The Grief of Midlife — Fertility, Youth, and the Woman You Were
Day 29 of the 30-day Perimenopause Series.
Nobody warns you that perimenopause is a grief.
The lists of symptoms warn you. The infographics warn you. The websites promise treatments and supplements and hormones. But almost no one pulls you aside and says the quieter truth: this passage will ask you to grieve. Not in the way a death asks you to grieve. In its own way. Slower. More diffuse. Harder to name.
You will grieve the body you used to have. You will grieve the years you did not know were the middle. You will grieve the woman who could go all day on four hours of sleep, drink two cups of coffee, and still show up sharp. You will grieve the assumption that your life would keep unspooling exactly the way it had been.
This grief is not a symptom to be treated away. It is a passage to be moved through.
Why This Grief Gets Missed
Because it does not look like grief. It looks like irritability. Like withdrawal. Like unexpected tears at a stoplight. Like a sudden inability to watch certain movies. Like scrolling old photos and feeling something wet at the edge of your eyes without quite knowing why.
The grief of midlife is not one event you can point to. It is many small losses accumulating in the background of a life that still, on paper, looks fine. That is what makes it hard to notice, and what makes it particularly hard to give yourself permission to feel.
What Women Actually Grieve
The body that used to bounce back — from a bad night, a hard workout, a stressful week. The body that recovered without effort.
Fertility, whether or not you wanted more children. The end of a possibility is different from the end of a wish.
The way you used to feel in a room — younger, more visible, more assumed-to-be-important in ways you did not have to earn.
Certain relationships that will not survive this transition, including sometimes marriages that came into being under a very different version of you.
The years you cannot get back — including the years you spent working through symptoms nobody named for you.
The mother-you-were-to-small-children — even if the grown children are wonderful, that specific version of mothering is over.
The plans that did not happen. The person you thought you would be by now. The dream that quietly went cold.
You do not have to grieve all of these. You may not grieve any of them exactly this way. But if the last year has been quietly heavier and you cannot quite explain it, this may be some of what is happening.
The Stages Do Not Move in a Line
You will not go tidily through denial, anger, bargaining, depression, and acceptance. You will cycle. You will think you are fine, then find yourself in tears folding your daughter's old clothes. You will bargain by promising yourself you will get back in shape and everything will feel like before. You will have days where you are peaceful and days where you cannot believe your body has done this to you.
None of that is failure. That is what grieving something large actually looks like.
What Helps
Name it out loud. "I think I am grieving." Even alone, in the car. Naming is 40% of the work.
Tell one person. Ideally another woman who has been through it. Grief metabolizes in the presence of a witness.
Write about it — even badly, even briefly. Journaling has more evidence for processing grief than most therapy modalities.
Move. Walking, especially outside, is one of the most reliable grief interventions we have. So is dance. So is strength training that reminds your body it is still yours.
Let go of the timeline. This does not resolve in 30 days. Give yourself a full year. Give yourself two.
Watch for depression that has moved in under the guise of grief. Grief has waves and lifts. Depression does not lift. If yours has stopped lifting, please talk to a clinician.
If your grief includes thoughts of self-harm, please contact a clinician or call/text 988. That is not weakness. That is exactly what those resources are for.
Loving the Woman You Were
One of the more surprising discoveries of this passage is that the woman you were deserves to be loved, not left behind.
She got you here. She carried the babies, wrote the papers, held the marriage together, showed up to the difficult jobs, said hard truths, kept impossible schedules, and did all of it without knowing what was coming. She deserves to be thanked. Softly, honestly, and by name.
Try this: write a letter to the version of you who was twenty-eight. Tell her what you know now. Tell her what you regret. Tell her what you would do differently. Tell her thank you. Do not send it. Let it sit in a drawer. Read it in a year.
Then Greet What Is Next
The women I know who move through this passage best are the ones who let themselves grieve — fully, without hurrying — and then get curious.
Curious about what they might want that they have not wanted before. Curious about how they might spend the time that used to belong to raising children or building careers. Curious about the friendships they never had bandwidth for. Curious about learning something entirely new. Curious about their own bodies as they are now, not as they were.
The old woman you are becoming — and I mean that word lovingly — has capacities the twenty-eight-year-old could not access. Wisdom that only comes from having survived things. A tolerance for ambiguity. A refusal to waste time. A knowledge of what actually matters. A hard-won ability to say no.
Grieve the woman you were. Thank her. Let her rest. Then meet the one who is coming.
Whole-Person Steps
Name the losses. Even a partial list. Even one. "I am grieving [the body I used to have / fertility / who I was to my kids / the years I did not know were the middle]."
Tell one trusted person. Do not carry this alone.
Write the letter to your younger self. Do not send it. Do read it in a year.
Give yourself a full year to feel this, without any expectation of being "over it."
Watch for grief that has slid into clinical depression. If it has stopped lifting or if you are having thoughts of self-harm, please contact a clinician or call/text 988.
If You Are in Utah
At Integrative Mind Body Psychiatry, I hold space for the grief that runs alongside the biology of this transition. Sometimes we treat with hormones. Sometimes with medication. Often with listening — to the losses no one else has named for you. Telehealth for adults, adolescents, and women in hormonal transitions across Utah. Insurance accepted through Headway. Learn more at integrativemindbodypsychiatry.com.
This post is educational and is not a substitute for individualized medical or mental health care. If your low mood is persistent, or if you have thoughts of self-harm, please contact a clinician or call/text 988.
Respectfully,
Beth Makar, RN, Dual-MSN, PMHNP-BC
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