If you’ve ever caught yourself saying “I just don’t feel like myself anymore” during midlife, you are not alone. Many women describe this experience as NFLM—Not Feeling Like Myself. It’s not a clinical diagnosis, but it’s a powerful phrase that captures the mix of perimenopausal and menopausal symptoms and physical, emotional, and cognitive changes that often happen during the midlife transition.

This stage of life is not just about hot flashes, night sweats, insomnia, or vaginal dryness, but these symptoms get most of the attention. NFLM is about the subtle, often confusing shifts that can leave women wondering where they went and what is happening in their bodies. There are so many myths and misconceptions about this timeframe, and these symptoms are real; they are rooted in biological midlife hormone changes, and there is help so that you do not feel alone.

NFLM can look different for every woman, but here are some of the most common ways it shows up:

• Mood changes: Increased irritability, anxiety, or low mood that doesn’t quite feel like depression but makes daily life harder.
• Sleep disruption: Trouble falling asleep, staying asleep, or waking up too early, leading to “brain fog” the next day.
• Fatigue and low energy: That dragging feeling even after a good night’s sleep.
• Cognitive changes: Forgetfulness, difficulty concentrating, “brain fog,” or losing words mid-sentence.
• Body shifts: Unexplained weight gain, joint pain, or changes in skin and hair.
• Loss of sexual desire or discomfort with intimacy: Often related to genitourinary changes or hormonal shifts.

When these symptoms pile up, it’s no wonder many women feel like strangers in their own skin.

Too often, women assume these symptoms are “just aging” or something they need to tough out. We’ve been conditioned to expect hot flashes (vasomotor symptoms) and vaginal dryness (genitourinary syndrome of menopause). But the truth is that the less visible symptoms—mood, sleep, and brain fog—can be just as disruptive.

Here’s why it matters:

• Quality of life declines when mood swings and sleep disruption go unaddressed.
• Symptoms are connected to long-term health risks, such as cardiovascular disease, osteoporosis, and cognitive decline.
• Support exists, but most women do not realize there are options to treat their menopause symptoms unless they ask.

The good news is that there are ways to manage and treat menopausal symptoms.

Unfortunately, not all clinicians are equally comfortable talking about perimenopause and menopause. Here are a few tips to find someone who will listen:

1. Look for specialists or certified menopause practitioners (such as those certified by The Menopause Society).
2. Ask about their experience: Do they routinely care for women in midlife? What is their approach to symptom management? Do they use FDA-approved options? What does care look like in their practices?
3. Bring your questions: Don’t be afraid to write down your symptoms and concerns.
4. Notice how you feel in the room: If you feel dismissed, rushed, or unheard, it’s okay to seek a second opinion.

You deserve a clinician who validates your experience and works with you to find solutions where you feel seen and heard. Midlife care is different for everybody and should be nuanced to each person.

Menopause hormone therapy (MHT) can be life-changing for many women, but it’s not the only tool in the toolbox. Some women cannot use MHT due to personal or medical reasons, while others feel hesitant.

Fortunately, there are many non-hormonal options available:

• Prescription medications: Certain antidepressants, anti-seizure meds, or blood pressure drugs can reduce hot flashes and improve sleep.
• Lifestyle strategies: Nutrition, exercise, stress management, and sleep hygiene can have a meaningful impact.
• Mind-body approaches: Yoga, meditation, cognitive behavioral therapy, and acupuncture are backed by research for symptom relief.
• Vaginal non-hormonal treatments: Moisturizers, lubricants, and non-hormonal options for GSM and painful sex.
• Supplements and nutraceuticals: Evidence is mixed, but some women find support from things like magnesium, omega-3s, turmeric, or probiotics (always discuss with your provider first).

The key is personalization; what works for one woman may not work for another.

I’ve seen countless women walk into my clinic feeling hopeless and like they’ve lost their spark, their sleep, or their sense of self. I’ve seen them walk out months later lighter, more confident, and more connected to themselves again.

• A 48-year-old teacher told me she thought she was “losing her mind” from brain fog. With a combination of sleep support, stress reduction, and tailored hormone therapy, she felt “like the lights turned back on.”
• A 52-year-old breast cancer survivor couldn’t use hormones but found relief with non-hormonal vaginal treatments, CBT for insomnia, and mindfulness. She shared, “I feel like I finally got my body back.”
• A 55-year-old executive who had battled fatigue and irritability for years was shocked to learn her symptoms weren’t just stress; they were related to menopause. With the right care and treatment plan, she rediscovered her energy and said, “I’m not just surviving work and family life; I’m thriving again.”

Stories like these remind us that there is always hope and that every woman deserves this discussion and gets to make a shared decision in her care.

NFLM is not a character flaw, a weakness, or “just aging.” It’s a signal that your body is transitioning, and it deserves attention. If you’ve been saying, “I don’t feel like myself,” know this: you are not alone, you are not imagining it, and you don’t have to suffer in silence.

With the right clinician, the right tools, and the right support, you can absolutely feel like yourself again or even discover a new, thriving version of yourself in midlife and beyond.

If you’re experiencing NFLM, reach out to your healthcare clinician today. If your current clinician isn’t listening, keep searching for a menopause specialist. You deserve care that sees you, hears you, and helps you reclaim your vitality.