How I Got Here
Dear Friend,
The first letter on this site got written at 4:23 a.m. on a Tuesday in March of 2024.
I was 44. I had been waking up at almost exactly that time for two years. My husband was asleep next to me. My daughter was asleep down the hall. I had a meeting at 8:30 with a client I respected, and I had been hoping — maybe even praying, in the loose, secular way I sometimes do — that tonight would be the night my body finally let me sleep through.
It was not.
I went into the bathroom because the bathroom is the room a woman goes into at 4 a.m. when she does not want to wake anyone else up. I sat on the cold floor with my back against the tub. I cried for about ten minutes. Quietly, the way you do when you have been doing this for a while.
Then I opened my phone — because of course I did, the way every other woman in The Window does at this hour — and I started typing.
I did not start typing because I had a plan. I started typing because I had been to four doctors in two years and the last one had told me, with what she clearly thought was patience, that I might want to consider whether my insomnia was a side effect of being a working mother. As if no working mother in the history of working motherhood had ever slept.
What I started typing on the bathroom floor was the first draft of what would eventually become Letter #1 on this site. I didn't know that's what I was writing. I thought I was writing an angry email. I thought I was going to send it to the doctor and then never speak to her again.
I'm glad I didn't send it. It would have been a worse letter than the one I eventually wrote. But the spine of it — the part that says this is not in your head, and your labs are lying to you, and here is what is actually happening — was already there.
The Two Years Before
The two years before that bathroom-floor moment looked like this:
It started with sleep. Around 41, almost without me noticing, I stopped sleeping the way I always had. I had been a 7-hours-on-my-back-to-the-alarm kind of sleeper my whole life. Not anymore. Now I would fall asleep at 10:30 and snap awake at 3 or 4 with a heart rate of 110 and a chemistry in my body that felt borrowed from someone else — someone in danger.
Then the weight came. Not much. Maybe 12 pounds across two years. But it was the kind of weight that scared me. It was specifically the kind that gathered in the front of my torso, between my ribs and my hip bones, in a place where I had never carried weight before. My jeans started fitting like they had been bought for someone else. I went down a size in tops and up a size in bottoms in the same year, which made shopping a small daily humiliation.
Then the brain. I started losing words mid-sentence. I would be telling someone the name of a restaurant we had been to twice and the word would not be there. I am a writer. Words are the thing I am supposed to be best at. Watching my brain reach for one and come back empty was the part of perimenopause that scared me the most, because it implied that the version of me who could earn a living was negotiable.
Then the mood. I cried at commercials. I yelled at my husband over a dish in the sink. I lost my temper at a cashier in a grocery store about the kind of bag they had used. None of those reactions were proportional. None of them sounded like me. I started apologizing more, and meaning it less, because I genuinely did not understand who was doing the yelling.
And under all of it, the slow loss of my sense of identity. Because every one of those symptoms had been told to me, by doctors and by the internet and by a particular kind of friend, as some version of: this is just stress. This is just being a working mother. This is just your forties. This is what it's like.
I did not believe them. But I had nothing else to offer. I did not have a name for what was happening, and so I had no leverage on it.
The Doctors
The first doctor was kind. She was a friend's friend, a primary-care MD in her early 50s. She listened, ran a basic panel, came back and told me everything looked normal and I should consider that my late 30s and early 40s were just a stressful time of life.
She was not wrong about it being stressful. She was wrong about that being why my heart rate was 110 at 4 a.m.
The second doctor ran more labs. He was a younger man, just out of residency, and he had the specific kind of professional confidence that made it slightly harder to disagree with him. My estrogen was within range. My TSH was within range. My fasting glucose was within range. He had no further suggestions. He told me to consider melatonin and to come back if things got worse.
The third doctor was the OB-GYN I had been seeing for a decade. I trusted her. When I told her, slowly and with notes, that I thought I might be in early perimenopause and that I wanted to look at progesterone, she was patient with me. She told me I was a little young for that conversation. She told me that progesterone replacement was complicated. She told me to come back in a year and we'd retest.
The fourth doctor — the one who told me my insomnia was a side effect of being a working mother — was the one I left crying in the parking lot. I sat in my car for a long time before I drove home, partly because I did not want to drive while crying, and partly because if I drove home I would have to tell my husband I had walked out of another doctor's appointment with nothing.
That was the day I decided I was going to figure this out myself.
What I Did Next
What I did next was not noble. It was just stubborn.
I started reading papers. I am not a doctor and I will never be one, but I am a reasonably intelligent woman with a research background and access to PubMed, and I had two years of accumulated rage to push me through papers I would otherwise have closed.
What I learned, slowly, over about eight months of late nights and weekend mornings, was that there was a coherent story in the medical literature that almost none of the doctors I had seen had told me. The story went roughly like this:
Perimenopause is not a sudden event. It's a 10-to-15-year transition. During that transition, three hormonal systems shift in concert: the ovarian hormones (estrogen and progesterone), the stress system (cortisol and the HPA axis), and the metabolic system (insulin and visceral fat distribution). The standard hormone panel that gets run on women in their early 40s measures one or two pieces of one of those systems at one point in time. It misses the others entirely.
That, more or less, is the foundation of what I now call The Insider's Window — the framework that runs underneath every letter I write here.
I wrote that bathroom-floor letter the night I finally felt like I had enough of the picture to explain it to another woman. Not perfectly. Not as a doctor. Just clearly enough that another woman walking out of another parking lot at 4 a.m. would have a different starting point than I did.
Why I Started Writing These Letters Publicly
Here's the part where I want to be honest with you about who I am and what I'm trying to do.
I'm not a doctor. I will not pretend to be one, and I will never write to you as if I am. I'm a 46-year-old woman who lived through this, did her homework, and writes for a living. The credential I'm offering you is that I will not lie to you, I will not flatten the science, I will tell you when I don't know, and I will tell you when I changed my mind.
I started writing these letters publicly because I noticed something: when I told my own story to friends — the doctors, the labs, the symptoms, the framework — the same thing happened almost every time. Someone would email me a week later and say I sent your story to my sister, and she just got off the phone with me crying because she didn't know. That happened often enough that I started wondering how many women were out there who didn't have a friend who had figured it out yet.
So I'm trying to be that friend. The one with the long letter on the bathroom floor.
What This Site Is And Isn't
It is a series of long, careful letters, in the voice of one woman, addressed to other women in the same Window.
It is not medical advice. I have a medical disclaimer at the bottom of every letter, in my own voice, and I mean it. If something I write contradicts what your doctor told you, listen to your doctor first, and then ask them better questions. The point of these letters is to give you better questions, not to replace the people qualified to answer them.
It is reader-supported. There is no pharmaceutical sponsorship, no “sponsored content,” no MLM supplement company writing my paychecks. When I eventually recommend a product — a lab, a book, a piece of equipment, a doctor network — I will tell you whether I make money if you click the link, and I will tell you what the product won't do as carefully as I tell you what it will. (I'm building that hub now. It's at /resources and it'll be quiet until it's honest.)
It is not a community, a forum, a Facebook group, or a Discord. The daily conversation lives on Instagram, where I post every morning and where you can find me. There's a follow link at the top of every page. Everything else lives in the letters.
Where To Start
If you read nothing else here, read Letter #1. It is the cornerstone, and almost every other letter on the site refers back to it.
If you've already read it, the natural next step is the cluster pillar that gives you the full sleep-and-cortisol picture:
P.S.
If you've made it to the bottom of this letter, thank you. The thing I wanted you to know — if you take only one thing from it — is that you don't have to keep walking out of parking lots empty-handed. There is a coherent story underneath your symptoms. It's the story I've been writing letters about for two years. Tomorrow I'll write another one.
If you want to know when, find me on Instagram.
— Marlowe