Kathy Kroening

A glance at the news headlines can be a stressful and depressing way to start a day. Whether it is the Epstein files, the economy, ICE, Russia, Ukraine, The Middle East, Venezuela, China, Greenland, mass shootings, or destructive weather, gloom and doom dominate. For the average American, tension is high and confidence in the current administration making changes that improve our daily lives is low, resulting in chronic stress for many.

There is a substantial body of research that supports a link between chronic stress and illness. The mechanisms of action are complex but a key component is the hypothalamic-pituitary-adrenal axis (HPA). The hypothalamus and pituitary gland are structures in the brain and the adrenal glands sit atop the kidneys.  With increased stress, the hypothalamus starts a hormonal cascade that ends with the adrenal glands releasing cortisol, helping cells and systems in the body prepare to fight or flee. (Knezevic et al., 2023) Centuries ago, when we were further down the food chain, this was a very useful mechanism for survival. After evaluating a threat such as a predator, the flight or fight response allowed us to choose the action that was most appropriate for the situation and eliminate the stress.  Once this was done, the body returned to a state of homeostasis.

In our current world, most of the stress we experience is no longer a matter of literal life or death. Health issues can certainly create chronic stress on the body but most of the stressors we experience are psychological and emotional in nature and while they may feel like life or death situations the probability of causing death is low. However, this state of chronic stress produces sustained cortisol release ultimately resulting in desensitization over time. This can lead to increased inflammation in multiple systems in the body, decreased immune function, and other hormonal changes that can cause autoimmune disorders like rheumatoid arthritis (RA) and inflammatory bowel disease (IBD), neurological conditions like Alzheimer’s and Parkinson’s Disease, psychiatric disorders like depression and anxiety, chronic pain disorders like fibromyalgia and migraines, and cardiovascular disease (CVD) including myocardial infarction and stroke. (Knezevic et al., 2023; Osborne et al., 2020)

While anyone experiencing chronic stress is at risk for the development of disease, women are at higher risk due to mid-life responsibilities and hormonal shifts. The changes women experience during perimenopause and menopause can significantly increase their risk of cardiovascular disease in particular.  There are a multitude of changes that can happen during this time that contribute to this risk including: early or premature menopause (less than 45 years of age); menopause as a result of bilateral oophorectomy (removal of both ovaries) without estrogen therapy; late peri-menopause and early menopause often leading to higher blood pressure, cholesterol, and triglycerides compared to other stages; disrupted sleep, hot flashes and night sweats linked with higher risk of CVD; lower estrogen levels; depression; increased lipids; metabolic syndrome; carotid atherosclerosis; weight gain; and central abdominal obesity. (Kaminska et al., 2023) While it may seem women at this stage of life are doomed when it comes to cardiovascular health there are many lifestyle choices and other factors that are protective. Genetics can certainly provide protection from CVD, but absence of family history does not create immunity. Eating a heart healthy diet, preventing excess abdominal fat, preventing obesity, regular physical exercise, avoiding nicotine, preventing or managing diabetes, and keeping cholesterol and blood pressure within recommended guidelines are all strategies that help reduce the risk of CVD. (Khoudary et al., 2020)

In addition to lifestyle modification, hormone replacement therapy (HRT) can be of tremendous benefit for women experiencing symptoms related to the menopause transition. Originally approved by the Food and Drug Administration (FDA) in the early 1940’s as a treatment for symptoms of menopause, HRT has had a tumultuous journey in the medical realm. When the findings from the Women’s Health Initiative (WHI) were made public in 2002, concerns about increased risk of breast cancer led to a sharp decrease in HRT. In 2003 boxed warnings were added by the FDA for HRT medications that included concerns about CVD, thromboembolism (blood clots), breast cancer, and possible dementia. Subsequent evaluation of the original WHI trials has linked the increase in breast cancer to use of medroxyprogesterone acetate, a formulation of progesterone that is not commonly used today. In addition, the original trials did not require initiation of HRT before age 60 and within 10 years of menopause. The reason this is significant is once a woman goes through menopause and loses the protective effects of estrogen, she is more likely to develop permanent vascular narrowing and hardening leading to CVD and clotting. This would confound the data from the study suggesting HRT caused these symptoms when in reality they were naturally occurring due to age and hormonal changes of menopause. Rather than causing the symptoms, HRT had no protective effects because it was started too late and the damage was already done.(Makary et al., 2025)

Recent reviews of prior studies and current research have led to new recommendations for HRT including starting before age 60 and within 10 years of entering perimenopause. A recent article in the Journal of the American Medical Association (JAMA) goes so far as to suggest that aside from antibiotics and vaccines, HRT may have the most positive impact on health outcomes in the population of older women than any other intervention. Long-term health benefits include reductions in fatal cardiovascular events (25-250%), bone fractures (50-60%), cognitive decline (64%), and risk of developing Alzheimer’s (35%). HRT can also help dramatically decrease symptoms of menopause including hot flashes and night sweats which improve sleep, cognitive function, and mood. Recent research suggests that starting HRT within 10 years of menopause reduces mortality by all causes in the following decade. (Makary et al., 2025)

Women can begin experiencing symptoms of perimenopause any time in their late 30’s to early 50’s with the cessation of periods usually happening some time in their 50’s. We have already discussed the health impacts of hormonal changes that take place during this entire transition, but what else is happening in the lives of women in their 40’s and 50’s that may contribute to increased stress? Many women are parenting during this stage of life. Some women are starting a family in their 40’s and others are launching children into adulthood, helping them with the transition to college or the work world. Needs vary depending on the age, number, and unique qualities of each child. Many women carry the bulk of parenting responsibilities. These include but are certainly not limited to feeding, clothing, scheduling and transportation to medical, dental, and vision appointments, tending to sick children, monitoring academics, communicating with schools, managing forms, fees, and transportation for extracurricular activities, monitoring electronic and social media use, setting boundaries, delivering discipline, and providing nurturing, love, and support. Parenting children with special needs magnifies stress. While rewarding, parenting is an incredible expenditure of energy, and it does not stop when children turn 18. Helping young adult and adult children navigate relationships, work, and parenting as they step into adulthood often consumes a significant amount of time and energy.

In addition to childcare, many women are working outside the home. Some jobs and careers provide little flexibility to accommodate parenting responsibilities, adding to stress. Job hours and requirements can also be incredibly challenging, depleting emotional and physical energy. Since many women are also responsible for the majority of daily household tasks including cleaning, shopping, cooking, and laundry, any time not spent in childcare, work, or household duties is most likely spent sleeping but it is one area that often gets sacrificed in order to perform other necessary tasks. As women age, they may also be providing care for grandchildren and for parents experiencing chronic health conditions and cognitive decline. This collision of caretaking responsibilities, work, and domestic duties with the hormonal changes that take place during perimenopause and menopause creates significant health and mental health risks for midlife women.

Given these assaults on health and mental health, what can women do to decrease stress and increase healing? Our role as caretakers often makes it difficult to honor and prioritize self-care but if we neglect it, resulting in compromised health, our ability to be present for others diminishes. It can also lead to frustration and resentment. Building routines that include space to be alone, time with friends, and inclusion of activities that nourish the soul promote optimal health and healing. Additional practices and skills that can facilitate healing include:

Learning to say no. While it is nice to be needed and declining invitations and requests can cause guilt, it is important to listen to your body and advocate for your own self-care needs even if it means saying no.

Learning to ask for and accept help. Many women pride themselves on being masters of multitasking and skillful problem solvers providing help to others but not needing it themselves. Doing it alone has significant consequences personally as well as relationally and learning to ask for and accept help can decrease isolation and resentment and increase connection.

Letting go of guilt and shoulds. Women often accept and hang on to guilt more often than men.  Some of this is self-imposed but some is assigned by others. There are times when examining guilt and decisions that should have been made leads to enlightenment, but more often this is unproductive and causes chronic feelings of negative self-worth. Releasing these thoughts and feelings can be freeing and decrease stress.

Taking news and social media holidays. Doomscrolling is dangerous. It is time-consuming and depending on the content you consume, it can leave you feeling depressed and stressed. With so many crises happening worldwide, the desire to stay well informed is understandable but allowing breaks can help reduce stress. These breaks may take the form of setting a time limit on news and social media consumption, skipping entire days, scanning headlines rather than reading entire articles, reading rather than watching or listening to news, and limiting discussion of hot topics with others.

Building community with other women. Women have unique ways of knowing and being in the world. Sharing these experiences can provide much needed acknowledgement, validation, nurturing, and support.

Exploring practices that promote centering and grounding. While a bit of research will uncover many recommendations it is important for each woman to find those that work for her. Considerations include time, cost, and the right fit with personality and interests. Some of these practices can be very simple and do not require anything other than building them into your routine while others require more planning and preparation. Things to consider when developing these practices include:

Making space. Balancing priorities can be challenging so it is important to create the space needed for self-care. Whether that space is for solitary activities or supportive time with friends, intentionally scheduling it increases the likelihood you will honor the commitment.

Focusing on moments. It is human nature to group and lump things together including daily experiences. At the end of a long and frustrating day it may seem like the entire day was negative and is labeled as a bad day. There is nothing wrong with this except it makes it easier to lump bad days into bad weeks into bad months and even bad years. The truth is there are most likely moments of joy, contentment, peace, and awe interspersed with the hardships. Pulling back, slowing down, being present, and focusing on moments can help gain a more balanced perspective.

Using the five senses. Many of us live in our heads, guided by thought, analysis, and inner dialogue. I have certainly been accused (and am guilty) of this for long periods of time, so I understand the difficulty of shifting perspective. In addition to being present in the moment, experiencing that moment using the five senses of sight, sound, smell, taste, and touch can broaden our awareness and enjoyment of our surroundings and situation.

Creativity.  Creativity engages a different part of the brain and often allows for the cessation of conscious, goal-directed thought that can be quite refreshing. Whether it is cooking, baking, quilting, sewing, crocheting, drawing, painting, playing music, dancing, listening to music, reading, writing, or other activities, making space for creativity can dramatically decrease stress and promote healing.  I have heard many people say they are not creative. I would argue we all have this ability, we just need to embrace and nurture it, allowing it to grow.

Calming the mind. Silencing the inner dialogue can seem overwhelming. We are so used to it we are often not even consciously aware of it. Practices like mindfulness, meditation, yoga, and prayer can help turn down the volume. Remember these are “practices” meaning it takes time to become part of your routine but if done regularly will help maintain a state of deeper calm.

Relaxing the body. Because our brains are in our bodies, they affect each other. Mental stress causes tension in the body that we may be unaware of. Activities like taking a warm bath or shower, floating (floating in salt water in a tank with restricted environmental stimuli), massage, and acupuncture can help reduce tension in the body, calm the nervous system, and lower the volume on that pesky inner dialogue.

Touch. The touch of others is a vital source of comfort and connection. Some people crave this more than others.  It is important to find safe and consensual experiences that provide much needed physical contact that run the gamut of touching, hugging, cuddling, holding hands, kissing, and making love depending on the context of the relationship.

Vibration. As a lifelong musician I have always been fascinated by the effects of vibration on the human body and mind. Singing produces vibration in the chest. Playing the cello produces vibration in the chest and abdomen but also the feet if you play barefoot on the right surface. Listening to music also produces vibration in the body.  A little over a decade ago, in my quest to expand my healing routine, I began looking for and experimenting with using vibration for healing. Chanting produces vibration in the chest while tapping acupressure points creates vibration in body tissues, both having a positive effect on the flow of energy. I use tuning forks and singing bowls in my self-care practice to unblock channels and keep the energy flowing freely.

Exercise. There is substantial research to support the benefits of regular exercise. Whether it is walking, hiking, running, cycling, swimming, weightlifting, or other activities, regular exercise not only improves physical health (improved cardiovascular and pulmonary function, improved immune function, optimizing flexibility, strength, and balance) it also improves mental health and well being and pain management. It is important to find the type of exercise that is the best fit given any physical or health limitations as well as personal preferences.

Diet. There are so many recommendations for what to eat and what to avoid, it is difficult to make sense of the information overload. What we put in our bodies does significantly affect how they function and how we feel. Gut health is extremely important for our immune system to function optimally. Good general rules to follow are trying to minimize highly processed foods and consume fat, salt, sugar, and alcohol in moderation. Paying attention to your body can also be helpful in eliminating foods your body has difficulty processing.

Nature. Spending time in nature has tremendous healing benefits. Depending on where you live and the time of year, it may be challenging to spend large amounts of time in nature. Look for ways to get fresh air, be near bodies of water, spend time in forests, and feel the wind against your skin.

Photo by Kathy Kroening. Quinault Rain Forest, WA. July, 2016

While being in nature has many physical and spiritual benefits it also provides many examples of resilience.  I am in love with old growth forests and the trees that live for centuries. They are thriving, not just surviving. What are their secrets that may help us emulate their success? To survive strong winds, they learn to bend but not break. They store up nutrients and moisture when plentiful and conserve when sparse. They find creative ways to photosynthesize when access to light is compromised. Root systems that are deep and wide help with anchoring and grounding and those that connect with other systems provide additional support. As a community of women, we can learn from these wise beings and utilize the same tools for building resilience. We can transcend survival and learn to thrive.

Until next time sisters stay safe, be well, be kind to yourself, support each other, and spread the love.

Photo by Kathy Kroening. Seattle, WA. May 2025

References:

Kaminska, M., Schneider-Matyka, D., Rachubinska, K., Panczyk, M., Grochans, E., & Cybulska, A. (2023). Menopause Predisposes Women to Increased Risk of Cardiovascular Disease. Journal of Clinical Medicine, 12(22), 7058. https://pmc.ncbi.nlm.nih.gov/articles/PMC10672665/

Khoudary, S., Aggarwal, B., Beckie, T., Hodis, H., Johnson, A., Langer, R., Limacher, M., Manson, J., Stefanick, M., & Allison, M. (2020). Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement from the American Heart Association. Circulation, 142(25). https://www.ahajournals.org/doi/10.1161/CIR.0000000000000912

Knezevic, E., Nenic, K., Milanovic, V., & Knezevic, N. (2023). The Role of Cortisol in Chronic Stress, Neurodegenerative Diseases, and Psychological Disorders. Cells, 12(23), 2726. https://www.mdpi.com/2073-4409/12/23/2726

Makary, M., Nguyen, C., Hoeg, B., & Tidmarsh, G. (2025). Updated Labeling for Menopausal Hormone Therapy. Viewpoint: Women’s Health. Journal of the American Medical Association (JAMA). https://jamanetwork.com/journals/jama/fullarticle/2841321

Osborne, M., Shin, L., Mehta, N., Pitman, R., Fayad, Z., & Tawakoi, A. (2020). Disentangling the Links Between Psychosocial Stress and Cardiovascular Disease. Circulation: Cardiovascular Imaging, 13(8). https://doi.org/10.1161/CIRCIMAGING.120.010931