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Women's Metabolic Clarity · Topic 15 of 15

The Shame and Guilt Cycle, and Identity

You are not failing. There may be a reason this is happening. Let's understand it together.

Educational disclaimer: This content is for education only. It is not medical advice, diagnosis or treatment. Pinnacle Coordinated Wellness is an education-first coordination layer, not a medical office, and Dr. Pat Pachciarz® is not a clinician. Nothing here is a protocol, dose or promise of results. Always talk with your own licensed clinician before making any health change. If you have chest pain, trouble breathing, thoughts of self-harm, or another emergency, call 911 (or call or text 988 for mental health crisis support).
On this page
  1. Why do I feel like I'm not trying hard enough?
  2. Why don't I recognize myself anymore?
  3. How do I get my doctor to take me seriously?
Question 43 of 45

Why do I feel like I'm not trying hard enough?

Short answer

  • Many women blame themselves when their bodies change.
  • But research shows real body changes happen during menopause, even when habits stay the same.
  • Weight shame can lead to more stress, less exercise and more emotional eating.
  • We listen, connect and help you understand what may be going on.

What to look out for

  • Talking to yourself in harsh ways.
  • Avoiding the doctor because of your weight.
  • Pushing harder and feeling worse.

Top 3 things to act on or ask your clinician

  1. Tell your clinician how you feel, not just what you weigh.
  2. Ask: 'Could my body changes have a medical reason?'
  3. Ask for support if shame is affecting your health.
Sources for this answer
  1. Peer-reviewed Puhl RM et al. The stigma of obesity: a review and update. Obesity (Silver Spring). 2009;17:941-64. PMID: 19165161. DOI: 10.1038/oby.2008.636
  2. Peer-reviewed Pearl RL et al. Weight bias internalization and health: a systematic review. Obes Rev. 2018;19:1141-1163. PMID: 29788533. DOI: 10.1111/obr.12701
  3. Peer-reviewed Greendale GA et al. Changes in body composition and weight during the menopause transition. JCI Insight. 2019;4. PMID: 30843880. DOI: 10.1172/jci.insight.124865
  4. Expert commentary, not research Dr. Mary Claire Haver (OB/GYN): The New Menopause (book, Rodale, 2024)
  5. Expert commentary, not research Dr. Stacy Sims (exercise physiologist): Next Level: Menopause and Beyond (book, Rodale, 2022)
Question 44 of 45

Why don't I recognize myself anymore?

Short answer

  • Menopause can change your body, sleep, mood and energy all at once.
  • Many women feel a loss of identity during this time.
  • Mood changes in perimenopause are real and treatable.
  • This can also be a time to redefine what health means to you.

What to look out for

  • Feeling lost, sad or numb for weeks.
  • Pulling away from friends and family.
  • Feeling hopeless (reach out for help; call or text 988).

Top 3 things to act on or ask your clinician

  1. Ask: 'Can we talk about how I'm feeling emotionally?'
  2. Ask about counseling or support groups.
  3. Ask: 'Could my mood be linked to menopause?'
Sources for this answer
  1. Peer-reviewed Maki PM et al. Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause. 2018;25:1069-1085. PMID: 30179986. DOI: 10.1097/GME.0000000000001174
  2. Peer-reviewed Bromberger JT et al. Major depression during and after the menopausal transition: Study of Women's Health Across the Nation (SWAN). Psychol Med. 2011;41:1879-88. PMID: 21306662. DOI: 10.1017/S003329171100016X
  3. Expert commentary, not research Dr. Mary Claire Haver (OB/GYN): The New Menopause (book, Rodale, 2024)
  4. Expert commentary, not research Dr. Lisa Mosconi (neuroscientist): The Menopause Brain (book, Avery, 2024)
Question 45 of 45

How do I get my doctor to take me seriously?

Short answer

  • Many women say their symptoms were brushed off.
  • Coming prepared helps your visit go further.
  • A symptom log, a question list and your history make a big difference.
  • You can ask for a menopause-informed clinician.

What to look out for

  • Leaving with no plan.
  • Being told it's 'just stress' or 'just age.'
  • Not feeling heard.

Top 3 things to act on or ask your clinician

  1. Bring a symptom log and your top 3 questions.
  2. Ask: 'What are the next steps if this doesn't improve?'
  3. Ask: 'Can you refer me to a menopause-informed clinician?'
Sources for this answer
  1. Peer-reviewed The North American Menopause Society (now The Menopause Society). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29:767-794. PMID: 35797481. DOI: 10.1097/GME.0000000000002028
  2. Peer-reviewed American College of Obstetricians and Gynecologists (ACOG). ACOG Practice Bulletin No. 141: management of menopausal symptoms. Obstet Gynecol. 2014;123:202-216. PMID: 24463691. DOI: 10.1097/01.AOG.0000441353.20693.78
  3. Expert commentary, not research Dr. Mary Claire Haver (OB/GYN): The New Menopause (book, Rodale, 2024)
  4. Expert commentary, not research Dr. Mary Claire Haver on Huberman Lab: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality (podcast episode, June 2024)
  5. Expert commentary, not research Dr. Peter Attia with Dr. Rachel Rubin, The Drive #348: Women's sexual health, menopause, and hormone replacement therapy (podcast episode, May 2025)
Sources

Every source on this page

Peer-reviewed research comes first, then society guidance, then expert commentary. Dr. Mary Claire Haver and Dr. Stacy Sims are listed first among the experts. Expert voices are commentary, not research. When an expert claim differs from the evidence, we follow the evidence and say so.

  1. Peer-reviewed Puhl RM et al. The stigma of obesity: a review and update. Obesity (Silver Spring). 2009;17:941-64. PMID: 19165161. DOI: 10.1038/oby.2008.636
  2. Peer-reviewed Pearl RL et al. Weight bias internalization and health: a systematic review. Obes Rev. 2018;19:1141-1163. PMID: 29788533. DOI: 10.1111/obr.12701
  3. Peer-reviewed Greendale GA et al. Changes in body composition and weight during the menopause transition. JCI Insight. 2019;4. PMID: 30843880. DOI: 10.1172/jci.insight.124865
  4. Peer-reviewed Maki PM et al. Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause. 2018;25:1069-1085. PMID: 30179986. DOI: 10.1097/GME.0000000000001174
  5. Peer-reviewed Bromberger JT et al. Major depression during and after the menopausal transition: Study of Women's Health Across the Nation (SWAN). Psychol Med. 2011;41:1879-88. PMID: 21306662. DOI: 10.1017/S003329171100016X
  6. Peer-reviewed The North American Menopause Society (now The Menopause Society). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause. 2022;29:767-794. PMID: 35797481. DOI: 10.1097/GME.0000000000002028
  7. Peer-reviewed American College of Obstetricians and Gynecologists (ACOG). ACOG Practice Bulletin No. 141: management of menopausal symptoms. Obstet Gynecol. 2014;123:202-216. PMID: 24463691. DOI: 10.1097/01.AOG.0000441353.20693.78
  8. Expert commentary, not research Dr. Mary Claire Haver (OB/GYN): The New Menopause (book, Rodale, 2024)
  9. Expert commentary, not research Dr. Mary Claire Haver on Huberman Lab: How to Navigate Menopause & Perimenopause for Maximum Health & Vitality (podcast episode, June 2024)
  10. Expert commentary, not research Dr. Stacy Sims (exercise physiologist): Next Level: Menopause and Beyond (book, Rodale, 2022)
  11. Expert commentary, not research Dr. Lisa Mosconi (neuroscientist): The Menopause Brain (book, Avery, 2024)
  12. Expert commentary, not research Dr. Peter Attia with Dr. Rachel Rubin, The Drive #348: Women's sexual health, menopause, and hormone replacement therapy (podcast episode, May 2025)
Your next step

Take this to your clinician.

  • Bring your questions and a short symptom log to your next appointment.
  • Want help organizing your questions and care team? Pinnacle Coordinated Wellness is here to listen and connect.
  • Practitioners: share this page with the women you serve.
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All 15 topics · Other topics: Weight and Body Changes · Muscle and Strength · Why HIIT or Cardio-Only Can Backfire · Insulin Resistance and Blood Sugar · Sleep and Night Sweats · Cortisol and Stress · Brain Fog, Mood and Anxiety · Thyroid · Bloodwork: What to Ask For · Heart and Bone Risk After Menopause · Hormone Therapy Basics · Gut Health · Nutrition and Protein · Alcohol