This is a book for any woman who has reached midlife and wondered, Is this . . . it? I thought it would get easier. I thought I would have more figured out by now. I always thought life would be more beautiful than this. Something is wrong, and I can’t put
my finger on it. I’m not the mother or partner I wanted to be. I’m not as successful as I hoped I could be. And, despite the growing pile of self-help books on my bedside table, I’m not turning out to be who I thought I would be. I’m just . . . tired, I guess. Maybe it’s my thyroid.

Which is basically every woman I know, including me.

I’ve been a family practice doctor for nineteen years. I’m a mom of five children and a wife to a brilliant physician and recovering drug and alcohol addict in recovery now for over fifteen years. I’m a daughter. A sister. A friend. I’m a published author and writer
with an online community where each month I may reach millions of women with my words. And every day, I’m trying to figure this life out, too. Still. Just like you. Each day I’m confronted with the truth that this one precious life in my one and only body is harder than I ever imagined it would be, and to be honest, sometimes I feel duped (yes, I’ve had my thyroid checked multiple times these last few years). I always hoped life would be more beautiful than this, didn’t you?

Yeah, me too.

I sent the first proposal for this book to my editor at the beginning of October, a month after my kids started back to school for the year. Our oldest of five children had just begun his senior year in high school and seemed singularly focused on playing basket-
ball, and our youngest child, and only daughter, was off to full-day kindergarten.

Suddenly for six hours every day, my house was silent and empty except for our dog, Fern, who regularly hounded me for walks and our kitten, Tilly, who occasionally peed on any wet towels left scattered on the bathroom floor. I found myself in one of those new “seasons” people talk about, and the silence of my days was magical. I had many plans for what I might do with this time—exercise classes I would take, closets I hoped to organize, friends I looked forward to catching up with, all the writing I wanted to accomplish. Except occasionally in those first few weeks of silence, I spontaneously burst into tears while loading clothes into the dryer or lying in savasana at the end
of yoga.

What was I doing with my one precious, beautiful life?

I wanted to write about midlife and life transitions (especially career transitions since I left my part-time position with Onsite Care Clinics, where I have worked for the past ten years, and began introducing myself as a “doctor, author, and well-being advocate”
in my author bio). I wanted to write about how we are constantly trying to figure out who we are, where we’re heading, and what is the meaning of our lives. But my publisher wasn’t sold on the idea exactly as it was. So instead, I met mom friends for lunch and walked my dog in endless loops around the path behind our house and finished our family’s Christmas shopping long before Thanksgiving week arrived.

In hushed phone conversations with my closest girlfriends, we discussed the calamities of midlife—things like a cheating husband, a teenager forced into non- consensual sex with a “friend” after a night of partying at college, a tween searching for porn on the iPad, and an aging father who was in and out of the hospital with failing kidneys. We spoke of our looming life doubts and troubled relationships and debilitating fatigue and motherhood angst and horrible periods. Sometimes my friend Angela texted memes of a bloody Carrie from that old Steven King movie to describe her current level of hormonal bleeding. Life seemed . . .hard. And, as the holidays ramped up, I spent most mornings typing at the rickety little Ikea desk perched under the window of my office in our silent home.

Maybe I could write about healing? After all, I’ve been practicing medicine for nearly two decades, and I had recently renewed my board certification to maintain an active and unrestricted medical license. Plus, since releasing my first book about surrendering perfect, I am attempting to unpack the hurts I’ve had shoved away
for most of my life and rid myself from the shame of childhood sexual abuse hidden under my lengthy list of shiny exterior accomplishments. I go to therapy regularly, and each day I am working on my own healing.

The publisher perked up a little at that idea. Yes, maybe there was something there! Healing. That’s a topic that might help a wide range of readers. So, I sent off a second proposal for a book about childhood traumas and hurts and the pain we carry into
adulthood alongside women’s general weariness during midlife and the ongoing process of healing right in this middle part of a hard, messy life. But that wasn’t quite it either. I was leaning against the kitchen counter one afternoon, eating directly from a super-sized bag of Ruffles from Costco and scrolling aimlessly on my phone when the politely worded email from my editor came through:

“Mikala, we love the idea of a book on healing. But I wonder if you could lean into your medical expertise a bit more. Could you write each chapter on topics like the thyroid, depression, insomnia, and hormones? Perhaps the pitch of the book can be about healing from these very real issues women are facing. We’re looking for a hopeful message that the best of life is yet to come. And we might want to steer away from any talk of “weariness.” Check out this comparable title. The team is excited!”

I shoved a few more chips into my mouth and clicked the link. A book with a chiseled middle-aged woman in a sports bra titled Next Level: Your Guide to Kicking Ass, Feeling Great, and Crushing Goals through Menopause and Beyond popped up on the screen. It had thousands of five- star reviews.

I thought about Maureen.

When she came to see me as a patient in clinic years ago, it looked like her brown and gray speckled hair hadn’t been combed in days. Her eyes were hollow-appearing and rimmed with dark circles underneath. Her hands were trembly. And when I closed
the exam room door behind me, she immediately burst into tears and fished a crumpled Kleenex from her purse. “Oh, Dr. Albertson! I’m sorry. I’m such a mess, look at me. I just need help, and I couldn’t find time to shower before I came in. I’m sorry.”

I smiled and shook my head at her unnecessary excuses, then shoved my paperwork aside and rolled my little round doctor’s stool so close that our knees were nearly touching as the heartbreaking details of a very real issue she was facing came tumbling out.

“He’s been struggling, and we knew it. We knew! I just hoped we could get him through school, you know? Get him graduated and off to college. I thought maybe he’d meet some friends in college. Some people who would accept him for . . . him.”

I listened.

“He’s different. We always knew he was different. And kids can be so mean. It’s my fault. I should’ve switched him to another school years ago. Or something. I should’ve done something! We tried counseling and medication. We talked to the principal. But I knew it wasn’t helping.”

She wiped at the tears spilling down her cheeks and blew her nose with those trembly hands before she went on, “I should’ve been there.”

Her teenage son Jason was admitted to an inpatient hospital room on the psychiatric floor after attempting suicide. He’d been bullied at school for years, and it was all becoming more than he could bear. What could I possibly say? Is there a worse feeling for a mother to endure than watching her child suffer? How could anyone step in and “fix” the helplessness and dread of this situation?

I listened some more.

It sounded like Jason was in good hands at the hospital with both a psychiatrist and a therapist he liked. There were individual counseling sessions and group therapy and medication. Plus, a support group for the parents. But Maureen
came to see me because she needed help with sleep. She needed something for her trembling hands.

“Honestly, I haven’t been feeling well for a while, you know. Mike is semi-retired now, but I’m still working quite a few hours. And not really sleeping. I’ve been gaining weight. And I’m just. . . tired, I guess. I’ve been wanting to make an appointment for
months to check my thyroid. Because . . .” her voice trailed away. “Dr. Albertson, do you think it could be my thyroid?”

“Maybe. I’m happy to check it.”

After a quick exam, I clicked orders into the computer for blood work to rule out causes of fatigue like anemia or hypothyroidism. Then I started her on something for anxiety and gave her an as-needed medication she could use occasionally for sleep. We talked about what self-care looks like during times of crisis—things like scheduled meals and at least weekly therapy and walks around the neighborhood, not for exercise really but just for moving forward.

We talked about sleep hygiene and the necessity of rest. We talked about asking for help and the importance of connecting regularly with at least one trusted friend during this time.

I could not imagine thrusting a book about kicking ass or crushing goals into this hurting woman’s hands.

As the nurse drew blood to fill a few small vials, I leaned against the exam table and waited. Blood gurgled through the little plastic tubing, and Maureen looked up at me, her face brightening. “You want to hear something strange?”

“Sure,” I said, nodding.

“It just feels good knowing he’s safe right now. He’s safe in the hospital, you know? And last night after group therapy, we played Scrabble together. He beat me, of course. And he laughed and teased me. He was just the same person he’s always been. And he
seemed . . . happy.”

She stopped then, and her eyes appeared to be far away, searching. “It was this beautiful moment with him. In a hospital. Isn’t that a strange thing to say?”

I smiled. Life is so bittersweet.

The nurse left the room, and Maureen gathered her things, shoved her phone and old, rumpled Kleenexes back into her purse, and stood. I held my arms open to give her a hug. As she pulled away from our embrace, I pointed gently toward her pants and said, “Hey Maureen, take as long as you need. But it looks like you’ve got your joggers on inside out. You might want to change them around before you head back out there. You can come see me anytime you need to, but let’s make a follow- up appointment for two weeks.”

She looked down at her pants, at the white cotton pockets sticking out from her hips then back at me, realizing she’d been walking around all morning with her pants on inside out. Her eyes sparkled and danced for a moment as we both burst into laughter.

Life is hard, isn’t it? Especially in this middle place. One thing I know for certain is that women are weary. We long to “kick ass” in midlife and “crush all our goals.” But then life happens. Our marriages fail, our children grow and change and we send them out into the pain of the real world where they must live very real lives, we lose jobs, we lose loved ones, our parents age and decline and require more help, our own bodies tire and our hormones begin playing tricks on us. We simply . . . struggle. And though the Christian publishing industry seems to prefer “prescriptive” type books and I am a
family practice doctor well- versed in writing prescriptions, I simply don’t have a tidy prescription to offer for all the complexities women face in midlife.

One of the challenges of this book is how to wear my “expert” hat and offer my medical expertise while also being truthful about my own personal struggles. I want to tell you everything I know about women’s bodies and medicine and healing, but I also want
to be real about what is hard and broken and painful. After all, I counsel women on their health and general well-being, but at the same time, I sometimes eat from the huge bag of Ruffles in my pantry. Somehow, my medical knowledge doesn’t prevent me
from struggling with anxiety and unhealthy body image, adult acne and weight gain, or the heavier periods that can be typical of our mid- forties.

I am weary, too.

* * * *

Years ago, on my surgery rotation during residency, the head surgical nurse leaned over before the next scheduled surgery of the day and nodded toward the cardiothoracic surgeon. “He doesn’t usually let the residents scrub in on these procedures, you know. He must like you.”

I felt a mixture of pride and bewilderment. Ever the hard worker, I’d been striving for weeks to be dependable and knowledgeable on rounds—thorough, punctual, confident. But what in the world was I doing scrubbing in on a cardiac bypass grafting
(CABG) procedure? It’s not like I could lend any real help.

I watched it all with awe anyway.

The team began by harvesting a vein from the patient’s leg to be used for a new blood vessel to the heart since the original cardiac arteries had become blocked with plaque over the years, inhibiting the supply of oxygen to the heart muscle and causing symptoms of a heart attack. Then, after they cut swiftly through the sternum with a little round bone saw, I watched as that head surgeon inserted a large metal retractor into the chest. It had a turn crank attached like those little wind-up toys that hop along on plastic legs or roll by themselves on the floor. “Want to take a few turns?” he asked. I heard the ribs crack a little wider with each twist of my wrist, slowly revealing the patient’s lifeless heart underneath.

During a CABG, the blood required by the body pumps through an elaborate cardiopulmonary bypass machine that mechanically exchanges the fresh oxygen needed to sustain all the body’s tissues to the heart lies still and quiet in the chest.

To me, these miracles of science are simply concrete evidence of the Divine.

The surgeon paused then and looked up at me, his rich brown eyes squinching as he smiled beneath his blue surgical mask. “Have you ever held someone’s heart in your hands?”

I shook my head no.

He grabbed my hands and wrapped my slippery gloves with gauze for some traction, then gently pulled the heart up and slightly out of the chest. “Here. Hold the heart right here and don’t move. Keep your fingers flat, like this. If you hold too light, the heart will slip and rip the vessels, which will ruin the graft. If you hold too tight, your fingers will poke a hole right through the heart.”

No pressure, right? On top of that, once he began the delicate process of stitching the freshly harvested vessels into place, I couldn’t see a thing. I just stood there sweating for what felt like an eternity with a human being’s heart in my hands. Literally holding on for dear life—not too light but not too tight. It was both exhausting and exhilarating.

And, thankfully, the surgery was a success. The graft took. Our patient’s blood began pumping once again through the heart that had been carefully laid back within the chest cavity. Then we wired his sternum closed with thick metal wire and stitched the remaining layers of muscle and skin gently over the top. I felt like I’d witnessed a modern-day miracle. And after work, I went home and told my husband with awe, “I got
to hold someone’s actual heart in my own two little hands today. Can you believe that?”

“That’s amazing. Bet you won’t ever get to do that again!” was his reply.

But he was wrong. Because that’s exactly what I did in the clinic that day with Maureen. It’s what I do with all my patients, really. Or with the readers who send messages after reading my first book or write to share pieces of their own story after relating to an online essay I’ve published. It’s what I do for the friends I walk with through the neighborhood. Or for my best girlfriends over the phone. Turns out, I often hold another human being’s heart in my hands.

And that’s exactly what I’m hoping to do with this book. I’m asking you to put your big, beautiful heart in my hands for a little while, and in return, I will offer you all of mine. If you came as a patient into the clinic, I might get one or two 15- or 30-minute appointments to talk with you every six months or so, which means it might take well over a year for me to get just an hour of your time and attention. And it isn’t enough. It isn’t enough time to look into your eyes and listen well and understand and really get to know you—who you are, what you’re facing, where you come from. It isn’t enough time to tell you all the things I long to tell you. It isn’t enough time to even begin to find true
healing. But here, now, and for the next 250+ pages, we have all the time we need. We can hold each other’s hearts—not too light and not too tight—while we work toward healing in this messy middle part of our lives. Together.

What you’re reading here is more than a typical “Women’s Health” book because women are more than menstruation and fertility and menopause. We are so much more than our reproductive organs and the outward appearance of our bodies. We are
hearts and minds and flesh and bones and bowels and bellies and breasts and sex and love and fire and rage and joy and whole entire lives all folded and forged into one uniquely beautiful God-given form.

Not every problem that arises for a woman in midlife can be chalked up to hormones or menopause. Instead, we must consider our age and other medical issues including medications or supplements if we take them, our diet and exercise and sleep patterns, our underlying genetics, our history of trauma, our experiences and current stressors, any socioeconomic stressors or discriminatory barriers, plus our ability to provide self-care and lean on appropriate support systems if they are available to us. Midlife is complicated, and our midlife bodies are certainly complex! What is considered healthy for one woman may be substantially different from what is considered healthy for another. So, during this phase of life we must make informed decisions and work together with our medical providers to develop treatment plans or lifestyle modifications based on the whole picture unique to each one of us.

What I’m sharing with you in the pages that follow are real heart stories about love and truth and life. Stories of pain and hurt and motherhood and marriage and faith and friendship entwined. Of struggle and strain and renewal and hope combined with our
health and healing along the way. I’m confident you’ll see a part of yourself here in one or more of these stories. And my hope is that not only will you learn something new about your body or caring for your health during this middle part of life’s journey,
but you will also take to heart the truth that you’re not alone in a single moment of this good, hard, ordinary life.

What follows is everything I wish I could tell you about midlife.

Each chapter will begin with a true-life event from a patient I’ve treated in clinic or a friend I’ve listened to on a long walk around the path by my house or from the very real issues I’ve faced in my own life. And each chapter will conclude with pertinent medical
information on a wide range of topics women routinely encounter in their later thirties, forties, fifties, and beyond along with tools to empower you to care for and heal the body you actually have (rather than the utterly impossible cultural ideal— ugh, more on
that later).

We’ll talk about the slippery subject of control, shame-based “health” practices vs. love-based healing, how to evaluate our readiness for change, and the importance of forming deep relationships with the team God sends to offer help and love and connection in our lives. I’ll bring scientific insight to your burning medical questions about the thyroid and symptoms of adult attention deficit hyperactivity disorder (ADHD) and the unexpected rage of premenstrual dysphoric disorder (PMDD) and perimenopause and various mood disorders like generalized anxiety and depression.
We’ll discuss the preventive healthcare measures applicable to you in your current life stage as well as dietary supplements that can offer additional support. I will give scientific definitions as well as additional resources for further reading and learning. And I hope to provide a jumping-off point for further conversations with your personal medical provider about your own specific situation and the parameters of your particular body.

My great hope with this book is that together we can open our brave, battered, beautiful hearts to God’s love and grace and mending and mercy, accepting that this one precious life we’re living is hard, especially in this middle place. As women we often feel weary, and I certainly cannot promise that the best of life is yet to come. But there are steps we can take toward health and healing in these precious bodies we’ve been given while discovering (often surprisingly) along the way . . .

there is beauty here, too.

You can order Everything I Wish I Could Tell You About Midlife: A Woman’s Guide to Health in the Body You Actually Have anywhere books are sold. I can’t wait to share it with you!