Dr. Siân West, board-certified OB-GYN and menopause specialist, takes apart imposter syndrome in midlife women: why it resurfaces in your forties and fifties, why perimenopause brain fog makes it worse, and what actually helps.

The pattern has a name and about fifty years of research behind it. Impostor phenomenon was first described in 1978 by psychologists Pauline Clance and Suzanne Imes, and their subjects were not underachievers. They were high-achieving women with real credentials who were privately convinced they had fooled everyone. A 2024 meta-analytic review of more than a hundred studies and over forty thousand participants found women scoring higher than men on measures of imposter feelings. The gap is modest and varies by field, but it is real and it has not shrunk over time. One survey of women executives put it at seventy five percent. In a survey of UK orthopedic surgeons, ninety two percent reported moderate to intense imposter feelings, women scored higher than men, and almost half said it had discouraged them from applying for leadership roles.

The episode separates two things that get confused constantly: being genuinely new at something, and being a fraud. Being a beginner at a format is not the same as being a beginner at the work. Siân talks openly about her own version of this, from a year spent opening a telehealth practice, posting online and launching this show in public.

It also makes the connection to what your body may be doing right now. Perimenopausal cognitive change is measurable. In the SWAN cohort, women were given the same cognitive test repeatedly over four years. Premenopausal and postmenopausal women improved with practice, which is what normally happens. Women in late perimenopause did not. Their scores did not decline, they simply stopped improving, and the effect resolved after the transition. If you are already primed to doubt your competence, a blanked-out name in a meeting does not land as a hormone thing. It lands as confirmation. That is a hormonal transition affecting focus and word retrieval. It is not a verdict on whether you know your job.

If you have been losing your train of thought mid-sentence, blanking on a word you have known for thirty years, or going back to work after time away and feeling like a visitor in your own career, this one is for you.

In this episode:

What the 1978 impostor phenomenon research found, and who Clance and Imes actually studied

What the 2024 meta-analytic review shows about the gender gap in imposter feelings

Why imposter syndrome spikes in midlife: returning to work, watching younger colleagues move up, wondering whether your moment passed

Why "fake it till you make it" makes it worse

What the SWAN study found about perimenopause and cognitive performance, and why the finding is more reassuring than the headlines

How brain fog feeds self-doubt directly

The difference between being new at the format and being new to the work

Why 92 percent of surgeons in one survey reported imposter feelings, and what it cost them

Three things to do: the friend test, a script for the moment it hits, and an evidence file on your phone

Feeling like you do not fully know what you are doing is usually a sign you understand how much there is to know.

Same building. Same kind of complaint. Very different response. Dr. Siân West, board-certified OB-GYN and menopause specialist, walks through what the research actually shows.

Sildenafil, the drug we know as Viagra, was approved by the FDA in 1998 after roughly a six-month priority review. The first approved drug for low sexual desire in women, flibanserin, did not arrive until 2015. Seventeen years later, and only after being rejected twice.

This episode puts both drugs side by side, which almost nobody does. Viagra worked well in its trials, taking men from about 1.5 successful attempts a month to about 5.9. Flibanserin worked modestly, about half an additional satisfying event a month. But the reason those numbers differ is the point. Blood flow had been studied for decades. Female sexual desire had almost no foundational science behind it, so the drug that finally arrived had almost nothing to build on.

The safety comparison runs the other way. Flibanserin carries a boxed warning, for low blood pressure and fainting. Viagra has never carried one, despite a nitrate contraindication that can be fatal, sudden permanent vision loss, sudden hearing loss, and priapism that can cause permanent damage. 128 deaths were reported in association with Viagra in its first eight months on the US market. The FDA strengthened the label wording. The drug stayed on the market and kept its six-month approval.

The pattern does not stop at which drugs get made. A 2024 study of nearly twenty two thousand emergency department records in the United States and Israel found women were less likely to be given pain medication than men at every pain score and in every age group, and their pain score was ten percent less likely to be recorded by the triage nurse at all. The same bias appeared with male and female clinicians alike.

Research on nearly four hundred thousand heart attack admissions in the nineteen nineties found women under fifty died in hospital at more than twice the rate of men the same age. Separate work on patients fifty and under found young women were less likely to be discharged on the right medications, and less likely to have had their arteries looked at.

The root of it: until 1993, FDA policy kept women of childbearing age out of early-stage drug trials in the United States. Decades of foundational work on pain, drug response and basic physiology was built on a study population that skewed heavily male, and then applied to everyone.

In this episode:

- The approval timeline, and the thirty-year head start sitting behind it

- The side by side almost nobody runs: what each drug does, and what each one is allowed to do to you

- What the 2024 pain study found at every single pain score, and whose pain gets written down at all

- Why "women just report more pain" does not explain the gap

- The exact sentence to use when a physical symptom gets blamed on stress: I would like this looked at as a physical symptom first

- How to ask what specifically is being ruled out, and how

- Why a second opinion is not dramatic

This is not an argument that individual clinicians are careless. Most people in medicine are trying, inside a system trained on incomplete information. The pattern is still real, and still measurable.

They are one thing, and it has a name.

Dr. Siân West, board-certified OB-GYN and menopause specialist, explains what perimenopause actually is. Menopause itself is a single point in time, defined medically as twelve consecutive months without a period. Everything leading up to it, all the years of change, is perimenopause. For most women it starts in the mid-forties, though it can begin in the late thirties, and it typically lasts four to eight years. The average age at the final period is around fifty one.

Then the part almost nobody explains well. Perimenopause is not a steady decline. It is not your hormones turning down like a dimmer switch. It is estrogen and progesterone swinging unpredictably, month to month and sometimes week to week. That turbulence is the mechanism behind nearly everything you are feeling. It is also why a single hormone blood test drawn on one particular day can look completely normal and tell a different story a week later. Your pattern of symptoms over time is usually more reliable than one snapshot.

In this episode:

• Perimenopause versus menopause, defined properly, with the timeline and the average age at the final period
• Why "swinging, not declining" changes how the whole symptom list reads
• Why estrogen receptors throughout the body mean this was never only about your cycle
• Hot flashes, night sweats, broken sleep, mood swings, brain fog and new joint aches, reframed through the fluctuation lens
• Why perimenopausal brain fog tends to improve for most women after the transition
• Why hormone testing is often not necessary to make this diagnosis after a certain age
• The two things worth tracking for the next two to three months, and a script for your next appointment

Not everyone gets every symptom, or in the same order or intensity. Some women barely notice it. Some get hit with almost everything at once. Both are normal versions of the same transition.

You pay your copay. Your labs come back normal. You leave empty handed.

This Meno Life is a weekly show for women in perimenopause and menopause. I'm Dr. Sian West, board-certified OB-GYN and menopause specialist, and I spend my days on the questions a short appointment never reaches.

The hot flashes and the sleep that fell apart. The weight that arrived without a single change in your habits. The rage that shows up out of proportion to whatever caused it, and the moods that swing hard enough to scare you. Painful sex and vaginal dryness, which not only did nobody warn you about, nobody likes to talk about, and far too few clinicians are trained to treat it.

And the bigger one underneath all of it: the woman in the mirror who you do not entirely recognise anymore.

We'll talk about MHT, what the evidence actually supports and where it's honestly thin.

It's also a show about the rest of it. The mental load. The career still in progress. Being awake since 3am and still being the one everyone needs.

What it isn't: a supplement pitch, a fear campaign, or a soft place to land. You will not be told to embrace this chapter or navigate your journey. You're an adult with a body, a schedule, and a limited tolerance for nonsense.

We say it out loud here.

Dismissal is not a diagnosis. Follow along so it's never yours.

Dr. Siân West is a board-certified OB-GYN and menopause specialist. In this first episode of This Meno Life she explains why she built a podcast for women in midlife, and what she wants it to do differently.

She tells the story of her own advanced maternal age IVF pregnancy, when she was the patient instead of the physician. She knew medicine. She knew how to advocate for herself. She still walked out of an appointment questioning her own experience, and the clinician involved was, by every measure, a good one. That is the point of the story. Dismissal in medicine is often not malicious. It happens through minimizing, redirecting, leaning too hard on a normal lab result, or simply not having the time to go deeper. The effect on the patient is the same either way.

From there the episode widens out to the position most midlife women are stuck in: dismissed by a medical system that does not always have time for nuance, and overwhelmed by an internet full of confident voices, some genuinely helpful, some selling something.

In this episode:

• Why a normal test result does not automatically mean everything you are experiencing is normal
• The difference between intentional harm and being dismissed, and why that distinction matters
• What perimenopause looks like in a real appointment: changing cycles, broken sleep, mood changes, brain fog, hot flashes
• The four things this show commits to: science without the nonsense, validation without overpromising, autonomy with guardrails, and medicine kept human
• What is coming: perimenopause, MHT, hot flashes, sleep, brain fog, libido, vaginal health, bone health, and the things the internet is getting wrong

The goal is not just that you listen. It is that you walk into your next appointment more confident, more informed, and harder to dismiss.