonsuppletie

Vandaag begint de Menopause Awareness Month…

22 days ago · 4 likes · Suzanne Rethans

The Women's Page

Menopause and Your Vagina

Menopause Brain is a column in The Women’s Page about menopause, perimenopause, midlife health, and all the changes that come with them. Part journalism, part personal diary, it combines what I’m researching and learning with what I’m experiencing myself…

24 days ago · 2 likes · 4 comments · April Maye

Vazken’s Substack

Confessions of an Ignorant Man About Menopause

“The afternoon of human life must also have a significance of its own and cannot be merely a pitiful appendage to life’s morning.” — Carl Gustav Jung…

23 days ago · Vazken Kalayjian

Dr. Sondos Al Sad

Founder’s Syndrome and the Menopause Problem

In the nonprofit world, there is a phenomenon known as Founder’s Syndrome. It describes what can happen when an organization becomes so dependent on its founder’s vision, assumptions, and way of doing things that it becomes less able to adapt to the people it was created to serve…

a month ago · 2 likes · Dr. Sondos Al Sad

If you find The Midlife Brief useful, please share it with others.

Midlife

Unmasked Midlife

Meeting Yourself Is Only the Beginning

I have been thinking about the slow climb of a roller coaster…

23 days ago · 13 likes · 6 comments · Unmasked Midlife | Dr. Erin

Midlife Encounters

Who Taught You to Feel?

At 58, Ada had become very good at being the person everyone needed. She was the eldest daughter. The dependable sister. The mother who could be called at any hour. The wife who kept things moving whenever her husband travelled. At work, she was the woman who stayed calm when everyone else was panicking. People admired her for it. “You are so strong.” …

25 days ago · 1 like

The Midlife Shift

You Can't Meditate Your Way Through Midlife, What My One-Year Insight Timer Streak Taught Me

I recently reached a 365-day meditation streak on Insight Timer. No, I didn’t automatically ascend. I didn’t look down and witness my transformation into a better, wiser and calmer person, either. I got up and started my day as usual. I chucked some skin care on my face (SPF counts as skin care), fed the cat and went for my morning walk…

a month ago · 17 likes · 22 comments · Kay W

The MidLife Threshold

Feeding The Forbidden Hunger of Midlife

There is a particular kind of hunger that overtakes you in midlife. It shows up especially when you have made a good life for yourself…

25 days ago · 7 likes · Marjorie Florestal, MA, PhD(c)

If you found this collection of articles interesting please share it with others that you think would benefit from reading it.

This Substack runs on copious amounts of tea. If you enjoyed this post you can always show that by buying me a cuppa.

Buy Me A Cuppa

Who Carries The Load in Midlife?

Simon Salt — Tue, 29 Sep 2026 13:26:01 GMT

Photo by Jackery Power Station on Unsplash

The menopause transition, happening as it does, in midlife, can bring challenges to existing relationship norms. A recent study conducted in Australia examined how the pressures of the menopause transition and midlife met. The study was conducted with 362 Australian cisgender women, aged 45–64 years.

One of the study’s findings was

“Many women constructed menopause as a period of upheaval and frustration, describing how symptoms, fatigue, and the broader pressures of midlife disrupted their sense of self, identity, and capacity to meet responsibilities during the transition.”

The Australian study had me looking at who keeps track of household life. A woman whose capacity to meet the responsibilities is reduced may find the level of oversight they have had in a household challenging to continue.

Who keeps track?

Catalano Weeks et al, revealed an interesting point about this distribution of labor among households with two heterosexual parents. “For women, higher earnings and employment were associated with reduced physical labor. But had no effect on cognitive labor.” They found that “even among socioeconomically advantaged parents, mothers perform most cognitive tasks.”

To use Catalano Weeks et al, expression “cognitive stickiness” the concept that once a task has been assigned the assignment tends to persist. Tasks like maintaining household schedules, knowing when appointments are, and meal planning. These are often assigned to the woman in the house.

A woman can create a meal plan for the week, check the pantry for ingredients and note other items that need restocking for the house, go shopping for them and put them away. That’s two forms of labor, both physical and cognitive. Who takes on which form of labor matters. Even in a situation where the task of meal planning and shopping has been handed over, prompting, checking and ensuring the planning and shopping associated with producing a meal have been completed often remain with the woman.

The work starts again next week

It goes beyond one task. Yes, the shopping was done. The meal was prepared. But one person didn’t put down that load. This week’s meal prep leads to next week’s shopping list, which leads to next week’s grocery shopping and this all takes cognitive labor. Who is actually carrying out that labor becomes clearer when the activities are looked at over time rather than through a snapshot.

The partner who “helped” can feel that they contributed time and effort. The partner thinking about that process may appreciate that contribution and yet remain unable to stop thinking about what comes next. Both can be true at the same time.

The Australian study I mentioned at the beginning of this article included symptoms and outcomes such as fatigue and difficulty meeting responsibilities. A woman who is being asked to maintain her previous level of contribution while at the same time feeling diminished capacity is going to face new challenges. They might find themselves having to create more reminders for themselves. They might find routine conversations about meal planning, shopping and scheduling more taxing than before. This can make rest harder because they are constantly monitoring the household around them.

Who picks up the dropped ball?

This is where the opportunity to relieve some of the cognitive load is. To notice, initiate and follow through on tasks that were previously the domain of the woman. At this point the woman can start to reduce the amount of monitoring they are doing, especially when this new sharing of cognitive load becomes more established.

I see opportunities here. For a man to step in, a woman has to step back. By this I mean there has to be an element of trust. That the man taking on the load will take it on fully. This is built through repetition. Tasks won’t be completed in exactly the same way as they always have been. Mistakes will be made and the ball will be dropped on occasion. Who notices this and picks up the ball matters. If the woman still has to notice the mistake and resolve it, then has the load been shifted?

Want to add to the conversation. Leave a comment. I reply to them all.

Leave a comment

If you found this post helpful, consider sharing it with someone who might also find it helpful.

This substack runs on copious amounts of tea. If you’d like to support it, you could always buy me a cuppa.

Buy Me A Cuppa

Subscribe now

The Midlife Brief

Simon Salt — Fri, 25 Sep 2026 13:52:57 GMT

Hi,

I’m sharing the posts that I found most interesting and helpful this week.

Some are menopause specific, others are more midlife focused. All have been posts that made my “saved” list.

Let me know if you’ve saved posts and if you think I would find them helpful.

Menopause Transition

Luisa’s Life Lab

Menopause Skin Changes: What Actually Helps, According to a Pharmacist

There are 2 words that my wife can never say. Divorce (we call it D word) and Menopause (M word…

a month ago · 3 likes · Luisa

Hedda's Mix Tape

We Have to Say the Word Menopause

Last week matters. This week matters. And women’s health matters every single day…

a month ago · 1 like · Heather Cook

THE EMPRESS

✨You Do Not Need to Win Menopause 👑

✨ A vibrant space for midlife women, The Empress now reaches over two million readers through our networks of networks. ✨ From bestselling author Alisa Kennedy Jones. ✨ If you enjoy content about midlife, humor, and agency, I’d love to welcome you as part of our community. ✨ For only $50/year ($4.17 a month!) or $5/month, you’ll gain access to all my ar…

a month ago · 38 likes · 9 comments · Alisa Kennedy Jones

Body of Evidence

Can menopause cause anxiety?

Type “can menopause…” into a search bar and watch what comes back. High blood pressure, nausea, dizziness, rage, itchy skin, heart palpitations, even randomly smelling cigarette smoke…

a month ago · 2 likes · Shelley

If you find The Midlife Brief useful, please share it with others.

Midlife

Midlife Light

Midlife Substack: An Unstoppable Army of Kindred Spirits

(If you like audio, press play! I’ve loved to read aloud since I was kid—so I’m narrating these! For the joy of it…

a month ago · 25 likes · 37 comments · Midlife Light

Midlife, Reconnected.

Most Exercise Advice Isn't Written For People Who Haven't Started Yet

If you are active on social media or open any women’s magazine, you will be aware of the messaging: women around menopause need to be active, strength training is crucial, but then there is also cardio, walking, HIIT…

a month ago · 4 likes · 6 comments · Midlife, Reconnected | Dr. Ute

Candidly Midlife

Goodbye, Midnight Me

It’s 12:47am. Kids are sleeping. Dishes are done. I’ve checked any emails I missed at work that day. Hubby is in bed, and the only light in the house is coming from the TV I’m not really watching, or from my phone where I’m doomscrolling or buying something from Instagram shops that I absolutely do not need. I know I should go to bed. But I don’t move…

a month ago · 2 likes · Candidly Midlife

CHARLOTTE DONOVAN

Midlife Mama turns Wildcat

Five years ago, I was 52 years old, weighing 20 stone and completely un-HRT’d. Then, someone introduced me to Zumba. It felt like a daytime rave packed into one glorious hour and it changed everything. Fast forward five years and I am now HRT’d up to my armpits, a certified gym-rabbit (midlife bunny) and 6 stone lighter…

a month ago · 8 likes · 6 comments · CHARLOTTE DONOVAN

If you found this collection of articles interesting please share it with others that you think would benefit from reading it.

This Substack runs on copious amounts of tea. If you enjoyed this post you can always show that by buying me a cuppa.

Buy Me A Cuppa

What Happens After the Appointment?

Simon Salt — Tue, 22 Sep 2026 13:26:18 GMT

Photo by Meho Mehić on Unsplash...

Menopause is being seen everywhere, or so it seems. Podcasts, celebrities, media coverage, and some workplace initiatives. You would think that with all this information available women would be more empowered and better informed and being so, would then be able to get better care. But greater awareness hasn’t necessarily removed the barriers once women enter the healthcare system.

A recent survey by Gallup found that 24% of women who had sought help for perimenopause/menopause symptoms had to push to be taken seriously or to receive treatment. 23% saw multiple providers; 20% couldn’t get the care they needed despite trying.

The advice women sometimes receive from friends or online sources when this happens is to see another provider, as 23% of women in this survey had done. But there are costs associated with that, time off from work, time and mental labor to fill in all the new paperwork and there might be a financial cost as well. Do that more than twice and it can be easy to see why a woman might become discouraged.

What are the consequences when the uncertainty isn’t removed by seeking medical help?

This issue is broader than just the menopause transition, it extends to women’s healthcare as a whole. The Gallup survey found that 51% of women reported at least one problem accessing healthcare, compared with 39% of men. One in three women said a provider had minimised or dismissed their symptoms, while similar proportions reported being misdiagnosed or unable to get a diagnosis.

An article in the Guardian reported on research by University of St Andrews published in PLOS One. The research was a scoping review that sifted 1,112 published studies, of which 38 studies analysing patient records met the relevant criteria. Thirty-three of those reported significant treatment differences between men and women. The overall review found women less likely to receive active management across a range of conditions.

Dr Miriam Veenhuizen said the surprising element was the consistency of the pattern across areas including cardiology, surgery, transplantation and emergency medicine, adding that the differences remained after statistical adjustment in most studies. She suggested women’s historical underrepresentation in clinical trials could be one contributor, because clinical guidance has consequently been disproportionately based on male data.

The question all this information raises is when women enter the healthcare system, especially with hard-to-diagnose symptoms, are they treated in a way that actually answers their questions or provided with answers that help them?

Symptoms fluctuate, they can overlap with other conditions. I’ve written about that here -

It’s certainly true that clinicians should be cautious about attributing every symptom and change in a woman’s health to the menopause transition, but existing menopause research supports women’s reports of being told they are too young, having symptoms discounted because they still menstruate, receiving conflicting information and seeing multiple providers.

The Gallup survey also reported that 40% of women who had experienced peri/menopause reported associated physical or mental health challenges negatively affecting at least one area of their life or work.

In the MATE survey 63% of men said that their partner’s menopausal symptoms had affected them personally and 34% reported it having a negative effect on their relationship.

These symptoms can lead to exhaustion, difficulty concentrating and general lack of motivation. All of these can be viewed through a lens of personalization by the male partner. Is their partner losing interest in them, in the relationship, are they doing or saying something wrong?

Women can find themselves not only advocating for themselves in the doctor’s office but in the home. With no clear language to explain what is happening, they are reliant on their partner to believe what they are hearing, regardless of what other reasons they might be ascribing to the changes.

And that belief is the first and most significant step a man can take. He doesn’t have to fix it, advocate on her behalf, diagnose it or suggest treatments. He simply has to believe what his partner is experiencing is real.

Healthcare studies are useful, they show us where the level of care women need isn’t being met. Equally relationship surveys can show us how relationships change during this transitional phase. What I believe is missing is the study that meets them both. We don’t know the impact on relationships of prolonged uncertainty. There is anecdotal evidence, I’ve written and spoken about my own experiences several times. But I haven’t been able to find a focus on that.

A woman leaving the consulting room doesn’t carry that experience into a vacuum. She brings it home and to the workplace. If she comes home with uncertainty, does that show up in the relationships she has? The menopause transition is experienced individually. Increasingly we need to know how it is lived collectively.

Want to add to the conversation. Leave a comment. I reply to them all.

Leave a comment

If you found this post helpful, consider sharing it with someone who might also find it helpful.

This substack runs on copious amounts of tea. If you’d like to support it, you could always buy me a cuppa.

Buy Me A Cuppa

Subscribe now

The Midlife Brief

Simon Salt — Fri, 18 Sep 2026 13:26:02 GMT

Hi,

I’m sharing the posts that I found most interesting and helpful this week.

Some are menopause specific, others are more midlife focused. All have been posts that made my “saved” list.

Let me know if you’ve saved posts and if you think I would find them helpful.

Menopause Transition

The Menopause Heart

How Menopause Rearranges Cholesterol

A quick note before we begin. This article uses a fleet metaphor to describe how cholesterol moves through the body: a network of tiny vehicles — lipoproteins — each with a job, a route, and an identifying tag on the outside. This morning on my other publication…

a month ago · 3 likes · Dr. Sameer Azhak

In Full Transparency

Do You Need Special Skincare for Perimenopause and Menopause?

Menopause, the word du jour. It wasn’t always this way. Both menopause—the single day in a woman’s life which marks 12 consecutive months with a period—and perimenopause—the years-long journey to that day—have been under-discussed and under-researched for decades. Then a shift happened. Miranda July released…

a month ago · 2 likes

Tending Our Fire by Fiona Brandon, MPS, MA, LMFT

Introducing A Self-Guided Healing Roadmap For Perimenopause and Menopause

As Octavia Butler once wrote, “God is Change…

a month ago · 2 likes · 4 comments · Fiona Brandon, MPS, MA, LMFT

Friday Fuel

Are we managing menopause, or finally seeing it

I’ve spent most of this week playing fact checker, more than anything else. A doctor’s reel that needed unpicking. Two newspaper stories that were both right and both incomplete. Even a podcast I loved that left one thing out. Consider this week’s edition a bit of an untangling…

a month ago · 2 likes · 1 comment · Karen Muldoon

If you find The Midlife Brief useful, please share it with others.

Midlife

The Unbothered Earner

The Woman You Were Before Motherhood Is Not Coming Back. GOOD.

Unbothered…

a month ago · The Unbothered Earner

The patterns we carry

Don’t Leave Yourself Out

I want to speak to women in their twenties and thirties who are raising children, staying at home or homeschooling because they believe deeply in those choices—and to women in their fifties whose children have grown and whose lives are changing…

a month ago · 4 likes · Joanna Daniel

Small Revolutions, Every Day

Why I don’t believe that the ‘Male Midlife Crisis’ exists

Doesn’t a week in Italy with me and group of like-minded feminist women, doing a lot of writing, discussing feminist subjects, swimming in the pool, enjoying yoga classes and consuming delicious Italian food and wine, sound like the stuff of dreams? Well, it’s real - and you can come too! I’m running a week-long Feminist Writing Adventure in Umbria, in Italy, from 18-24 July 2027. The Early Bird price is available until the end of October, but it’s only been on sale for a week or so and one third of the places have already gone - so, if you’re interested, do sign up as soon as you can. You can read all about it, and book, here…

a month ago · 17 likes · Rachel Hewitt

If you found this collection of articles interesting please share it with others that you think would benefit from reading it.

This Substack runs on copious amounts of tea. If you enjoyed this post you can always show that by buying me a cuppa.

Buy Me A Cuppa

Why Did Women Have to Become Consumers Before We Listened?

Simon Salt — Tue, 15 Sep 2026 13:25:37 GMT

Photo by Bernard Hermant on Unsplash

Menopause is starting to generate real conversations around it. This is happening after decades of neglect. Unsurprisingly this has led to the rise of companies, products, services, influencers and claims. The focus of the discussion around this boom is mostly focused on whether commercialization is improving outcomes for women or simply taking advantage of them.

Three articles recently caught my attention that look into that dichotomy:

Women Mastering Midlife

The Menopause Industrial Complex: What It Is, How It Works, and How to Move Through It with Your Wits Intact

Something has shifted. If you’ve been paying attention over the last few years, you’ve probably noticed that menopause is everywhere now. It’s on the cover of magazines, in your social media feed, the subject of Ted Talks and Netflix documentaries and New York Times essays. Celebrities are talking about it. Physicians have become influencers. Entire pro…

5 months ago · 19 likes · 2 comments · Victoria Byrd

https://www.wired.com/story/inside-the-perimenopause-industrial-complex/

What moves you

Perimenopause is not a buzzword. WTF, Wired?

Hi! If you’re new here, I’m Naomi. I’ve been teaching movement for 21 years and writing about all things movement, fitness, wellness, and health for nearly as long…

a month ago · 4 likes · 1 comment · Naomi Gottlieb-Miller

As Victoria Byrd says in her article - “When a population that has been historically underserved suddenly becomes a recognized market, predictable dynamics follow.”

And that is certainly true. Menopausal women have been an underserved population for decades. What all this made me ask was, what exactly is the gap that industry is filling? Yes women’s healthcare is grossly underfunded and underresearched.

Let’s be clear here. Visibility is not the same as commercialization. Without doubt the visibility of menopause as a transitional phase in a woman’s life is much needed. More books, conversations, education and women’s symptoms being recognized is long overdue. The commercial ecosystem - the “menopause industrial complex” develops when that attention becomes monetizable. And let’s not doubt the commercial value of that marketplace - PwC estimates the menopause market is already worth around $10–15 billion and could reach $15–25 billion by 2030

A woman struggling to find answers about her symptoms, or who has a partner who doesn’t understand them, perhaps friends, family and physicians that dismiss her, suddenly encounters a commercial marketplace that is saying things like “We understand what you are going through”, “Your symptoms make sense”, “You’re not imagining it”. What this all adds up to in reality is simply recognition. Suddenly this woman feels seen.

Some of those commercial sources are backed by excellent clinicians, some are selling legitimate solutions and some are not. Some elements of the commercialization process have actually filled real needs.Telehealth can provide access to specialists where geography or a scarcity of experts exists. Better information can lead to a woman recognizing that the symptoms she is experiencing may be associated with perimenopause.

Making a woman feel seen benefits both the business and the woman. The issue comes when commercial interests push a particular kind of certainty onto a woman. “We see you, we hear you, we understand you and this is what you need to help you”. This is counter to what medicine sometimes says - “We don’t know yet, or we need to rule other things out”.

Ideally a woman entering perimenopause would have a knowledgeable physician, access to reliable public health information, an engaged partner who understands the transition she is facing, friends and family that don’t dismiss her and a workplace that encourages her to discuss her symptoms and how they might impact her role. She is unlikely to find all of these, all at once, but the fewer of them she has the more likely she is to look elsewhere for them.

These are the gaps I see, clinical, informational, relational and workplace. These are the gaps I think that the “menopause industrial complex” is trying to fill. I don’t think that the existence of a marketplace is necessarily a sign of failure. I do wonder why a woman has to pay for some of the things that shouldn’t have to be purchased.

Accessing knowledge shouldn’t require a subscription to a supplement plan. Being taken seriously shouldn’t only happen on a $200 telehealth call. A woman shouldn’t have to rely upon a commercial source to fill the knowledge gap in her own relationship. Being supported in the workplace shouldn’t be reliant on purchasing a corporate wellness package.

I don’t believe the answer to the rise of commercialism simply stops at more consumer skepticism. We also need to shrink the gap it is currently filling. We need better educated physicians, better public information, partners and family members who are more aware and workplaces that provide meaningful support. Commercial solutions can definitely be part of filling the gap but they shouldn’t be the only place a woman receives recognition.

If we are truly uncomfortable with the size of the menopause marketplace, perhaps we should spend less time asking why businesses entered it and more time asking why we left so much space for them.

Want to add to the conversation. Leave a comment. I reply to them all.

Leave a comment

If you found this post helpful, consider sharing it with someone who might also find it helpful.

This substack runs on copious amounts of tea. If you’d like to support it, you could always buy me a cuppa.

Buy Me A Cuppa

Subscribe now

The Midlife Brief

Simon Salt — Fri, 11 Sep 2026 13:25:45 GMT

Hi,

I’m sharing the posts that I found most interesting and helpful this week.

Some are menopause specific, others are more midlife focused. All have been posts that made my “saved” list.

Let me know if you’ve saved posts and if you think I would find them helpful.

Menopause Transition

Alexandra MacKillop

Press Pause on Perimenopause

Most of my patients are in their 40’s…

2 months ago · 1 like · Alexandra MacKillop

A Second Sky

Perimenopause is a Freeloader

This Substack is reader-supported. To receive new posts and support my work, consider becoming a free or paid subscriber…

2 months ago · 7 likes · 4 comments · A Second Sky

Mindful Movements with Rebecca Moos, LPC, NCC Substack

Life keeps coming...

Life keeps coming. For a while, the temptation is to interpret all of this as something going wrong…

2 months ago · 2 likes · Rebecca M. Moos, LPC-MHSP, NCC

Ghiselle

Struggling With the Biology of Perimenopause?

Should you start HRT…

2 months ago · Ghiselle

If you find The Midlife Brief useful, please share it with others.

Midlife

Your better, bolder, brighter life, with Alana Kirk

Are you owner or finder of your time?

Quick note - only 2 places left on my next ‘elbow your way back into your own life’ adventure. My Midlife, redefined - A Practical Reset starts Monday 14th. Ten weeks to change the way you live the next decade…

a month ago · 2 likes · Alana Kirk

Annie Scott's Wankery Watch

The Rise Of The Midlife Bullshit Machine

2 months ago · 56 likes · 18 comments · Annie Scott

Midlife Couturier

I Think I Just Figured Out Why So Many Midlife Women Feel Stuck Even When Nothing Is Wrong

There is a peculiar kind of restlessness that can arrive in midlife when, from the outside, absolutely nothing appears to be wrong…

2 months ago · 1 like · 2 comments · The Midlife Couturier

The Portal: Sacred Unraveling™

Maybe You Haven’t Lost Your Drive. Maybe You’ve Lost Your Willingness to Abandon Yourself.

2 months ago · 2 likes · Shannon Graham

If you found this collection of articles interesting please share it with others that you think would benefit from reading it.

This Substack runs on copious amounts of tea. If you enjoyed this post you can always show that by buying me a cuppa.

Buy Me A Cuppa

Menopause is Everywhere

Simon Salt — Tue, 08 Sep 2026 13:25:13 GMT

Photo by Magnet.me on Unsplash

“Menopause is having a moment”, how many times have you heard that? And in part it is true. Menopause is talked about more freely than before. There are books, podcasts, news articles, Substack articles, blog posts, etc. Celebrities are opening up about their own menopause transition journeys. It has nicknames like the Age of Rage, or Reverse Puberty.

It feels like everyone is talking about it

Even men (yes, myself included) are writing and talking about it (though not in great numbers). But it’s happening. There are supplements being advocated for, MHT conversations about whether it is a good solution, a solution at all, the answer to everything. There are sex toys that promise better sex during the menopause transition. Many of them are promoted by well known clinicians. This article by Naomi Gottlieb Miller -

What moves you

Perimenopause has an Influencer Problem

Hi! If you’re new here, I’m Naomi. I’ve been teaching movement for 21 years and writing about all things movement, fitness, wellness, and health for nearly as long…

2 months ago · 267 likes · 10 comments · Naomi Gottlieb-Miller

describes the issues with that particular aspect of the menopause conversation, so I won’t repeat it here. Needless to say, separating the wheat from the chaff is no easy task.

I decided to look at a small ecosystem - Substack and see how the menopause conversation is going there. I publish a weekly article - The Midlife Brief - https://www.thequiettransition.com/t/midlife-brief where I feature four different writers covering the menopause transition each week. I have been publishing this for 27 weeks and have featured 108 different writers over that time. And those are just the ones I selected for the article, there were many more to choose from.

It would seem from my own experiment that Substack has a healthy amount of conversations happening about the menopause transition. I decided to broaden my scope and look at Substacks own rankings for Health & Wellness - https://substack.com/explore/category/health

What does Substack tell us

Of the 166 distinct publications represented across the bestseller and rising lists I looked at (some publications appear on both the bestseller and the rising lists) I found only four that explicitly referenced menopause in their publication title or bio.

(If this topic interests you at all, I highly recommend subscribing to these writers).

For the people writing, reading, listening and watching menopause content on a regular basis this can seem like it is the topic du jour but is it? Writers read one another. Doctors appear on the same podcasts. Advocates follow one another. Readers subscribe to several menopause publications. Algorithms learn that we’re interested in menopause and consequently show us even more menopause content.

All this creates the impression that menopause has entered the mainstream conversation. In some ways it clearly has. Being visible isn’t the same thing as being integrated into the wider health conversation.

In a 2025 AARP survey of 4,436 U.S. women aged 18+, 32% said they lacked important knowledge about menopause. Nearly 70% said there was a need for greater public education about menopause. We have more menopause information than perhaps ever before, while women themselves continue to report that they need more information.

Another study of 947 perimenopausal women found that more than 60% said they had felt “not informed at all” about perimenopause/menopause before age 40. 68.2% only began looking for menopause information once their symptoms had started. If women are largely encountering menopause information only once they have a reason to search for it, then producing more menopause content alone doesn’t necessarily close the information gap. The information also has to reach women before they know they need it.

Has menopause become a widely discussed subject without yet becoming a widely integrated health subject?

What does “mainstream menopause” look like?

We tend to measure the success of a topic by the amount it is being talked about. But is that really just a crude measurement that only holds true for those already seeking the information?

The next real stage is if menopause becomes part of the greater women’s health conversations. A woman reading about cardiovascular health in midlife should encounter menopause. Someone trying to understand changing sleep shouldn’t have to already suspect perimenopause before it enters the conversation. The same applies to bone health, mental health, sexual health and cognition. Women shouldn’t have to know the word they are looking for.

The menopause conversation hasn’t failed to grow, but it seems to be growing sideways, at least that’s what my small experiment seems to show. There are a lot of writers and clinicians creating extraordinary work about this stage of life. A lot of that conversation is still happening within the menopause ecosystem.

Perhaps a better measure of progress isn’t how much menopause content we can find when we go looking for it. It’s how much we find when we aren’t looking for it at all.

Want to add to the conversation. Leave a comment. I reply to them all.

Leave a comment

If you found this post helpful, consider sharing it with someone who might also find it helpful.

This substack runs on copious amounts of tea. If you’d like to support it, you could always buy me a cuppa.

Buy Me A Cuppa

Subscribe now

The Midlife Brief

Simon Salt — Fri, 04 Sep 2026 13:25:05 GMT

Hi, , welcome to the 6th month edition of the Midlife Brief.

I’m sharing the posts that I found most interesting and helpful this week.

Some are menopause specific, others are more midlife focused. All have been posts that made my “saved” list.

Let me know if you’ve saved posts and if you think I would find them helpful.

Menopause Transition

What moves you

Perimenopause has an Influencer Problem

Hi! If you’re new here, I’m Naomi. I’ve been teaching movement for 21 years and writing about all things movement, fitness, wellness, and health for nearly as long…

2 months ago · 252 likes · 8 comments · Naomi Gottlieb-Miller

Alchemy & Ash

11 Things I Wish I Knew Before Perimenopause

When I first started going through perimenopause, I was flailing in a sea of podcasts and audiobooks telling me all the things I should be doing, from hormones and diet to strength training and supplements…

2 months ago · 17 likes · 12 comments · Jessie May ✨ Alchemy & Ash

The Gingham Edit

I’m almost afraid to say this, to put it out here on the internet, for any and all to critique. I can already anticipate the eye rolls, hear the patronizing commentary. Yet, I feel compelled to share my perimenopause experience. Partly because as women it is a universal life stage and hearing candid stories can be so helpful. But mostly because, desp…

2 months ago · 59 likes

Emma's Coven II

Perimenopause Starts Earlier Than Anyone Admits and Nobody’s Ready

I was in Tesco last Tuesday grabbing emergency oat milk when it hit me. Not a hot flush. Not yet. Just this stupid, nagging thought that would not leave me alone. I am 30. My periods are still regula…

2 months ago · Emma Webb! 🇬🇧❤️

If you find The Midlife Brief useful, please share it with others.

Midlife

Why High-Achieving Women Are Exhausted in Midlife

The Four Tired Types

You’ve told people you’re “fine” so many times it’s started to feel true, even when it isn’t…

2 months ago · Dr. Peggy Gleason

The Evidence

Why Are So Many Midlife Women Calling Themselves Lazy?

I keep seeing women confess that they have become lazy…

2 months ago · 1 like · Cheryl Pullins

Tanya Lawson In Practice

The Beautiful Life Isn’t What I Thought

Starting this project felt a little daunting at first. Beginning again always does…

2 months ago · 4 likes · 3 comments · Tanya Lawson In Practice

Actually Honest with Libby Ward

Heaven is Female Friends, Outdoor Yoga and Dinner I Didn’t Cook.

Recently, after a long day of attempting to work while meeting the needs of my medium sized children who were less capable of entertaining themselves than I anticipated this summer, I got a break…

2 months ago · 3 likes · 1 comment · Libby Ward

If you found this collection of articles interesting please share it with others that you think would benefit from reading it.

This Substack runs on copious amounts of tea. If you enjoyed this post you can always show that by buying me a cuppa.

Buy Me A Cuppa

What If Menopause Isn't the Whole Story?

Simon Salt — Tue, 01 Sep 2026 13:25:09 GMT

Photo by Branislav Rodman on Unsplash

A woman in her mid 40’s might be experiencing poor sleep, leading to her feeling exhausted. Her joints ache. She can’t concentrate as well as she used to. She’s more anxious than usual and occasionally feels her heart racing.

She does what a lot of women do, she begins a search for her symptoms, perhaps she discusses them with friends or relatives, maybe even consults social media. The conclusion she might arrive at - Perimenopause.

Awareness vs Assumption

We now have much greater public awareness of the menopause transition (though I would argue not nearly enough), but that public awareness doesn’t always translate into either clinical or familial support. In a 2026 survey of 1,000 U.S. women aged 35–59 in the perimenopause stage, 72% reported experiencing pushback from doctors, friends, or family when they raised the possibility that their symptoms were related to perimenopause (ThisIsMenopause, 2026).

Using the resources she has available she has come to her own conclusion that perimenopause is the most likely reason for how she is feeling. The problem is that awareness shouldn’t become assumption.

Let’s look back at her symptoms - poor sleep, aching joints, can’t concentrate as well as she used to. She’s more anxious than usual and occasionally feels her heart racing.

All of these can occur during the menopause transition. But they are also non-specific. They can occur across numerous conditions and as part of other processes.

What we can say is that knowing that a symptom can occur during perimenopause doesn’t necessarily tell us that perimenopause is causing it.

When Symptoms Overlap

Long COVID - common symptoms include fatigue, brain fog, sleep disturbance, headaches, dizziness, palpitations, muscle and joint pain. In fact Newson et al (2021) found that seventy percent of women surveyed with Long COVID believed that some of their symptoms could be related to perimenopause or menopause.

Thyroid disease - common symptoms include fatigue, cognitive difficulties, mood changes, temperature sensitivity, palpitations and menstrual changes. Sowers et al. (2003) found that because of the overlapping of symptoms clinicians differentiate between Thyroid disease and menopausal symptoms.

Sleep disorders - A review (Hall et al - 2015) specifically examining insomnia and sleep apnea in midlife women found that approximately 50% experience insomnia and reported that around 20% develop sleep-disordered breathing during the menopause transition. The consequences of sleep disturbance include impaired mental and physical functioning all of which can also be attributed to the menopause transition.

Aging - Given that aging and the menopause transition happens at the same time, how do we clearly define which is responsible for a particular symptom. This does not excuse women being told their symptoms are simply due to them aging. Harlow et al. (2017) found that symptom patterns in midlife women were present before menopause and often remained stable throughout the menopause transition.

OR vs AND

The question becomes not is the menopause OR something else but is this menopause AND something else.

A woman can be perimenopausal and iron deficient.

Perimenopausal and have Long COVID.

Perimenopausal and develop thyroid disease.

Perimenopausal and have sleep apnea.

And all of the above will have symptoms that can also be identified as part of the menopause transition. What becomes important is the symptoms that can be more readily assigned to the menopause transition, for example changing periods and suddenly experiencing hot flashes tells a clinician a lot more about the likelihood of perimenopause than fatigue and brain fog on their own.

What we are moving toward is that “common in menopause” and “specific to menopause” are very different things. The risk is that as awareness improves, menopause shouldn’t become a diagnostic endpoint that prevents investigation of other possible contributors.

We are making progress in informing women, men and clinicians about menopausal symptoms, we still have a long way to go. Taking menopausal symptoms seriously is an important step and at the same time it requires us to also look beyond that as the only cause.

What this really means is treating the whole woman. Not a group of symptoms, but her complete experience. That doesn’t mean the menopause transition isn’t the cause, it means it could be that and something else.

This article is not meant as medical advice and is for information purposes only.

Want to add to the conversation. Leave a comment. I reply to them all.

Leave a comment

If you found this post helpful, consider sharing it with someone who might also find it helpful.

This substack runs on copious amounts of tea. If you’d like to support it, you could always buy me a cuppa.

Buy Me A Cuppa

Subscribe now

The Midlife Brief

Simon Salt — Fri, 28 Aug 2026 13:25:37 GMT

Hi,

I’m sharing the posts that I found most interesting and helpful this week.

Some are menopause specific, others are more midlife focused. All have been posts that made my “saved” list.

Let me know if you’ve saved posts and if you think I would find them helpful.

Menopause Transition

Dr. Susan Fox

A Healthy Menopause

I recently had a conversation with Katrina Valenti, in which she strongly asserts that a woman’s healthy aging builds years, and sometimes decades, before menopause. While hormones naturally change over time, the way we experience those changes is influenced by how we move, how we eat, how we manage stress, how we care for our mental health - in short, …

2 months ago · 1 like · 1 comment · Dr. Susan Fox

The Feminine Shift

Menopause and Female Power with Dr Sharon Moloney

2 months ago · 3 likes · Lisa Fitzpatrick

Nervana Medical-C.Debenham

Perimenopause vs Menopause

Hot flashes do not tell us which decade your ovaries are in. A missed period does not either…

2 months ago · 3 likes · Nervana Medical-C.Debenham

Dr. Jumana Al-Deek DO Substack

What Really Happens To Your Skin In Menopause

Women expect hot flashes, night sweats and changes in their periods during perimenopause. What many don’t expect is how much their skin can change. Suddenly the moisturizer you have used for years doesn’t seem to work anymore. Your skin feels drier or more sensitive. Fine lines seem deeper. Your face may not feel as firm. You might develop acne along yo…

2 months ago · The Midlife Medicine Report

If you find The Midlife Brief useful, please share it with others.

Midlife

Laura | Midlife Reimagined

The Yoga that EVERY Woman in Midlife Needs

If you are new here, welcome to Midlife Reimagined! My name is Laura and I’ve been inspiring women navigating midlife through Life Coaching + Yoga + Wellness for over 30 years. If you are ready to ma…

2 months ago · 1 like

Hotflash inc menopause + midlife by Ann Marie McQueen

A few things making my midlife lighter

Dagsmejan pajamas…

2 months ago · Hotflash Inc

Reboot Midlife

The Midlife Middle :

Have you ever looked in the mirror and thought…

2 months ago · Reboot Midlife

Twenty tabs open with Robyn Law

Midlife adult friendships

Midlife is wild…

2 months ago · 1 like · Robyn Law

If you found this collection of articles interesting please share it with others that you think would benefit from reading it.

This Substack runs on copious amounts of tea. If you enjoyed this post you can always show that by buying me a cuppa.

Buy Me A Cuppa

Menopause Doesn’t Create the Cracks

Simon Salt — Tue, 25 Aug 2026 13:25:43 GMT

“I sometimes wished for five or six years that more men would get involved in the conversation.”

This is something that Ann Marie McQueen, the creator of said to me on our recent Substack Live.

Men And The Important Conversation

We are slowly seeing more men enter the conversation. The MATE survey shows that 72% of the men they surveyed said they were having conversations about their partners menopause experience with them. The data point that goes with that is less encouraging. 72% said their partner initiated the conversation.

We want men in the conversation, but they still don’t know how to enter it. They are reliant on women inviting them in. For some men, I believe what stops them is fear. Fear of saying the wrong thing, at the wrong time, and making the situation more tense than it needs to be.

Ann Marie and I agreed that men need to take the initiative to educate themselves about this transitional stage in their relationship and that it isn’t incumbent on women to be their educators. That education goes beyond books, podcasts and newsletters. All of those are very useful and allow men to ask well informed questions during those conversations. What they don’t replace is the education that the men can get from their partner’s lived experience.

It is one thing to have read about Hot Flashes, it is quite another to understand what that means to your partner. And until you do you don’t have the knowledge you need.

These conversations also need to extend beyond symptoms.

The Cracks That Are Already There

As the title of this article says, perimenopause doesn’t usually cause cracks in relationships, it reveals them. And this is the important extension of those conversations. Because they are still about the lived experience that the partner is having.

Those cracks can take many forms. Who carries the emotional load? Who remembers appointments? Who plans meals? Who knows what the household needs?

A University of Michigan study found that women with husbands pick up about 7 extra hours a week of housework, while men with wives saved themselves about an hour a week. The real takeaway here isn’t that women do more to operate a household, it’s that the arrangements that have set this up have been in place for years, sometimes decades. And at this stage those arrangements become no longer tenable. This is not the fault of individual relationships, this is a familiar pattern shaped by the society we live in. As I said during the conversation

“Men are centered and women are taught to orbit them.”

Ann Marie highlighted this with a simple question that a woman might ask herself

“Why have I been doing that?”

Time To Renegotiate

This is more than just the division of labor in the home though. This period of unmasking involves changes in biology and physiology for the woman. Those include the symptoms that she is experiencing but also how those symptoms show up. For example a lack of sexual desire can’t simply be ascribed to a low libido (though that is certainly one symptom) sometimes penetrative sex is physically painful. Changes in thermal regulation, showing up as hot flashes which can reduce the desire for physical contact.Sleepless nights can lead to irritability which can create tension in the relationship and a breakdown in communication.

All of this can change the way a relationship works. And to weather those changes the relationship needs to be renegotiated. This renegotiation requires a careful look at those cracks that have been revealed. As Ann Marie put it

“We both hold the responsibility for readjusting the relationship in this time.”

What does this renegotiation actually look like? As I mentioned this is more than who takes on which responsibility around the house (though that plays a part), it’s about making the needed adjustments that reflect the new reality that partners find themselves in.

For my relationship the outcome of the renegotiation was very simple. My Wife said

“I finally feel seen”.

Being in the conversation is more than just understanding or talking about symptoms. It’s being willing to listen to the lived experience of your partner and what that tells you about her, about you, and about the relationship you’ve built together.

You can watch the full conversation below

Want to add to the conversation. Leave a comment. I reply to them all.

Leave a comment

If you found this post helpful, consider sharing it with someone who might also find it helpful.

This substack runs on copious amounts of tea. If you’d like to support it, you could always buy me a cuppa.

Buy Me A Cuppa

Subscribe now

The Midlife Brief

Simon Salt — Fri, 21 Aug 2026 13:25:46 GMT

I’m sharing the posts that I found most interesting and helpful this week.

Some are menopause specific, others are more midlife focused. All have been posts that made my “saved” list.

Let me know if you’ve saved posts and if you think I would find them helpful.

Menopause Transition

Kirsten

Menopause care is primary care

Menopause medicine belongs in primary care…

2 months ago · Kirsten

Hormone Literate | Moore Integrative Health

Most People Think Perimenopause Is Something to Survive. I Don’t.

A few years ago, I started noticing subtle changes. My stress tolerance wasn’t what it used to be. My sleep felt less predictable. Workouts that once energized me sometimes left me feeling depleted. There were moments when I felt like I was doing all the “right” things and somehow getting different results…

2 months ago · 2 likes · Chelsie Moore, MS, CNS, LDN

The Quiet Work

Nobody thought women needed to know.

If you’re wondering why everyone’s suddenly talking about menopause. It’s because there was ZERO information until Generation X reached menopause…

3 months ago · 19 likes · 19 comments · Wilde

Deborah McCarren

Menopause is Over. The Health Effects Aren't.

Menopause marks an important point in a woman’s health story, but it doesn’t stop there. It keeps going—through our bone health, heart health, muscle strength, bladder and pelvic health, sleep, and all the other things that still matter long after our periods end…

2 months ago · Deborah McCarren

If you find The Midlife Brief useful, please share it with others.

Midlife

Midlife Business Brain

How Independent Midlife Providers Can Turn Internet "Menopause Celebrities" into Practice Growth

Let’s face it: the internet has completely transformed how midlife women approach their health. Everywhere you look, high-profile celebrity doctors, authors, and online advocates are breaking decades of medical silence. Figures like Dr. Mary Claire Haver, Dr. Jen Gunter, and Kelly Casperson, etc. have cracked open a massive cultural conversation. Millio…

2 months ago · 1 like · Midlife Business Brain

Midlife Gracefully

They Used The Word Selfish To Make Me Small. I'm Taking It Back.

Selfish…

2 months ago · 27 likes · 23 comments · Midlife Gracefully

Midlife, Reconnected.

What’s It Called Again?

The Midlife Brain, Explained Thanks for reading Dr. Ute Swanson Coaching! Subscribe for free to receive new posts and support my work…

2 months ago · Midlife, Reconnected

Midlife Atelier

Midlife Pivot at 42: Desperate for a Change

A childhood dream was reawakened in me when I turned 30. After a divine appointment (more on that in another article), the dream of becoming a fashion designer and having my own boutique became very real to me. It had lied dormant for over 10 years (and….now you understand the name of my publication…

2 months ago · 4 likes · 9 comments · Dari Hernandez

If you found this collection of articles interesting please share it with others that you think would benefit from reading it.

This Substack runs on copious amounts of tea. If you enjoyed this post you can always show that by buying me a cuppa.

Buy Me A Cuppa

Bring Your Partner to The OB/GYN

Simon Salt — Tue, 18 Aug 2026 13:24:28 GMT

The Fashion Times recently published an article under the title - ‘Unfair’: Woman Says She Had to Bring Her Husband to Be Taken Seriously Over Perimenopause, Sparking Debate Over Women’s Healthcare

They picked up the story from the woman’s TikTok post seen here reposted on Reddit.

In the video she describes having been dismissed by four OB/GYN’s, being told that she should try diet and exercise etc. For her most recent appointment she decided to take her husband with her to provide an extra voice that her symptoms were real.

Surprise - An Unsurprising Outcome

Unfortunately, and perhaps unsurprisingly, it worked. At the end of the video she tells us that she has labs ordered, a prescription filled and an ultrasound ordered. We don’t know what happened at those previous appointments but what we do know is that she finally feels seen and heard.

Sadly this isn’t an uncommon story. I’ve heard from many women and couples who have faced this struggle.

What we don’t know is if this particular OB/GYN would have been open to the conversation without her husband present anyway. Regardless of whether they would or wouldn’t have been open to it, the very fact that this woman saw taking her husband along as a last resort opens all kinds of questions.

Take Your Husband To Your Appointments

It might make you and/or your partner uncomfortable but take them anyway. For too long men have been excused from these conversations because it’s a “woman’s issue”. On the one hand we say we want men to be included and to be involved in these conversations and at the same time we shut them out of the room where the most important conversations are happening.

One poster left this comment -

“I bring my husband to every gyno appt. I swear I get better care. Plus, he needs to see and hear first hand what goes down there. He’s been to a pap, uterine biopsy, cervical biopsy, my IUD placement, etc. He always asks great questions, including gems like ‘why aren’t you giving her pain medicine for this highly invasive procedure.’ I ain’t going on this bullshit journey, with bullets to dodge left and right, on my own!”

Men should be in the room because they can then see and hear what she is being told firsthand. He provides another voice to ask questions, perhaps ones that she might have missed because of his perspective. Most importantly it makes it real that this isn’t something happening somewhere else in her life, it’s happening in the part of her life that affects both of them.

What stands out to me from that comment is this line - “he needs to see and hear first hand what goes down there.” I couldn’t agree more. Women’s health shouldn’t be a mystery to men, something that is shuffled off to a box marked “Women’s issues”.

What Debate?

What exactly are we debating? Are we debating that women experience these symptoms? Are we debating that their pain and suffering doesn’t deserve as much attention as men? Because there shouldn’t be a debate about women’s healthcare in the 21st Century. Historically there have been significant underfunding of research into women’s health. Men and their bodies are seen as the default, while women are seen as a “specialist” category. It’s much easier to underfund and sideline “specialisms” than it is to sideline mainstream healthcare.

I don’t think there is anything wrong with taking your partner to your OB/GYN appointments, there are very good reasons to do it. What should concern us most is that this woman got to the point where she felt taking him was the only way to be taken seriously.

Would you take your male partner to your next OB/GYN appointment because you want him there or because you think you’ll get better treatment?

Want to add to the conversation. Leave a comment. I reply to them all.

Leave a comment

If you found this post helpful, consider sharing it with someone who might also find it helpful.

This substack runs on copious amounts of tea. If you’d like to support it, you could always buy me a cuppa.

Buy Me A Cuppa

Subscribe now