1. Google- I’m looking at keyword patterns, “People Also Ask” related searches, autocompletes, all those sorts of responses.

2. Social media- I’m reading comments, watching countless videos, digging through Reddit, and trend-spotting.

My unsophisticated critique is not “influencers = bad and doctors = good,” it’s more of a question of what happens when we can no longer easily tell where education ends, identity begins, and selling starts?

I’ve learned that influencers filled a real vacuum, and I believe it’s important not to erase why this has happened.

Women remain systematically underrepresented in medical research, underrecognized in clinical care, and underfunded across healthcare, period.

During the rise of The Influencer, menopause (as a topic) was under-discussed on social media. Many patients describe feeling dismissed, inadequately counseled, shrugged off, or receiving fragmented bites of information. Social media gave people a specific vocabulary for experiences they previously couldn’t name. It made topics like hot flashes, vaginal symptoms, low libido, sleep disruption, changing cycles, brain fog, and hormone therapy discussable in public. Influencers helped break a genuine silence. And that’s precisely why they acquired so much authority.

I’d be mistaken if I flatly labeled the influencer boom as “irrational consumer behavior”. People migrated toward people who appeared to be listening when their healthcare institution didn’t! Where it gets sticky for me is what happened after the attention arrived.

Menopause went from neglected to monetizable posthaste:

Once menopause became culturally visible, it also became a massive market. Search for enough things in your 40’s and a version of you begins to materialize.

• Why am I waking up at 3 a.m.?

• Period suddenly every 3 weeks.

• Why am I gaining weight when I haven’t changed anything?!!

• Suddenly anxious before period!

• Why do my joints hurt in the morning?

• Low libido at 42.

• Hair thinning women 40’s.

• Can perimenopause cause heart palpitations?

At some point, the internet connects the dots…

Maybe you haven’t called yourself perimenopausal or menopausal yet, but Google has already started filing you accordingly. We spend years being categorized by what we are doing: we’re students, newlyweds, newly-divorced, midlevel management, a working mom, a stay-at-home mom, and on & on. Each category comes with its own expectations, risks, products, language, and assumptions.

You’re in your 40’s: here’s your basket of products to treat the gamut of things you’re feverishing typing into Google and your Rolodex of platforms to follow on social media.

When we start filing ourselves into categories, we can lose the nuance that actually matters when it comes to understanding and addressing our symptoms. This brings me to an article I read recently on obsessively categorizing ourselves into oblivion…

“Online we’re sorted into categories, boiled down to keywords and types of people. We aren’t really individuals, rather data sets with shared interests who get pushed into different streams of content. But I think what’s most unsettling is that we’ve all started to take these labels to heart. The algorithms don’t even need to do the heavy lifting anymore, we seem to want to categorize ourselves.”- Hannah is Spiraling

Categorization can get clunky quickly. To Google, she belongs to a search category. To advertisers, she belongs to a demographic. To medicine, she belongs to a reproductive stage. To social media, she may become an archetype of a moody, sweaty, unhappy woman who needs more supplements. But up close, the “category” is much more layered. And once one of us searches one menopause-related symptom, we’re fed more menopause-related explanations, products, experts, communities, and fears. The category begins reinforcing itself on a loop. That creates 2 opposite risks at once.

• One is under-recognition. A symptom is dismissed as stress, aging, or “just menopause” when it deserves its own thorough evaluation.

• The other is over-attribution. Every headache, mood change, pound gained, forgotten word, crappy night of sleep, or painful joint gets folded into the menopause story because the woman has reached the “right” target age.

Both are forms of flattening.

When we type something into Google or into an AI chatbot, we’re usually seeing a mix of paid & unpaid results. The paid results are ads, which I’m sure you’re seeing a ton of on your social media feeds lately. Companies can spend money to appear prominently for certain searches. Think of how commercially valuable that can be for companies! A great example is a virtual telehealth platform promoting GLP-1’s for weight loss. The unpaid results are different. How often do you think unpaid articles are ranking #1 on Google???

Large health companies, supplement brands, telehealth platforms, and media organizations can afford teams devoted to search engine optimization. They can research exactly what we’re typing into Google, commission hundreds of articles around those phrases, continually update them, build links to them, and structure their websites in ways that make them easier for Google to find + rank. That matters in perimenopause and menopause because some of the most commonly searched questions also happen to be some of the easiest to monetize.

The answers that require more context are typically harder to package.

Healthcare providers and researchers may never match the content machinery behind full-time influencers, but more experts are starting to show up where people are actually looking for information. I find that refreshing! Health education is slowly becoming its own genre of social media content, competing with the endless stream of “get ready with me” routines and unboxings that used to dominate the space.

And with that said, I’ll be bringing what I continue to uncover through social media and Google into future Substack posts alongside the latest research and publications on perimenopause and menopause with a continued focus on individualized care, clinical context, and the details that often get lost in broader conversations.

Instead of treating search trends as an editorial instruction sheet, I want to use them as a window into what people are curious, frightened, or confused about during perimenopause and menopause.

If thousands of women are searching “menopause belly,” I want to share what the evidence actually says about changes in body composition. If they’re searching “best supplements for menopause,” I want to look at which supplements have actual evidence and which claims have gotten ahead of the science. If they’re searching “does menopause cause anxiety?” I want to talk about what we know about mood during the menopausal transition, but also where menopause stops being a useful (or “convenient”) explanation and another evaluation may be needed.

I’m grateful to have your eyes on my publication. See you in the not-so-distant future! Xx.

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I am a licensed healthcare provider, but the information I share here is for general educational purposes only. It is not medical advice, diagnosis, or treatment, and it should not be used as a substitute for care from a healthcare provider who knows your individual medical history and circumstances. Reading, subscribing to, or interacting with this Substack does not establish a clinician-patient relationship with me. Always consult your own qualified healthcare professional before making decisions about your health, medications, supplements, or treatment.

Reference shared in today’s article: https://pmc.ncbi.nlm.nih.gov/articles/PMC12657800/

Time flies when you overextend yourself into oblivion. Clinic prep is in full swing, which means I’ve spent the past few weeks patching walls, building websites, and learning (yet another) electronic health record system. Grateful for every single packed second, all things exciting!!!! Will keep you in the loop for the soft launch.

In the little pockets between wall spackle, website copy, and password reset links, I’ve been doing what any overstimulated person does: wandering the internet and pretending it counts as recovery. ;)

So here we are: the Anti-Basic basics.

A small, highly specific pile of summery things I found from all ends of the algorithm, for the girl who is quasi-minimalist with a dash of maximalist, currently held together by one good skirt, 3 beauty products, a book she probably won’t finish, and a pair of purple micro-lens sunglasses.

Zara is usually guilty until proven interesting, but this fringe knit top makes a strong case for acquittal. Loving this Zara fringe knit top. It has that slightly feral vacation energy I always think I’m going to have in July. Wear it with jeans, a slip skirt, or cutoffs.

The & Other Stories layered panel skirt is for anyone who wants movement without looking like they are auditioning for a period drama in a garden. The red is strong but not obnoxious.

The Nou zebra ponyhair mule is the item that makes the rest of the outfit behave. A white tee and jeans become a look. Zebra ponyhair is not neutral, but it does have the confidence of neutral, which is more important. It says, “I may be late, but these shoes have arriiiiived, honey!”

Then there are the ALPEN purple micro-colored sunglasses, which resemble something found in a Delia’s magazine from the late 90’s. They’re a bit impractical, but who doesn’t want to see the world through purple lenses?!?! You may squint a little while wearing them, but you’ll look interesting while doing it.

For the girls who prefer a faux tan over an outdoorsy tan, there’s Loving Tan 8HR Deluxe Face Self-Tanning Cream. I’m deeply committed to self-tanner as a concept, though my white linen sheets have filed several formal complaints.

I’ve been scouring the globe for Victoria Beckham’s bronze water tint, but it’s been sold out everywhere. I did find a solid dupe, though! The Ben Nye Bronzing Body Tint is the industry’s reliable IT-girl for transfer-free, water-resistant bronzing body tint. Shins, shoulders, cheekbones, collarbones, even the tops of feet if you are feeling ambitious.

Another skin fave that made the cut this week: Colorescience Sunforgettable Total Protection Face Shield Flex SPF 50. It’s for the person who wants sunscreen to do more than simply cover their face. No weird chalky cast, no strange sunscreen film, no “I’m being responsible and everyone can tell” finish.

I’m sure a few of us in our perimenopausal era can relate to hair thinning and hair loss. Agent Nateur Holi (Growth) 84 Advanced Leave-In Hair Growth Scalp Spray is for the scalp-care era we all apparently entered without a formal vote. It’s a weightless leave-in treatment meant for thinning, shedding, or that general “where did my ponytail go?” feeling, with actives that support the hair growth cycle and help improve the look of density over time (hence, the 84-day estimate). Absorbs quickly, doesn’t make roots greasy, and allows you to style your hair like normal, which is essential because no one needs another product that requires a lifestyle change! Smells great, too.

Having a cuppa tea after dinner is one of those small rituals that feels immediately civilizing, and Dr. Stolberg Rest + Digest Tea fits the brief: warm, easy, and made with simple organic ingredients. The brand positions it for digestion and bloating support, but as a healthcare provider, I’m not here to casually prescribe tea on the internet. For me, it sits firmly in the nice after-meal habit category, especially when summer dinner starts to look like burrata, fries, 5 bites of someone else’s pasta, and a flimsy promise to drink more water tomorrow.

A note before I go: I’ve turned off paid subscriptions for now. I still love writing here, but life is very much in clinic-launch mode and my attention is going toward building that with the care it deserves. I don’t want anyone paying for a rhythm I can’t realistically keep at the moment. So for now, this space will stay casual, irregular, and unreasonably specific. I’ll still publish pieces on perimenopause and menopause from time to time, but I’ll write when I have something worth sending. That feels more honest than pretending I’m a lady with a strict editorial calendar.

Kisses + hugs,

-Shelley

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This particular edit is for those of us who want COS-adjacent looks at a fraction of their price. So, a fraction-of-a-fraction of The Row’s price. Nothing too serious or too precious! Clothes for hot days, swamped calendars, iced drinks (or HH cocktails), and the cheap thrill of finding something cute for less than lunch.

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The cotton muslin shorts (top center of my graphic) are the breezy little summer basic you end up wearing 3-4 times a week. The soft stripes make them feel a bit more thoughtful than plain pull-on shorts, and the gathered waist keeps them casual and easy to move around in. These are beach bag shorts, errand shorts, “I’m technically dressed” type shorts.

The stretch lace maxi dress (below) is casual yet slightly romantic. It has that pretty, 90s nostalgic feel. Super wearable with flat sandals and simple sunnies. I’d keep everything around it unfussy.

The cotton denim Bermuda shorts (also below) are the practical hero of this edit. A good Bermuda short makes a white tee look less like laundry day and more like a polished fit. Add a thin black belt, a tank, maybe the shell necklace, and you’re suddenly giving editorial on a budget:

The knitted asymmetrical crochet tank feels like the piece everyone will ask about. It has texture, shape, and enough detail to make basic bottoms feel Non-Basic. I’d wear it with wide-leg black pants, capris, a white or butter yellow linen skirt, or thrown over a swimsuit when you want to look like you planned ahead:

The Edit trapeze maxi dress is my favorite of the bunch. It’s loose, swingy, and easy, which is exactly what you want when it’s warm and you have no interest in being squeezed by your clothes. The chocolate color makes it feel a little more upscale and less beachy cover-up:

Now for the accessories!!

The satin fringe midiskirt brings the drama without requiring an event. It’s the kind of piece you wear when you want your outfit to move a little. The animal-pattern heeled mules add a tiny bit of cheek.

The 90s tinted oval sunglasses are perfect because they make any outfit look more finished, even when you’re running behind schedule. The woven red flats add the pop of color every neutral summer outfit needs. Cute, practical, and far less predictable than a meh tan sandal:

And then there’s this shell necklace, which is exactly the kind of vacation-coded accessory that makes sense even if your summer plans mostly involve answering emails near an open window:

I tried my best to avoid 100% polyester, so I’ll be upfront by saying this draped tank is. Listen, I’m not here to shame anyone about their material preferences, but I figured it’s worth mentioning the composition because it initially had me fooled! Nonetheless, versatile, great color, cute embellishment on the nip of the waist:

Primark may not be where you go for heirlooms, but it’s great for giving that wallet a break. Hope you found something you loved!

Xx. - Shelley

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Disclaimer: Some links are through ShopMy, which means I may earn a small commission if you buy something through them. Tiny kickback, same price for you!

Current rabbitholes I’m climbing into:

Libby-maxxing! Because reading between study sessions gives my brain a clean reset without fully disengaging. A mix of escapism + self-improvement, I suppose…

What’s Libby-maxxing?? It’s essentially the art of getting the most out of your Libby app by stacking library cards, placing a gaggle of strategic holds, borrowing digital magazines, and treating free library access like my own personal media empire. Recently, I started loading up my magazine loanshelf on there, along with adding cards from different library systems. Who knew you could actually do that?! Am I the only one who didn’t know??? You can add multiple library cards to the app, which can also help cut back on dreaded wait times.

Reciprocard is another amazing option. It’s a database of ~ 8,500 U.S. libraries that helps people find additional library cards they’re eligible for and access more digital collections.

A visual representation of me maxxing out my digital library:

Speaking of books & reading, I have a humongous stack of books that I’m slowly peeling my way through.

Here’s a few I have on my Libby shelf/partially started:

• I WHO HAVE NEVER KNOWN MEN- A young woman imprisoned underground with 39 women who know almost nothing about why they’re there, what happened before, or what might exist outside:

  

• THE ART THIEF- This story’s about Stéphane Breitwieser, who stole hundreds of artworks across Europe with his girlfriend as lookout, less “criminal mastermind” and more “a man with museum taste and absolutely no internal brakes.” It’s a heist story, but also a portrait of taste taken past the point of sanity:

  

• ANGEL DOWN- Five soldiers in WWI are sent into No Man’s Land for a mercy killing and instead find a fallen angel in the wreckage. From there, I hear the story turns into this sort of grim morality test about faith, greed, fear, and whether humans should ever be trusted with something holy:

  

• CHINATOWN PRETTY- A street style book about fashionable Chinatown elders who dress w/ more instinct, nerve, and personality than an entire sponsored fashion week front row. It’s proof that the best personal style comes from living a life, mixing patterns, and refusing to explain yourself to anyone under 40. ;) Definitely up my alley:

  

• SHE WHO REMAINS- The story follows Bekija, a young woman in the Albanian mountains who escapes an arranged marriage by becoming a sworn virgin, which allows her to live as a man in her community. What looks like freedom at first becomes something more complicated because survival still asks her to give up parts of herself. I’m hearing it’s an emotional story about gender, family, duty, and the cost of choosing your own life inside a world built to prevent it:

  

• MY YEAR OF REST AND RELAXATION- follows a young woman in early 2000s New York who’s beautiful, rich, depressed, and determined to sleep through the parts of life she finds unbearable. Her plan is both ridiculous and deeply sad, helped along by a psychiatrist with the judgment of a raccoon in a medicine cabinet. Heard it’s funny, cold, and glamorous w/ the emotional aftertaste of canceling plans for 6 months and calling it healing:

  

• REJECTION- Tulathimutte’s linked stories follow people unraveling after (all types of) rejection in a world where humiliation has wifi. Just started it. So far, it’s kinda vicious, hilarious, and maybe tooooo accurate if you’ve ever watched someone narrate their own humiliation in real time:

  

• TAIWAN TRAVELOGUE- This book just won the 2026 International Booker Prize. It follows Aoyama Chizuko, a fictional Japanese writer traveling through Japanese-occupied Taiwan in ‘38, accompanied by her Taiwanese interpreter, Ō Chizuru, who guides her through the island’s food, language, and daily life. Their relationship becomes increasingly intimate and uneasy, shaped by affection, translation, class, colonial power, and what each woman chooses not to say:

  

So that’s the current state of my brain: studying, reading in fragments, adding too many Libby holds, and/or inviting myself to follow whatever odd little trail catches my eye. It’s not exactly rest, but it does feel like an exam prep reboot.

What are you reading this summer?

Xx. -Shelley

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I woke up bright-eyed & bushy-tailed, ready to attend a really hard Pilates Xformer class, but my GPS and local road construction had other plans! My navigation then decided to enter its performance art era and sent me in several incorrect directions, many of which were closed, blocked, or spiritually hostile.

So yeah, I feel kinda nudgy today. I feel like an unanswered email in human form.

And I know this problem is infinitesimal in the grand scheme of things, but it really had my spandex in a bunch today! Now I’m sweating without the exercise and feeling like Ali Wong from BEEF:

Brief background if you’re new to my publication. I’ve been prepping for the MSCP exam, which means my kitchen counter looks like a NAMS guideline went headfirst into a Vitamix. I’m opening up a clinic in the next 2 months, and there’s quite a bit to do before my door opens. My running list of tasks bred overnight…

There is a list, then a list of the lists, then a Post-it shrieking at me about something I forgot in the second list!

It’ll all get done. It’ll all be fine. We’ve all had one of these days. I know I’m in good company.

So please enjoy the following Marks & Spencer picks I didn’t buy this week but wanted to! Looking at clothes is the closest thing I have to a “nervous system reset” this morning.

The denim striped collarless jacket. The last thing I need is another jacket, hence why I didn’t purchase. However, maybe it’ll interest you or a friend!

The crochet cropped knitted waistcoat. Soft, romantic, slightly grandmother-coded in the best way. Great option for a vacation. Anyone planning anything fun in the next few months?

The satin lace mini slip in olive. Love this olive color! Can’t see myself wearing it, but I’m sure someone else can :)

The embellished balloon trousers. Balloon trousers used to make me feel like a clown, so they were a fitting choice for me today. I was clowned by cones, confusion, and a gentleman in a vest gesturing like he was conducting an orchestra only he could hear. That aside, love these!

The satin shorts. In theory, I love the concept of satin shorts. No way I’m buying them for myself today, but aren’t they the cutest shorts?!

The satin smock detail midaxi dress. I love the color of this dress, however, I already know it’s not flattering on my shape. I would love to see this out in the wild.

The satin ankle strap kitten heel sandals in red. The jury is still out on whether kitten heels are easy to walk in. I prefer them because my 42yo feet aren’t a huge fan of 6” heels anymore. Another great color, this burnt sienna color is really having a moment this Spring!

The tie-hem drawstring balloon trousers in chocolate. Yes, another pair of balloon trousers! How about that!

The crochet striped shoulder bag. Another thing I desperately don’t need is another bag. If I were to pick one for a summer pool party or a picnic, this would be the one.

Will I buy any of these? No. I will instead stare at this edit on my phone between flashcards on follicle-stimulating hormone, convince myself looking is the same as owning, and add 3 of them to a cart I’ll (likely) abandon at checkout.

Until then, the cart sits open in another tab! Again, thank you for humoring me today. I hope you can find solace in the fact that everyone needs a moment to vent, even if the rationale seems ridiculous!

Going outside to touch grass.

Xx- Shelley

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Disclaimer: This edit includes ShopMy links. If you shop through them, I may earn a small commission at no extra cost to you. As always, everything featured here is chosen because I genuinely like it and think it deserves a spot in the edit. Over the next 2 months, I’ll be posting less frequently to better prepare for clinic. Can’t wait to share the progress with you.

I’ve been sitting with the peculiar etiquette of women’s health. The way so many of us arrive at appointments with a little internal press secretary prepared to sound reasonable, concise, agreeable, and not overtly dramatic. We say things like, “…it’s probably nothing, sorry for asking!” while describing symptoms that have not-so-subtly rearranged our lives.

We tend to understate, don’t we.

We edit down, revise our questions, and then re-edit again to avoid sounding long-winded. We apologize for the length of our own stories, even when we skip over details in an effort to be brief.

So, friends, I want to ask this plainly because I’m in the midst of opening my practice in Washington and I want to get things right for you.

Well, for us.

What would you change if the system had to take your lived experience as seriously as your lab results?

• What would you immediately change about women’s healthcare in the US?

That’s a big one, huh. I’ll start by saying that I know some fabulous women’s health providers. They are deliberate, comprehensive, and they know when to refer out. They are open to feedback. They’re willing to admit when a thought or inquiry needs deeper exploration. On the flipside (and without being disparaging), I’ve also heard horror stories about dismissive providers. Knowing that time is our most valuable currency in life, that really irks me because everyone’s time is valuable and should feel valued. So if I were to answer the second (bullet-pointed) question, I would say I’d want every patient to feel that their time, concerns, and lived experience are being treated as valuable from the moment they walk in the room. Plain & simple.

• Would you want longer visits with your provider?

When I worked in ortho as a medical assistant maaaaany years ago, the first 7 minutes were swallowed by medication reconciliation, verifying allergies, taking off casts, and re-checking your social/family/personal medical history. Yes/no questions mainly, unless something needed to be changed. Of course, all of these things matter. But when we’re staring at computer screens like alert-fatigued, hypnotized robots, I start to rethink the order of it all. Is the patient able to mention anything else that would be pertinent to the visit? Were they asked-asked? Did they feel like they were able to ask? Looking back at that time, I felt like I barely had time to get to know my patients, another thing that irks me.

• Would you want providers trained to ask better questions about perimenopause, libido, pain, sleep, bleeding, mood, weight change, autoimmune symptoms, pelvic floor issues, and the little details you almost left out because they sounded too “weird”?

My answer: 100000% yes. I’m working on it!!!

Nothing is weird. You, me, and every other human roaming around are just that. Human! We all have different experiences within our bodies, and one person’s definition of feeling “healthy” may not be the same as someone else's definition. My job as the provider is to cultivate an environment where you can ask anything without feeling “weird”, humiliated, ashamed, or too embarrassed to ask. And it’s also my job to make sure that I’m asking the right questions to fully understand where you are coming from and what you’d like to achieve by trusting me with your time.

• Would you want fewer after-visit summaries filled with redundancies in turn for something more actionable? Less “your labs are normal, follow up in a few months” and more “your labs are one piece of the picture, so let’s talk about what your body is doing”?

The “labs are normal” conversation is one I hear all the time. “Normal” is a statistical category but not a full statement about how well someone feels or functions. Lab values don’t always mean the person sitting in front of you feels well, sleeps well, feels clear-headed, recovers well, has a regular cycle, digests comfortably, or recognizes herself in her own body. Sure, a “normal” CBC can be reassuring, yes, but it doesn’t rule out every cause of fatigue. One piece of the picture, as I mentioned.

• Would you want breast health, bone health, metabolic health, mental health, and hormone health treated like roommates in the same house instead of strangers who keep passing each other like ships in the hallway?

This is really, reaaaaaaaally important to me. We don’t experience our bodies in separate departments. All of these “departments” and hormones all talk to each other, whether the healthcare system does or not. When we treat them as completely separate problems, we’re left trying to connect the dots alone. That’s exhausting, and it’s also how important patterns get missed. Better women’s healthcare shouldn’t make a patient prove that her body is one body.

• Would you want more in-person visits? More virtual visits?

I’ve been thinking more about “what kind of care does this situation deserve?” instead of having a clear-cut one vs. other stance. Virtual visits are helpful when you need follow-up, some medication questions, simple lab review, symptom tracking, or a conversation that doesn’t require a pelvic exam, breast exam, vitals, or hands-on assessment. There are cases to be made for some urgent care situations as well. The option can certainly save time and remove some of the friction. For women balancing work, caregiving, fatigue, anxiety, pain, or unpredictable schedules, that option makes a huge difference.

I’d never discount the importance of in-person care. It’s my personal preference for a whole host of reasons, but I’m also aware it’s not always convenient. There are things a provider can miss when a visit becomes only a face in a Zoom box. Swelling can be hard to see, gait changes, specific skin findings, pelvic pain, breast concerns, abnormal bleeding, blood pressure, weight changes, tenderness, and the general sense of how someone is physically doing often need a room, not a screen. The list goes on & on.

• Would you want healthcare providers to say, “I don’t know yet,” without that sounding like the end of the conversation?

Truth is, no single provider knows everything, even if they’ve been in practice for ages and have participated in 10,000+ fellowships or double residencies. The medical field is humbling and constantly evolving, and our knowledge base will continue to evolve as new studies emerge and old studies are updated (or dare I say, even debunked). The most skilled providers I know fully acknowledge this. Kendrick Lamar said it best: be humble!

• Would you want less suspicion around women who arrive informed? Less eye contact with the clock? Less moralizing about weight, pain, fatigue, fertility, aging, desire, and the thousand ways a body asks for attention?

I’m sure we can all agree here that we shouldn’t have to perform calmness, ignorance, or likability to receive great care.

An informed patient is not a threat. Paying attention and trying to make sense of symptoms, risk, treatment options, and whatever strange thing one’s body started doing at 3 am after four nights of bad sleep should be welcomed and not punished. It’s a huge privilege to work in this space!!! People confiding in you, relying on you, and developing a therapeutic alliance with you, none of these are small things.

I keep wondering how many women are walking around with a private archive of dismissed symptoms. A notes app full of dates, cycle changes, rashes, migraines, pelvic pain, sleep disruption, hair shedding in the shower, rage, dizziness, swelling, and that one sentence from a provider they still remember years later. Maybe that’s the tightrope so many of us know by heart, trying to sound concerned but not panicked, informed but not difficult, honest but not too much.

So maybe the better question is this.

What would make you feel believed before you had to prove you were suffering?

Because that answer, I suspect, is where better women’s healthcare begins.

Xx.

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I came across a creator talking about the “eccentric aunt” wardrobe recently, and it’s been rattling around in my head ever since!

In my mind, she’s got a closet full of clothing with no coherent thesis, however every piece is attached to a memorable anecdote. She lives in a spacious, sun-drenched apartment with too many books and one cat she talks to in French. She takes you to the MoMA and buys you the dupe of an Issey Miyake clutch from the gift shop. She dated a bass player in ‘98 and still gets postcards.

She’s got her finger on the pulse of eccentric taste.

Is this style a rebuttal to the “eclectic coastal grandma” who wanted you in a cable knit while savoring a scone w/ chamomile tea? Personally, I love them both, and they both deserve a seat at the table. Instead of competing forces, they’re more like Practical Magic aunties. The canon is deep, and the canon is finally fashion!!

This week’s The Basics for the Non-Basic conjures up that energy…

• Blanch Wear Raggi bag in butter yellow. Studded, slouchy, fully impractical in the best way. This is the bag she carries a paperback, mints, a pair of earrings she forgot she’d taken off last week for yoga. Studs are back, and butter yellow is the It color of the season. You’re threading 2 needles at once.

• Dove blouse in eggshell from Arcs London. Open back, tied at the spine, the kind of top you notice from behind first. This is what she wears to her friend’s gallery opening in a neighborhood you’ve never been to, something she bought in London on a trip she still talks about.

  

• Designs by Si Scandivv trousers in rust. Rust is the color of an old photograph and the color of every good October. Reminds me of the early 2000’s when everyone wore wrapped/draped pants like this. Also 100% cotton, which seems rare these days!

• Charcoal Clothing Bonfire pants. Feels very off-duty ballet teacher headed to a cafe to read poetry. Has a similar vibe to the Designs by Si Scandivv trousers.

• Olga Joan flounce front skirt in acqua. Now THIS is your jolt of color!! Acqua is not your typical skirt color. It’s the color one picks because the salesperson told them not to. The skirt is the outfit.

  

• Moody Mumu blue ruffle cotton crew socks. Baby blue, ruffled at the ankle, worn with virtually anything. Socks with flats is the foundation of this entire trend and the atypical ruffle is what sends it home.

  

• Poeve Janelle sandals. The color is similar to combining ochre + chartreuse. Slingback, Nappa leather, peep toe, super cute.

  

• Chan Luu capri crocheted wrap skirt with Edison chain loop earrings. Tassels, fringe, a skirt that says she’s back from a week in Formentera with a friend you’ve never met. The earrings are whiskey quartz w/ chain loop attachments.

  

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Stat first…

Roughly 83% of breast cancer diagnoses each year are among women aged 50 or older.*

The tissue biology that explains why just got mapped at single-cell resolution for the first time.

A new paper in Nature Aging** documents what happens inside your breast tissue as you age. Researchers at UBC and Cambridge imaged over 3 million cells from 527 women aged 15-86 using imaging mass cytometry, which measures 40 proteins at subcellular resolution while holding every cell in its spatial context. They tested 233 tissue features against age to find the windows where change accelerates. A lot to digest, I’ll do my best to simplify.

One dominant peak: late 40s. Menopause is the aging event for breast tissue.

Now the older I get, the more invested I am in my health. And let me tell you, I really put myself through the wringer in my early 20’s!! These days, anything I can do to stay on top of screenings and take better care of myself, I’m fully on board.

Breast tissue ages on its own schedule

Much to our chagrin, the body doesn’t always age in a smooth, gradual way. Some biological changes appear to cluster in phases. Plasma proteins, the gut microbiome, and immune-related markers can all show nonlinear shifts across the lifespan.

Breast tissue does none of that.

The researchers** found one dominant peak of change in the late 40s, tracking estrogen withdrawal. A minor secondary peak appears in the 20s, driven by B and plasma cell density shifts (B cells = the earlier immune cell that can recognize a target & get activated, plasma cells = “mature” version focused on pumping out antibodies), but it remains small next to the menopausal signal.

Estrogen builds and maintains the architecture of your breast tissue. When estrogen drops, the tissue restructures. The event (no shocker here) is menopause.

The researchers found:

• Fewer total cells across epithelial, stromal, and immune compartments with age.

• Fewer lobules and more adipose tissue in older breast tissue.

• Reduced cell-to-cell interactions, meaning the tissue becomes less tightly organized.

• A more inflammatory immune environment, including more M2 macrophages and granzyme B-positive T cells. (For context, M2 macrophages tend to reduce inflammation, help with wound healing/tissue repair, support blood vessel growth, and remodel tissue after injury. A granzyme B-positive T cell is a T cell that contains granzyme B, a serine protease it can release to help kill infected, abnormal, or cancer cells.)

  

Significant, yes, because tissue structure influences how cells behave! When the microenvironment changes, the rules that normally help keep cells stable can also change.

Why menopause stands out.

One of the most interesting findings to me was that breast tissue didn’t show the same smooth pattern of change seen in some circulating blood markers. Instead, the breast had one dominant aging peak in the late 40s (as you can see in the graphic below), aligning with menopause. In other words, menopause appears to be a major remodeling event for breast tissue, not just a reproductive milestone.

Fascinating stuff!!

To be crystal clear, that does not mean menopause itself causes breast cancer. The authors are careful here! What it does suggest is that the tissue environment in the breast becomes (meaningfully) different during and after menopause, and those changes may influence cancer risk over time.

What this means, clinically speaking.

What I took from the study:

I think it helps explain why breast cancer risk rises with age and why menopause is such an important biological transition. The breasts aren’t just “dangling around” (no pun intended) unchanged until something goes wrong. Breasts are actively changing in ways that affect density, inflammation, and cellular behavior.

For patients and for my beloved readers, I don’t think fear should be the takeaway here. Awareness should! We already know that menopause is a whole-body transition, and the breast is one component of that larger story. It’s also a reminder that age-appropriate breast screening remains important, especially as tissue composition changes over time and cancer risk rises with age.

A breast tissue analogy, for some context.

You can think of breast tissue before menopause like a well-tended garden with lots of active growth and structure. After menopause, the garden doesn’t fully disappear, but it changes: some plants become less abundant, the layout opens up, more space is taken by other tissue types, and the growing environment shifts. That change in the environment may affect how the tissue behaves.

For those of us in perimenopause and menopause, studies like this matter because it helps explain why breast symptoms, shifts in breast density, and conversations about breast cancer risk are rarely as simple as blaming one hormone or asking a yes/no question about estrogen. Understanding normal breast aging helps us (and the healthcare providers caring for us) tell the difference between what’s expected and what needs more attention without minimizing symptoms or overreacting to every change.

Do you find coving these topics on The Basics for the Non-Basics helpful? Boring? TLDR? Feedback helps!

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References:

1. U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. Updated June 2025. Accessed August 14, 2025. www.cdc.gov/cancer/dataviz.*

2. Gupta P, Lee E, Masqué Soler N, et al. Single-cell spatial atlas of the aging human breast. Nature Aging. 2026. doi:10.1038/s43587-026-01104-3**

Disclaimer: I am a healthcare provider, but I am not your provider. This article is for educational purposes only and is not a substitute for individualized medical advice, diagnosis, or treatment.

I went looking for sneakers this season and found a few worth sharing. Six pairs pulled from gym floors and aerobics VHS tapes, not the performance running obsession of the last few years.

Starting with the Asics Gel EL-NYC 2.0. Mesh, overlays, a grey + blue palette Cindy Crawford would’ve approved of in the 90’s. It reads archival and present-day all at once. Much more than the quintessential “dad sneaker”, but I bet you can still comfortably mow a lawn or two in these.

Another pair from Asics I’m currently loving is the HYPERSYNC. Silver paired w/ anything is a great statement option. Different functionality, but a statement pair nonetheless.

Onitsuka Tiger Mexico 66 PF keeps surfacing because of Kill Bill:

The 66 PF runs slimmer and cleaner than the platform drops clogging your feed. Navy stripes on cream, classic pairing. Highly versatile!

The Puma King Indoor was built for futsal in the 70’s. Now it pairs well w/ denim and a blazer. Gum sole, low profile, and a pop of color that makes ballet flats look fussier. The ’70s are having quite the fashion renaissance right now!

NikeSKIMS Rift Mesh is the capsule’s most polarizing piece. All black, all mesh, split-toe silhouette reworked for summer similar to the infamous Margiela Tabi ballet flats that debuted in the late 80’s. The toe-split interrupts the silhouette in a way your eye keeps returning to, which is why every Tabi photo on the internet has a comment section bickering over whether they’re chic or clunky and hoof-like.

The Osmosis Sponge in Feta closes it out. Porous, off-white, unorthodox. A fun alternative to the typical basic white sneaker. They’re a bit reminiscent of the suction cups on octopus tentacles. Notice the resemblance?

Love them? Leave them? Let me know!

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The education gap in this space is diabolical.

And on that note: today, we’re talking about age-related skin changes during the menopausal transition.

I’ve been routinely working out my skin care routine for the past 10+ years. The minute I laid eyes on my first wrinkle, I sprung into action like a pouncing tiger. Botox, tretinoin, I threw the whole kitchen sink at it. Over the past 2-3 years, I started to notice some other changes that seemingly came out of nowhere. Some bruising without any memory of bumping into things, the texture shift on my jawline, the creping along my inner arm. My FAVORITE moisturizer, the one that worked fine for 10+ years, stops doing whatever it was doing.

When you work in healthcare, your mind tends to go straight to the most invasive questions first to rule out anything serious…

Am I low iron? Do I need labwork? Am I drinking enough water?? Am I overlooking a zebra?! Easy, tiger.

Here’s what is happening...

Estrogen is a structural hormone, and it does far more than regulate your cycle or influence your mood. If you’ve been reading my publication, you already know this. ;) A few things I’ve learned that I want to share with you:

• Estrogen helps maintain the structure of your skin, from the facial fat pads that contribute to your face’s shape to the fibroblasts in the dermis that build collagen. As estrogen fluctuates + declines during perimenopause, the downstream effects on skin thickness, collagen content, hydration, and elasticity are, no doubt, measurable.

• Collagen production drops. That sentence gets tossed around so casually in skincare marketing that it’s lost (nearly) all clinical weight, so let me restate it. Fibroblast activity slows, collagen synthesis decreases, and the result is lines, wrinkles, and volume loss. Women can lose up to ~30% of their skin collagen in the first 5 years after menopause. Significant!!

  

• Another impact on the skin during menopause due to estrogen dropping is elastin disruption, meaning your skin loses its ability to “snap back”. The NAMS guide describes this as the “stretched out rubber band” effect, which is blunt and on point.

• Glycosaminoglycan (GAG) production also decreases. GAGs are the molecules responsible for holding water in your skin. Less GAG production means less hydration at the cellular level. The “grape to raisin” pipeline. Their words, not mine!

• There are other changes that people rarely connect to hormones at all. Melanocyte regulation gets disrupted, which leads to blotchiness and dyschromia (skin color alteration) on sun-exposed areas. Decreased blood flow and reduced cellular oxygenation to keratinocytes (a primary cell type of your epidermis) causes epidermal thinning, so that “thin skin” you are noticing is literal. Some will notice easier bruising, veins becoming more visible, and bony landmarks becoming more prominent.

• Going deeper: cellular growth factors and repair enzymes slow down, meaning wound healing takes longer. Makes sense considering the fragility of skin with all of these changes. Beneath the surface, accelerated lipoatrophy (loss of fat) hollows out the face while fat pad migration changes its contours.

• Bone resorption in the facial skeleton contributes to sagging eyelids, jowling, and the folds and shadows that no serum will address.

So what do we do with this information?

First, we can stop buying skincare based on a 22-year-old’s morning routine!!! The perimenopausal/menopausal skin barrier has different needs, different vulnerabilities, and different biology than it did a decade ago. A new approach needs to reflect that.

(Please note: this is general information only and not medical advice. Yes, I have to state that.)

1. Talk to a dermatologist. In fact, if you’re not going for regular skin checks at this point, please strongly consider doing so. Derms are all different, and some cosmetic dermatologists might be more helpful for medical-grade skincare, pigment, texture, retinoids, or peels. Come equipped w/ a few specific questions.

2. Licensed estheticians can also be a great resource. That said, they’re not (always) the right person to see if you need a rash diagnosed or help managing a medical skin condition. That is Derm’s department.

3. Retinoids are still one of the best‑proven ingredients we have for helping our skin make more collagen. Over time, they nudge those fibroblasts to build new collagen and repair some of the damage that shows up as fine lines and texture changes. They’ll likely tell you to start low, go slow, and use them consistently.

4. Vitamin C, especially L‑ascorbic acid in a stable 10–20% formula, helps your skin build collagen and can lighten some of the uneven pigment that shows up with hormonal and UV changes. My esthetician talks about this all the time. Since I’ve started using one, I’ve noticed a major decrease in hyperpigmentation.

5. Niacinamide can help strengthen the skin barrier and calm the redness and blotchy patches. Beware: it can tingle and cause some mild irritation, but nothing too dramatic!

6. Peptides and growth factor serums have a growing evidence base for supporting the repair pathways that are slowing down. That’s a whole other publication.

7. Hyaluronic acid helps with surface hydration, but won’t replace the GAG production you’re losing at the dermal level.

8. SPF!!!!

And then there’s the conversation most skincare content avoids entirely…. estrogen!

Systemic and topical estrogen therapy has documented effects on skin thickness, collagen content, hydration, and elasticity. And as I’ve stated before, this doesn’t mean hormone therapy is the right choice for everyone. It means that a conversation about perimeno/menopausal skin that never mentions hormones is incomplete. I’ll get into estrogen topicals in another publication.

Honey, your skin is an organ.

The largest organ. It responds to the same hormonal shifts affecting your bones, your brain, your cardiovascular system, and your metabolic function. Treating it as a surface-level cosmetic concern while ignoring the biology underneath is how we end up with a $204 billion skincare industry and a population of women wondering why none of it works the way it used to!

The more we know, the more intentional we can be with how we spend, right? Thoughts, musings, questions, please share.

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Source: NAMS Menopause Practice, A Clinician’s Guide, 6th Edition.

Disclaimer: This publication offers general information on skin and menopause and is not a substitute for medical care or individualized advice from your healthcare provider.

He grew up in his family’s tannery in Turkey, crafting his own sheepskin jacket at 11!!! After learning more about him, I realized he has a background in chemical engineering. He literally dissects bags on camera. I’m not talking metaphorically. He takes a knife to them and peels back the leather, examines the stitching, tests the tanning, and tells you whether what you paid for is what you got.

He’s reviewed thooooousands of bags and spent over $100,000+ buying products to cut apart. He does not accept sponsorships. That approach earned him millions of followers and a reputation as the person who will tell you the truth about your $3,000 handbag.

I love a good quality handbag. In fact, many of the bags I’ve bought over the past 2ish years came from his recommendation.

His central argument: a higher price tag does NOT automatically mean better quality. Some brands are charging in the thousands because the name carries weight, not because the materials or construction are actually better. At the same time, there are other brands using leather from the same tanneries, sourcing similar materials, and sometimes producing in the same workshops as the heritage labels, but selling for way less.

I wanted to share a few of his favorite handbags, including ones I’ve personally handled, purchased, or heard endorsed by other people I trust. *The price ranges listed are approximations. Tap the links to see the prices.

• Stow London:

  

Stow London snagged the #1 spot. Tanner was so impressed that the review went viral and Stow shifted to preorder-only for ~8 months because of the demand. He later invested in the company and became their Director of Craftsmanship. I’m a sucker for blue suede, so naturally I fell in love with the one above.

The bags are made in Ubrique, Spain, the same town where many heritage luxury houses manufacture. Stow uses “Mozart” leather from Curtidos Badia, a full-grain pebbled calfskin w/ a natural grain finish. Tanner found the interior craftsmanship clean, the hardware solid, and the design thoughtful without being overwrought.

Price range: approximately $300-$700(ish).

• The Horse

  

I LOVE this brand, and at this point I’ve probably recommended it to 10 or 15 friends who’ve since become completely hooked!! This Australian brand builds everyday bags with clean lines and super durable leather. Tanner gave The Horse high marks for material integrity and honest pricing. These bags work for daily use, not for sitting on a dusty shelf. No prominent logos, very demure. No unnecessary embellishments, very tasteful. For the price, you can’t beat it.

Price range: approximately $200-$400ish.

3. Strathberry Nano Tote

   

Strathberry is a Scottish brand (crafted in Spain) known for its signature metal bar closure. Tanner described the Nano Tote as compact but well-built, with leather sourced from the same Barcelona tannery that supplies Stow London. The construction quality seemed to really stand out to him. At its size, the bag packs a punch, positioning itself between contemporary and luxury without cutting corners on materials.

Price range: approximately $200-$995 (across the website).

4. Songmont Luna

   

Songmont is all over social media, which almost made me leave it off this list out of Non-Basic principle. I decided to include it because it is such a fun, playful bag. The handle adjusts so you can wear it crossbody or carry it by hand, which makes it far more versatile than half the bags people are fighting over online. I own the jade one:

Price range: approximately $279-$600.

5. Léo et Violette

   

This Parisian brand rounds out Tanner’s top picks. Léo et Violette uses Italian-sourced lambskin leather and focuses on a clean, minimal design language. The bags are built for longevity w/ attention to edge finishing and stitching. Love the “tuning fork” clasp!

Price range: big range depending on bag size.

None of these brands charge thousands of bucks for their primary offerings. Several of them use the same tanneries and workshops as houses charging 5-10x more! All of them prioritize material quality and construction over logos and marketing spend. Tanner’s perspective is useful because it comes from someone who has handled + deconstructed bags at every price point. He’s looked at the grain of the leather under magnification, evaluated stitching tension (not to mention thread quality), and even tested edge paint adhesion! His recommendations come from what he found inside the bag, not from how the bag photographs on IG or TikTok. I consider his input to be legit.

I’m learning that the gap between a $400 bag and a $4,000 bag is a lot narrower than most of us realize as consumers. When you remove the brand premium, you’re typically looking at the same raw materials, the same tanning processes, and comparable (sometimes even identical) workshops. If you’ve been hesitating to step outside the traditional luxury brand ecosystem, this list is a very decent starting point.

Did I mention any personal favorites? Or do you have any to add?

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There’s no annual “brain check”, no baseline brain marker, no routine conversation about cognitive trajectory at 45, 55, or 65. That may be starting to change.

A new study out of the Women's Health Initiative Memory Study followed nearly 2,800 older women for up to 25 years and found that a single blood biomarker, p-tau217, predicted who would go on to develop mild cognitive impairment (MCI) or dementia with impressive accuracy. The hormone therapy findings buried inside the data are (I believe) equally important.

The women in this research were part of the Women’s Health Initiative Memory Study. They were 65-79, cognitively healthy when they entered the trial in the late ‘90s, and they had blood drawn and frozen at baseline. Decades later, scientists thawed those samples and measured a biomarker called p-tau217, then looked back to see who developed MCI or dementia over up to 25 years of follow-up.

What is p-tau217 and why does it matter?

Glad you asked! ;)

So, p-tau217 is a fragment of the tau protein that shows up in the blood when Alzheimer-type changes are happening in the brain. Tau tangles are one of the hallmark features of Alzheimer’s disease. Until recently, detecting them meant either a spinal tap or a super-expensive, specialized PET scan. This pathway uses a simple blood test instead.

Findings in a nutshell:

Women who started out with higher p-tau217 levels were far more likely to develop mild cognitive impairment (MCI) or dementia down the line. For dementia alone, each standard deviation increase in the biomarker roughly tripled risk. Women whose levels placed them in the top quarter had about seven times the risk of dementia compared with women in the lowest quarter. The higher values were also linked to earlier onset, in some cases within just a few years of that initial blood draw.

That’s a remarkable amount of information from a single tube of blood, right?!

Where hormones enter the conversation

The women in the cohort had all been randomized (years earlier) in 1 of 2 hormone therapy trials or to placebo. The regimens: oral conjugated equine estrogen alone for women without a uterus, or the same estrogen combined with a synthetic progestin called medroxyprogesterone acetate (MPA) for women with an intact uterus. Each arm had a matching placebo group. Btw, an “arm” of a study means a group receiving a specific treatment.

When the researchers looked at how p-tau217 related to dementia across these groups, they found a valuable difference. In women assigned to estrogen + MPA, higher p-tau217 carried a stronger link to future dementia than in women on placebo. A one-unit step up in the biomarker was associated with roughly a fourfold increase in dementia risk in the combination therapy group versus about a threefold increase in the corresponding placebo group.

In the estrogen-alone trial, the relationship between p-tau217 and dementia looked similar whether a woman received estrogen or placebo. For this particular question, estrogen by itself did not amplify the impact of having higher p-tau217 at baseline.

I think it’s also important to remember that dementia cases occurred in the placebo groups in both trials. That would then suggest the study population already had a meaningful underlying risk of cognitive decline, even in the absence of hormone therapy!! So while we’re sitting here spinning our wheels together interpreting these findings, the more relevant question is how much additional risk, if any, was associated with the hormone regimen itself compared w/ placebo. Without that context, people can wrongly assume hormone therapy created the entire risk, when the more “accurate” question is whether it changed risk BEYOND what was already present in that older study population.

There’s two ideas that need separating here.

The original Women’s Health Initiative cognitive analyses found that starting these hormone regimens after age 65 increased risk of cognitive problems overall, without any reference to p-tau217. This new paper tweaks the question a bit more: among women with higher Alzheimer-type pathology (reflected in p-tau217), where does the extra dementia risk concentrate? The answer is that it concentrates most clearly when estrogen is paired with MPA, not when estrogen is used alone.

Progestin isn’t the same thing as bioidentical progesterone.

MPA is NOT micronized progesterone. They’re different compounds, so they should not be treated as interchangeable! This distinction matters because without it, people can overgeneralize a study beyond what it actually tested. We all know media headlines flatten nuance to sensationalize topics for clickbait, but the specific progestin used in the trial was medroxyprogesterone acetate (MPA), which isn’t the same as micronized progesterone. Because HRT formulations differ in molecule, dose, route, and timing, the results may not apply to lower-dose transdermal estradiol paired with micronized progesterone or to therapy started earlier in the menopausal transition

So if/when you see future headlines about “hormone therapy and dementia” built on this paper or other papers referring to this one, the missing adjectives matter. This is late-life, oral conjugated equine estrogen, combined with MPA, in women who were already in their late 60s and 70s.

What if you’re in your 40s or 50s???

If you’re in perimenopause or the first decade after your final period and weighing hormone therapy, this study doesn’t tell you to avoid it. Those ages and regimens were NOT studied here. What it does give you is a better set of questions to bring into the exam room. That alone can be helpful.

• Which estrogen are we talking about, and what route: pill, patch, gel?

• Which progesterone: a synthetic progestin like MPA, or micronized progesterone?

• Is this regimen being tailored to your risks and goals, or copied from a template that made sense in 1998?

That level of precision makes a difference and isn’t overthinking for the sake of overthinking. It’s the difference between responding to scare headlines and making a very deliberate, informed choice.

Why this matters now…

A blood test that can flag Alzheimer-related brain changes years before symptoms show up does not prevent disease, and it raises the emotional and ethical questions that come with knowing your risk early. But it does something our current system rarely does for women’s brains: it opens the door to proactive, individualized conversations about what comes next.

The real opportunity is what could happen if healthcare providers started looking at your brain markers alongside your hormone history, genetics, vascular and metabolic health, sleep, and stress load, and then helped you build a plan that fits you.

At the risk of sounding cliché… only time will tell.

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Reference: Shadyab AH, Zhang B, LaCroix AZ, et al. Plasma Phosphorylated Tau 217 and Incident Mild Cognitive Impairment and Dementia in Older Women. JAMA Netw Open. 2026;9(3):e261295. doi:10.1001/jamanetworkopen.2026.1295

This publication is for educational and informational purposes only. It is not medical advice, diagnosis, or treatment, and it does not replace care from your own licensed healthcare provider. Always speak with your own healthcare provider about questions related to your health.

A girl loves to window shop!!! Half the thrill is filling the cart, leaving the site, and then returning later to see if fate (or my browser) kept everything exactly where I left it.

I can’t be the only one…

I pulled 9 pieces from H&M’s current drops that read like a cheat sheet to some of the most talked-about runway moments and designer must-haves from the past few seasons. These aren’t exacting dupes, I’d say they’re more like spiritual adjacencies. You’re not required to liquidate your retirement account to get these looks!

Fringe is on everyone’s Pinterest board right now. The brown melange fringed dress lives somewhere between the Khaite Fiore dress and Simon Miller’s Beja. H&M’s version captures that same warmth and roundabout weight, and the asymmetrical fringe at the hem is what sells it. Great for resort wear, vacations, and happy hour.

The white flower cluster earrings tap directly into Jonathan Anderson’s Dior Fall ‘26 moment. He showed his second womenswear collection at the Jardin des Tuileries roughly 3 weeks ago, and the accessories were half the conversation: water lily earrings, 3D fluttery dahlia brooches/appliqués and the SHOESSSSSS (I shared a bunch on my Substack Notes). These earrings capture a similar effect. Worn with a simple knit or a collarless jacket, they turn the face into the focal point and make the rest of the outfit feel like a deliberate frame around your work-of-art face card. The black flower earrings hit a similar note in a darker, slightly more subversive register.

The felted wool jacket with scarf collar channels some of the energy the Khaite Scarlet sweater has, and the price tag puts WAY less of a dent into your wallet. This cropped cream silhouette with the soft collar looks expensive. Throw it over a white tee and straight-leg denim, and you’re in that zone where people assume you spent more than you did.

The large drawstring tote plays in the same visual language as TRADEMARK’s Cooper cage tote, the latticed leather carryall that became an IG fixation for turning a simple bag into woven end candy. The dark brown metal handle handbag is Bottega Veneta Sardine, adjacent. I’m a sardine girl, so I fell in love with this bag right out the gate! The sculptural handle is fun and functional, however the Sardine one retails ~ $4,800!!! This dark brown metal handle handbag is much more price-conscious.

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This asymmetric tiered ruffled skirt in burgundy has enough movement and texture to anchor an outfit on its own, and this one is very similar to what we’ve seen on the runway coming out of Alaïa's collection. The Alaïa version is priced around ~$2k.

The appliquéd strappy sandals reference the 3D floral footwear that Nina Christen designed for Dior’s FW26 runway, sculpted water lilies in painted satin that turned each shoe into its own little runway a-ha! moment. The leather ballet flats in cream are the most versatile piece here, and the flat, refined shoe is the dominant silhouette heading into next year. The flats are very Delia Aeyde-adjacent, but they have a heel and a higher pricepoint.

Someone on the H&M design team was clearly locked in during runway season, taking notes on the silhouettes, the meticulous styling, the overall temperature of things. The trend forecasting team nailed it. Designers study archives, borrow from older decades, and reinterpret references most people never see, let alone recognize! What shows up on the rack is built from looking closely at the past, and fast fashion is now doing the same thing to the runways in real time.

The algorithm won’t spell out these connections for you, it’ll only give you that vague sense that you’ve seen it before. To spot the reference, you have to know where to look. That’s what this column is for! ;)

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Lately, I’ve noticed how frequently different conversations arrive at the same emotional endpoint. Different women, similar constellation of symptoms, and the nagging sense that the bigger picture’s getting lost. A woman goes in hoping someone will connect the dots, then leaves feeling like only one fragment of her life made it into her chart. I recently spoke with someone who had a disappointing experience with her PCP, and she asked me, with mixed parts curiosity and frustration, why providers seem so focused on a single issue per visit.

My answer was that most outpatient visits are shaped by time limits, billing rules, documentation requirements, and safety concerns. Focusing on 1 main issue helps providers gather a history, do their exam, make decisions, document appropriately, and reduce the chance of missing something important. It’s not always ideal, but in many clinics it reflects how modern medical practice is structured, not necessarily a sign that the provider doesn’t care.

Someone might disagree with the single-complaint model because humans don’t experience their health in nicely compartmentalized, isolated categories. Symptoms can be linked, and splitting them across multiple visits can fragment care, slow recognition of the real pattern, raise costs, and leave patients yearning for something else. Several fragmented complaints may point to one underlying issue, so treating them separately can be shortsighted.

Starting today’s publication with a hypothetical scenario, one that’s likely either personally or peripherally relatable. Hypothetically, this case is a 41yo female presenting to your hypothetical clinic with shoulder pain…

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The category today is: strictly jewelry. You won’t see your algorithm pushing these picks. We’re skipping the dainty gold layering sets and “everyday hoops” that look like every other day. Keep in mind the price points vary because I'm still trying to figure out who my target market reader is (and honestly, that's part of the fun right now).

If you want safe, Mejuri has a website. No shade, Mejuri! It’s just not your edit today! <3

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CastleCliff River Earrings: These River earrings have that satisfying weight and movement, the kind of style that can be worn with any bland outfit and it immediately becomes the talking point. I’m a mixed metals kind of lady, so this pair really caught my attention.

Walton Ring: The amber-toned stone set in that chunky silver frame gives old-world apothecary energy. It’s a ring that says you likely had a mood ring as a kid, and amber-was-the-color-of-your-energyyyyy.

Third Reasons Block 29 Smooth Smoky Quartz: Smoky quartz doesn’t get the respect it deserves in the gemstone hierarchy. This Block 29 ring has that sleek, almost sculptural silhouette that reads modern but still organic. Each piece is handmade, which I love because we’re all OOAK, okay?!

Purple Pink Iridescent Baroque Pearl Earrings: Baroque pearls are nature’s proof that perfection is boring. These have that purple-pinkish iridescence that shifts depending on the light, your outfit, and your mood. They’re the earring equivalent of wearing something people want to touch.

Chunky Czech Glass Necklace with Drop Beads: Czech glass beads carry decades of craft tradition, and this necklace puts that heritage right up front. The red drop beads mixed with those pale blue spacers give it a color story that feels vintage European market, not mass-produced. Another standalone piece!

Asymmetric Baroque Pearl Earring with Natural Amethyst: Asymmetry in jewelry signals someone who understands that balance doesn’t mean matching. The amethyst paired with those cascading baroque pearls makes this earring feel like a small wearable art piece. Dress it up, down, all-around, any which way doesn’t matter!

Carnelian and Silver Bar Drop Earrings: Carnelian is activating all 7 chakras right now. Loving the warm terracotta tones, they never go out of rotation. These bar drops give the stone a modern, architectural setting that keeps them from reading too boho. They work with a white t-shirt or a blazer.

Jade Onyx Dangles Green jade + black onyx together = SWOON! These earrings have that vintage cocktail hour quality, the kind of earring your most interesting auntie wore to dinner parties while smoking Virginia Slims and re-applying her red Revlon lipstick. Something about these dangles feels very vintage-inspired.

Belden Earrings in Amber: Amber is making a bit of a resurgence, and these earrings landed in my Pinterest feed at the right moment. Consider them a future vintage pick.

Black Anthurium Earrings: Stop the music for one of the most dramatic houseplants alive! The black anthurium form gives them an organic, sculptural presence on the ear. They’re statement earrings for people who think statement earrings are usually too much. After seeing some of the recent accessories from Jonathan Anderson’s Dior Fall 2026 Ready-to-Wear Collection, I immediately jumped down the statement florals rabbit hole and tumbled upon these. Love the iridescent look, another great standalone accessory.

Favorites? Help me pick my next edit:

This post contains affiliate links to my Shop My. If you purchase through those links, I earn a small commission. Rates vary by item. Every piece in this edit was personally selected by me. I only share what I like! Xx.- Shelley

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You’re who I write for, and in a lot of ways, I’m right there in the mix too which is why I feel comfortable exploring these topics with you. I see what you’re seeing, and because I’m an inquisitive lady by nature, I’m not someone who simply takes a statement at face value.

If you’ve been on TikTok or IG for more than 15 minutes this year, someone has told you that cortisol is ruining your life. Your belly fat? Cortisol. Your puffy face? Cortisol. Your inability to lose weight despite doing everything right? Cortisol, obviously.

And if cortisol is the problem, don’t worry, there’s a product!! A supplement. A cortisol mocktail made from orange juice and coconut water and a sprinkle of something that sounds vaguely medicinal. A 30-day reset, or maybe a detox. A protocol. Always a protocol!!!

We are protocoling ourselves to death here.

I’m gonna say this with love (and some clinical insight)…

Here’s what’s happening. People are Googling “how do you reduce cortisol levels” and “what foods are high in cortisol” and “how to get rid of cortisol belly fat naturally” in record numbers. The “People Also Ask” boxes are stacked with these questions and the answers they’re getting are coming from influencers, not endocrinologists. The information sounds medical. It uses the right words, and many posts/videos have the cadence of authority. And much of it doesn’t comprehensively reflect how cortisol works in the human body.

Cortisol is a hormone made by your adrenal glands. You need it to live. It regulates your blood sugar, your blood pressure, your sleep-wake cycle, your immune response, and your metabolism. Without it, you wouldn’t get out of bed in the morning. Literally, friend. Addison’s disease, which is what happens when your body doesn’t make enough cortisol, is a life-threatening condition. Treating cortisol like a villain or a traaaaaitor is doing us a major disservice. It’s one of the most essential hormones in your body.

Can chronically elevated (excessive) cortisol cause problems? Yes. The classic syndrome of endogenous (endogenous = internal cause or originating from ‘inside’) cortisol excess is called Cushing’s syndrome and it’s rare, affecting roughly 40-70 people per million. It’s diagnosed through formal clinical evaluation and specific testing, not through a TikTok self-assessment. And the sustained cortisol excess seen in true Cushing’s syndrome is not the same as the normal cortisol fluctuations your body produces in response to a stressful week.

The symptoms people associate with “high cortisol” online, the fatigue, the belly fat, the puffiness, the sleep disruption, are real symptoms. I’m not dismissing them whatsoever. But they overlap with a long list of other conditions, including thyroid dysfunction, insulin resistance, perimenopause, depression, poor sleep hygiene, and the baseline experience of being a human in 2026. Attributing all of them to cortisol is like blaming every noise in your house on the furnace. Sometimes it is the furnace. Usually it’s something else.

And this is where the testing conversation gets important, because I see this in practice. In fact, I saw a patient yesterday who asked me about their cortisol levels and how they saw something online that mentioned testing is the first step. Believe me, I understand that impulse. You feel terrible. You want a number that explains why. That’s human.

I’m here to tell you what the internet usually leaves out: a single serum cortisol draw is not a useful screening test for what most people are asking it to do.

Cortisol fluctuates throughout the day. It is usually highest in the morning and lower later on, so a blood draw at 2pm can look very different from one at 8am, and neither means much in isolation. The Endocrine Society recommends formal cortisol testing when there is a specific clinical suspicion, not as a wellness screen for vague symptoms like stress or fatigue. The AAFP has also stated that a serum cortisol level should not be used as the initial screen for hypercortisolism. When clinicians do evaluate for cortisol excess, the standard first-line tests are late-night salivary cortisol, 24-hr urinary free cortisol, or an overnight dexamethasone suppression test. Those are diagnostic tools, not wellness screens. That being said, serum cortisol is not useless across the board. In the right clinical context, especially when adrenal insufficiency is being considered, morning serum cortisol can still play a role as part of a targeted endocrine workup.

What concerns me most as a healthcare provider is what happens downstream when people get tested without the right clinical context. Cortisol results are easy to misread and timing matters. The assay (a type of test that specifically determines the presence/amount/activity of a target specimen) matters. Medications also make a difference here. Endocrinologists and primary care providers both warn that a random serum cortisol can look abnormal without meaning anything pathologic at all, especially when the wrong test was ordered for the wrong question. That can set off a chain of unnecessary referrals, repeat testing, and treatment people didn’t need.

Regarding the products, which there are plenty!!! The cortisol-lowering supplements, the adaptogenic blends, the creams marketed as if they can somehow “block cortisol!!!” The evidence here is nowhere near as clear or as convincing as the marketing makes it sound. Marketing can be a sneaky little bugger, can’t it?! Some supplements, like ashwagandha, have small short-term studies suggesting effects on perceived stress or measured cortisol, but the data are limited, heterogeneous, and/or not strong enough to turn these products into a legitimate answer for vague symptoms or self-diagnosed “high cortisol.” More concerning to me, some over-the-counter supplements have even been found to contain hidden steroids, which can trigger real endocrine harm, including exogenous (and iatrogenic) Cushing syndrome and adrenal insufficiency.

So you’re probably thinking: what do you do if you’re exhausted and bloated and sleeping terribly and carrying weight in your midsection and none of the things you used to do seem to work anymore???

You see your healthcare provider, and if your provider doesn’t specialize in this stuff, you find one that does.

You get a real workup. You talk about thyroid disease, family history, metabolic health, medications, sleep, mood, diet, movement, and the rest of your clinical picture. You look at the whole picture instead of fixating on 1 hormone because your algorithm handed you a shrewd explanation. The recommended tests for suspected cortisol excess are used when there is actual diagnostic suspicion, not as general wellness screens for stress, fatigue, or feeling off.

That is good for sales. One cause gives people a villain. One supplement gives us something to buy. One protocol gives us the comfort of certainty. The body is not that simple, it’s nuanced and context-dependent. The internet does not monetize nuance nearly as well as it monetizes a fix.

Cortisol testing has a place in medicine, but it’s not a catch-all answer for every symptom cluster, and a social media symptom list is not an endocrine diagnosis. For most people, the issue is unlikely to be a self-diagnosed cortisol disorder. The better question is whether the rest of the system is getting what it needs, and that conversation belongs in a healthcare provider’s office, not in a comment section.

Xx.

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A brief note, and a genuine thank you for your support. I’m in the process of building a new clinical practice centered on perimenopause and menopause specialty care, which feels both exciting and deeply meaningful! The content I share on this Substack is for educational and informational use only and does not constitute personal medical advice. More on my future practice soon.

Her sheets were damp. Her mind was racing through a mental Rolodex of every embarrassing thing she’d ever said, starting in ‘96. By 3:15am, she was Googling “heart palpitations perimenopause or something else” and by 3:30am she was somehow reading about Hailey Bieber’s skincare routine.

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She told me this with a half-laugh, the way women do when they’re describing something that actually terrified them but they don’t want to seem dramatic. And then she said the thing I hear more than almost anything else in my practice:

“My doctor ran labs and said everything was normal. So I guess I’m fine?”

She was not “fine”. And she knew it.

If you’re here, I’m guessing some version of this sounds familiar.

I’m a healthcare provider in my 40s, currently navigating perimenopause myself, and I started this newsletter because I got tired of watching smart, informed women leave their providers’ offices feeling gaslit. You know the visit. You describe the insomnia, the rage that arrives out of nowhere like a summer thunderstorm, the brain fog so thick you forgot the word “colander” and just stood in your kitchen holding it like an artifact you’d never seen before. Your doc runs a basic panel, maybe checks your TSH, and a week later, you get a message through the portal:

“Your labs are within normal range. Follow up as needed.”

Cool. Super helpful!!! Thanks for the bill!!!!!

Here’s what I want you to understand, and I want to be very clear about this: “normal range” on a lab report is a statistical reference range derived from a broad population.

It tells you where most people fall. It does not tell you where you function best. A TSH of 3.5 is technically “normal”. But if your TSH (or thyroid-stimulating hormone) used to sit at 1.2 and now you’re dragging yourself through the day like you’re walking through wet cement, that shift matters. Context matters. Just like your symptoms matter!

When a provider logs into a typical electronic health record, most (if not all) have lab ranges set, so anything technically outside of the pre-determined lab range will be considered abnormal. An abnormal lab result triggers an alert, but that alert needs to be interpreted in a clinical context. As an example: a “normal” TSH range for most adults is generally ~0.4 and 4.0 to 5.0 mU/L(or µU/mL). Certain meds may impact this result, even some vitamins. Pregnancy is also another consideration when classifying/targeting “normal”. If you want to read more about “The ‘new normal’ for thyroid function test ranges”, you can find a good (brief) article from Clinical Thyroidology^® for the Public here.

The frustrating truth is that perimenopause is largely a clinical diagnosis. I’ve been beating this drum since I started this publication, so that’s old news to you.

Hormone levels fluctuate all over the place during this phase, sometimes within the same week, which means a single blood draw is basically a snapshot of one moment in a hormonal terrain that’s constantly shifting. Your FSH could look perfectly “normal” on a Monday and tell a completely different story on a Thursday. This is why so many women hear “your labs are fine!!!” when they feel anything but.

So what do you actually do with that?

You advocate for yourself, even when it’s uncomfortable. I know, I hate that this is the answer, too. I wish I could tell you the system will catch what’s happening and hand you solutions. The average OB-GYN residency includes far less menopause-specific training than many patients might expect, and that’s a systems-level issue, not a reflection of any individual healthcare provider. We’re talking hours, not semesters. Many primary care providers are working with outdated frameworks or simply don’t have the bandwidth to investigate further when your numbers check out on paper. Again, a function of a system, not a reflection of any individual healthcare provider.

A few things that help:

Track your symptoms with specificity. Not “I feel bad.” Write down when the insomnia started, how many nights per week, whether your cycles have changed in length or flow, and when the anxiety kicked in relative to your cycle. Bring that to your appointment. Data is hard to dismiss.

Ask for a more comprehensive hormone panel, and ask for it to be drawn at a specific point in your cycle if you’re still having periods. Take to your provider about estradiol, progesterone, FSH, DHEA-S, testosterone (free and total), and a complete thyroid panel that goes beyond TSH to include free T3, free T4, and thyroid antibodies. Many providers will only run TSH unless you specifically request the rest. You’re allowed to request the rest. And please, just keep in mind: labs are only a piece of the overall puzzle, not the be-all-end-all of any diagnosis.

Finding a menopause practitioner is another option. More on the how-tos in a future post.

Now, the questions I get asked constantly:

• “Is this really perimenopause? I’m only 38!”

Perimenopause can start in your mid-30s, and symptoms can show up years before your periods actually change. If you’re experiencing new-onset anxiety, sleep disruption, heavier periods, shorter cycles, or brain fog that your previous coping strategies can’t touch, it’s worth exploring.

• “Should I try hormone therapy?”

I can’t make that call for you, but I can tell you that the WHI study from 2002 created a level of fear around HRT that was, frankly, disproportionate to the actual findings once they were re-analyzed. The conversation has shifted enormously in the last 5ish years. For most symptomatic women under 60, or within 10 years of menopause onset, the benefits of hormone therapy tend to outweigh the risks. Talk to someone who actually stays current on this literature. If your provider’s last update on HRT came from a textbook printed before the first iPhone, it might be time for a second opinion.

• “My doctor says I’m too young for menopause labs.”

This is a common one, and there’s a tiny kernel of truth buried in it. A single hormone draw in your late 30s or early 40s may not be diagnostically useful in isolation because of those fluctuations I mentioned. But that’s an argument for better testing and clinical context, not for doing nothing while you suffer.

• “What about supplements? Ashwagandha? Maca? That thing my friend’s friend swears by?”

Some of these have emerging evidence. Some are basically expensive placebos in a nice jar with a pretty label on it. I’ll dig into more specific supplements in a future post because this deserves its own conversation. I’ve shared some thoughts on it in prior publications, too. For now, I’ll say this: be skeptical of anything marketed with the word “goddess” or anything alluding to “curative” on the label.

Here’s the part where I could wrap this up with something neat & tidy about trusting your body and finding your power. But I think what’s more honest is this: it is genuinely disorienting to live in a body that seems to have changed the locks without telling you. And it’s maddening to seek help and be told everything is fine when you know, in your bones, that something has shifted. You are not making this up. The labs might be “normal.” You are still valid in feeling all the feelings while demanding better answers.

More soon. Xx.

-Shelley

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Text threads.

Ads. “Flavorless protein is the new IT girl!!”

Instagram influencers counting their grams, telling you breakfast is unless it hits 40 grams.

TikToks with someone aggressively blending & whisking cottage cheese into eggs.

Do you need 40g at breakfast? Should you be tracking grams like your life depends on it?? Does every snack now need to involve Greek yogurt, jerky, or a meat stick? Should I just inhale this plate of spaghetti & meatballs and be done with this?!?!

The fixation on protein is real right now. And I’ve been sucked into that same vortex before! To be fair, protein matters, especially now. But for women like us moving through perimenopause & the subsequent fabulous years beyond, the protein conversation has gotten so loud that two other basics keep getting pushed out of frame.

Fiber and water.

Not sexy, I know. Not the kind of thing that gets wrapped in glossy marketing and sold back to you as a breakthrough. But if you’re in your 40’s or 50’s and wondering why your digestion feels off, your energy feels wonky, and your body composition seems to be operating by a new and mildly insulting set of rules, these two basics are almost certainly part of the story.

What’s happening in the gut?

Estrogen affects more than cycles and hot flashes. It also appears to shape the gut microbiome, and the relationship runs both ways. As hormone levels shift across midlife and menopause, the microbial community shifts too. Researchers are building a clearer picture of this gut-estrogen axis, where hormones and microbes stay in ongoing conversation.

Fiber’s role here goes well beyond digestion, yet nearly 19 out of 20 Americans still fall short of the minimum recommended daily target.* It feeds the bacteria that produce short-chain fatty acids, compounds that help support the gut lining, immune balance, and inflammatory regulation. Gut microbes also help regulate how estrogen is metabolized and recycled through the body through what is known as the estrobolome. When fiber intake drops, the consequences do not stop in the gut. The entire system becomes less supportive.

That gap shows up metabolically, too. In a cross-sectional study of postmenopausal African American women with obesity, higher fiber intake was associated with a better overall metabolic profile, while women who were not meeting fiber recommendations were far more likely to have metabolic syndrome. Lower fiber intake was also linked with higher fasting glucose and triglycerides. It does not prove fiber alone caused those differences, but it adds to the case that when fiber quietly disappears from the plate, the body notices.

This is where the protein conversation starts to go sideways. Many protein-heavy eating patterns (especially the ones built around animal protein with too few plants) are also low in fiber. So yes, you might be hitting 130 grams of protein a day and still underfeeding your microbiome. High protein isn’t the issue on its own, a plate with plenty of protein but not enough plant diversity is.

Your next question may be “how much fiber should I get in daily?”

Well, there’s no separate official fiber “target” for perimenopause or menopause in U.S. guidelines. The recommendation is based on age, not menopausal status. For women 50 and younger, the target is 25g per day. For women older than 50, the target is 21 grams per day. In order to hit my own personal goals, I drink psyllium husk + water which can also help lower LDL cholesterol and BP. It’s bland, but it does the trick.

Then there is water…

This piece gets missed all the time, and I’m also here to tell you that I rarely drink enough water, but I’ve been working on it! But here we are, holding one another accountable ;).

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Progesterone has mild natriuretic and diuretic effects, so as hormone patterns shift during perimenopause, fluid balance can feel a bit less predictable. Some of us may notice more puffiness, more bloating, or more swelling while still not drinking enough fluid overall. Those two things can exist at the same time, which is part of what makes this stage so confusing.

Then add real life: stress, crappy sleep, caffeine, exercise, busy schedules…simply forgetting to drink enough!!!

Thirst cues also tend to become less reliable with age, so low intake is easy to miss until symptoms start stacking up. What follows is not always dramatic dehydration. More often, it is low-grade underhydration that shows up as brain fog, constipation, fatigue, headaches, and sometimes a faster heart rate. Easy to dismiss, and very easy to miss!

I should also mention that hydration matters even more when protein intake increases. Breaking down protein creates nitrogen waste products, including urea (it’s a waste product your body makes when it breaks down protein), that the kidneys have to clear. That doesn’t mean a high-protein diet is automatically harmful in a healthy person!!! It does mean water stops being a side note once protein goes up.

So where does protein fit?

Preserving muscle becomes harder with age. Adequate protein helps support muscle protein synthesis, especially alongside resistance training. Leucine-rich (leucine = an essential amino acid, one of the protein building blocks that helps “turn on” the muscle-building process), high-quality protein sources also matter because aging is associated with anabolic resistance, meaning the body becomes less responsive to the usual muscle-building signals over time.

But protein works best in context. Without enough fiber, the gut pays for it. Without enough fluid, your system has more work to do.

A better reframe is to stop treating these as competing priorities. Think of protein, fiber, and hydration as the 3 basics that need to move together. Pull one too far out of line and the rest stop working as well as they should. And also: if we don’t hit every influencer’s goal, don’t punish yourself over it.

For most of us, the “win” is not chasing the most aggressive protein target on the internet. The real “win-win” is building a day that includes enough protein to support muscle, enough fiber to support the gut, and enough fluid to stay consistently hydrated. In practice, that can look more like 25-35 grams of fiber, regular fluid intake across the day, and a protein target that matches your size, activity, age, and goals, often around 1.0- 1.2 grams per kg per day for many women.

By this point, most of us don’t need more nutrition theater. We need a body that feels strong, clearer, and more supported. That usually starts lower down the food chain than the internet would have you believe. Enough protein, yes. But also enough fiber, enough water, and enough respect for the basic physiology holding the whole thing together.

The flashy part of wellness rarely carries the heaviest load. More often, it is the quiet, unsexy things, done consistently, that change how you feel.

Thoughts? Musings? Please share!

Additional sources cited in this Substack:

https://pmc.ncbi.nlm.nih.gov/articles/PMC11150820/

https://pmc.ncbi.nlm.nih.gov/articles/PMC10498976/

https://pubmed.ncbi.nlm.nih.gov/36054124/

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Disclaimer: This post is for educational purposes only and is not medical advice. It’s not a substitute for care from your own physician or licensed healthcare professional. Nutrition, hydration, menopause, and metabolic health are highly individual, and what’s appropriate for one person may not be appropriate for another. Always speak with your own clinician before making significant changes to your diet, supplements, or treatment plan.

With my birthday coming up next week, I gave myself full permission to daydream. No budget, no restrictions, just the pure unbothered pleasure of adding things to a cart with zero regard for the total.

A girl deserves a treat, even a hypothetical one!

CO Fringe Top + Skirt combo

The CO fringe top + skirt is the kind of pairing that photographs beautifully and looks even better in person, which is a rarer quality than it should be. The feathery fringe does something interesting in motion. Wear it together for the full effect or treat the pieces as separates when the moment calls for a little more restraint. The skirt even pairs well w/ a plain white tee.

Carelli Bambi Faux Fur Jacket

This jacket is the reason the phrase “statement piece” exists. The ultrasoft fawn-spotted faux fur with black cuffs walks a very specific line between woodland creature and downtown art world, and somehow sticks the landing. It’s the outerwear equivalent of a conversation you didn’t plan to have but couldn’t stop having.

Izie Eleven D’Orsay Heels

Deep oxblood, architectural “I” heel, that signature D’Orsay crescent toe cutout that makes a pump feel like it has a personality. These are the shoes that make people ask where you got them before they even say hello. (See the heel in my collage!)

Diotima Margot Top

I’m loving everything Designer Rachel Scott is doing right now. She also happened to show her 2nd Diotima runway this Fashion Week while quasi-simultaneously debuting her 1st collection for Proenza Schouler. She’s kiiiiiilling it! Now, for this top… Pink tank w/ velvet trim —> a little Star Trekkie, a little surrealist. Diotima consistently makes clothes that feel like they belong to a very cool woman you haven’t met yet. The Margot Top is precisely that energy, bottled into a funky '60s-style tank.

YSL Loafers in Deep Bordeaux Eel

Saint Laurent loafers in eel leather. Deep bordeaux. That’s the whole pitch. There’s nothing casual about these, which is exactly why they work so well with everything casual. A true Non-Basic basic.

Khaite x Oliver Peoples Eyewear

Khaite + Oliver Peoples = two houses that understand the assignment. Collaborating on sunglasses that are anything but basic. The tortoiseshell wraparound frames are oversized in that deliberate, I-know-exactly-what-I’m-doing way. Fashion folks will clock them immediately. Everyone else will just think you look incredibly put together

Madison Seidman Madbar Hairclip

This cerulean blue hairclip has been living rent-free in the heads of anyone paying attention to accessories right now. Small, slightly industrial, somewhat of an unpredictable type of hairclip. It’s the detail that makes a whole look feel considered without trying.

Lola Brooks Peppery Diamond Ring

Jewelry that looks like it has a backstory. The 18k yellow gold peppery diamond setting sits somewhere between heirloom and contemporary, the kind of ring that gets passed down and fought over. Peppery = how I best describe myself.

Khaite Liria Ankle Strap Sandal in Crystal Blue Ostrich

The perfect strappy heel exists! Crystal blue ostrich leather, a slim heel, and a ribbon-like ankle strap. Khaite heels already have a cult following, but in this color, they become something closer to wearable art. I’d wear these with basically anything.

Emi Mess Charles Culottes in Black Leather

Black leather culottes sound like a lot on paper. In practice, they’re incredibly wearable, especially in Emi Mess’s relaxed, midi cut. Pair them w/ a simple white tee (my favorite item to get stains on) and let the leather do the heavy lifting.

I’ve got about 7,000,000 more things on my radar, but Substack says we’re about to hit the email length limit. ;)

Which ones did you like the most? The least? Lmk! Xx. -Shelley

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ShopMy edit

This post includes a few links to my ShopMy page. Some links may earn me a small commission at no extra cost to you. Not every item is commissionable, and I only share products I genuinely like and would recommend either way!

Xx. - Shelley

When you’re lying awake at 3am, drenched in sweat for the third time that night, your brain starts making deals with the universe. You promise you’ll start eating kale. You’ll meditate every morning! You’ll finally get that sleep study done because you’ve been snoring like crazy and waking up with a dry mouth!! But I’m willing to bet that in the middle of your nocturnal bargaining, you’re not thinking about your experiences as a kid.

Should we be?

A study I read recently made me think about this question.

A large study out of the Mayo Clinic just revealed something that stopped me in my tracks: the severity of your menopausal symptoms might have roots that stretch all the way back to your childhood. Not just the psychological symptoms (though yes, those too), but the physical ones. The night sweats, the joint pain, the vaginal dryness you don’t want to talk about at dinner parties.

Quick preface…

This doesn't mean that if you're having a terrible time with menopause, it's because of childhood trauma. Plenty of women with no adverse childhood experiences have severe symptoms. Menopause is hard, full stop. Hormonal changes alone can create misery without any trauma history whatsoever. What this research shows is that for women who did experience childhood adversity, there appears to be an additional layer of complexity that may make symptoms worse.

The researchers looked at data from 1,670 women between 40-65 who came through their menopause clinic in Rochester, Minnesota. They filled out questionnaires about their current symptoms and their childhood experiences. What emerged from the data was a pattern so clear it’s hard to ignore. Women who experienced trauma as children were having a significantly harder time with menopause. And it wasn’t a small difference.

I want to talk numbers…

The study used something called the ACE questionnaire. ACE stands for Adverse Childhood Experiences, and it asks about 10 different types of childhood trauma. Physical abuse, emotional abuse, sexual abuse, neglect. Growing up with a parent struggling w/ addiction or mental illness. Witnessing domestic violence, having a parent who was incarcerated.

Each time you answer yes, you get a point. Add them up, and you have your ACE score.

Nearly 60% of these women reported at least one adverse childhood experience. Not in some high-risk population, not in women selected because they had difficult childhoods. Women who showed up at a menopause clinic. Look around the next time you’re in a waiting room. More than half of the women there may be carrying something from childhood.

And 17% of the women in this study had 4 or more ACEs. That’s roughly 1 in 6 women.

The researchers divided all the women into 4 groups based on how severe their menopausal symptoms were, from the “mildest” quarter to the “most miserable” quarter. Then they looked at how childhood adversity mapped onto those groups.

For women with 1-3 adverse childhood experiences, the odds of landing in the worst symptom group went up about 2.5x compared to women with no ACEs. Okay, that’s significant!! But for women with 4 or more ACEs, the odds jumped nearly 10x higher.

I want to mention this because it’s (really) worth sitting with and exploring: if you experienced significant childhood trauma, you’re almost 10 times more likely to have severe menopausal symptoms.*

And this wasn’t just because women with childhood trauma were more depressed or anxious (though they often were). The researchers adjusted for current depression, current anxiety, education level, whether you had a partner, whether you were employed, and whether you were using hormone therapy. Even after accounting for all of that, women with the most childhood adversity had 4.5x the odds of having severe symptoms.

The connection showed up across every type of symptom they measured.

Hot flashes and night sweats.

Sleep problems and exhaustion.

Irritability and brain fog.

Sexual problems and bladder issues.

The whole package.

The strongest association was with psychological symptoms, which makes sense. We’ve known for a long time that childhood trauma increases the risk for depression and anxiety. But the physical symptoms, that’s where this research breaks newer ground. The hot flashes that wake you up at night, the ones you can practically set your watch by, might be connected to something that happened ~30-40 years ago. Your body is still carrying that experience, and menopause is somehow bringing it to the surface.

The biological mechanisms aren’t completely understood yet, but researchers have some compelling theories. Childhood adversity appears to rewire your stress response system. This is a topic I’ve aleways been interested in, as I can personally relate. Both the sympathetic nervous system (your “fight-or-flight” response) and the hypothalamic-pituitary-adrenal axis (your main stress hormone system) get recalibrated when you experience trauma as a kid.

Here’s the thing: those same systems are involved in hot flashes. So there may be actual shared pathways between childhood trauma and vasomotor symptoms. Your body learned to respond to stress in a certain way when you were young, and decades later, when your hormones start shifting, that old wiring is still running the show.

There’s also evidence that childhood adversity changes serotonin pathways in the developing brain. These changes might not cause obvious problems when your estrogen is humming along normally, but when estrogen drops during menopause, suddenly those altered circuits become apparent. The trauma was always there in the background, menopause just turned up the volume.

What about the patterns we carry forward?

The study also found something that won’t surprise anyone who works in this field, but needs to be said anyway: women with more childhood adversity were significantly more likely to be experiencing abuse right now, in adulthood.

About 7% of women with 4 or more ACEs reported physical, sexual, or emotional abuse in the year before their clinic visit. Compare that to only 1% of women with no childhood adversity. And more than 84% of the women reporting current abuse also had ACEs in their history. Trauma doesn’t just stay in the past, it can influence who we end up with, what we tolerate, and how we see ourselves. If you’re facing ongoing abuse while also dealing with menopause and old childhood trauma, it makes sense that sleep is tough to regulate. That’s a lot for one body to carry, and it’s not your fault.

The study also suggested that childhood adversity influences health behaviors. Women w/ ACEs are more likely to smoke and more likely to have higher body weight, both of which can make menopausal symptoms worse. So there are multiple pathways here, biological and behavioral, all pointing in the same direction.

Here’s what frustrates me about this research.

If you think about your last appointment. Did your doctor ask about your periods, your hot flashes, your sleep? Probably. Did they ask if you wanted to try hormone therapy or an antidepressant? Maybe. Did they ask what your childhood was like? Did they ask if you felt safe at home as a kid? Did they ask about adverse experiences? I’m guessing not. And I ask this with all due respect to my profession, it’s not something that’s considered “standard of care”. Is it their responsibility to ask? Is it our responsibility to bring this up during our visits? All things to think about.

The researchers point out that childhood adversity is significantly underreported. Women don’t volunteer this information unless they’re specifically asked, and often not even then. So the 60% number might be an underestimate. The real rate could be even higher. This means the connection between childhood trauma and menopausal suffering could be even stronger than what this study found.

It’s telling us something that should change how we approach menopausal care, but I’d bet money that most women reading this have never been asked about childhood trauma by their healthcare provider. Again, not the typical question we would ask a patient in the context of perimenopause or menopause symptoms (maybe some do?), but certainly something to reconsider.

Who was (and wasn’t) included…

This study looked at a fairly specific group: mostly white, well-educated, employed women who were able to get to the Mayo Clinic in Minnesota for specialty menopause care. The average woman in this study had completed college or graduate school. These are not the women we typically think of as most vulnerable. These are women with resources, with access, with the ability to seek out specialized care. And still, nearly 60% had experienced childhood adversity.

It begs the question, what would these numbers look like in more diverse populations? What about women of color, who face not only potential childhood trauma but also the compounding effects of racism and systemic inequity? What about women with lower incomes, less education, and less access to healthcare?

The researchers acknowledge this limitation directly and they’re calling for more inclusive studies. Because if childhood adversity is this common and this impactful in a relatively privileged population, we need to understand what’s happening in communities with fewer resources.

What you can actually do w/ this info…

Maybe you’re reading this and recognizing yourself. Maybe your symptoms are severe, and you had a rough childhood, and you’re wondering what the hell you’re supposed to do with this information.

First, it validates what you’re experiencing.

1. Your symptoms are not all in your head. There are real, measurable associations between what happened to you as a child and how your body is responding to menopause now. The standard treatments (hormone therapy, SSRIs, lifestyle changes) can absolutely help, but if there’s unresolved trauma underneath, treating only the surface symptoms might not give you complete relief.

2. Consider whether trauma-focused therapy might be part of your menopause treatment plan. I’m definitely not saying your symptoms are purely psychological. I’m saying that addressing past trauma might help your current physical symptoms in ways that surprise you.

Approaches like EMDR (which stands for Eye Movement Desensitization and Reprocessing) or cognitive processing therapy have strong evidence for treating the lasting effects of childhood trauma. For some women, this kind of work alongside medical management might provide more relief than either approach alone.

3. Advocate for yourself. If you’re seeing a healthcare provider about menopausal symptoms and you have a history of childhood adversity, it may provide some additional context by bringing it up. Don’t wait to be asked, because you might be waiting a long time. Again, this is NO shade to your healthcare provider, it’s not the general practice to go this deep. Your childhood experiences are relevant medical history, and they might influence which treatments work best for you.

Bottom line- you deserve care that sees you as a whole person, not just a collection of symptoms to suppress.

The limitations of the study (because science is complicated)

This was a cross-sectional study, which means it’s a snapshot in time. The researchers didn’t follow women over many years to see how childhood experiences influenced their menopause journey, however it’s perfectly appropriate for the objectives of this study.

They asked women to look back at their childhoods, which means the data relies on memory of events that happened decades ago, which means there could be a recall bias. Some women might not remember. Some might not want to remember. Some might have dissociated from those experiences so completely that they genuinely don’t have access to the memories anymore. All of which means the ACE scores in this study might underestimate the true level of childhood adversity.

Nonetheless, the goals and analysis were well done. This is, in essence, a “burden of disease” type study.

The study also relied on self-reported symptoms rather than objective measures. They didn’t hook women up to monitors to measure their hot flashes or track their sleep with actigraphy. They asked women how they felt, and women answered. Which is very valuable data, albeit subjective.

That said, the findings are remarkably consistent across all types of symptoms. And the associations remained strong even after adjusting for hormone therapy, depression, anxiety, and abuse in the preceding year, which suggests this isn’t just about women with trauma being more likely to notice or report symptoms.

I think what this research is asking us to do is expand how we think about menopause.

Not just a hormonal transition.

Not just about estrogen levels nose-diving and progesterone disappearing and FSH going haywire.

Menopause is a whole-body, whole-life transition. And for women who experienced trauma early in life, it might be a time when all of that unresolved pain resurfaces in ways that feel physical because they are physical.

Your body kept the score, as Bessel van der Kolk would say. And now, during menopause, your body is presenting you with the bill.

I read these studies and comb through them with you because I want you to know that there’s always hope, and there’s always options for you to truly feel better. But here’s Understanding the connection is the first step toward better treatment. If we know childhood adversity links with worse menopausal symptoms, we can screen for it more thoughtfully. We can ask about it. We can create treatment plans that address both the hormonal changes and the trauma history.

We can stop treating women like they’re being dramatic or difficult when they say their symptoms are unbearable. We can believe them. We can offer them more comprehensive care.

The menopause transition is hard enough without carrying decades of unresolved trauma through it. As I always say, you deserve support that recognizes the full scope of what you’re dealing with. You deserve healthcare providers who understand that your body’s response to this transition didn’t start at 45 or 50. It started a long time ago, and it’s been building ever since.

This research is opening a door, and once the door’s open, we have a chance to ask better questions, screen earlier, and offer support that fits the whole person.

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Share The Basics for the Non-Basic by Shelley

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This article is for general information only. This article is educational and does not replace medical care. I am a medical provider, but I am not your medical provider. Talk with your own healthcare provider for diagnosis and treatment decisions, and if you feel unsafe or at risk, seek urgent help right away. Additional resources below:

• Domestic Violence Hotline 1-800-799-SAFE (7233) 1-800-787-3224 (TTY)

• Sexual Assault Hotline 1-800-656-HOPE (4673)

• Suicide & Crisis Lifeline 988

• CDC’s Information on ACEs

• Study referenced in this article