When Everything Feels Like “Middle Age”: Why Women Must Keep Showing Up—and Speaking Up—for Their Health

‍This week’s blog is a departure from my normal content. It is very personal but in this phase of my life I’ve learned very personal is a road map for someone like me to navigate this phase more confidently and successfully.

There is a strange and sometimes dangerous season in a woman’s life when nearly every symptom can be explained away by the same familiar words: menopause, stress, hormones, aging and exhaustion.

‍We are tired because we are busy. We are not sleeping because our hormones are changing. Our joints hurt because we are getting older. Our minds feel foggy because we are carrying too much. Our weight changes because our metabolism has apparently decided to work against us, and our moods shift because, well, middle age. And sometimes all of that is true.

‍But sometimes it is not.

‍Sometimes the symptoms we have learned to tolerate are trying to tell us something. Sometimes a laboratory value that is only slightly outside the normal range is the first visible piece of a much larger story. Sometimes our bodies whisper for a long time before they begin to shout.

‍That is why women in their 40s, 50s and 60s must remain faithful to their wellness visits, recommended screenings and appropriate laboratory monitoring. It is also why we must learn to advocate for ourselves when an explanation may be reasonable but still does not explain everything.

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When Every Symptom Has More Than One Explanation

‍I understand how easily symptoms can be absorbed into the general category of “life.”

I am a healthcare professional. I understand clinical patterns, risk factors, documentation, follow-up and the importance of looking at the whole person. But I am also a woman in my fifties who works, writes, leads, travels, supports her family and manages the same competing responsibilities that cause so many women to put themselves at the bottom of their own lists.

For me, fatigue did not seem especially unusual. Changes in my body could be attributed to medically induced menopause after years of advanced endometriosis. Aches and discomfort could be blamed on aging, inflammation, old injuries or simply doing too much.

Then add idiopathic acute pancreatitis in 2023 and idiopathic osteomyelitis of my left femur in 2024. Add a dash of middle age, an empty nest, a husband with significant health challenges, the loss of my father and all the other “normal” things that happen during this season of life.

So, when my endocrinologist asked whether I had been feeling tired or not sleeping well, I almost laughed.

I mean, he was right to ask. But what woman in her 40s, 50s or 60s can confidently say she does not struggle with sleep, fatigue, brain fog, muscle aches, mood changes or a growing list of other conditions that can produce the exact same symptoms?

That is one reason primary hyperparathyroidism can be so easy to overlook. It most commonly affects people between the ages of 50 and 60, and women are affected three to four times more often than men. Its symptoms may include fatigue, muscle weakness, difficulty concentrating, depression, digestive complaints, increased thirst or urination, and bone or joint pain—all symptoms that can easily be assigned to menopause, stress, poor sleep, medication effects or aging.

The disease often appears in women at exactly the stage of life when we are most likely to have our symptoms explained by something else.

My Laboratory Results Began Telling a Story

My story started with an elevated calcium level during routine laboratory testing. Thankfully, my primary care provider did not ignore it. He repeated the testing over several weeks, appropriately giving the result an opportunity to declare itself as either a temporary fluctuation or an actual trend.

It remained elevated.

Next came the endocrinology referral. Additional testing showed elevated calcium in my urine, while my parathyroid hormone level was not appropriately suppressed in response to the high calcium.

Then came more testing.

My bone-density study revealed very advanced osteoporosis in my hips and sacrum. Talk about a shocker. I felt like a flunkie when they told me. Here I was, just walking around and living my life, completely unaware that something inside my body was steadily weakening my bones.

A thyroid ultrasound identified a small suspicious area. A nuclear parathyroid scan supported the presence of that area. I was referred to a surgeon. More laboratory testing continued to show abnormal results, and a four-dimensional CT scan was ordered to help narrow down the location.

The process began in February. On July 17, I finally underwent a parathyroidectomy to remove the adenoma. I stayed overnight so my laboratory levels could be closely monitored before returning home.

What was expected to be a relatively straightforward adenoma was approximately three times larger than anticipated and had grown significantly into the parathyroid tissue. It had to be removed in three separate pieces.

That experience reinforced something I have said professionally for years but now understand even more personally:

The details matter. The trends matter. Follow-up matters.

Delay Is Not Unusual—and It Is Not Harmless

My experience is not unique.

Research involving more than 10,000 patients with elevated calcium found that only 31% had a parathyroid hormone level checked, only 28% had hypercalcemia documented as a diagnosis and only 8% had hyperparathyroidism recorded in their medical records. Even among patients whose calcium and parathyroid hormone levels were consistent with classic primary hyperparathyroidism, only 22% were referred to a surgeon.

Another study examining the journey from an abnormal calcium level to surgery found that, among patients age 50 and older, it took approximately 3.2 years for half of them to undergo surgery. ‍

A large cohort study also found that only 9.7% of people with hypercalcemia received a diagnosis of primary hyperparathyroidism. Compared with people diagnosed within one year, those whose evaluation took longer experienced higher rates of fatigue, weakness, depression, anxiety, joint and muscle pain, reflux, abdominal pain, headaches and other related conditions.

In the delayed-diagnosis group, the rate of osteoporosis increased from 17.1% to 25.4% during the study period.

Those numbers matter to me because I am confident that I experienced symptoms almost two years before my diagnosis that, in hindsight, may have warranted further exploration.

But hindsight is always clearer than the middle of the story.

Sometimes We Help Set the Stage for Our Concerns to Be Minimized

We set ourselves up to be gaslit.

Yes, I said it.

That does not mean women cause poor care, and it certainly does not excuse a healthcare professional who dismisses a patient’s legitimate concerns. It means that many of us have become so accustomed to minimizing our own symptoms that we walk into an appointment carrying years of concerns, apologizing for the length of the list and struggling to explain which problem matters most.

I remember going to see a new nurse practitioner after my longtime physician left medical practice. I was an absolute mess during that appointment. I had a laundry list of concerns, all valid and all personally challenging.

She stopped me and said, “Okay, I need you to pick one thing to work on.”

I broke. I simply started crying.

I understand what she meant. Appointment times are limited, providers are under pressure, and a long list of complex concerns can be difficult to address safely in one visit. She immediately apologized because she recognized how deeply her words had affected me.

But in that moment, I did not feel redirected. I felt completely deflated.

I had finally gathered the energy to show up and explain that I did not feel well, only to realize that I could not package what was happening into one neat, billable complaint.

That experience reminded me that advocating for ourselves as women is hard. We are often asked to identify one primary concern when the real concern is that something simply does not feel right and we do not yet know which symptom will ultimately prove to be the most important clue.

Middle-Aged Women Are Exceptionally Good at Functioning While Unwell

We work tired. We care for other people while we are hurting. We push through headaches, digestive issues, interrupted sleep, brain fog, muscle weakness and emotional exhaustion because people depend on us.

We become accustomed to being told and sometimes telling ourselves that discomfort is simply part of being a woman.

Menstruation hurts. Pregnancy changes you. Menopause is difficult. Aging is uncomfortable. Stress is unavoidable.

Many of us Gen X women were also raised by Baby Boomer mothers who simply pushed through everything. We watched them work, care for families, manage homes and carry burdens without stopping to ask whether they themselves were okay.

That strength deserves respect. But it also created a generational pattern that we now have to challenge and rewrite.

We can be strong without ignoring our bodies. We can be dependable without becoming invisible. We can care for the people we love without treating our own health as an inconvenience.

There may be truth in every explanation we are given, but none of those explanations should become a universal answer that prevents appropriate evaluation.

Menopause can explain many symptoms, but it should not become a clinical junk drawer where every unexplained symptom gets tossed. I am thankful for the increased attention being given to women’s health and menopause, but we are still far from consistent, best-practice solutions for women in this age group.

Aging can change our bodies, but aging should not become a diagnosis of convenience.

Man, that one hurts.

By this stage of life, many women already feel like an inconvenience. We do not want to take up too much time. We do not want to complain. We do not want to sound dramatic. We do not want to be labeled anxious, difficult or demanding.

So we minimize. We edit ourselves. We leave things off the list.

We say, “It’s probably nothing,” before anyone else has the opportunity to say it for us.

Stress may absolutely affect our physical and emotional health, but the presence of stress does not mean something else cannot also be wrong.

This was a key issue for me. I lived with abundant stress while people I loved battled their own significant health challenges. I was a caregiver trying to get care for myself.

As I shared earlier, I had also experienced two idiopathic medical events: acute pancreatitis and osteomyelitis. “Idiopathic” is the clinical way of saying there was no known or clearly identified cause. These were not minor issues, and I did not have the usual predisposing health factors that would explain why either one happened.

That is unsettling. It can cause you to question every new symptom and wonder whether it represents another unexplained medical problem.

I suppose there has been one positive result from that uncertainty: it has made me more committed to completing my wellness visits and recommended testing.

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Wellness Visits Matter—Even When You Feel Too Busy to Go

National recommendations support at least one preventive care visit each year for women throughout the lifespan. That visit is intended to coordinate preventive services based on a woman’s age, health status, medications, reproductive history, family history and individual risk factors.

That does not mean every woman needs the same laboratory panel every year. It means we should complete the visits, screenings and laboratory monitoring recommended for our individual health histories and then make sure someone reviews those results as a complete story rather than a collection of unrelated numbers.

Recent national data show why this remains important. In 2023, approximately one in five eligible women was not up to date with breast cancer screening, nearly one in four was not up to date with cervical cancer screening, and about one in three eligible adults was not up to date with colorectal cancer screening.

Among adults ages 45 to 49, the exact age at which routine colorectal cancer screening now begins for many people,  only 37.1% were up to date.

The same analysis found particularly low screening rates among people who had not completed a wellness visit within the previous three years. Depending on the type of screening, only 18% to 39.6% of people without a recent wellness visit were up to date.

A wellness visit may not identify every illness, but it creates an opportunity to notice change. It establishes a baseline. It allows blood pressure, weight, medications, family history, screenings, symptoms and laboratory trends to be viewed together.

My diagnosis did not begin with a dramatic medical crisis. It began with a laboratory value that could easily have been dismissed as only a little high.

Because I had experienced several medical events during the previous years, I had plenty of older laboratory results available for review. Interestingly, my calcium had often been on the high end of normal. Only once had it clearly resulted as high, and that occurred during my hospitalization for osteomyelitis.

I remember the hospitalist saying, “Your calcium is high, but we will have to worry about that later.”

Later never came.

I was also in no condition at the time to advocate for myself or remember that one abnormal result once I left the hospital.

That is the reality of fragmented healthcare. The clinician treating the immediate crisis may appropriately prioritize the crisis. The patient may be too sick, frightened or overwhelmed to remember every secondary issue that needs follow-up. The result remains buried in a hospital record while everyone moves on.

This is not always the fault of one person. But it is a gap and patients can fall into it.

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“Slightly Abnormal” Does Not Mean Meaningless

Sometimes monitoring an abnormal result is entirely appropriate. Not every elevated value requires an extensive workup, and not every symptom is evidence of serious disease.

But “we will watch it” should come with an actual plan.

What are we watching? When will it be checked again? Has it been abnormal before? What change would trigger additional testing? Could the result be connected to another symptom, medication or diagnosis? Are we looking at the trend, or only at today’s number?

Asking these questions is not challenging a provider’s expertise. It is participating in your own care.

One mildly abnormal calcium result might not reveal the entire story. But repeated elevated calcium, an inappropriately normal or elevated parathyroid hormone level, increased calcium in the urine and osteoporosis begin to form a pattern.

The body often tells its story in pieces.

The danger comes when no one places the pieces beside one another.

Advocacy Is Not the Same as Self-Diagnosis

Advocating for yourself does not mean searching the internet, selecting the most frightening diagnosis and demanding every available test.

It means becoming an informed participant in your healthcare.

It means asking your provider to explain the working diagnosis and what else is being considered. It means understanding what has been ruled out and what has not. It means completing the follow-up laboratory work, scheduling the imaging, returning for the next appointment and seeking another opinion when the pieces still do not fit.

It also means keeping copies of your own results.

Healthcare remains fragmented. Your primary care provider may not automatically receive every result from every specialist, hospital, urgent care clinic or imaging center. You may be the only person who sees the entire story.

Before an appointment, write down what has changed and when it began. Include changes in sleep, mood, energy, concentration, weight, digestion, urination, muscle strength and bone or joint pain. Bring an updated medication and supplement list. Note abnormal results from other providers and questions that were never fully answered.

Most importantly, tell the truth about how you feel, even when the symptom seems vague or difficult to describe.

You do not have to arrive in crisis before your symptoms deserve attention. You do not have to prove that you are suffering enough. You do not need a dramatically abnormal test result before you are allowed to ask what a persistent trend might mean.

And you are not being difficult when you say:

“I understand that this could be menopause, stress or aging. But what else should we consider?”

Make the Appointment—and Keep the Follow-Up

Schedule the wellness visit. Complete the recommended bloodwork. Get the mammogram, bone-density study, colorectal cancer screening or other preventive service that is due based on your age, history and risk.

Then review the results.

Do not automatically assume that no phone call means every result was normal or that every mildly abnormal result was meaningless. Ask for copies. Look at the trends. Return for the follow-up appointment. Make sure the test that was supposed to be repeated was actually repeated.

My adenoma did not teach me to fear every symptom. It taught me not to dismiss every symptom. There is a difference.

Women spend much of their lives making sure everyone else gets where they need to go, takes what they need to take and receives the care they need to receive. During this season of life, we must extend some of that same diligence, compassion and persistence to ourselves. Showing up for your health is not an indulgence. Asking questions is not disrespectful. Requesting follow-up is not overreacting. Seeking a second opinion is not betrayal. It is stewardship of the life, purpose and body you have been given.

‍So, make the appointment. Complete the testing. Follow the pattern. Ask the question. Use your voice.

Do not wait until your body has to shout before you decide its whispers are worth hearing.

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This article reflects my personal experience and is intended for education and encouragement. It does not replace individualized medical advice, diagnosis or treatment from a qualified healthcare professional.

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