This is the seventh and last dispatch in this arc, and I want to use it to name what I have been trying to say across the previous six. Not to summarise them — you have read them, you do not need a summary. I want to name the editorial position underneath all of them. The thing that has been the same in every dispatch, even when the topic was different.

I want to start, though, with a phrase.

"I don't feel like myself."

It is the most common phrase women in perimenopause use to describe what is happening to them. A 2024 study published in the journal Menopause surveyed 1,529 women and found that 63.3% of midlife women report not feeling like themselves more than half the time over the previous three months (Coslov, Richardson, & Woods, 2024). The phrase is so common in clinical practice that the researchers had to invent an acronym for it: NFLM, not feeling like myself. Google "I don't feel like myself perimenopause" and you will get 5.3 million results.

This is not a small thing. Almost two-thirds of women in midlife are walking through their daily lives feeling like they have become someone they do not recognise. That is the single most consistent description of perimenopause in the literature — more consistent than hot flashes, more consistent than cycle changes, more consistent than any individual physical symptom. I don't feel like myself.

I want to close this arc by naming what that phrase is actually signalling — because I do not think it is signalling what the framework most women are handed assumes it is signalling.

The framework most women encounter at midlife treats not feeling like myself as a symptom. Something to address. Fix the hormones, fix the sleep, fix the inflammation, address the mood, and the woman should return to feeling like herself. That is the underlying logic of every clinical conversation a woman in perimenopause has, even the ones from clinicians who do this work well. The premise is that there is a self waiting underneath the symptoms, and the work is to clear the symptoms so the self can come back.

The framework is not bad, exactly. It does what it is designed to do, which is move a high volume of women through a system that was not built for the kind of reading their bodies actually need at this stage of life.

What the framework cannot do is read the arc of her. It cannot read that not feeling like herself might not be a temporary state caused by the menopausal transition. It might be the visible expression of a body that has been recording her life for forty years, and is now — in the most consequential decade of her long arc — finally making the recording legible to her.

The position that runs through every dispatch I have written in this arc is this:

A woman's body in midlife is not a system to be managed. It is a document that has been writing itself for forty years, and the only person qualified to be the first reader of it is her.

That is the sentence I want every woman reading this to carry with her. It is the editorial position that runs underneath everything AION Atelier publishes, and it is the position I want to leave you with at the end of this arc.

Let me say what I mean by it.

In Vol. 011 I wrote about the year I thought I was in perimenopause and was not — about how chronic relational stress and postpartum biology had reorganised my nervous system in ways the framework I was given could not see.

In Vol. 012 I wrote about the Endocrine Society's clinical guideline on what chronic stress actually does to the menstrual cycle — a document that has been sitting in the literature for almost a decade, naming the mechanism, naming the reversibility, and almost no woman who has experienced it has been handed it.

In Vol. 013 I wrote about the 3am wake-up — what the SWAN longitudinal data actually says about perimenopausal sleep, and why what feels like insomnia is, more often, a measurable shift in the architecture of how the body produces sleep at all.

In Vol. 014 I wrote about inflammation as the through-line running underneath every dispatch in the arc. The Penn Ovarian Aging Study showing that the inflammatory load a woman arrives at midlife carrying is set, in large part, by the decades before she got there.

In Vol. 015 I wrote about mould — the environmental layer I did not see until I was out of it, and the way it had been hijacking my nervous system in ways I had been attributing to grief, motherhood, and stress.

In Vol. 016 I wrote about the continuum nobody had named for me — that postpartum and perimenopause are not two separate biological events but two windows in one continuous HPA-axis story, and that whatever the system was last left in is what it brings forward.

Six dispatches. Six different topics. One argument underneath all of them: the framework most women are handed in midlife is too small to read the biology they are actually carrying.

The framework most women encounter in their forties is the framework of symptoms and management. You arrive with a complaint. The clinician runs a panel. The panel returns numbers within range or slightly outside it. A protocol is offered — sometimes hormonal, sometimes lifestyle, sometimes pharmaceutical, sometimes nothing at all. The conversation lasts fifteen minutes. The next conversation, in a year, will be fifteen minutes also.

That framework is not bad, exactly. It does what it is designed to do, which is move a high volume of patients through a system that was not built for the kind of reading a woman in midlife actually needs.

What the framework cannot do is read the arc of her. It cannot read that her cortisol pattern at forty-four is the cumulative expression of a postpartum experience at thirty-three, a chronically stressful job in her early thirties, a childhood that taught her nervous system to be vigilant before she had words for what vigilance was. It cannot read that her erratic cycle and her broken sleep and her brain fog and her inflammatory baseline are not separate problems to be managed in isolation — they are one continuous reading of a stress system that has been carrying more than it could comfortably carry for a long time. It cannot read that the woman in the chair is a document that has been writing itself for four decades, and that the chapters of that document are not separable from one another.

The 2023 review I cited in Vol. 016 — the Hantsoo paper, on the HPA axis across the female reproductive lifecycle — names exactly this. The research literature is clear that women's biology in midlife is not the start of something new. It is the visible expression of something that has been adapting and re-adapting across decades. The framework that does not include that arc is not a framework that can read the woman accurately. It is a framework that can manage some of her surface symptoms.

This is not a small distinction. This is the difference between being a patient with elevated risk factors and being a woman with a body she is finally able to read.

There is something I learned slowly across the arc that I described, and that I want to put on the page here clearly, because I think it is the most important thing I have to say.

You are the most important reader of your own biology. Not your clinician. Not the publication you subscribe to, including this one. Not the protocol you read about on the internet. You. The framework that any of us can offer — including AION Atelier — is a framework for helping you read. The reading itself is yours.

What this means in practice is that the work of midlife, the actual work, is not finding the right protocol. It is becoming fluent in the document your body has been writing for forty years. Learning what your cortisol pattern actually does across the day. Learning where your inflammatory baseline sits, and what it has been carrying. Learning what the irregular cycle is reading, and what the sleep disruption is reading, and what the emotional reactivity is reading — and learning to hold all of those readings together rather than as separate symptoms to be addressed in isolation.

This is not work that gets done in fifteen-minute appointments. It is not work that gets done by reading any single article, including this one. It is work that gets done across a lifetime — and the woman in midlife, the woman in her forties or fifties walking into the most consequential decade of her long arc, is the woman who has the most material to read and the most reason to learn how.

If there is one thing I want every woman who has read this arc to take from it, it is that her body is not a problem to be solved. It is a text she can become fluent in. And once she is fluent, the conversations she can have — with herself, with her clinician, with the life she is choosing to build in the second half of it — become entirely different conversations than the ones she was equipped for before.

I want to close where I closed Vol. 011, because the topic of this arc is exactly what that sentence was reaching for.

That is AION Atelier's foundational sentence. It is the sentence the brand was built around. I want to bring it back here at the end of the arc, because the six dispatches you have read across the past weeks have been an attempt to demonstrate it — that long life is not the goal of any of this work. The goal is the woman you are inside the life. The mother you can be in it. The friend, the partner, the worker, the thinker, the person who shows up for the people she loves. That is what longevity is for.

Reading your own body is one of the ways you become the woman who can hold what comes next. The decade ahead of you is the most consequential one of your long arc. The version of you who reads her body fluently is going to be a different woman in that decade than the version who does not.

This is what AION Atelier is here for. To help you read. To put the literature in your hands — not as a publication that explains it at you, but as one that hands it to you and trusts you to know what to do with it. To stand with you in the work of becoming fluent in your own biology, and in the larger work of deciding what that biology will be for.

I have written seven dispatches in this arc, and I want to thank you for reading them. I will be back next Monday with a new one — a new arc opens, on a different set of variables I have been thinking about — but for today, I just want to say:

I am glad you are here. I am glad you are reading. The phrase 63% of women in midlife use — I don't feel like myself — is not the thing it is most often taken for. It is not a symptom. It is your biology asking you to come closer and read what it has been recording. The work of midlife is hard and the framework you have been given for it is too small, but the woman doing the reading is large enough for it. She always has been.

If you would like to begin reading your own biology, the place to start is the AION Atelier Baseline — the panel built to read the cluster of markers the dispatches in this arc have described (cortisol, sex hormones, inflammation, metabolic) against women's reference ranges, not male-default ones. It is the architecture for becoming fluent in the document your body has been writing. Begin here.

Curious about the framework underneath this — read about the Othala Method here.

I stand by you in this, un abrazo.
— Belinda Singkepe Holloway

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We do not provide medical advice. We provide the intelligence to ask better questions.

THE SOURCES:

Coslov, N., Richardson, M. K., & Woods, N. F. (2024). "Not feeling like myself" in perimenopause — what does it mean? Observations from the Women Living Better survey. Menopause. PMC11465791. (A survey of 1,529 women aged 35-55 documenting that 63.3% of midlife women report not feeling like themselves more than half the time. The dispatch's editorial anchor.)

Hantsoo, L., Jagodnik, K. M., Novick, A. M., Baweja, R., Lanza di Scalea, T., Ozerdem, A., McGlade, E. C., et al. (2023). The role of the hypothalamic-pituitary-adrenal axis in depression across the female reproductive lifecycle: current knowledge and future directions. Frontiers in Endocrinology, 14, 1295261. DOI: 10.3389/fendo.2023.1295261. PMC10750128. (The HPA-axis continuum across the female reproductive lifecycle — the spine of the editorial argument.)

The peer-reviewed sources cited in the six prior dispatches of this arc — Gibson 2019 (Kaiser), Epperson 2017 and Metcalf 2021 (Penn Ovarian Aging Study), Gordon 2017 (Endocrine Society FHA Clinical Practice Guideline), Kravitz 2013 (SWAN Sleep Substudy), the Institute of Medicine 2004 Damp Indoor Spaces and Health, and Bromberger & Epperson 2018 — are the literature this arc has been drawing from. Each is fully cited in its respective dispatch.