Heart palpitations, panic attacks, fear of the future, psychosomatic illness, body dissatisfaction, anxiety and clinical depression are plaguing women in their 30s, 40s and 50s, contributing significantly to the astounding rise of the wellness and functional medicine industries as millions seek out alternative routes to improve their well-being. I should know— as a health and life coach in Singapore, the majority of my clients are women in this age bracket who wrestle with personal dissatisfaction, low energy, baffling physical symptoms, and self-sabotaging habits.
From changing physiologies, increasing stress loads, existential crises, and maladaptive cultural coping strategies, midlife packs a wallop and women, more than ever, are feeling it.
In fact, studies consistently show that the midlife crisis is a real phenomenon, with women experiencing their lowest point of happiness somewhere between the ages of 40 and 53 (peak happiness is reached at age 34, according to international research). Combined with inevitable hormonal changes during this period that radically change the circuitry in both brain and body, women are struggling.
Today in the US and the UK, an estimated one in four women are taking at least one mental health medication, making up the majority of those prescribed an antidepressant, and that number appears to be climbing in Singapore as well. In many parts of the world, middle-aged women are one of the primary groups seeking treatment for substance abuse, particularly problem drinking. And, measures of subjective well-being indicate that women’s happiness has declined in relation to men’s across industrialized countries and demographic groups.
So, what the heck is going on? Here are five reasons I’ve observed that underpin stress and depression for women in midlife, as well as some initial tips on how to turn things around.
1. Your Hormones Are Dramatically Changing During the Menopause Transition:
Although menstruation doesn’t completely stop until around age 51, women generally enter the perimenopausal phase sometime between their late thirties and mid-forties, propelling a cascade of changes to hormone levels as the body gradually produces less progesterone and estrogen while ovarian function declines. During the transition into menopause, cortisol levels rise and adrenal function may be compromised, contributing to stubborn weight gain around the abdomen typically experienced by women in their forties.
The roller coaster of perimenopause generally lasts for three to four years although it can stretch on for a decade or more, bringing with it extreme fatigue, hot flashes, vaginal dryness, heavy periods, sexual dysfunction and erratic moods. This drastic shift, coupled with popular culture’s shame-based attitudes etched upon aging women as well as changes in appearance and sexual functioning contribute heavily to increased stress, generalized anxiety disorder and depression. Fascinatingly, North American and European women tend to have far more extreme symptoms than women in societies which revere older women as wise matriarchs and honor the seasons of life as well as those which subsist primarily on plant based diets, including Southeast Asia, Japan and Mexico’s Yucatan peninsula.
Balancing your hormones during this time without the intervention of hormone replacement therapy is typically a challenge, but there are a few things you can do on your own to reduce anxiety and depression during this phase:
- Change up your exercise routine. Perimenopausal women often hire health and fitness professionals to help them tackle unwanted weight gain after finding that, despite exercising themselves into the ground, the weight still isn’t budging. A cyclical problem arises, particularly when personal trainers and health coaches aren’t knowledgeable about the impact these hormonal changes have on the body. HIIT (high intensity interval training) is generally the protocol for torching body fat through exercise, but can work against women in the menopause transition by further increasing their cortisol levels, fatigue and muscle and joint soreness. Instead of high intensity interval training and running, adopt low to medium intensity modalities with adequate rest periods. Breath-focused Pilates and strength training, which can help stave off osteopenia, are good options during this time. Additionally, “while guidelines have advocated an accumulation of at least thirty minutes a day of moderate-intensity exercise most days of the week (150 minutes per week), a major study (the DREW study) found that a lower amount of activity was associated with a significant improvement in fitness for women in their mid- to late-fifties,” just after menopause.  Lower amounts of exercise can also benefit clients in the perimenopause phase, particularly if they’re not getting enough restful sleep.
- Make sleep a priority, and aim to get at least 8 to 9 hours of shuteye a night. Sleep length and quality plummets during this time as melatonin levels decrease, cortisol rises, and everyday life takes on a frantic quality.
When women don’t sleep, restorative DHEA and growth hormone cease production, which in turn compromises the immune system and contributes to inflammation in the body. This reaction has a tendency to set off clinical depression.
In this age, sleepless warriors are touted as demi-gods, celebrated for their ability to subsist on 4 or 5 hours a night. In Singapore, most people are clocking just over 6 hours per night— not nearly enough for restoration and rejuvenation. Ignore the hype and commit to some serious rest. Turning your bedroom into a peaceful, device-free and cocoon-like sanctuary, practicing a bedtime ritual such as prayer or mindfulness, and taking melatonin and ZMA (zinc+magnesium+B6) supplements half an hour before lights off can all help contribute to better quality sleep. If you’re bolting up in the middle of the night— common for perimenopausal women— don’t just lie there! Get out of bed, make a cup of relaxing tea such as kava tea and read a boring book. Whatever you do, avoid looking at your phone or laptop screens- exposure to blue light is a primary culprit of insomnia.
2. You’ve Lost Sight of a Life Purpose or Worthwhile Goals:
Around one’s mid-thirties, some people begin to wake up to the fact that they’ve designed a life and chosen a career path that they thought would please others— usually their parents, a peer group, or some nebulous societal definition of success. However, many of us find that as we stabilize financially in our thirties and forties through careers that are personally unfulfilling, regret and energy depletion eventually catch up, particularly for women who have tucked their artistic or altruistic ambitions into the cobwebbed corners of their hearts.
At this point, one is faced with the decision to remain shackled to proverbial golden handcuffs, or to take a radical dive into the unknown, doing battle with the prevailing (and idiotic) notion that when one hits her forties, it is too late to make a successful career change (hello- you’ve got a good twenty-five to thirty productive years ahead. You’re just getting warmed up!)
Other women who have taken years off to stay at home with their children may discover in their forties or fifties that they're itching to rejoin the workforce, but have lost their sense of professional identity in the process of attentive motherhood. While I am not a career coach, I do a lot of work with clients to explore their purpose and goals through an investigation of their values and life narrative. In this coaching work, I’ve discovered numerous ways to craft a new purpose beyond fashioning it from the insights garnered by personality tests like the Enneagram and Myers-Briggs. Here are three helpful tips:
- Become an apprentice. Rather than diving in to what you think might satisfy your purpose, seek out opportunities to volunteer or intern in roles that appeal to you, or audit diverse courses to get a taste of your options. Apprenticeships are not just for twenty-somethings. Increasingly, midlife adults are seeking internship opportunities as a way to hone new skills and explore what might be most pleasing to the child within.
- In uncovering one’s true vocation— a summons to an occupation that a person is specifically designed for— world-renowned spiritual guide and counselor Henri Nouwen suggested taking a piece of paper and drawing a foundation stone at the base of the page, filling it in with one’s birth date and life circumstances during the time. From there, “build on the stone, adding all the major events of your life, whether joyful or sorrowful. When you’ve finished, go back and add notations about cultural or world events happening during those times: political changes, natural disasters, war, etc. When you have finished, look at the whole picture and reflect on this question: what might God be doing in my life and in the world?”
- Honor your subconscious and body wisdom by ceasing to overthink. In his book, “How To Be An Adult,” psychotherapist David Richo writes that “in matters of the heart, thinking (ironically) leads only to more confusion. What works best is simply noticing a) what your body feels, b) what your actions are, and c) what your intuition keeps coming back to.” We have a tendency to overanalyze our options. Free journaling, body scan meditations, and centering prayer are all tools you can use to get out of your head and into your heart.
3. You Are Drinking or Otherwise Self-Medicating to Cope, Rather Than Making Space to Resolve the Real Issue:
It’s no wonder that levels of happiness and satisfaction begin to dip in midlife. During this time divorce rates increase, kids begin to cling to their independence, more women find themselves sandwiched between elder care and child duties, and a lack of self-realization sets in (see #2!)
While the “midlife crisis” has typically been seen as the domain of forty-something men who trade their responsibilities in for a flashy car or a fling, women also contend with a shifting sense of self.
But they usually deal with it differently. In Australia, the US and Europe, as well as in expat communities around the world, women in midlife are becoming increasingly dependent on alcohol, engaging in high risk drinking that has been normalized by celebrities and on social media threads. A recent report from the OECD indicates that college-educated women in Australia should now be considered a high-risk category for binge drinking. And in the US, studies show that problem drinking is on the rise across all age groups while “drunkorexia” is the new trend for middle-aged women who replace usual food calories with booze in an effort to remain trim…and blitzed. Deaths among middle-aged women from prescription painkillers and anti-anxiety tranquilizers like Xanax are also climbing as women take far more than the recommended dosage while washing the pills down with wine— a lethal cocktail. I will be bold enough to assert that alcohol abuse is one of the greatest public health crises women face today, contributing to hospitalization rates for anxiety, depression and suicide attempts; increasing the risk of breast cancer and cardiac disease; disintegrating relationships; and generally eroding one’s overall quality of life. Untangling yourself from a reliance on substances to get through the day is tricky, but millions of people each year prove that it can be done. Here are some options for mapping out a path to sobriety:
- Enlisting a qualified psychologist or psychotherapist to help you uncover, work through and process any trauma or present life circumstances contributing to substance use is paramount in obtaining an awakened, clear-eyed life. Some coaches, including myself, are trained and experienced in supporting individuals battling a reliance on alcohol or prescription drugs, and in helping to change self-sabotaging habits and behaviors. Ceasing to self-medicate generally requires some professional support, at least in the beginning. Don’t be afraid to ask for help!
- Fellowship-based support groups like Moderation Management, SMART Recovery and AA are available around the world, and many have women-only options. Find what works for you… and you may also find many other women that you can relate to.
4. A Spiritual Framework Has Not Been Fully Developed:
The culture of wellness has morphed into a religion of sorts, replacing ancient teachings and rituals with the shiny promises of green juices, colonics, westernized yoga, app-led meditation and “clean eating.”
As more women identify as “spiritual but not religious,” discontent with life has also seemed to escalate, evidenced by increases in antidepressant and anti-anxiety prescriptions, heavy drinking, eating disorders in midlife... and a wellness industry that’s now estimated to bring in $4 trillion dollars globally at last count, with no signs of stopping.
In fact, according to a study published in the British Journal of Psychiatry, people who are spiritual but not religious are more likely to suffer from poor mental health, including a dependence on drugs, eating disorders, anxiety, phobias and other neuroses— findings that support other similar studies. Surprisingly, atheists tend to fare better than the “spiritual but not religious” group, while those who identify as “religious” have the highest rates of life satisfaction as well as lower rates of depression and suicide.
Today’s “spiritualish” approach lacks the very definition of integrity— a wholeness or completeness— as diverse practices and traditions are taken piecemeal and appropriated, usually without some well-defined life guidelines or ethical foundation, which leaves many feeling hungry or confused. The explosion of corporatized yoga is a perfect example of this, with some of India’s yogis sounding the alarm on its commoditization, fitness-oriented focus and Instagrammable lifestyle. Without a strong spiritual framework, a close-knit community is also missing as modern forms of spiritual practice seem to be more about self-improvement (and arguably, self-absorption), and less about helping your fellow woman, furthering social justice or drawing closer to (God, a higher power, universal life force, the divine, the ineffable, etc.) Developing strong spiritual roots requires openness and faith, which is premised by a yearning to seek out the truth with eyes wide open, and to accept suffering as intrinsic to the human experience. This challenge is an extremely personal one, and more people are finding that the religious options available to them are at odds with our current culture, as well as their original teachings— hence new movements like emergent Christianity and a resurgence of mystical practices. As you endeavor to build a framework that is rooted deeply into solid ground, here are two things to consider doing:
- Seek out true spiritual leaders who have devoted their lives to their faith or belief system and have a conversation with them about your questions and struggles. Come armed with questions and a healthy curiosity about how they’ve come to know what they do, as well as their routines and overall outlook. This can seem extremely intimidating, but many will be willing to talk with you.
- Spend time regularly in nature, open to the silence and the wonder surrounding you. Book a walk with your friends through jungle or forest, basking in each other’s company while staying present to the sounds and sights of the natural environment. It’s no coincidence that many mystics, monks and saints found their connection to the divine while on a mountaintop or deep in the woods.
5. You’ve Got Way Too Much Going On for One Person to Handle:
In Singapore, wealth and status are doggedly pursued, fueling the rise of moneylenders, pawnshops, plastic surgery and marital strife. Social media compounds this insatiable need for prestige, providing a virtual platform to “keep up with the Joneses”. Between the duties of family and career, as well as social responsibilities and the pervasive need to live a double life— the one based in reality and the one shared on social media— women play professional juggler while striving to look the part of perfection, people-pleasing in the process. No wonder they’re drained!
Philosopher and writer Jiddu Krishnamurti remarked over seventy years ago, “it is no measure of health to be well-adjusted to a profoundly sick society,” which certainly applies today. We are, as a collective of people in urban areas all over the world, driving ourselves into the ground by subscribing to an unsustainable lifestyle that is better designed for soulless robots than for human beings. A large part of the problem exists in the rising cost to stay afloat, as evidenced by the widening income gap in Singapore and the subsequent outcry from its citizens. In the midst of writing this, a taxi driver lamented to me, “I work twelve hours a day to support my family. I barely get in 1,000 steps a day. What can I do?”
On the other side of the issue are our expectations of what it means to have a comfortable life, and how much is actually enough. Two common sights in Singapore are the luxury sports cars parked outside HDBs (public housing) and the administrative assistant carrying a new Louis Vuitton handbag. Privileged expats are also stretching themselves to the limit in an effort to keep up with appearances.
In response to runaway consumerism and the stress of modern life, movements in minimalism and essentialism are spreading beyond a niche group of millennials and into the mainstream.
While these movements emphasize simplicity and conscious consumerism, they are primarily tools for obtaining freedom and peace of mind. Greg McKeown, author of the bestselling book, Essentialism, writes that it’s “not about how to get more things done; it’s about how to get the right things done. It doesn’t mean just doing less for the sake of less either. It is about making the wisest possible investment of your life and energy in order to operate at the highest point of contribution by doing only what is essential.”
Here’s an initial exercise to launch a life that embraces the essentials:
- Fold a paper lengthwise down the middle, creating two separate columns. In one column, write down every single thing that takes up your time and energy in a one week period. Be specific! Now, in the second column, write down no more than half of the things that you really and truly need to do each week. Finally, highlight or underline the top three things that matter. Can you envision what your life would be like if you lived by the second column, paying particular focus to the three things you underlined?
Suffering is an inevitable part of life woven into the human experience. But, accepting suffering as one of the many waves we’ll each face does not have to equate to a life of stress and depression.
Cultivating purpose, self-respect, and a strong spiritual foundation along with a focus on the essential and an acceptance of the seasons that each of our bodies will endure invites peace and vitality back into our lives, no matter what our age or circumstances.
I wish you good health, and thanks for reading!
Wow- you got to the end- it was a long one! Did this post help you in some way? If so, share the love on social media or in an email to someone who could use the read.
 (2009) Stevenson, Betsey and Justin Wolfers. “The Paradox of Declining Female Happiness” http://www.nber.org/papers/w14969
 (2017) “Perimenopause: Rocky Road to Menopause.” Harvard Women’s Health Watch, Harvard Medical School.
 Sweet, Wendy PhD, (2018). “The Connection Between Exercise and Menopause.” ACE Fitness, https://www.acefitness.org/education-and-resources/professional/certified/january-2018/6882/the-connection-between-exercise-and-menopause
 Nouwen, Henri. (2013) Discernment. Harper Collins.
 (2015). “Women and Children First: Tackling Harmful Drinking.” OECD http://oecdinsights.org/2015/05/12/women-and-children-first-tackling-harmful-drinking/
 (2017). “The Big, Booming Business of Wellness” Self Magazine. https://www.self.com/story/the-big-booming-business-of-wellness
 (2013) King, Michael, Louise Marston, et al. “Religion, Spirituality and Mental Health: Results from a National Study of English Households” The British Journal of Psychiatry.