This is a great term to nail clinically. “I don’t feel like myself” gets dismissed as vague when it’s actually a cluster of measurable, describable shifts:

“NOT MYSELF” / IDENTITY DISCONTINUITY
A subjective sense of disconnection from one’s own baseline personality, mood, and mental sharpness, driven by fluctuating estrogen and progesterone and their downstream effects on serotonin, dopamine, and GABA signaling.

Commonly reported as:

• Flattened joy or reduced pleasure in things that used to feel effortless (anhedonia-adjacent, as in a reduced hedonic tone — NOT full anhedonia, the complete loss of capacity for any pleasure at all)

• Disproportionate irritability or rage, often cyclical

• Brain fog: word-finding trouble, slower processing, difficulty holding a thought

• New-onset anxiety with no clear external trigger

• Fatigue unresponsive to sleep; a “wired but tired” quality

• Difficulty naming what’s wrong — the hallmark that distinguishes this from clinical depression

HOW IT DIFFERS FROM DEPRESSION:
Perimenopausal “not myself” tends to fluctuate with hormonal timing (often worse in the luteal phase, easing at other points in the cycle), rather than persisting steadily. It typically lacks the hopelessness and pervasive anhedonia of major depressive disorder. Tracking symptoms alongside cycle timing — and screening with a tool like the PHQ-9 when warranted — helps distinguish the two and flags when medical intervention may be appropriate.

A model that understands health, illness, and well-being is a complex interaction between biological (genetics, physiology), psychological (thoughts, emotions, behaviors, stress), and social (culture, family, socioeconomic factors, environment) elements, rather than just a biomedical issue. This approach emphasizes that a person’s overall health depends on how these three areas work together, offering a holistic view of diagnosis and treatment.

With MIDIMANUAL we work with an enhanced definition of metabolism:

The OLD definition: Metabolism is the sum total of all the chemical reactions in the body.

The NEW Definition: METABOLISM IS THE SUM TOTAL OF ALL THE CHEMICAL REACTIONS IN THE BODY PLUS THE SUM TOTAL OF ALL OUR THOUGHTS, FEELINGS, BELIEFS, AND EXPERIENCES

More Metabolic Power = More Energy | Less Pain | Balanced Hormones | Leaner Figure | Happier | Healthier

We’ve believed that a metabolic enhancer must be exclusively of the order of food, a pill, or a push-up, yet these nine metabolizers are of a different category. Let’s call them trans-substantial, meaning “above and beyond the realm of matter.”

You can’t touch them, see them, bottle them, or sell them online, yet they are as fundamental to metabolism as vitamins, minerals, water, and exercise—perhaps even more so. Without them, we could never blossom into the vital and expressive creatures we are meant to be.

Meet the next generation of powerful biologic rejuvenators that will prove themselves essential to your health at the deepest level of medical reality.

The Nine Universal Metabolizers are:

• Story

• Awareness

• Relaxation

• Quality

• Rhythm

• Community

• Thought

• Pleasure

• the Sacred

If you’ve worked for a stronger metabolism but have not received success chances are you were missing some key ingredients. Indulge in the important nutrients that are vitamin L—love, vitamin H—happiness, and vitamin S—soul. Nourish the soul and you’ll nourish the body.

The chaotic, non-linear phase of the “pause,” when fluctuating hormones—specifically wild swings in estrogen and dropping progesterone—cause unpredictable physical and mental symptoms. It signifies a “full-body, full-brain transition” where the brain and ovaries fall out of sync.

1. Progesterone: The “First Domino”

Progesterone is typically the first hormone to decline, often starting in your late 30s or early 40s.

• Why it drops: Progesterone is produced by the ovaries primarily after ovulation. As you age, you begin to skip ovulation (anovulatory cycles) more frequently.

• The result: Without regular ovulation, your progesterone levels stay low. This can cause shorter cycles, heavier bleeding, and increased anxiety or sleep issues, as progesterone normally has a “calming” effect on the brain.

2. Estrogen: The Wild Card

Unlike progesterone, which mostly trends downward, estrogen fluctuates wildly before it eventually stays low in menopause.

• Wild fluctuations: Your estrogen levels may spike much higher than normal in some cycles and then drop precipitously in others.

• Estrogen “Dominace”: Because progesterone drops first, you may have “unopposed estrogen”. This doesn’t necessarily mean you have too much estrogen, but that the ratio is off. This imbalance often leads to breast tenderness, bloating, and heavy periods.

• Final decline: In late perimenopause, estrogen production finally sinks to a consistently low level, which is when classic symptoms like hot flashes and vaginal dryness become more intense.

Perimenopause is a critical period that sets the course for the rest of your life. The changes in hormone levels that you experience in perimenopause affect every system of your body for the long term, regardless of how severe (or not) your symptoms may be.

Perimenopause symptoms you might expect:

• Irregular and Unpredictable Menstrual Cycles

• Brian Fog and Memory Problems

• Dental Issues

• Heart Palpitations

• Hot Flashes

• Mood Swings

• Night Sweats

• Sleep Difficulties

• Metabolic Syndrome

Menopause technically isn’t a stage, but a moment in time. You reach it when you’ve gone exactly 12 months without a menstrual period. This occurs, on average, at age 51, but can happen earlier or later.

Symptoms you experienced in perimenopause are likely to continue during your period-free year.

Post-Menopause starts once you hit the 12-month mark with no periods. Women more commonly refer to this phase as “in menopause.” Yes, you’ve passed a significant milestone, but symptoms can continue and change for years to come.

Symptoms you may expect post menopause:

• Dry Skin

• Hot Flashes

• Low Libido

• Mood Swings

• Night Sweats

• Sleep Difficulties

• Urinary Incontinence

• Vaginal Dryness

• Weight Changes

• Osteoporosis

• Heart Disease

Menopause causes neuro symptoms like “brain fog,” memory issues, concentration problems, mood swings (anxiety, irritability, depression), fatigue, and sleep disturbances, stemming from declining estrogen affecting brain function, neurotransmitters (serotonin), and blood flow, sometimes presenting as migraines and auras, electric shock sensations, tingling, or nerve pain (paresthesia). These cognitive and emotional changes, though often temporary and linked to sleep loss, can impact daily life.

Musculoskeletal Syndrome of Menopause describes common joint, muscle, and bone problems from declining estrogen, including increased pain/stiffness (arthralgia and fibromyalgia), inflammation (like frozen shoulder), muscle loss (sarcopenia), significantly impacting quality of life for many women. It stems from estrogen’s role in supporting connective tissues, bone density, and reducing inflammation, leading to weakness, tendon issues, and fragility. Management focuses on exercise (resistance, weight bearing), nutrition, stress management, sleep, and sometimes hormone therapy.

A common, underdiagnosed condition in midlife women caused by low estrogen, leading to vaginal dryness, itching, pain during sex (dyspareunia), and urinary issues like urgency, frequency, and recurrent UTIs; it worsens without treatment and significantly affects quality of life, but is effectively managed with local estrogen therapies or other nonhormonal options.

OB/GYNS are not always the best option for helping to manage these symptoms. Finding a urologist trained in menopause care and who can refer you to a pelvic floor specialist if needed may be in your better interest.

Much safer than anti-anxiety drugs, “progesterone” has a mellowing effect in the brain. It’s best known for preparing the uterine lining for a fertilized egg to implant. It also increases bone formation and helps with muscle strength. It’s a builder. Your body makes progesterone from cholesterol in the ovaries, adrenals, and, in men, the testes. Progesterone is used to make androgens, which are used to make estrogens. We have more progesterone in our bodies than estrogen.
“Progestin” specifically refers to synthetic progesterone and is used in medications like birth control. Progestins fit the same receptors as progesterone but have different actions and side effects.
“Progestogen” is an umbrella term for both synthetic progestins and progesterone.

Thank you Dr. Kelly Casperson, for this NEW definition!
Testosterone is the main “sex” or comprehensive hormone in humans. It is produced by the ovary, testis, adrenals, brain, and other tissues. It is then converted to estrogen in all humans, more so in females. Women have, on average 1/10th to 1/20th the total testosterone of male bodies but more than four times the estrogen.
In humans, testosterone plays a key role in the development of reproductive tissues, including the clitoris, labia, testicles, and prostate, as well as promoting lean body mass and bone health and the growth of body hair (except on the top of your head).
In all bodies, testosterone exerts a significant effect on overall mood, cognition, social and sexual behavior, metabolism and energy output, the cardiovascular system, and the prevention of osteoporosis.

Estrogen is the archetype of a female hormone. Mainly produced in the ovaries, estrogen is responsible for puberty, pregnancy, and premenopausal changes. It controls the menstrual cycle. It maintains bone density and helps regulate cholesterol levels, promotes vascular health, and influences body fat distribution. Estrogen also supports brain function, mood regulation, skin elasticity, and the health of the vulva and vagina. Low estrogen may cause hot flashes, night sweats, vaginal dryness, and mood swings. High estrogen may cause irregular periods, breast tenderness, bloating, and fatigue. There are four types of estrogen:

E1—Estrone: the primary estrogen in postmenopausal women. Estrone is found in small amounts and is not sufficiently researched, but there are some concerns that it may play an inflammatory role. Estrone is stored and produced primarily in adipose tissue (body fat).

E2—Estradiol: the most common and active estrogen in reproductive-aged women and the most studied. AKA when we say “estrogen” we usually mean “estradiol.”

E3—Estriol: Produced in high quantities during pregnancy.

E4—Estetrol: produced exclusively during pregnancy by the fetus’ liver.

Estrogen has, in recent decades, been termed the metaphoric “Cinderella” of hormones, banished to the attic, subsumed into nothingness, and pathologized to be something that causes cancer at worst. However, it is coming into the light, and the talents and worth of this amazing hormone are rising from hardship and neglect to rightful recognition.

HRT—Hormone Replacement Therapy

MHT—Menopausal Hormone Treatment/Therapy

NHT—Natural Hormone Therapy

PET—Progesterone/Estrogen/Testosterone Therapy

Used interchangeably, these terms mean the same thing—giving back the hormones one naturally makes—just like giving back insulin, thyroid, and other less familiar hormones when needed.

Peptides are molecules that are a combination of two or more amino acids joined together through a peptide bond. They are the building blocks of proteins. There are over 7,000 naturally occurring peptides in the human body, and hundreds are being used in healing practices to manage regenerative treatments, especially those related to metabolic disease. Peptides work through an endogenous process (naturally occurring), so they work with the body. Peptides are selective, meaning we can target pathways of the body to heal ourselves faster, optimize our hormones, and increase our immune system.

AKA; Body Similar/Body Identical

While many therapeutic chemicals are synthetically produced in a lab, their chemical structure is identical to the chemicals naturally produced and used as signaling molecules in the human body.

This bioidentical nature is a key reason for their favorable safety profile in clinical settings, as the body recognizes and responds to them in a predictable way, potentially minimizing the risk of adverse reactions compared to foreign synthetic compounds.

Examples: Peptides like Insulin, BPC-157, and GLP-1, and hormones like estradiol and micronized progesterone.

There is a pretense that argues that if something is “natural,” it must be good/better/superior/more ethical. It can be an anti-intellectual tool that unfairly separates facts from values. The Ethics Center has termed it the “Naturalistic Fallacy,” and it is the reason why you may find some “should-ing” all over your midlife: “Menopause is natural; you do not need to get your menopause treated.” I’ll just say this: hearing aids and contact lenses aren’t natural. Socks aren’t natural. Arsenic is natural, so is formaldehyde and radon. You do not need to suffer. If your “natural” supplement isn’t really working for you, perhaps consider the alternative. Besides, what is more natural than just replacing what our body naturally makes?

Professor Thomas Clarkson was looking at atherosclerosis in menopausal monkeys when he coined the term the Timing Hypothesis. The timing Hypothesis, also known as the “healthy cell” hypothesis or the “critical window” hypothesis, is the theory that the earlier you start hormones, the safer and/or more effective they will be for you. There are things you can feel changing with low hormones, like mood, sexual function, hot flashes, but few people stop to think that their body is changing in ways they can’t feel—bones are losing their elasticity and density, blood vessels are losing their elasticity, muscles are both losing strength, size, mitochondrial health and the composition is becoming more infiltrated with fat. Professor Clarkson showed that the longer you wait to start hormone therapy, the more unseen changes progress, reinforcing the importance of early intervention for optimal health.

A situation where there is a lack of data to make informed decisions (especially compared to clinical trial populations). Where there is clinical uncertainty, decisions must be made without clear, evidence-based data. Significant portions of women’s health lack robust scientific data.

For an individual, the stack is a set of tools and services they use to manage their health. This can include diets, medications/supplements, movement methods, therapeutic treatments, etc.

“Yo” = to nourish, to tend.
“Jo” = life.

A 300-year-old philosophy that got wellness right before wellness was an industry.

Yojo means nourishing life, tending to the body before something breaks, not after. It isn’t a routine, it’s a relationship you keep with yourself, daily. Yojo isn’t something you do once you feel unwell. It’s something you practice while you’re already well.

Modern wellness sells fixes. A quick fix for the crash. A cleanse for the damage. A routine for the burnout.

Yojo asks a different question: “What does my body need today, so tomorrow doesn’t need repairing?”

Longevity isn’t a destination you arrive at. It’s a hundred small decisions made in your 30s, 40s, 50s…consistently, without waiting for a crises to start caring.

Yojo says, care given early is worth more than care given in emergency.

What you do to your body today is for the body you’ll have in 10 years.

Nourish it, not eventually, but now.

Yojo isn’t a wellness trend, it’s a way of living.