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Welcome to The Modern Midlife Collective—where midlife isn’t a crisis, it’s a rebirth. Hosted by Dr. Ade Akindipe, DNP, and Dr. Jillian Woodruff, MD, this is the podcast for women ready to unapologetically own their power, thrive through the ups and downs of hormones, weight, and self-care, and show the world that thriving at 40 and beyond isn’t just possible—it’s your birthright.
Biweekly, we bring you science-backed insights on hormones, menopause, longevity, and sexual health—real tools to empower women in midlife and beyond. With a fearless blend of functional medicine, real-life wisdom, and no-nonsense empowerment, we’re here to challenge the norms, break through the barriers, and help you step into a life of vitality, confidence, and unstoppable strength.
Ready to rise? Let’s do this.
Jillian Woodruff MD (00:26)
Midlife is complicated and today it's just me. For those of you who are new here, I'm Dr. Jillian Woodruff. I'm an OBGYN and the cohost of the Modern Midlife Collective. A day my cohost is off on holiday with her family, so I'm holding the mic solo, thinking out loud about what I see every day in exam rooms, what I hear in conversations with friends and family who are moving through perimenopause and midlife.
And really how poorly we've been prepared for it. The most common thing that I hear from women is not, I don't feel well. It sounds more like I don't feel like myself anymore. They say things like I'm irritable and angry all the time. I'm anxious all the time. I'm exhausted. I don't recognize my body. I can't lose weight.
A big one is I would honestly be fine if I never had sex again. And that's sad to hear. Sex is painful is another thing that I hear from women. A lot of things about feeling emotions differently than they felt them before. And almost always that is followed with, my lab results are normal. So why do I feel like this? And when you ask that question often enough,
and you're not getting any answers, this can really start to mess with your reality. So today I want to talk about that space, that in-between place where nothing looks wrong on paper, but you were very clearly not fine. I want to talk about one of the biggest myths. I definitely want to stop right now. And it's the idea that menopause or perimenopause looks the same for everyone.
There is no universal symptom list, no required suffering checklist. And also the timeline is very different for everyone. It may be a year, some people may not even realize that they've ever been in that perimenopausal transition. And for others, they may have these life altering symptoms for 18 years. That's really ridiculous.
Some women may never have hot flashes. Some women may never experience a decline in their libido or desire. Some women sleep beautifully, others don't. Some feel emotionally steady, but physically unrecognizable. And none of those experiences are more correct than another. Variation is biology. Women, you we are...
constantly comparing ourselves to other people, to our friends, to our family, sisters, coworkers, social media, and thinking, why am I feeling miserable when my friend is not? Or why don't I have the symptoms everyone talks about? Or why do I feel crazy? I hear that a lot. And here's the thing that rarely gets said out loud.
Difference doesn't mean that something is wrong with you. It means your nervous system, your hormone shifts, your genetics, your stress load, your life circumstances are interacting in a way that's uniquely yours. I don't know if that's comforting or not, but yes, we are all very different and we're all going to experience the transitions of life in our own unique way. When people
think about perimenopause symptoms. usually think hot flashes and night sweats and that's about it. And they may even say things like, yeah, I don't think I went through menopause because I didn't have hot flashes. That can be further from the truth. So I want to talk a little bit about symptoms that may not make that glossy menopause list. A big one is dry eyes, dry mouth, having to drink
in the middle of the night. And then of course that leads to other problems like running to the bathroom, post nasal drip. That's a strange one. And that's not one that I think probably more people have that problem than they would actually say, especially to their gynecologist, right? Because they wouldn't really associate that with perimenopause, but yes, it's like one of those symptoms that starts to pop up in perimenopause.
A big one is heart palpitations. And again, one that isn't typically associated with perimenopause, but it is so common in perimenopause. Dizziness and vertigo, pretty common to come and go at different times. Disrupted sleep, even in the absence of night sweats. Irritability, anger, anxiety that feels physical, not situational.
And depression symptoms like sadness and just feeling low or not feeling like you want to do the things that would usually make you, you know, happy in the past. And these symptoms, they may seem random. are not random and they're not imagined. There, there aren't biological reasons for each of them. They are pretty common. They're truly disruptive, often misunderstood.
And the the secret culprit is typically estrogen. Many of these symptoms live at the intersection of hormones and your nervous system and how those two things go together. But when you state one of these complaints to your primary care provider, your doctor, you know, they're going to send the dry eyes to ophthalmology, the heart palpitations to cardiology, the vertigo to
neurology, mood changes, they'll go to psychiatry or psychology, get labeled as anxiety or depression and many times without context and each symptom gets treated as an isolated problem or even entirely dismissed. And what gets missed is this pattern, the timing, the clustering, the fact that estrogen, progesterone, testosterone, cortisol,
neurotransmitters, none of them operate in isolation. They're all part of this system. And when the system shifts, as it does in midlife, the symptoms don't always show up neatly. That would make it too easy. If we just knew if you say this, if you have this complaint, then this is the problem. And this is what you need to do about it. And unfortunately, it just never works like that.
because it is all intertwined, but medical care is very segmented, separated, because nobody can know everything. The story that I see played out over and over and over again is, okay, let's take a woman with heart palpitations and she may see primary care be sent to
cardiology, and then she goes through this extensive workup, this cardiac evaluation, maybe even a neurological evaluation, endless slaps. And when nothing dangerous shows up, story ends there. Everything's normal. That's what she's told. Everything is normal. And that phrase is probably meant to be reassuring, but it becomes the end of a conversation instead of the beginning of curiosity. Normal tests,
don't mean that nothing is happening. They mean, maybe we've rolled out immediate danger, but not dysfunction. Medicine is excellent at rolling out emergencies. That's really what our healthcare system is for, like keeping you alive. This is not an emergency or here's an emergency. This is how we're going to fix it. It's less skilled at explaining dysfunction and the nuance of medicine, let's say. So then women are left.
holding symptoms without a framework, without language, without validation and self doubt creeps in.
Again, midlife is complicated and part of what makes this season so frustrating for women, think, is that the medical system itself, the providers were never really trained to support them through this transition. There's a massive gap in menopause and hormone education at medical school and in most medical training programs.
That's slowly changing, but for decades it simply wasn't there. Many of us who trained in the late 90s and early 2000s were trained in the immediate aftermath of the Women's Health Initiative, that landmark study that studied post-menopausal hormone therapy. And the message we received was loud and very clear. Hormone replacement therapy was dangerous. We should not use it.
Full stop. And what we didn't learn, because the nuance wasn't taught, were the true benefits, the actual risks, who hormones help, who they may not help, how timing matters, how to individualize care. So an entire generation of providers learned to fear hormones, the very hormones women had lived with most of their lives now somehow became dangerous. I don't understand.
And we were never given like updated education to correct that fear. We had to really go out and find that we had to first recognize that we didn't know what we didn't know, and then go and seek an opportunity to learn more. And that's, that's hard to do. So because many providers may not recognize what they don't know. And those that do, they stay curious, of course, they read, they
refer patients to someone with more expertise because that's good medicine. None of us can know everything. You want someone to specialize in different aspects of your health, of your body, because you want someone that does the same thing over and over and over again and become an expert in that system. But we really do need to, I think, communicate more with each other.
because many providers still don't know, they don't realize that they're working from outdated or even incorrect information. And that's where medical care stops being neutral and starts becoming dangerous. When a woman's told, this is just normal aging, what she's often hearing, what I would hear is not a careful medical assessment. I would hear,
this is just normal aging, I would hear we don't plan to help you or deal with it. I get upset when my patients come to me and tell me, you know, that they've described these real symptoms that they're experiencing, that's these symptoms that are disrupting their lives. And then they were told just to accept it or, that's normal. That's normal at your age. I really, it burns me up. I don't like it.
And again, not because I expect every provider to know everything that's clearly impossible. I actually respect it when a doctor or a medical provider says, I don't know, or I haven't encountered that before. Or maybe I'm not sure what the next step is because you just may not know, you know, but let's, let's figure it out. Or sometimes the most
responsible thing a provider can say is, this is outside my lane. I just don't know. Let's bring in someone who can help us. And that's not a failure of competence. That's integrity because curiosity keeps patients safe.
Humility keeps medicine honest. What concerns me isn't uncertainty, it's certainty rooted in outdated information.
dismissing symptoms instead of questioning your knowledge. That's not benign. Women pay the price for that.
And then women doubt themselves and they may stop asking for help. And they just start suffering quietly or maybe, maybe not so quietly. And maybe even they're told that they should be grateful because nothing's wrong. But common doesn't mean normal and aging shouldn't require suffering.
And what makes this even harder to ignore is that we don't aging this way when it comes to men. Menopausal symptoms aren't just uncomfortable, they affect sleep, they affect mental health, cardiovascular risks, bone health, metabolic health, brain health, relationships, identity. I could go on and on. And ignoring symptoms.
It doesn't make women more resilient. It makes them depleted, exhausted, wanting to give up. know, quality of life is not a luxury outcome. And I love luxury. It's not a luxury outcome. It's a medical outcome.
midlife isn't a single event. That would make it too easy. It's a very long transition. And it's one that is biological, emotional, neurological, existential. And
We need more training and we need more education for everyone. So not just medical providers, but women themselves, their families, those that love them. Because many times people have not even heard of all that encompasses peri-mitopause and menopause. Some may not even know that peri-mitopause exists.
or they may think that menopause is a one-time thing and because they don't have hot flashes, it's over. So this is the start or a continuation really, because this conversation has been started. So it's a continuation that I hope we all bring other people into so that they can hear about.
this transition period. What I've shared today is really shaped by what I see in exam rooms and with my conversations with women who are trying to make sense of their bodies that feel unfamiliar. And by years of watching how midlife gets minimized in medicine and my own personal experiences in midlife and with
perimenopause, but my perspective is just one, it's just one perspective. And it's one I know Adea and I talk about often. So when the timing's right, she will add her voice to this in her own way. But if any of this sounded familiar with you, you're not alone and you are not imagining things. Join this conversation, keep this conversation going.
and share with me, with Dr. Adai, with your community, what you're demanding to hear more of, what you need in your care. That's all I have to share with you today. I'm very grateful for this time that we have at the beginning of the year. Thank you for spending your time with me today, and please share any thoughts you have or
even ideas for future episodes by emailing connect at modernmidlifecollective.com. Until next time, bye.