The presenter mentioned a few nonpharmaceutical options, including black cohosh, evening primrose oil, and CBT. But the primary tools were pharmacological hormones and antidepressants. When I shared that the side effects of these treatments were too much for me and significantly affected my mental health, there wasn’t much else to offer.

I left feeling like I’d attended a corporate meeting where everyone had been handed the same Kool-Aid. It was FDA-approved, evidence-based, and considered the standard of care. And if your body or brain couldn’t tolerate it? Well, that was unfortunate.

These are caring, highly respected professionals who genuinely want to help women. That’s what makes this so frustrating. How easily can we accept a limited set of treatment options as sufficient simply because they’re established, approved, and familiar? Especially when so many women are saying it doesn’t work for them, or makes them feel worse? Why is that ignored?

Evidence matters. But so does clinical curiosity. So does the willingness to acknowledge uncertainty, individual differences, and the limitations of our current approaches.

We are the physicians and mental health providers caring for women. We have to do better than offering the same solutions and leaving women behind when they don’t work. We are part of an evolving field.

When did we stop demanding better?

Would we consider this acceptable care for our daughters and granddaughters? Would we tell them that if the standard treatments made them feel worse, they should simply accept that there were no other options?

If not, why do we accept it for ourselves?

Women deserve more than a standard of care that works for some and leaves others struggling. We deserve providers who keep asking questions, exploring possibilities, and pushing beyond what is familiar.

If we want better for the next generation of women, we have to start demanding better for ourselves.

What if there were explanations for what we were experiencing, and perhaps even solutions, but we spent generations being ignored and, more painfully, learning to ignore ourselves?

I have a PhD in clinical psychology, and much of my professional life has been devoted to understanding psychopathology: how we recognize psychological symptoms, how we make sense of distress, and how we determine when and why people need help. Yet professional training does not make us immune to the experiences we study. As a woman navigating perimenopause, I have found myself trying to understand what is happening to my brain, why I feel like I am losing it some days, and whether my brain will eventually come back.

I want to write honestly about this experience. Not because I have all the answers, but because I have questions that seem worth asking. What happens when changes in our bodies affect how we feel, think, and experience the world, but we lack the information or support to understand those changes? How much of our distress is compounded by not knowing what is happening to us, or trying to ignore it? And how often do women learn to question themselves before anyone thinks to question if something is really wrong, or treatable?

As a mother with daughters, I hope that someday this writing feels archaic. Bizarre, even. I hope future generations read about what women experienced in their forties before 2030 with some of the same disbelief I feel when I look back at the history of psychiatric treatment, including the ways people with severe mental illness were misunderstood, stigmatized, and subjected to harmful interventions. The experiences are not the same, but I wonder what future generations will think about us, and question why we didn’t give more attention to something that profoundly affects a large portion of humans? Will they ask, what happened to women in their forties before 2030? Did they really experience so much uncertainty with so little support? Why did so many women suffer and assume it was normal? Why weren’t their concerns taken more seriously? Why didn’t their doctors have more information, better options, or a greater willingness to look beyond the symptoms in front of them? Why was so much knowledge about this stage of life left unspoken, leaving women to discover it for themselves rather than passing it along to the generations that followed?

Why were women expected to keep working, parenting, caring, producing, and showing up for everyone else while navigating changes they couldn’t control? In the workforce, why were they expected to excel with sleep deprivation, pain, mood changes, difficulty concentrating, and feeling unlike themselves?

I hope that the future generations ask: Didn’t anyone tell them to take a break? To reconsider their expectations of themselves? To allow for the possibility that they might need something different during this stage of life?

Why didn’t anyone send them flowers?!

I mean, I dealt with 3 a.m. insomnia every day last week. I woke up in sweaty pajamas each morning. I was in horrible back pain, wanted to tell off anyone who made too much noise, and struggled to focus and get a day’s work done with what felt like only part of my brain working.

If I had been experiencing those symptoms with a socially recognized medical diagnosis attached to them, I imagine someone might have sent me flowers. Of course, I might have hated the flowers, given how unpredictable my mood has felt lately. But I like the image of them. Flowers are a small gesture that says, I see that something is happening to you. You don’t have to explain it perfectly for me to care.

Something significant is happening to women in this stage of life, and we deserve to be met with understanding, curiosity, and care.

I don’t have the answers. I want to share the helpful information I find, ask better questions, and document this challenging stage of my life as a woman living through it. I want other women who feel as lost as I sometimes do to know they aren’t alone. Maybe along the way, we will discover something about ourselves that helps us understand what we are experiencing and what we need.

I don’t expect to provide a solution to an experience that is so complex and individual. For now, I want to pay attention, be honest about what I find, and make space for conversations that perhaps should have been happening a long time ago.