The Quiet Transition

Millennials Meet Menopause

Simon Salt — Wed, 10 Jun 2026 13:27:05 GMT

And The Cost Of Being Unprepared

87% of Women Don't Seek Help for Menopause

Simon Salt — Tue, 09 Jun 2026 13:25:55 GMT

A recent Mayo clinic survey found that 87% of women don’t seek medical help for their menopausal symptoms.

That’s a surprising number.

The Story Behind The Numbers

The reasons are even more revealing. 65% said they prefer to manage their symptoms on their own. For 37% time was the biggest factor, a lack of awareness of potential treatments was the reason given by 22% of women and embarrassment as a reason was given by 18%.

What interests me is the other responses.

For 37% of women, time was a factor. That speaks to the type of women I believe are being left out of the mainstream conversations. Frontline workers. Those women who don’t have flexible schedules and for whom taking time off to see a doctor has financial implications, loss of wages and the cost of seeing a doctor when they don’t have adequate healthcare solutions.

A lack of awareness is also not surprising. Women are still left in the dark in terms of adequate and well grounded information about the menopause transition. When they do seek information research suggests it comes from a variety of sources, Google, Friends and Family, social media and online communities. What’s missing from this list is clinicians.

Why Aren’t Doctors The First Place Women Turn?

Why might clinicians be one of the last places that a woman turns to? We already identified that 22% of women weren’t aware of potential treatments. But it’s broader than that. Women often don’t connect the symptoms they are feeling together as coming from one source.

The reality for some women is that they may have faced long wait times to see a doctor, perhaps their doctor wasn’t helpful the last time they saw them, or their symptoms were dismissed.

For 18% of women, embarrassment was a factor. They just didn’t want to discuss their symptoms. Some of that can be cultural, some of it ingrained in them to “not be a bother”.

If some of these women aren’t discussing their symptoms with their doctors and they are discussing them in community spaces where they feel safe discussing this topic, the other person that is likely to be left out of the conversation is their partner.

Where Do Men Get Their Information?

Where do their partners turn? Often to similar sources as the women in their lives, Google, AI and online communities. What they don’t have is the knowledge to leverage those sources properly. While a woman might search or discuss symptoms a man is more likely to search or discuss impact. Those are very different perspectives of the same situation. The symptoms are the root cause of the impact but without understanding that men will often jump to conclusions or even imply reasons that don’t exist.

In the MATE survey 63% of men said they had been impacted by menopause, 25% said it had affected their relationship. Those aren’t symptom discussions, those are impact discussions. In many situations, while men want to help they just aren’t finding the answers that can lead them in the direction that their partner needs most.

There is a big difference in searching for information based on “Why is my wife suddenly so different?” and “How can I help with hot flashes?” The results are not going to produce the same results in the relationship.

If women aren’t primarily getting their information from clinicians and men aren’t getting their information from women, then we have two separate people trying to navigate the same situation in isolation. This information gap can be, amongst others, the source of friction between partners. A lack of shared language, of shared knowledge.

When partners start to close that gap they can navigate this transition together.

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

The Midlife Brief

Simon Salt — Fri, 05 Jun 2026 13:25:31 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

Ladyparts

What's the deal with menopause boobs?

My grandmother Kate and her sisters, Ruth and Gussie, all wore the kinds of 1950s-era bullet bras that turned their ample bosoms into, well, not really bullets per se but more like torpedos. I couldn’t wait to have a similarly large and pointy pair of my own…

a month ago · 190 likes · 16 comments · Deborah Copaken

Nichola Raihani's Substack

Why did evolution give us menopause?

In a typical ant colony, there are the haves and the have-nots. The queen, who can reproduce—and the workers, who cannot. The workers are expendable units, cogs in the machine. They exist only to serve the queen, and to increase the reproductive output of the colony…

13 days ago · 7 likes · Nichola Raihani

Awaken Apothecary

What Comes After Menopause?

Lately, I’ve been feeling like I might be standing at the very edge of menopause. Like maybe the hard yards are behind me, and it’s time to take stock and decide what comes next…

10 days ago · 9 likes · 4 comments · Cindy Johns

Teresa Tarmey

Me, Myself And Menopause

Like a third of the UK female population (a third!) I, am menopausal. And not ashamed to admit it, clearly - I’ve spoken about it in British Vogue, I talk about it regularly with my team and clients and, since I’m being perfectly honest, I am dealing with the fallout of it on a daily basis…

8 days ago · 14 likes · 3 comments · Teresa Tarmey

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

Midlife

I Hate to Tell You, Darling

GenX is ready to save us all.

Here you are, getting smacked by yet more “unprecedented times” …and who better to be your ride-or-die than a generation that’s been there, done that, and bought the Massive Attack concert T-shirt…

10 days ago · 5 likes · Kirstine Stewart

The Longevity Vault

Why Sleep Gets Easier to Break After Midlife

Today's piece is a little different: Scott Anderson interviewed me about sleep after midlife, why a full night can still leave someone unrested, what sleep trackers can show, and why 3 a.m. wakeups often need a more personal read…

9 days ago · 4 likes · Kat Fu, M.S., M.S.

The Worst Years Of Our Lives: The 2000s

Are Millennials Killing the Midlife Crisis Industry?

Life comes at you fast, huh, fellow fortysomethings? Why, just moments ago, we were coming out of our cages and feeling just fine, wriggling into our skinny jeans and laughing at media coverage about how we didn’t understand the value of hard work, marriage, or…

13 days ago · 91 likes · 14 comments · Gabrielle Moss

The Mythic Masculine

The Second Fire: 1:1 Mentorship for the Midlife Passage

Two decades ago, I graduated university…

Listen now

9 days ago · 7 likes · Ian MacKenzie

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When Midlife Arrives Earlier Than Expected

Simon Salt — Tue, 02 Jun 2026 13:25:56 GMT

“I had barely heard the term perimenopause, even though I’m very well educated and passionate about women’s health.” That was the surprising quote from a recent conversation with Laura Tetenbaum, author of the book Millennial Menopause.

Watch The Recording

I was surprised by this because we typically see millennials as well informed. They are digital natives, they talk openly about subjects that have been previously almost taboo, like mental health. They live in an information rich society. So where is the disconnect?

The lack of good, well grounded and relatable information available for women, while getting better, is still nowhere it needs to be. If it isn’t reaching GenX women, it most certainly isn’t reaching millennial women.

Even when they have some information, some awareness, what they are usually missing is the preparation. What does the menopause transition mean for a millennial woman? Mothers, who may be experiencing this transition themselves may not have talked about it with their daughters, or if they have it may well have been just a conversation about symptoms.

Nobody Expects It Yet

Typically, when we talk about the menopause transition we envisage women in their late 40’s, early 50’s (after all the average age in the US for arriving at menopause is 51). That places those women firmly in Gen X territory.

Except the true picture of the menopause transition is much broader than that. The symptoms can arrive as early as the mid-30’s, and persist for up to 10 years, sometimes longer. These women aren’t expecting this life stage. A lot of them are at a career inflection point, deciding to move forward and embrace new opportunities. Perhaps some of them are considering starting a family or adding to an existing one.

What they are not thinking about is a life stage that changes everything.

As Lauren pointed out:

“Women that I see still tend to not recognize themselves within the label of perimenopause.”

That label just doesn’t fit the image of a millennial woman. But of the 2 million women entering perimenopause each year in the US up to 500,000 of them are millennials.

When Nobody Believes You

The type and severity of the symptoms they might experience are as unique as the woman herself. Perhaps she decides to consult with a medical professional, her PCP or OB/GYN, only to be told that she is too young to be perimenopausal.

As Lauren pointed out in our conversation -

“If someone is constantly telling you, no, you’re fine, and you’re not, that is going to really impact your mood and your sense of self.”

Women being dismissed by the medical profession isn’t something that is surprising. It is especially common with the menopause transition because of the lack of training that Drs receive. So when a woman is told she is fine, her labs look great, she is left with this feeling that there is something else wrong with her. Perhaps she is imaging things, being over-reactive to situations, or just not coping as well as she should.

Then there is the relationship that starts to become strained. I recently had a conversation with a woman who told me her partner refused to believe she was in perimenopause. Even after her Doctor confirmed it for her. Why? Because what did that mean for him if she was at that stage of life, was he suddenly “old”?

This isn’t uncommon among men, to personalize the menopause transition. To place themselves at the center of the issue. They look to fix a situation, to provide a solution. That is what they are taught to do. To solve things. When faced with a situation that can’t be fixed and has no neat solution, they can find themselves facing an identity shift. “Who am I, if I can’t be useful?”

The Ripples Beyond Her

The menopause transition doesn’t stay at home, the symptoms don’t stop at the front door. A woman carries them with her into her daily life. Perhaps she works outside of the home. Does her workplace make accommodations for women facing this life change? Many don’t. I recently heard an HR professional say “Menopause isn’t on our radar yet”.

These ripples affect their partner, they can roll into his work environment, disturbed sleep, a cycle of conflict at home and more means that others are experiencing the impact of the menopause transition without even realizing it. There aren’t workplace accommodations for men experiencing the menopause transition alongside their partners.

The symptoms people talk about, hot flashes, brain fog, mood swings are the focus of a lot of conversations. And those symptoms are very real. But the symptoms don’t stop there. Each woman’s symptoms will vary across a plethora of symptoms (anywhere up to 100). Suddenly that person that was self-confident and had vision and focus, starts to shift. And that shift can bring with it a loss of confidence.

The Opportunity Millennials Have

For some women it isn’t all doom and gloom. For many they find that they have a new clarity about life. Lauren expressed this as:

“I feel like the best version of myself. I know myself. I don’t stand for bullshit anymore.”

What happens when a generation is more informed, more aware and better prepared for this transitional phase?

The symptoms don’t disappear. The hormonal changes don’t become less significant. The challenges to relationships, careers and identity don’t suddenly go away.

What changes is the experience of them.

Women recognize the signs earlier. Partners understand what they are seeing. Conversations happen sooner. Healthcare is sought earlier. Support arrives before years have been lost to confusion, self-doubt and misdiagnosis.

Preparation doesn’t prevent the menopause transition. It prevents people from facing it alone.

And perhaps that is the real opportunity for millennials. Not to avoid this life stage, but to become the first generation to enter it with the language, knowledge and support that previous generations were denied.

Thanks for reading The Quiet Transition! This post is public so feel free to share it.

You can connect with Lauren here:

Website

You can purchase her book Millennial Menopause here

Watch the full conversation

The Midlife Brief

Simon Salt — Fri, 29 May 2026 13:25:26 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

This Changes Everything

I don't want to talk about my bones...

I know it’s a bit of a boring topic. We can’t see or feel them. But we midlife women seriously do need to think and talk about our bones. I’ve been a bit hesitant to do this, but I’ll start by talking about mine…

a month ago · 13 likes · 5 comments · Niki Bezzant

Health Longevity Secrets

Perimenopause Is the Inflection Point Breaking Women’s Health

One of the core problems in healthcare today is that modern medicine keeps confusing “normal” with “healthy.” Nowhere is that distinction more damaging than in the way we treat women at midlife. My recent conversation with Dr. Mayoni Gooneratne took that idea and landed it with the precision of someone who has seen the consequences play out on the opera…

22 days ago · 24 likes · Robert Lufkin MD

Wise Woman Method by Alli Worthington

Sleep Divorce: why you suddenly can't sleep next to him

The American Academy of Sleep Medicine ran a survey of 2,007 adults last year and found that 31% of U.S. adults are now sleeping in a separate bed or a separate room from their partner. For couples in their late 30s and 40s, that number jumps to 39%. The trend has a name now. Sleep divorce…

15 days ago · 9 likes · 8 comments · Alli Worthington

The Breadwinners

A Love Letter to Your 40s (And Your Unhinged Hormones)

Nobody told me my nipples would hurt…

20 days ago · 5 likes · 1 comment · Alexis | The Breadwinners

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

Midlife

Helen Out of Office

Graduation Season: Midlife Moms Are Not Okay

Last year at this time, I watched my daughter graduate from high school. It felt like walking the plank. Like celebrating being fired. Rejoicing at my redundancy. But I was determined to feel the joy that accompanied her achievement…

18 days ago · 12 likes · 1 comment · Helen B

Lisa Hill

Why You Should Choose Identity Over Obligation

In my last article, The Midlife Success Formula, we explored identity as the engine behind high performance, and why alignment makes you more effective, more resilient, and more capable of building the life you want. This article turns more inward…

16 days ago · 15 likes · 8 comments · Lisa Hill

The Midlife Edit - with Dr White

Afraid this the beginning of the end?

Hello and welcome to Edition 6 of The Midlife Edit - with me, Dr White…

22 days ago · 25 likes · 7 comments · Dr White MBBS BSc (Hons) MRCGP

Anthony B. Bradley

The Quiet Crisis: Why Middle-Aged Men Are Dying

Somewhere between 35 and 65, something happens to men. It happened to me, and it happened to many of my friends: we hit our mid-40s or early 50s and started asking, “Is this it?” I hit a wall. Something happens to American men when they reach middle age. There’s a real crisis of meaning…

15 days ago · 39 likes · 8 comments · Anthony B. Bradley

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Why Menopause Isn't A Woman's Issue

Simon Salt — Wed, 27 May 2026 14:43:13 GMT

And Why It Is A Human One

Menopause is not a woman's issue

Simon Salt — Tue, 26 May 2026 13:25:52 GMT

I’ve been thinking a lot about how the impact of menopause ripples out from a woman.

It Starts Within

It starts with her symptoms, and how they have an impact on her and how she shows up.

That is the first ripple, the way her life changes. From the ever popularized “Hot Flash” and “Brain Fog” to the lesser known symptoms, the unexplained aches and pains, things like “meat ick”. The itchy ears. The mood swings and the irritability. The lessening of a desire to put up with things that have gone unsaid, perhaps for decades. Sensory overwhelm. A loss of interest in things that used to bring her joy. The sheer effort of holding it all together without support.

Each of these as symptoms on their own would be enough for most people. But there are anywhere between 35 & 100 symptoms, depending on which literature you are consulting. On any given day a woman can wake up with any combination of these or none at all. Without being able to predict which the day will bring.

The Relationship Ripple

The internal becomes interpersonal. The loss of physical and emotional intimacy, and the impact that has on the relationship she is in. The cycle of conflict. The strained communication. The sense of not being seen.

A confused partner who, without understanding and language may internalize and personalize the experience. Withdrawing just at the moment their partner needs them the most.

Men personalize because they have no other cues. If they can’t fix what is wrong then they are failing the relationship. Not realizing that there is nothing to fix. The distance they are feeling isn’t the relationship failing, it is a readjustment to a new reality. Without the knowledge they need they can’t engage in productive conversations. “I want to help, I just don’t know how”, is something I have heard from men when talking about their early experiences with the menopause transition.

They aren’t alone. Often their partner doesn’t know what help they want. They can’t express it, it comes out in pieces, sometimes emotionally laden and at other times so directly it leaves a mark.

The Weight of Daily Life

The interpersonal then becomes functional. Children, who suddenly find that Mom is somehow “different”. Domestic, emotional and physical labor become bigger issues. The answer to the evergreen question “What’s for dinner?” becomes less predictable. I’ve spoken to women who have said if they could have one major change in their lives it would be to never hear that question again. Not because they don’t enjoy the role of caregiver or even cooking. It is the emotional labor required to answer it. I have had conversations with men who say they help. They do the grocery shopping. Then it is pointed out to them, they didn’t check the pantry and the refrigerator or create a meal plan for the week or write the list that they took to the grocery store. And suddenly a light bulb comes on and they can see the weight of emotional labor their partner has been carrying. Not just recently but perhaps for decades. Then there is a school event that is missed off the calendar and suddenly Mom is unreliable. Aging parents that now require her to increase her caregiving. During menopausal age, it is common for couples to move into the “Sandwich Generation”, children are growing and perhaps leaving home, parents are aging and require more attention.

When Systems Fail

Then the functional becomes systemic. Dismissal by the medical system, a lack of belief, “you’re too young”, “your symptoms aren’t connected” etc. An overall lack of education. The stigma of “aging”. The expectation that women remain youthful to be functional, to have value. So women delay seeking help, they put it down to aging, to being over emotional. They double down on diet and exercise, trying to out run something they don’t recognize as being hormonal because they haven’t been given that information.

When medical care is offered it is often offered for “depression” and so anti-depressants are prescribed instead of a deeper more meaningful conversation happening. And this isn’t surprising given how little education most doctors receive about the menopause transition.

This translates into the workplace as well. HR policies and management systems that aren’t structured to help employees. Performance reviews become a solution to a woman whose performance has changed, without ever asking why. She doesn’t speak up because she is tired of justifying her symptoms and the way she feels or simply because she doesn’t want to be a burden.

That lack of support has bigger implications downstream for organizations. Women start to step back, presenteeism and absenteeism become more common. Women start to cut back on the load they carry and some even leave the workforce itself.

The Ripples Keep Moving

Ripples go out beyond these. The partner who is now feeling rejection and confusion takes that with them to their world. If they work then it can spill over into their work relationships. Suddenly that easy going co-worker or manager has become a bear to work with. People start to reassess whether they can continue to work with them. People don’t typically leave jobs, they leave managers. They react to stress without knowing the source. So companies start to see this impact as attrition, without even knowing why.

Children take this change to school or college, they see and feel the strain their mother is under, they experience the sudden strain of their parents relationship.

Marriages can become transactional, conversations focus on logistics and whose turn it is to carry out certain tasks. Constantly circling but not touching on the root cause of the distance.

All this can leave the woman unrecognizable to herself, not just physically, though that happens as well, but emotionally. Is she too difficult, asking too much? Has she simply become unreliable personally and professionally?

The impact may start with the woman but it ripples beyond her in many ways. And like all ripples they return to the center. And those ripples returning bring their own cost. The erosion of the sense of self.

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

The Midlife Brief

Simon Salt — Fri, 22 May 2026 13:25:29 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

HOPE For Menopause

Menopause & Insulin

Insulin…

22 days ago · 3 likes · Doc Mac

Nothing But The Truth

What's Wrong With Menopause?

“Blue Flower” by Georgia O’keeffe…

20 days ago · Evolutionary Menopause

What’s Happening to Me? Midlife and Menopause Reframed

Menopause Doesn’t Need Another Program

Many women reach midlife and notice a shift in their health. Energy changes, sleep is less predictable, and weight, mood, and focus shift in ways that are uncomfortable and often difficult to explain…

21 days ago · 10 likes · 3 comments · Patricia Mclelland MD

Dr. Corey Babb

The Partner’s Guide to Menopause

Why I’m Writing This Series…

a month ago · 2 likes · 3 comments · Dr. Corey Babb

Midlife

Letters To Midlife Women

Dear midlife woman who is tired of overthinking everything.

It starts innocently enough…

22 days ago · 14 likes · 4 comments · Letters To Midlife Women

Midlife Sentences

(Re)Emerging in Midlife

In my early twenties, my sister sent me a copy of The Highly Sensitive Person. I found the title embarrassing, so I kept it tucked between my dorm room mattress and the bed frame, only pulling it out occasionally to flip through when no one else was in the room. I never read the whole book (sorry, Anna), but I didn’t need to read the whole thing to conf…

a month ago · 4 likes · 5 comments · Katherine Van Dis

Midlife Adventure Club

my midlife gap year

A few weeks ago I was sitting on the floor in my favorite spot, next to the coffee table stacked with books, a bowl of gemstones and little treasures alongside my daily oracle card pull. The candle was lit, coffee with cream in my favorite diner style mug that reads ‘good energy’ and a picture of me with my dad when I was about 5 years old. This space…

a month ago · 42 likes · 33 comments · Melissa Abdine

Midlife Nomads

When the Roles That Organized Your Life Have Gone Quiet

A note: what I'm describing in this piece is not depression. If what you're feeling is depression — and there's no shame in that, I have a long history with it myself — please talk to someone qualified to help…

a month ago · 3 likes · Miranda Miller

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Millennials Meet Menopause - Simon (The Quiet Transition) & Lauren (Millennial Menopause)

Simon Salt — Thu, 21 May 2026 19:49:05 GMT

Thank you to everyone who tuned into my live video! Watch for the next live.

Available for iOS and Android

The Pill Bottle That Changed Everything

Simon Salt — Wed, 20 May 2026 13:25:18 GMT

And not in the way you might think.

When doing something starts making things worse

Simon Salt — Tue, 19 May 2026 13:25:36 GMT

I sat down with recently for a substack live. During our conversation Pat said, “They’ve been accustomed, they’ve wired their mind to be on the go all the time, to fix, to fire-fight…” and that made me think about how difficult stillness can feel for men who have spent their entire lives believing action is what makes them useful.

Why “just be there” feels impossible

As men we so often think in terms of solutions, to be the fixer. For some men that is how they were raised, for others it is something that is impressed upon them from society. However they acquire that way of thinking it becomes their go to for every and all situations.

This is especially true of the way they approach relationships, be they personal or professional. They want to be of help, or they simply want to provide a fix and move on. In many situations this works. Mostly it helps them. They can feel useful. That’s not to say their solutions or fixes don’t work, many times that is exactly what is needed.

The menopause transition provides a situation where solution providing, fixing isn’t possible, at least not in the way many men are used to doing. Women in the menopause transition aren’t broken, they aren’t a problem to be solved. This creates a tension in men. If their role isn’t to fix or solve then what is their role?

Suddenly, the paradigm through which they frame the world ceases to work. Usefulness equals action, action means solving. And now they are faced with a situation that requires them not to act. That stillness can feel irresponsible to men who have built their identity around fixing things.

Presence feels passive

Often what the woman wants is not a solution, not a fix, just a presence. To be seen and heard. To have their experience acknowledged. This is where tension can come in. Presence feels passive, even though it isn’t. For a man, realizing that there is no solution to this situation, that this isn’t just going to be resolved because of a few actions that they take can lead them to withdraw from the situation.

The withdrawal doesn’t come from a place of not caring, rather they withdraw because they don’t wish to do or say the wrong thing. It is a form of self-protection. And it happens at precisely the moment the woman needs support. Friction can feel as though it is inevitable. Silence becomes a norm, easier to not mention it than to say the wrong thing. Except silence itself feels dangerous.

Emotionally, this lack of action feels wrong. “If I care about this person, then I should be able to help, I should be able to make things better, I should be able to do something”.

The nervous system doesn’t know the difference

For some men, not knowing what to do sets up the same alarm system as any other unresolved threat. The nervous system can’t distinguish between the friction created externally by the unresolved relationship issues and being chased by a lion.

So the nervous system reacts. The most common way for it to react is to remove the man from the threat. Withdrawal, emotional avoidance, defensiveness. These now become the norm. Over time this heightened state can lead to things like hypervigilance, the replaying of every encounter.

Becoming steady instead of useful

What if the man can come to see that their role isn’t to provide solutions or fix things? What if the man comes to see that his role is to stay present without escalating the situation? That his role is to remain, even when things are uncomfortable or it strays into unfamiliar territory.

This steadiness, of remaining, of self-regulation may be the opposite of what he is used to. Ultimately, it achieves exactly what he was looking to do by being useful, identifying his role. A simple framework that I recommend for men is, Sit. Listen. Believe.

Find time to sit, not in the middle of dinner, or a chore. A time when you can both be present. Listen actively, not just waiting your turn to speak, but actively listening to what is being said and considering the impact of that. Finally, believe. Even if you’ve done your research, attended the training, read the book, believe the lived experience of the person in front of you.

Many men are led to believe that caring is best expressed through action. That being passive shows a lack of concern. Therefore it is easy for them to bring these two together and create a sense that “simply being” is showing a lack of care.

The menopause asks a different question of us as men. Can we remain present when there is nothing to fix?

Places where you can connect with Pat

Instagram

Substack

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

The Midlife Brief

Simon Salt — Fri, 15 May 2026 13:25:51 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

Dr. Kelly Casperson's Substack

The Top Takeaways from the 2022 Menopause Society Guidelines

If you’ve ever tried to make sense of hormone therapy (HT) and felt like you were lost in a swirl of conflicting opinions, you’re not alone. Science is messy. Innovation requires trying new things and challenging dogma. And here is some good news: in 2022, the North American Menopause Society (NAMS) - now renamed The Menopause Society - released a signi…

a month ago · 47 likes · 2 comments · Kelly Casperson, MD

Caffeinated & Perimenopausal

I Thought I Was Fine. My Hormones Said Otherwise.

You know that feeling where someone asks you one more question… and you can physically feel your patience leave your body…

a month ago · 12 likes · Caffeinated & Perimenopausal

This Is Perimenopause

They need us to believe our best days are behind us.

What if everything you've been told about aging is a lie…

a month ago · 1 like · Mikelle & Michelle

Elayne Kalila

Perimenopause Is Your Second Puberty

THE HYSTERICAL RECKONING SERIES | ARTICLE SIX…

a month ago · 37 likes · 6 comments · Elayne Kalila

Midlife

Midlife Strong

Can You Trust Your Hunger in Midlife?

In my twenties, I became an intuitive eater by accident. Ironically, it happened during my 10-month internship to become a dietitian…

a month ago · 17 likes · 13 comments · Maryann Jacobsen

Midlife, Together by Dr. Heidi

Your Brain Is Not Declining. It’s Being Neglected.

I remember the moment clearly. Exiting the shopping center, I suddenly couldn’t remember how I got there. I am not talking about where did I park my car, as the rows all look the same. Losing sense of which car to look for and where was a much deeper disorientation…

a month ago · 1 like · 2 comments · Midlife, Together by Dr. Heidi

Unfucking Midlife & Sobriety

Midlife Women, Wine, and the 3am Wake-Up

I asked everyday women what the number one motivating factor was for them when it came to giving up alcohol or cutting back and they all said the same thing: sleep. Which is ironic because those same women, myself included when I was drinking, were reaching for it to… unwind, relax, let go and sleep better at night…

a month ago · 28 likes · 2 comments · Ashley Kelsch

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

Where To Turn Next

Simon Salt — Thu, 14 May 2026 13:25:56 GMT

Most people don’t struggle because support doesn’t exist.

They struggle because they don’t know what kind of support they need.

When communication starts to feel off, it’s not always clear where to turn, or what would actually help.

This is a simple guide to a few places people start, depending on what’s really going on.

Table of Contents

When Communication Starts To Break Down

Conversations don’t land the way they used to.

Things escalate more quickly or shut down completely.

Trying harder to explain often makes things worse, not better.

This is where structured support around communication can help.

Here are some places you can start today.

Growing Self

Best for:
When communication issues are part of a bigger relationship shift

What they help with:
Couples therapy and coaching grounded in structured communication work (including Gottman-informed approaches)

What partners should know:
They offer online couples counseling, which makes access easier than traditional therapy practices

Thriveworks

Best for:
When you want quick access to licensed couples therapy

What they help with:
Connecting you with therapists (some Gottman-trained) across a large national network

What partners should know:
They accept over 360 insurance plans, which can make access easier and more affordable than many private practices

Regain

Best for:
When you want fully online couples therapy without a long search process

What they help with:
Ongoing therapy that creates space for both people to be heard, with flexible access

What partners should know:
Operates on a weekly subscription (cancel anytime), typically ranging from $70–$100 per week.

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When you don’t know what’s happening

Even when support is directed at one person, the clarity it creates often changes things for both.

Midi Health

Best for:
When you need clear, medical context for what might be happening

What they help with:
Virtual menopause care focused on symptoms, treatment options, and understanding physical changes

What partners should know:
This support is focused on her health—but it often provides the clarity that helps both of you make sense of what’s changing

Gennev

Best for:
When you want both medical insight and practical guidance in one place

What they help with:
Access to menopause-trained doctors and coaches who can help make sense of symptoms, treatment options, and day-to-day changes

What partners should know:
This support is focused on her experience, but the combination of medical and coaching guidance can make it easier for both of you to understand what’s happening and how to navigate it.

Evernow

Best for:
When you want a simple, direct way to explore treatment options

What they help with:
Online menopause care focused on symptom relief and hormone therapy, with a streamlined, easy-to-follow approach

What partners should know:
This is a more direct, treatment-focused option, but gaining clarity around symptoms and options often helps reduce confusion and tension for both of you.

Nila

Best for:
When you have a specific question and don’t know where to start

What they help with:
AI-powered menopause information designed to provide evidence-based answers about symptoms, treatments, and the menopause transition

What partners should know:
This can be a useful first stop when you’re trying to make sense of a specific symptom or concern, but it shouldn’t replace personalized medical advice

When you don’t understand your role in this

Without a clear understanding of your role, it’s easy to move between doing too much and not enough.

This is where the focus shifts. From trying to fix the relationship to understanding your place within it.

BetterHelp

Best for:
When you need space to think clearly without reacting in the moment

What they help with:
One-on-one therapy focused on your own experience. How you’re interpreting what’s happening and how you’re responding to it

What partners should know:
This isn’t about fixing the relationship, it’s about having somewhere to step out of it briefly so you can return with more clarity.

Man Talks

Best for:
When you want to hear how other men are navigating similar experiences

What they help with:
Conversations and coaching focused on emotional awareness, relationships, and identity

What partners should know:
This can help normalize what you’re experiencing, especially if you’ve never had language for it before.

ManKind Project

Best for:
When you want to better understand how you show up in relationships

What they help with:
Workshops and men’s groups focused on self-awareness, emotional responsibility, and how your patterns affect the people around you

What partners should know:
This isn’t therapy. It’s structured personal development that can help you see your role more clearly and respond more intentionally.

Books, Podcasts & Trusted Voices

Dr Mary Claire Haver

Dr Kelly Kasperson

Tamsen Fadal

Podcast
Book - How To Menopause

Cynthia Thurlow

Podcast
Book - The Menopause Gut

The Perimenopause Hub

Let’s Talk Menopause

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It Must Be Me

Simon Salt — Wed, 13 May 2026 14:33:41 GMT

It Usually Isn't

There's Nothing Wrong With You

Simon Salt — Tue, 12 May 2026 13:25:01 GMT

In my recent conversation with he said something that I’ve been thinking about since then - “It’s not that they think they’re causing the problem. They think there’s something fundamentally wrong with them.”

What does that feel like for a man to have the belief that there is something fundamentally wrong with them? It can manifest as a lack of confidence in their role in the relationship, this can roll over into other aspects of their life. They start to second guess what they actually bring to the table, if anything.

Men Think They Are Fundamentally Flawed

At the core of this is the fact that men often take on changes in their relationship as something personal. As Ramiro pointed out, they think there’s something fundamentally wrong with them. This personalization starts early as things start to change.

There is the sensation that something is off but they can’t quite put their finger on it. That the relationship “looks good on paper”, on the surface everything is continuing as it has always done and at the same time things are moving in an unexpected direction.

What isn’t happening is men saying “maybe it’s me” out loud. They internalize these feelings. If they externalize them, say them out loud, then they might have their worst fears confirmed. That it is them. They are the problem. So these thoughts stay internal, unspoken and unaddressed.

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Becoming Hypervigilant

This leads to changing behaviors in them, they start to examine every interaction, every word said, everything left unsaid. They become observers of their own actions and of their relationship. None of this is done externally, it is all internal at this stage. They are becoming hypervigilant.

This hypervigilance isn’t created out of a fear of conflict. They aren’t monitoring what they say or what is being said to them, simply so they can defend their position. In fact, the opposite is true, what they fear most is abandonment. That their partner is disengaging because they have somehow discovered “who they really are,” and that can create feelings of being unlovable, undesirable.

If that inner person is discovered, then the relationship might end. Because this self-blame and internalization of the change being their fault leads to that conclusion. In reality, this hiding and withdrawing is the opposite of what their partner most likely needs. They are more likely to be seeking an engaged partner who is ready to support them.

As this continues, the amount of safety in the relationship declines and the threat level increases. Without feelings of safety, there can be no vulnerability. Without vulnerability, everything stays internal and hidden. The only safe action is to withdraw.

That withdrawal leads their partner to feel unsupported. It is hard to open up to someone who has emotionally withdrawn from the relationship. Even if they are doing it because they perceive it as the only way to keep themselves safe.

The Turtle Withdraws Into Its Shell

Ramiro used the analogy of a turtle. A man withdraws into his shell when he feels unsafe in the relationship. Safety isn’t something that is restored instantly, it’s a gradual process. Small conversations about nothing in particular, shared moments, experiences, and even memories, can lead him to slowly poke his head out of the shell for a moment. Just because he feels safe at that moment doesn’t mean he won’t withdraw again. He is still checking for feedback that he isn’t actually the problem.

The biggest danger to the relationship is the creation of a sense of isolation. Of being alone with these feelings and not being able to communicate what he is experiencing. Ramiro pointed out that often, the first person to offer that space to communicate might be another person. That affairs often begin not because of physical desire but rather because a space is created for emotional safety to appear.

Given that this change happens over years, possibly a decade or more, creating a sense of safety for both partners is essential. Allowing a space where both can bring their perspectives on how the change is impacting them.

Once a man realizes that this change is not because of their failings, not because they are inherently flawed, but because it is a life stage that is best faced together, then safety evolves, and the relationship can start to feel like a partnership once more.

You can connect with Ramiro in the following places:

YouTube

Website

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The Midlife Brief

Simon Salt — Fri, 08 May 2026 13:25:58 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

Hormonal Rage & Other Breakthroughs

My Perimenopause Meltdown Turned Out to Be a Gift

When I left my career in New York City for the south, I brought my Excel spreadsheets and expectations for perfection (from myself and everyone else) with me. I had no idea of the breakdown waiting for me in the Scrapbook and Paper Crafts aisle of the Hobby Lobby…

2 months ago · 8 likes · Kerri Devine

The Therapist Who Came Undone

Perimenopause: The Fine Print

If you’re squeamish about “women’s issues,” you may want to stop reading now, because I’ve decided to write candidly about perimenopause, and quite frankly, she’s no joke…

a month ago · 57 likes · 84 comments · The Therapist Who Came Undone

Divergent Menopause

The Divergent Menopause Q&A: Jenn Lyster

Are you autistic or ADHD and suddenly can’t cope like you used to…

a month ago · 5 likes · 1 comment

In The Pause Life

What the Pause Taught Me About Pleasure

I made myself a proper dinner on a Thursday…

a month ago · 3 likes · Tew Green

Midlife

NatalieJillFit

The Protein Lie Midlife Women Have Been Told

The Protein Lie Midlife Women Have Been Told (And What to Do Instead) with Angelo Keely…

a month ago · 1 like · NatalieJillFit

The Practice of Self-Leadership

The Breadcrumbs Were There All Along

Looking back, the breadcrumbs feel obvious now…

a month ago · 1 like · Dr. Deonne Johnson

MUM. CEO. WTF.

Women in Midlife Are a Menace

I thought it might just be me. The ferocity of these feelings. The dangerous desire to poke holes in my own skin while skinning alive any sense of stability, or at least the people that placate me enough to safeguard the status quo…

a month ago · 29 likes · 12 comments · Amy Mowafi

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When there's nothing to fix, what does he do?

Simon Salt — Thu, 07 May 2026 16:47:20 GMT

When men are used to solving problems, being told to “just be there” can feel deeply counterintuitive. In this conversation, and I explore why uncertainty can trigger a threat response in high-achieving men, and how presence, regulation, and curiosity can become more powerful than trying to fix everything.

This conversation is part of an ongoing series exploring men’s responses to the menopause transition.

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Available for iOS and Android

It's Not Happening to Her

Simon Salt — Wed, 06 May 2026 13:25:50 GMT

It's Happening Through Her

The Pill Bottle That Saved My Relationship

Simon Salt — Tue, 05 May 2026 13:25:48 GMT

When It Started to Change

When my wife first started to experience perimenopause symptoms she didn’t know what they were. The sleeplessness, the sudden changes in mood, the strange hip pain that appeared out of nowhere.

Successive doctors dismissed her symptoms as aging, diet, the need for more exercise, even repeated UTI’s. Her labs were “normal”. You probably aren’t that surprised by this. Most doctors aren’t trained well, if at all, to recognize and be able to diagnose women in the menopause transition.

When It Became About Me

One of the side-effects of her symptoms was a withdrawal from intimacy. Not just physical, but emotional intimacy. Like most men I used that intimacy as a barometer for the health of the relationship. Without it to measure our relationship, I immediately jumped to the conclusion that the relationship was failing. And if it wasn’t my wife that was the problem, after all her labs were normal, then the problem must be me.

Personalization is not an uncommon reaction in men to changes in a relationship. It becomes about you, as a man, not part of a bigger transition within the relationship. This is certainly where I went. There was no other explanation in my mind. That led me to question why it was my fault. Was I doing things wrong? Was I no longer attractive? Was it because I was not as successful in my work as she was? How was I failing her and our relationship, and what could I do to fix it?

Finally, a Name for It

This struggle continued for four years, before my wife finally met a doctor who recognized her symptoms, not as a series of unconnected ailments but holistically and as part of one transition. Finally my wife was getting answers and offered options to how she might better cope with these symptoms.

Now we had language that could be used to describe what was going on. Perimenopause was the guilty party, not me. What didn’t happen with this new knowledge was a reset to our relationship. The intimacy was still lacking, and so I was still unsure of what Perimenopause meant for our relationship.

Was this just how things were in relationships that reached this point in life? Were we doomed to simply drift along becoming little more than roommates? The problem I was facing was I had a list of symptoms, I had language, I could even describe what some of the symptoms meant. I knew what a hot flash was, I even had an idea of the biology involved behind them.

What I Was Missing

What I was missing and this is the piece I think a lot of men miss, is what did that mean for my wife. What was a hot flash like for her, not what was it described as on a website, or by an influencer. I didn’t ask those questions. I was still at the personalization stage. This is happening to me and now I have to live with it.

This continued for another two years. I wasn’t asking the right questions, she was overloaded and overwhelmed by this transitional stage in her life. She didn’t have either the capacity or the mental bandwidth to educate me as well as herself.

She eventually made the decision, after discussion with her doctor, to try Menopausal Hormone Therapy (MHT). Before I continue, yes this was a privileged decision, MHT is not available to all women, for some it isn’t a viable option medically and for many it isn’t a financial option. It was, however, a pathway that was available and viable for my wife.

She started with a pill based treatment. For her this was real progress. She now had a doctor who listened to her, believed her symptoms were real and wanted to help her. What she didn’t have was a partner who was doing the same things.

At this point I was still stuck in the “Why is this happening to me?” stage. Even though I now knew I wasn’t failing the relationship in the way I thought I was, I was still personalizing it. I was missing an important piece of the puzzle, my wife’s lived experience. It hadn’t occurred to me to step outside my experience of this situation and try to see what her experience was.

My wife is very logical. She is a scientist. She deals in facts. I’m an artist, I deal in emotions. Some people would say we aren’t a good match. But the fact is we complement each other in many ways. She brings a grounded approach to situations that I sometimes am too deep in emotions to see properly. I help her see the humanity in situations that she might have only seen data in.

Being a logical person, she isn’t prone to emotional outbursts. She is very measured in her response to almost every situation. I don’t mean to paint a picture of an emotionless person without empathy. She is one of the most empathetic people I know, she just doesn’t lead with emotion.

We were discussing our relationship in broad terms one day, in of all places, the kitchen. I don’t remember the exact conversation, but I do remember that our positions were entrenched in our way of viewing things. I was very emotional about the situation, she was very practical about it.

But as the conversation carried on, she became increasingly agitated. She couldn’t understand why, if I was so connected to emotions, that I couldn’t see what she was going through.

And then came the break.

She picked up her bottle of pills and threw it at me.

The Pill Bottle Between Us

I stood there stunned. Never once in our relationship had she ever shouted at me, let alone thrown something. And suddenly everything snapped into focus. I understood what I had been missing, by personalizing the stage we were going through I had missed her experience completely.

The pill bottle lay between us. It could have so easily marked the breaking point in our relationship.

Instead it became a bridge bringing us closer together. For something to have caused her to snap so completely it must be very serious. I started to ask the right questions. She started to see how I was experiencing loss.

Over time, we’ve rebuilt our relationship on a new understanding. Intimacy returned as we both re-discovered what that meant for us. She has continued on her MHT journey and, while still experiencing various, and sometimes, completely random symptoms, she is now able to communicate those to me in ways that help me understand the how, not just the what.

In turn I took on the task of educating myself. I am a voracious reader. And so I read and read. Dug deeper and deeper so that I could better understand what we were facing.

We aren’t a perfect couple, I don’t believe there is such a thing. But we are better communicators.

And I have a pill bottle, both a physical reminder and a metaphoric reminder of where we were and how far we have come.

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The Midlife Brief

Simon Salt — Fri, 01 May 2026 13:25:54 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

Liberating Motherhood

It's not perimenopause. It's patriarchy.

I’m currently surveying readers about their experiences with sex, and will release the data soon. Participate by clicking this link. I’m also surveying women about their relationship preferences. Take that survey here…

2 months ago · 284 likes · 16 comments · Zawn Villines

Dr. Jones' Hello Hormones Substack

Has Your Anxiety Increased in Perimenopause?

Recently I did an estrogen and progesterone Q&A that was filled with wonderful questions about how to take them, dose them, side effects, etc. In there, I was also asked about anxiety specifically as it relates to the decline in progesterone…

a month ago · 11 likes · 3 comments · Dr. Carrie Jones

Truly in Progress...

Perimenopause broke me enough to finally take my vitamins

Truly in Progress... Week 1…

2 months ago · 16 likes · 7 comments · Taryn Truly

Suzanne’s Substack

My Top Ten List of Insomnia Tricks for Perimenopause

Trouble falling asleep, staying asleep, feeling rested; insomnia is a common topic of conversation with my patients, family, and friends. Defined as a dissatisfaction with sleep quantity or quality, and associated with difficulty initiating or maintaining sleep or with early-morning awakening, the…

2 months ago · 4 likes · 2 comments · Suzanne BartlettHackenmillerMD

Midlife

MidLife Musings

A Good Listen

At any given moment, I’m reading one book and listening to another…

a month ago · 1 like · 1 comment · Midlife Musings

Midlife Strong

The Ideal Body Fat % Myth We’ve Been Sold in Midlife

I was scrolling on social media when I saw a post stating that, for optimal cardiometabolic health, women in their 40s and 50s need to have 18–24% body fat…

2 months ago · 29 likes · 10 comments · Maryann Jacobsen

The Midlife Renaissance

Archetypes in Midlife: The Woman You’ve Been, The Woman Emerging

What Archetypes Actually Are…

2 months ago · 6 likes · Carla Moss, NBC-HWC & Founder

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