"How perimenopausal of me..."

I caught myself thinking it the other week: how perimenopausal of me to quit my job, leave the standard medical system, and go build something of my own.

In perimenopause your lens widens and focuses at the same time. There is a duality of strength and grace. Tolerance for things not worth worrying about and intolerance for what was tolerated previously. In perimenopause you can put together all of the super powers you gained through experience and use them to create the life you want. That is what I am up to, focusing on creating the practice I want for patients and I want to work in. It's a risky but beautiful thing and I am so happy you're here for it.

What GynJess actually is

Picture the friend you text your questions to at 11pm, except she went to school for this. That is the relationship I am building. A cozy clinic, a comfortable space, somewhere you actually want to go. Nobody rushing you out the door.

Patients 14 and up, which means I can care for you across decades, and care for the people you love in the same practice.

This is my "Second Spring"

Traditional Chinese medicine has a name for this midlife transition. Dì èr chūn, the Second Spring.

Not a decline. A season of renewal, transformation, and energy returning in a different form. Just as spring follows winter, this transition marks a shift from outward fertility toward inward wisdom and vitality.

In the United States the message is different, black balloons on your 50th. Jokes about being "over the hill". Society narrates this transition as a slow subtraction. Expectations of fading energy, and less of us.

This is a newsletter though so let's consider some research and data. For example anthropologist Margaret Mead who saw it differently: she called midlife "postmenopausal zest," a period of profound awakening. The research agrees with her. The average age of the founders behind the fastest-growing 0.1% of US companies is 45, and a 50-year-old founder is 2.8 times more likely to succeed than a 25-year-old. Midlife is not where ambition goes to fade. It is where experience, resilience and execution peak to make dreams a reality.

And yet, right around the time we step into this peak, our biology quietly changes. Which is how most of us land in this duality. Two things can be true at the same time:

This duality is written into our physiology. Dr. Lisa Mosconi's brain imaging shows that during perimenopause the brain undergoes a temporary drop in energy activity as estrogen shifts, a literal neurological renovation before it adapts and stabilizes into a new baseline. Your body is running a systemic recalibration often in the moments you are creating your most ambitious work. This can be happening in parallel with caregiving.

Navigating this season is about evidence, options, and whole person support, so your physical self can keep up with the life you are shaping.

You have spent decades building judgment, resilience, and skill. Your hormones are changing, but your relevance is not.

You are recalibrating and evolving.

Words are interesting to me. Some feel overused, but they help us define experience. Journey, for example. We pack for journeys, bring supplies, read to prepare, hire guides for support. The human experience is a journey, and the female experience is a unique piece of that journey.

As a person who loves analogies, it does feel like my role is that of an experienced guide, here to support you in your journey. Awww (heart hands)

So who am I? I realize many of us haven't met yet.

Hi, I'm Jess.
If you're new here, I'm so happy to meet you.

I'm a board-certified physician assistant. I hold two of the rarest credentials in this field: Menopause Society Certified Practitioner (MSCP) and Fellow of the International Society for the Study of Women's Sexual Health (IF).

That depth of training wasn't built into standard medical education. I went looking for it because my patients needed me to. And because I believe your care deserves a comprehensive, evidence-based approach.

Too many women sit in my office describing symptoms that were dismissed elsewhere. Told they were too young. Told it was just stress. Told to come back when things got worse. Or when their periods change!

Symptoms are siloed, considered individually missing the big picture and diagnosis. This is often due to time constraints and stipulations to address one problem a visit. But that is not how humans work, we are beautifully complex. That complexity can take time and attention.

I take the time you need to address it all. Bring the list you have been keeping in your phone; we will get through it. We will discuss the individual pieces to the puzzle and how they fit together. Expect hand gestures, analogies and drawings.

Now that I've introduced myself properly, a word about the name of this letter.

Common is not the same as normal

I say this in exam rooms so often it may as well be the name of this letter. A bell curve tells you what is common. It tells you nothing about what is normal.

Menopause at 44 or at 55. Desire that arrives before touch or long after it, or on a Tuesday and not a Saturday. A medication that changes everything in three weeks, or takes four months, or was never going to be your answer. Every one of those sits somewhere under the curve. Not one of them is a dysfunction.

And still, the question I am asked more than any other is some version of three words: am I normal?

Which tells you what we have all absorbed. Say "that's less common" to a woman and she will often hear "something is wrong with you." So she observes, wonders, and compares herself to an average that is not a target goal.

That word "normal" though.

That cuts both ways, because what is normal can still be distressing, even intolerable. A perimenopausal bleeding pattern can be entirely expected and still upend your week. Sleep that fragments at 3am is common in midlife, and it will still take your job performance, your patience, and your joy with it. Normal is not a reason to endure something.

So here is the editorial position of this newsletter: where you sit on the curve is interesting. Whether it is working for you is the actual question. Statistics are for populations. You are a person in a room with a life to run.

Data matters; I will never practice without it. But data alone is not medicine. Medicine is what happens when the evidence meets your lived experience and a clinician's judgment in the same room. That is the art of it. And that is what this letter will be: evidence-based, always, with you at the center of it.

Another word for another issue: "natural."

Ready for care that starts with believing you?

I am welcoming new patients now, whether you're deep in symptoms, due for an annual exam, or just starting to ask questions.

Come talk with me in person