There is a particular kind of exhaustion that comes from spending years believing your body is something you should be able to manage.
You learn to push through the tiredness because there is work to finish, children who need you, parents who need you, emails waiting to be answered, and a house that somehow continues to need cleaning no matter how many times you clean it. You learn to ignore the headache, postpone the appointment, eat when you remember, sleep when you can, and tell yourself that next week will be different. You become remarkably good at functioning, even when functioning is costing you something.
Then somewhere around midlife, the old arrangement starts to feel harder to maintain. Sleep changes. Energy changes. Recovery changes. Your mood may feel less predictable. Your relationship with food, movement, stress, your body, and even your own sense of vitality can begin to shift. And because we have been taught to see health through the lens of performance, our first instinct is often to ask what we are doing wrong.
Perhaps we need a better diet. A different supplement. More exercise. Less exercise. More protein. Fewer carbohydrates. A new wearable. A hormone test. A stricter bedtime. A more disciplined morning routine. Another podcast. Another expert. Another protocol.
The irony is that midlife can become the moment when we are most desperate to care for ourselves and simultaneously most likely to turn self-care into another job.
So I wanted to ask a different question.
What if the problem isn’t that women don’t know enough about health? What if, after decades of information, advice, and increasingly sophisticated wellness products, what we are missing is a different relationship with our own bodies?
For this week’s Health & Overall Well-being conversation during Midlife by Design, Not by Default Awareness Month, I brought together four women who approach midlife health from different professional perspectives but arrive at some surprisingly powerful common ground: Stacy Naugle, EAMP, Karen Barry, Dr Natalya Borakowski, and Dr Trisha Schimek.
What emerged wasn’t another list of things women should be doing; it was something much more interesting.
A conversation about attention, agency, self-respect, capacity, curiosity and the possibility that caring for ourselves in midlife might require us to stop treating our bodies as problems waiting to be solved.
We became very good at overriding ourselves
Perhaps the most important place to begin is with something many women don’t recognise as a health behaviour at all: how often we ignore ourselves.
Dr Trisha Schimek describes the years before midlife as a period in which many women become extraordinarily skilled at working through hunger, too little sleep, exhaustion and pain. We adapt. We carry on. We learn that being dependable often means putting our own needs somewhere near the bottom of the list.
Dr Natalya Borakowski sees something similar in the way women can come to relate to their bodies through performance. We have absorbed ideas about what a successful woman looks like and how she should function: productive, capable, thin, energetic, caring, and somehow able to do all of it without becoming inconvenient.
There is something deeply revealing about that word: inconvenient. Because how often have women learned to experience their own bodies as inconvenient when those bodies need rest, attention, food, treatment, pleasure, or simply a slower pace?
Stacy Naugle argues that one of the first steps towards rebuilding our relationship with our bodies is to pay attention without immediately trying to fix what we notice. Fatigue, poor sleep, appetite changes, cognitive changes, and reduced recovery are not moral failures. They are information. They may not tell us the entire story, but they are worth listening to.
Karen Barry approaches this through awareness, education, and choice, drawing on an Ayurvedic perspective that asks us to become more observant of the whole person rather than immediately reaching for an intervention. Before we decide what to do, we need to become curious about what is actually happening.
That sounds deceptively simple.
For women who have spent decades being rewarded for coping, it can be revolutionary.
Because there is a difference between noticing that you are exhausted and immediately deciding that you need to override the exhaustion, and noticing that you are exhausted and becoming curious about what your body is trying to tell you.
One approach asks, How do I make this stop? The other asks, What is this telling me? That shift in question may be one of the most important health changes we can make at midlife.
Midlife is not an optimisation emergency
We are living through an extraordinary moment in women’s health. There is more conversation, more research, more awareness, and more willingness to talk openly about experiences that previous generations were often expected to endure in silence.
That is progress.
But somewhere along the way, awareness has collided with an enormous wellness industry that has become very good at convincing women that there is always one more thing they should be doing.
Dr Borakowski is particularly critical of what she describes as treating midlife like a “personal optimisation emergency”, where restrictive diets, prolonged fasting, excessive exercise, supplement regimens, hormone testing, wearables and endless online advice can create the impression that the right combination of interventions will finally allow us to control every variable.
The problem is that health is not a spreadsheet.
Stacy makes a similar point from a metabolic perspective, encouraging women to stop collecting protocols before they have even understood their own patterns. Instead of jumping from symptom to solution, she wants us to look at the bigger picture: energy, sleep, cognition, appetite, recovery and our ability to meet the demands of our actual lives.
Dr Schimek brings the same principle back to basics. Rather than believing we are one supplement, wearable or perfect routine away from becoming healthy, she encourages women to return to foundational behaviours and repeat them consistently. Nourishing food, adequate sleep, movement, stress relief and supportive relationships may not be particularly glamorous, but health rarely requires us to make our lives more complicated than they already are.
Karen adds another important dimension: comparison itself can be depleting.
We are constantly looking at someone else’s morning routine, body, diet, supplement stack, exercise regimen, or apparent energy and wondering why we cannot replicate it. But we don’t inhabit her body, her history, her circumstances, or her constitution.
Designing midlife means resisting the temptation to outsource our understanding of ourselves. The question is not, What is she doing that I should be doing too? It is: What is true for me?
That distinction matters because self-care can quietly become self-surveillance. We can begin tracking our calories, steps, sleep scores, weight, workouts, and supplements so closely that the act of caring for ourselves starts to feel like being monitored by a particularly demanding manager.
And that manager lives in our own heads.
Hormones matter. So does the rest of the woman.
One of the most useful threads running through the experts’ responses is the refusal to create a false choice between hormones and everything else.
Midlife health is often discussed as though we have to decide whether a symptom is “hormonal” or caused by stress, lifestyle, or something else. But the human body doesn’t organise itself into neat categories simply because we would find that convenient.
Stacy describes stress and hormones as interconnected systems that can affect and amplify one another. Dr Schimek similarly explains that hormonal fluctuations during the menopause transition can influence temperature regulation, sleep, mood and stress response, while chronic stress and inadequate recovery can intensify experiences such as anxiety, irritability, brain fog, palpitations and hot flushes.
Dr Borakowski makes an equally important medical point: hormones genuinely affect multiple systems, including thermoregulation, sleep, mood, cognition, bone, muscle and the genitourinary system. At the same time, a single laboratory result cannot necessarily explain what a woman is experiencing, particularly during a period when hormones can fluctuate considerably.
This is where good healthcare matters.
Not because every symptom is hormonal, but because women deserve a thoughtful assessment rather than a reflexive dismissal in either direction.
“Just stress” shouldn’t be the end of the conversation.
“Just hormones” shouldn’t be the end of the conversation either.
There can be other explanations worth considering, including thyroid problems, iron deficiency, sleep apnoea, depression, medication effects and metabolic issues. The answer isn’t to panic about every symptom or demand every possible test. It is to take our observations seriously enough to ask good questions and seek appropriate professional evaluation.
That, too, is part of designing midlife.
Sleep isn’t just about going to bed earlier
Sleep may be where this becomes particularly obvious.
We talk about sleep as though it is a simple equation: go to bed earlier, put your phone down, get eight hours and wake up refreshed.
But the women I spoke to paint a much more complicated picture.
Sleep can be affected by hormonal fluctuations, night sweats, pain, bladder symptoms, anxiety, hyperarousal, restless legs, sleep apnoea, stress and metabolic factors. Sometimes the problem isn’t that you aren’t trying hard enough to sleep. Sometimes your body is giving you information that deserves investigation.
Dr Schimek’s point that the cause of disrupted sleep matters is important because it moves us away from self-blame. If your sleep is being interrupted because of night sweats, for example, the answer may be different from the answer for someone experiencing chronic insomnia or sleep apnoea.
Karen brings the conversation back to the whole system, encouraging women to create grounding rituals and a calmer transition into sleep rather than treating bedtime as another performance target.
There is something lovely about that distinction. Instead of asking, How can I make myself sleep perfectly tonight?, perhaps we can ask, How can I help my body feel safe enough to rest?
The first sounds like a task. The second sounds like care.
What if health became an act of self-respect?
This may be the deepest shift the experts are asking us to make.
For years, health has often been presented as self-discipline. Eat the right things. Do the right exercise. Maintain the right weight. Track the right numbers. Follow the plan. Be consistent.
There is nothing inherently wrong with discipline, of course. But discipline without compassion can become punishment dressed up as wellness.
Dr Borakowski makes a distinction between health self-management and health self-respect that stayed with me. Self-management asks, How do I keep functioning? Self-respect asks, What does my body need so that I can live the quality of life I actually want?
That is a very different question.
Dr Schimek similarly frames the shift as self-compassion. Rather than treating health as another job we have to perform perfectly, she encourages women to ask what would be kind and nourishing for their bodies today.
Stacy takes us back to the same principle through the idea of vitality. Movement, nourishment, and recovery are not simply tools for keeping the body functioning at an acceptable level. They are ways of supporting the life we want to live.
Karen reminds us that nourishment itself is much bigger than food. It includes digestion, emotions, lifestyle, connection, pleasure, beauty, meaningful experiences, and the relationship between mind, body, and spirit.
And suddenly health becomes less about shrinking, correcting and controlling the body and more about creating the conditions in which a woman can inhabit her life fully.
That feels like a very different definition of well-being.
Movement should give something back to you
There is another place where midlife asks us to reconsider the rules we inherited: movement.
Exercise has spent decades being marketed through punishment: burn the calories, earn the meal, push harder, don’t quit. No pain, no gain.
But the experts are much more interested in movement that supports the woman rather than punishes her.
Strength matters. Cardiovascular health matters. Mobility, balance and maintaining physical capability matter enormously, particularly as we age. But Dr Schimek emphasises that movement needs to reflect a woman’s current capacity and what she actually enjoys. Stacy similarly argues for an amount of movement that we can recover from, and that contributes to vitality rather than leaving us depleted.
That word, recover, deserves more attention.
Because perhaps one of the most significant midlife shifts is realising that the workout isn’t the whole story. What happens afterwards matters too.
If we continually demand more from our bodies without giving them enough recovery, nourishment and rest, we are not necessarily becoming healthier simply because we are doing more.
Karen’s idea of “Walk Your Wisdom” captures another dimension of movement: the possibility that walking can become not just physical exercise but an opportunity for an inner conversation. There is something wonderfully midlife about that.
Movement doesn’t have to be another place where we disappear from ourselves; it can become a way of coming back.
Being heard is part of being healthy
Perhaps no conversation about women’s health is complete without talking about what happens when we seek professional help and don’t feel heard.
Dr Schimek believes women should leave a healthcare consultation understanding what their clinician thinks may be happening, what has been ruled out and what the plan is. Dr Borakowski similarly emphasises that being heard does not mean a clinician has to agree with every requested test or treatment. It means the symptoms have been taken seriously, the reasoning has been explained, and appropriate possibilities have been considered.
That is an important distinction.
Good healthcare isn’t about telling us exactly what we want to hear. It is about being listened to carefully enough that our experience becomes part of the clinical picture.
Dr Schimek suggests asking questions such as what else could be causing a symptom and how those possibilities have been assessed. Dr Borakowski encourages women to describe what changed, when it changed, how it relates to their menstrual pattern where relevant, what makes it better or worse, and how it affects daily functioning.
And if something doesn’t feel right, seeking another perspective can be an act of self-trust rather than an act of confrontation.
We don’t have to become experts in medicine to advocate for ourselves, but we do, however, need to believe that our experience is worth describing.
Nourishment is everything that makes life feel like life
Perhaps my favourite thread through this conversation is the expansion of the word nourishment.
Because once we stop reducing health to food, exercise and medical interventions, an entirely different picture emerges.
Dr Borakowski includes sleep, daylight, movement, touch, meaningful relationships, sexual wellbeing, psychological safety, boundaries, recovery and those precious periods when nobody needs anything from you.
Dr Schimek talks about connection, being outdoors, play, intimacy and reconnecting with our wants, desires and values.
Karen brings in pleasure, beauty, emotional wellbeing and the broader relationship between our daily lifestyle and our sense of balance.
Stacy reminds us that nourishment is also about what restores us, not simply what we consume.
This feels especially important for women because so much of our lives can become organised around giving.
We nourish everyone else.
We create the meal.
We remember the birthday.
We make the appointment.
We carry the emotional load.
We answer the message.
We notice who is struggling.
We keep the family moving.
And then we wonder why our own reserves feel empty.
Perhaps midlife well-being requires us to stop defining nourishment as something we earn after everything else has been done. Perhaps nourishment is part of the life itself.
The body is not a project. Neither are you.
Across four very different perspectives, I kept hearing the same underlying invitation: become curious again.
Not obsessive, fearful, or hypervigilant, but curious.
Notice what is changing. Pay attention to patterns. Learn enough to make informed choices. Ask better questions. Seek help when something doesn’t feel right. Build foundational habits. Move in ways that support your body. Rest without having to justify the rest. Eat in a way that nourishes you. Protect your capacity. Make room for pleasure. Pay attention to your emotional health. And perhaps most importantly, stop assuming that every change in your body is evidence that you have failed.
Dr Borakowski offered one of the most powerful reframes in the entire conversation: the goal isn’t to respond to every change with more intervention, but to understand what matters most now.
That may be the heart of health by design. Because designing your midlife doesn’t mean designing a perfect body. It means designing a life in which your body has a place.
A life where you don’t have to abandon yourself in order to keep everyone else comfortable. A life where rest isn’t a reward for exhaustion. A life where movement isn’t punishment. A life where seeking medical help isn’t an admission of weakness. A life where nourishment includes pleasure, connection, and recovery. A life where your changing capacity is information rather than an inconvenience.
And perhaps, after decades of asking our bodies to keep up with the lives we built, midlife gives us an opportunity to ask a more compassionate question.
Not, “How do I make my body behave?” But “What kind of life would allow this body, this woman, at this age, in this season, to feel supported?”
That is a very different starting point, and maybe that is what it means to begin designing health rather than managing it by default.
September is Midlife by Design, Not by Default Awareness Month, something I created because I believe we need a different conversation about midlife.
For so much of our lives, we become incredibly good at responding to what is needed of us. We build careers, raise families, care for others, navigate change, and keep everything moving. Then midlife arrives and, often for the first time, we start asking: Who am I now? What do I actually want? What do I want the next chapter of my life to feel like?
I don’t believe those questions mean something has gone wrong. I think they mean we’re paying attention.
Midlife by Design, Not by Default is about making conscious choices about the life you’re living now, rather than continuing on autopilot simply because that’s how you’ve always done things.
Throughout September, I’ll be exploring five areas at the heart of Midlife by Design with in-depth essays and expert interviews: Personality & Self-Discovery, Health & Wellbeing, Relationships & Connections, Money & Purpose, and Quality of Life.
And to celebrate the month, I’m offering 20% off monthly, annual, and Founding Inner Circle memberships throughout September.
If you’ve been feeling that quiet pull to do things differently, perhaps this is your invitation.
Because midlife doesn’t create the woman you’re becoming; it reveals her x