“Hormones cause cancer, na?” A nurse in the Ob/Gyn department (of a leading hospital in Gurgaon) said it like she was reminding me of something that I had forgotten, and not like something I could question.

This was from an Ob/Gyn meet-up I had scheduled before I had to pack up that wagon and get on this journey myself.

While the nurse made notes of my symptoms before queuing me for the appointment, I was warily answering her outdated questions on intimacy and fertility, worded sensibly for a sensitive audience.. (and almost all of them missed the point!)

I’d gone in with a list – insomnia, joint pain, a temper I did not recognise lately, shortening periods and left with a pamphlet on calcium and the distinct feeling like I’d asked for something slightly indecent.

My mother backed her up without missing a beat. “Better to suffer a little than take chances.” She meant it lovingly… that is almost the worst part.

So I did what I do now – I went home and read the actual study everyone keeps quoting, the one from 2002 that started all this. And I sat there a little stunned, because it wasn’t even about women like me. Older women, years past menopause, on an old hormone formulation barely anyone prescribes now.

The fear outlived the footnote!

NAMS’s 2022 update says the opposite – for most symptomatic women under 60, benefits outweigh risks. Nobody in my famil(or apparently most of the women on Instagram) got the memo.

What made me angry wasn’t the caution, but it was what that caution was costing me!

A Mayo Clinic study found menopause symptoms cost women real income and career ground (Faubion et al., 2023).

Insomnia doesn’t stay home when you go to work… Neither does the fog.

I was living that.

Missed a deadline.

Snapped at someone in a meeting I still feel bad about.

I ended up trying five-flavor tea, on a friend’s TCM aunt’s advice, mostly because I was desperate and it felt like doing something.. I once almost ordered $700 of supplements on a friend’s whim and I’d say it only helped a little.

What actually helped more was finding a doctor who’d read past 2002.

Twenty-two years is a long time to keep flinching at a shadow.

If you’re wondering why menopause has been held up as a subject of general health, head to www.supple.care and see for yourself!

Yet another friend told me that she lost a word in the middle of a client call this time..
Not a big word.

“Invoice.”

It just wasn’t there.
I laughed it off, said something about too much about our obsession for coffee, and felt my face go hot in a way that had nothing to do with ‘her’ embarrassment…

That evening, as I lay awake doomscrolling, I recalled my own math of my body like it was my friend’s spreadsheet: the early periods, the 4am wake-up and not being able to fall asleep again, and the sudden crying over a Cadbury ad.
I told myself I was just tired. Well, everyone’s tired. I have said it before, and yet it doesn’t strike me as being ‘too much for being tired’

And then I remembered my mum’s answer, when I shared this with her, was haldi doodh (Turmeric milk with pepper)and “yeh sab normal hai, beta, chala jaayega.”
Not unkind... just unclear, and sort of final...
The kind of final where you stop asking and feel like you’re being a menace to yourself.

Here’s what actually sat wrong with me; once the fog cleared enough to think straight, I realized that nobody was arguing perimenopause was dangerous.

They were arguing it was natural, and somewhere that got translated into “so don’t ask for help.”..

A pregnant friend gets scans, appointments, a Buddy (I love these support-systems from Australia!), a whole universe built around her pregnancy.

And I? I got a doodh recipe and a pat on the hand.

The Lancet’s 2024 series actually said the quiet part out loud:

What women need isn’t reassurance, it’s a real model of care that includes 1) Information,
2) Options, and
3) Someone to actually treat the thing instead of managing your feelings about it.

And this isn’t a handful of women being dramatic...

Close to a billion women globally are moving through this transition, many of them hitting it early!

I did eventually find something that helped, oddly : a friend’s acupuncturist had me soaking my feet in warm ginger water before bed (along with the recent “salt stomping” for magnesium) an old Chinese remedy for what she called “heat rising.”
It didn’t fix the biology, like some people call it to do... but it came close to feeling like someone treated the problem like it deserved a solution instead of a shrug.

That’s the real difference: our menopause care must feel like someone thinks you’re worth helping.

If you’re exploring and educating yourself on more around perimenopause and beyond: check out https://supple.care/

Part 3: The word on the tip of my tongue ..

Did you forget your colleague’s name? And, the reason you laughed after admitting it, so it wouldn’t sound like fear?
Thankfully, all poor memory can’t be Dementia or Alzheimers, but Brain fog during this transition is quite normal.

Researchers actually measured this: in a four-year study of women moving through the transition, women in late perimenopause didn’t get the normal practice-related improvement on a learning-&-processing task that every other group got:

a real, measurable Dip in the cognitive and executive performance domain.

And, here’s the good part of what I most want you to know, that, it was largely transient.

The learning ability tended to rebound after the transition.

However, the fog is real, and for most women it gets better.
Thankfully, you are not watching your mind leave, but you’re moving through a really annoying stretch of traffic on a bullock-cart.

There’s also an interesting cousin to the fog that I must name gently, because my friend has touched it in a 2am voice note, under an awkward haha.. And that cousin is called ‘Low mood’.
It’s a flatness that doesn’t feel like you, and it is quite common in this transition window, and not simply because life is hard right now.

Low mood and depression may be some sort of in-laws : In a study that followed women with no prior history of depression, the risk of a first-ever episode was higher during the transition into menopause than before it.

I tell you this, not to frighten you but for the opposite reason, that, naming a hormonal contributor does not mean it isn’t a mental-health matter that does not deserve support.
A hormonal explanation and a mental-health one are not rivals, and you do not have to figure out which it is before you ask for help.

If the low mood has lingered long enough for you, and you don’t know how to articulate it, or justify it, or label-it (like we need to for our emotions), or deem yourself a Lore’al woman (who is worth it), please take it to a Doctor who may listen. And if s/he doesn’t, please take it to another. And then take it to a 3rd Doctor. Remember if even Melinda Gates had to traverse through 3 Doctors to get her (terribly late) diagnosis, you should’t cringe talking to 30.

Want to know more about the symptoms other women have and self-educate? Try https://supple.care/journal/help-shape-supple-survey

Keep reading for more!

If this is the one thought that made you cry, so let me be careful and clear.

You told me you haven’t changed how you eat, and the shape of you has changed anyway (softer around the belly, in a way that feels like a cheese wheel), so here is what the research shows, and it changes everything (yes, everything!), so read on:

During this transition,

The rate at which women gain fat roughly DOUBLES while muscle mass falls

and this can happen even when the number on the weighing scale barely moves, because fat is going up as muscle comes down. It’s a double whammy, and we should know what it means!

So you can feel your body composition change while the scale says “you’re fine,” then know that this is exactly the gaslighting loop that you’ve been stuck in.

It’s not willpower. It’s an obvious shift, and it’s independent of just getting older.

(One honest observation: in that same study, Japanese women showed a somewhat different pattern than white and Black women, which is more proof that our bodies deserve their own data.)

One practical turn from this finding: this is the season to protect muscle, and definitely not to eat less and less. Muscle is the thing that your body needs more of right now, and it is also the thing that keeps your metabolism and blood sugar steady.

Strength : even bodyweight, even household-heavy work, plus enough protein does more than another chapati lost to stupid instagram gaslighting and unverified whatsapp forwards. If you take one thing from this Part 2, let it be feed the muscle, don’t starve the body.

The gut burn is REAL too, and I’ll be honest about where the science is firm and where it’s still evolving:

Slower digestion, new bloating, and a stomach that behaves differently.

Many women notice it, and researchers are actively studying the two-way relationship between estrogen and the gut microbiome (there’s even a name for the gut bacteria that help recycle estrogen, called the “estrobolome”). This is an emerging field, not a settled fact, so I won’t tell you anything off the back of it, but I am diving deeper into this section and will soon update you of news.

What I will say is that the boring foundations which are 1) fibre, 2) fermented foods, the 3) warm-not-iced water our grandmums pushed on us, and 4) movement after meals (or 10 squats please) are all low-risk and sensible things to do to support our metabolism and sedentary lifestyle, while the science catches up with remaining of our symptoms.

My friend is as awkward as me. She sent me a long rant, not heard the best in a raspy voice note, but the TLDR is:“I’m fine, ya, just can’t sleep, and I’ve put on all this weight, and honestly I forgot my own colleague’s name in a meeting today, and felt so so stupid, so clearly I’m losing it.” And then the laugh. and the “lol” and the 2 syllable “haha”

I’ve been where you are, and I want to tell you the thing I wish someone had told me before 3 years of being sent home with

“It’s just stress, you’re doing too much.
Stop over-exercising, and
Your belly fat shows because you’re not eating clean.”

So here it is, the long version, because you deserve more than a sheepish haha after baring your 2am honest voice notes to your friend.

First: None of this is in your head. And a lot of it is not random : it has a cluster, it has a pattern, and there is a lot of evolving research that will explain most of what you feel and describe.

Another truth is, that, that research mostly wasn’t done on women like us: the big menopause studies contain almost no South Asian women, but where Indian data exists, it says the ‘transition tends to start earlier for us’: the Indian Menopause Society’s pan-India survey put the average age of menopause at around 46, roughly 5 years before the Western textbook number.

So if you’re 41 and feeling this, you’re not early to a party nobody else has reached. You may be right on time and just never told.

Let me take 3 things in that order. But this part will first contain the most-neglected symptom, sleeplessness.

Part 1 : The 2am wide-awake zombie that you are

First, you are not imagining that your sleep has got worse, and worse in a specific way. In the largest long-running study of women moving through this transition, more than 80% reported sleep disturbance, and the trouble became stronger as they moved deeper into perimenopause : not just difficulty falling asleep, but waking and staying awake, and the cruel early-morning kind where you’re up at 4 and your brain won’t switch off.

It tracked with the hormonal shift, not with how “stressed” the women said they were. That study included mostly Chinese and Japanese women and found that the picture wasn’t identical across groups : which matters, because our nights don’t always look like the Western nights either. We are awale till late, we have chores to do, almonds to soak, and a myriad other things before we head to the bed. (And who are these women who get to sleep at 10pm?! :) )

Now, there’s a 2nd layer some of us get: the heat.
Even when the daytime hot flushes are mild, and for many Asian women they are much quieter and slightly less explicit than the Western stereotype: the night version of hot flushes (that just feels like a specific devilish kind of heat that the aircon at 16degrees can’t beat) can still surface you out of sleep, in a very damp and awake state.

Those night-time heatwaves are not a forgiving and kind 2-month nuisance that will pass. In one seven-site study, frequent hot flushes and night sweats lasted a median of about seven and a half years; far longer than the “6 months to 2 years” that women were told casually.

Knowing that number doesn’t fix our sleep issues, but it will stop you blaming yourself for a phase and will better educate you than any mattress advertisement would.

So what do you actually do, tonight, without a prescription?

The honest answer is: boring things almost always have the best evidence.

A cool, dark, screen-free wind-down is not a fobbing-off (I know it’s hard!) for the racing midnight mind, the therapy called CBT-I has the strongest evidence base for stubborn insomnia, though I’ll be straight that finding it in India or Singapore isn’t easy yet.

Magnesium is something a lot of women use; the research on it is genuinely mixed rather than conclusive, so try it if you like but don’t expect a miracle, and check with your doctor if you’re on other medication. Magnesium glycinate actually works better than most, but again,ask yor doctor please.
For Melatonin I’d raise it with a doctor rather than order online: it’s regulated differently here than in the US.

We have more nuggets of tried and tested wisdom coming up, so wait for part 2 and part 3.

My friends have asked me why I’d start another health company after the first. The honest answer is that the deeper I personally go into perimenopause, the harder it becomes to look away.. It’s the most common thing in the world; half of all humans will live through it, and somehow it remains one of the least seen phases of the female life.

One of my favourite authors, Gabor Maté has a phrase for the kind of suffering that hides inside the word “normal”: too vast and too near to be noticed, the way water is invisible to a fish. That invisibility is the thing I want to attempt to undo.

But like all of my previous selves evolved through the decades, I will argue against myself first, and also, because I owe it that. Perimenopause is a phase (a decade long phase!), not a disease, and the last thing any woman needs is to be told a life stage is a ‘condition’ that someone can sell her a cure for. I’ve sat with that fact for a long time. But naming something is not the same as pathologising it, and silence has never protected anyone. The women in my own family were told their symptoms were normal, right up until one day the “solution” was a hysterectomy. Remove the organ, end the argument.

I am building Supple so that dismissal stops being the standard of care. Here are the pillars of belief that I want to work around:

1. Being told it’s in your head

The first thing I kept running into, when I spoke with my doctors, was my own self-judgement and the certainty that all of it was in my own head. Maybe it was the midlife itch, maybe it was depression, maybe something was wrong with my way of being. What else can you imagine? A seemingly healthy woman, who looks nice but feels tired, foggy, aching, fully not like herself … what could be wrong with this woman, other than her being a moody woman? This has felt and will continue to feel regressive and utterly ridiculous.

So, naturally, I want to change the direction of that. I want to turn that scattered thought of symptoms into data that women can hold in their hands, something with a shape and a slope, so that they never again have to argue her own body into being believed.
And when it comes to relief I want every option on the table, with nothing withheld because “someone” decided it was too much for women, and not oversold either, because the honest truth is it can feel worse for a couple of weeks before it feels better, and women deserve to hear that up front. Comfort has its place... but comfort offered instead of the truth is only another kind of dismissal, and I would rather educate women first and soothe them second.

2. Less than 7% of doctors ever felt ready for this!

I was flabbergasted when I first learned that Doctors actually weren’t well-informed on the subject, because for a long while I blamed them for the wrong reason.

I assumed doctors simply weren’t listening, too overwhelmed by the long list of whines, couldn’t confirm the actual discomfort in a 3 page essay of the symptoms some ladies brought them, until I looked at what they’re actually taught, and the whole picture turned over.

Only about one in five OB/GYN training programmes offers any real menopause education, and most of that is an elective that a student can quietly skip! (same Mayo study)

When Mayo Clinic surveyed residents, only 6.8% reported feeling adequately prepared to manage women experiencing menopause.

So women patients weren’t always being dismissed by a careless doctor, but more often they were being met by a well-meaning one who was simply never taught the best.

And it begins further back still, in 2002, when a single large study frightened the world off hormone therapy almost overnight; the one that we’ve since learned was badly misread, drawn mostly from women already a decade past menopause, and a whole generation of clinicians was trained inside that long shadow, with the guidance only now being improved.

So here is what I want to do about it:

I want to place a valid account of data into the doctors’ hands and not only the patients’, so the few who ever get to see one are no longer working half-blind…

I want to build Supple alongside clinicians rather than around them, with co-developed protocols, a doctor kept in the loop, honest briefings.

3. Care built for someone else’s body

The thing is that most of what we call knowledge actually comes from Western women and Western studies, and Asian bodies, Asian diets, our budgets and our families were never really part of that sample.

So what I want to build are recommendations genuinely tuned to how Asian women metabolise, eat and live, with all the household constraints that come with that, vs pasting advice designed for a different body!

And underneath it I want to build the definitive Asian ecosystem for personalized health, for all of us, and that begins with getting to know each woman deeply: learning her body in her own rhythm, following her own story rather than the average of a thousand strangers.

That’s where our name comes from.

To be ‘supple’ is to bend without breaking, to stay soft and adaptable to change instead of braced against it… which is exactly what a body is trying to do through this transition if only we would let it.

And, there is a great deal here that can’t be predicted or controlled: how a body will shift from one month to the next, which remedy will land and which won’t, how long the whole passage will take. But there is so much that we can solve for, making the invisible visible, clearing away the noise and the guesswork and the endless conflicting advice, and letting a woman spend her attention on living well rather than on quietly decoding herself, alone.

Supple will open to its first women later this year, in a few select places to begin with. In the meantime, I’ll leave you with this: how we move through this one decade shapes the decades that follow more than almost anything else — and that is far too important to be left to chance, and far too personal to be handed a one-size-fits-all script. We’re building Supple to give women the care they have always deserved.

If you’d like to be there from the very beginning, come and build it with us, and help share your struggles of perimenopause to menopause and beyond.

More soon.
If you want to know more, write to me at shrutiwire@gmail.com

I tried protein, supplements, red date tea, turmeric milk, and seven doctors before realizing patience is not a treatment.

I am very good at solving things. Give me a target and I hit it; give me a problem and I out-plan it. This is a story about the one thing that hasn’t worked, and how long it took me to notice I’d been handed my own patience and told it was a cure. It starts, like most of my problems do, before I’ve finished my coffee.

The first call is at 830am, so I’m up by 630. Protein shake, because thirty grams before nine is the rule now, and getting all from a plate that’s mostly dal and paneer takes actual planning. I’ve soaked the sprouts, with a close fistful of nuts.. I’ve measured the curd, and did not succeed in making ambli for a good gut. As I sip my coffee, I know that it is either extending my liver’s life or spiking my cortisol, and that I’ve already missed the nine-minute window for morning sun.

I do more than is needed.. I always have. It’s the thing that got me here, the belief that if I plan a little further ahead and put in a little extra, and the outcome will bend my way.

So I bring that to my body too. The tracker, the daily macros, the supplements lined up like a small pharmacy by the diary. The well-traveled journal with wilted corners, shows and hides a variety of my inner monologue about this mind and this body… and there is ever more to be written.

On paper, I’m doing everything right…

And I am tired. Not sleepy-tired.

But again, everyone’s tired… my mother was tired her whole life and never titled it anything.

My friends are tired.

So I put up with it, take it “in my stride” and I “keep going”, except some nights it refuses to be defended. 4am in the morning, wide awake, heart palpitating as if I’d sprinted somewhere.. i see my husband breathing beside me, fast asleep, that beauty.. And, then the alarm goes, and the feeling gets folded back into the morning, because what else is there to do with it?

So I deal with it the way the women in perhaps this world, always have, with my hands… I try turmeric milk (with black pepper) at night, Methi seeds (as a matter of fact, not the seeds but only the water) soaked overnight and drunk first thing, because instagram tells me for certain that it cools the body. This with other little gems (or are they?) of knowledge, is widely shared and populated amongst my friends.

A colleague of mine, Chinese, laughed gently when she caught me refilling a bottle of cold water and said her grandmother would have scolded me for it, because bodies our age need warmth, never cold, never raw. The next week she left red dates and goji berries on my desk, a fistful to boil into a sweet red tea meant to build the blood back, the qi, whatever it is we’re all quietly losing… So now it all sits together by my desk: the protein scoop and the red date tea, the new science and the old care.. all amalgamated into some system that most women my age will relate, but not understand fully.

Honestly, I couldn’t tell you which one is working, but the tea, at least, tastes like someone paid attention..

But, It was only when it got loud enough that I finally went to a doctor (and another, and another, a total of 7 to date): and, these are the parts that still makes me angry, visibly angry. The stiff shoulder went to the bone doctor who told me about calcium RDAs. The palpitations bought me 3 heart tests (a painful scan and multiple pricks) all clean, all fine, and not once did anyone say the word hormones out loud. And o haven’t bought the $988 cheap mattress that will align with my spine and my chakras to get that sleep I deserve.

And, well, my mood walks with impossible heels into every room except the one I need.

So I stopped going. I decided I was overreacting…

And, that’s what I felt stuck with – not the symptoms, but how quickly I agreed to “be” the problem.

I’m someone who fixes things by trying harder; it has never once failed me at work. So when my body didn’t respond, I assumed I simply hadn’t tried hard enough… More protein, better deeper sleep, 1 DIM here and another supplement there. And underneath all that, the older training persists: “don’t complain, don’t make it about yourself”.

So, when the system shrugged (and it didn’t feel like Atlas), some trained part of me shrugged along with it, almost relieved to put the blame back to my own body. Maybe ….its just supposed to be like that.

Here is what I’ve landed on, slowly, over these mornings.

I keep being told I can live with all of this. And yes “I can” – that’s the whole trick of the word. Yes, i can. I probably won’t die of it. I’m living with it right now, optimising around it, out-planning it a day at a time and FAILING…

But living with something and it being fine are not the same, and somewhere the two got swapped without my say.

What I can tolerate got quietly rebranded as ‘what’s acceptable’ and I was too busy hitting my targets to notice the swap that the world made for me. Who cares about middle aged women anyway ;)

I’ll keep the red date tea. I’ll keep the haldi doodh, the protein, all of it. They help me carry this being… But I’ve stopped believing that carrying something well is the same as being cared for.

That’s the one thing I won’t tolerate anymore, being handed my own patience and told it’s a treatment.

Confessions of a tolerant mid-lifer was originally published in Thoughtfultini Publication on Medium, where people are continuing the conversation by highlighting and responding to this story.

Building the intellectual spine to really ‘back’ your opinions requires a fair amount of hard work, but we all dodge it cuz it isn’t easy.

However, there’s no shortcut.

You have to look at the variables, and listen to their oppositions.
You have to think deeply, evade your confirmation bias, drop your emotional guards to allow criticism to change you..

You have to do the reading → the diverse the better, the rigorous the better.
You have to engage with smart people, understand their perspectives, observe their twitches, read their micro expressions.

It is not easy → it requires you to have a grounding intellectual humility → the humility to be proven wrong, and as many times as it takes till you solidify the facts you had based your previous opinion on.

Ofcourse, I am no proponent of decision paralysis, but the fact remains that we’re all Jon Snow, and we know nothing… well, till we finally do.

The truth (my opinion) is that the work required to get to the stage of ‘knowing’ can’t be skimped on or skipped on → it will need you to give in.

It is not easy, but that’s how you become intellectually worthy of holding an opinion.

Smart farmers don’t plant crops in the same field year after year. They let the land rest — lie fallow.

It looks unproductive, but underground, magic is happening… the soil rejuvenates, getting ready for an even better harvest next season.

Our brains work the same way.
The moments when we’re “doing nothing”, or when we’re “off-duty” are actually crucial. It’s when our subconscious connects dots we didn’t even know were there → It’s when creativity blooms and big ideas take root.

So maybe we need to rethink this whole productivity obsession. Maybe “downtime” isn’t wasted time at all, and downtime definitely isn’t laziness.
It’s essential, and an investment in our future brilliance.

Next time you feel guilty for taking a break, remember the smart farmers, and give yourself permission to be fallow.

Embrace your inner couch potato (just a little); your future self might thank you for it.

And, It makes me feel a tad bit Squeamish.

I was skimming through a book ‘You Die only once’ and came across the often done self- reflection exercise, of writing your own obituary. And that led me to read other examples, to notice that, in their self-obituaries as well, people tend to highlight their social impact, as if it was a barometer of social worth.

It makes me wonder if all that we do, is somehow reduced to our ability to create value, or some sort of seen/measurable/tangible impact?

And even though not economically motivated, when you live (or die) to “create impact”, I feel the concept to be unhinged (and irrationally reductive.)

Your ‘being’ on this planet earth cannot be equated to being ‘productive’ and ‘driven for duty’ and only living for others. As much as I’m a proponent for being kind (to others, but to yourself as well), the radical human life given to us, does not justify itself to be well-lived for a reason other than self- actualization.