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Midlife Rules for Ladies

Midlife Rules for Ladies

PART 1: Mom Reboot, Think Space, Matriarch, Ladies First

CLICK HERE to listen to the audio version of this blog by Dr. Adam Miller.

It’s not quite the same as teaching your kids about the birds and the bees, but stepping into the midlife discussion has a similar awkwardness for a doc’. Like the timid parent, I’m unsure if my patients need to know all the graphic details. There will be a few “oh really” big-eyed moments. And of course we have to talk about sex. But, if I don’t go there, ‘the kids are going to hear versions of this stuff on the bus’ as the saying goes. The bus, in this context, being the local coffee shop, wine club, or yoga studio, or worse yet – social media. Who is out there delivering real navigation for the midlife transition? Recently, it’s been me.

Let me first say congratulations. You’ve made it. We’ve made it. You and I both know classmates from high school who didn’t make it to life’s half time. Be grateful – even if it takes all your might. The midlife discussion matters to me personally and professionally. I’ve studied our tribe as a cosmetic surgeon and as an age-management specialist. And I’ve studied “us” through the eyes of a single 45 years young bachelor looking for Misses Miller.

Many would say that my not being a parent disqualifies me as a real expert in the midlife discussion. But, I disagree. You married people—especially those of you with kids—have done something I’ve always dreamed of doing. I marvel at the journey you’ve been on. I am inspired. And inspiration begets study. I’ve studied your tribe well. And I believe I can help.

As your doctor and fan, I’ve assisted the midlifer with dental, skin, hair, weight, sleep, hormone, sex, and other issues. Since 2014, however, I’ve been formally treating the mind of aging patients also. My first step in therapy is usually to undo some bogus conditioning. The midlife crisis is an American construct that does a serious disservice to anyone who falls into its trap. I believe it is better thought of as an appropriate re-evaluation of who you are, what you really want, and where you’re trying to go.

After two decades of school; learning how to manage money; and successes and failures in both the workplace and in relationships, it would be crazy, or at least very unAmerican, not to contemplate a more fulfilling path. To think that the transition from the first to the second half of life is nothing more than a wild streak where one jumps off her standard path; goes rogue for a few months; then jumps right back on the same track is, to me, illogical.

The midlife transition is a legitimate thing. It’s a multi-dimensional mind, body, spirit, metabolic phenomenon that reaches unexpectedly into your past and forces you to choose a better vision for your future. It’s a process with a front windshield and a rearview mirror and you’ll find yourself switching from one perspective to the other often in this season.

Despite the lack of safe spaces out there to dialogue about this, I promise you that If you are between the ages of 40 and 55, you are not alone. And, after fifteen years of doing cosmetic surgery and five years of doing anti-aging medicine consults I can tell you that women go first. It’s like a second puberty. Guys are destined to go through it, but it may take six to eighteen months for them to catch up. Ladies, don’t allow that to frustrate you.

CLICK HERE to listen to the audio version of this blog by Dr. Adam Miller.

The midlife contemplations start for a woman in her late thirties and early forties. A niece or nephew or grandparent comments about her gray hair or wrinkles. Or she may simply take note of her aging face in the mirror one wearisome morning after the kids have left for school. The midlife warning flares start while the kids are still around. However, for most of the women in my practice, the real emotional labor involved with the midlife (or pre-menopausal) period doesn’t begin in earnest until the kids have moved out of the house.

It’s in the empty nest that the first phase of the process, which I will refer to as the Mom Reboot, unfolds. I call phase one Think Space. After decades of being in three places at once and putting everyone before herself, mom has a chance to sit at a coffee shop with a book, a journal, or a friend and think. For years she’s dreamed of having this time to herself. Once Think Space finally arrives, however, it can be overwhelming.

Think Space is a place of reconciliation. Women look in the mirror and weigh out self-sacrifice versus rewards gained. Think Space is fraught with unexpected emotions like guilt, shame, regret, embarrassment, and fear. It only takes a few visits to Think Space – in contrast to men – before a woman goes looking for guidance. I’m grateful when they choose me. And in my consult room this is what I hear:

“I feel bad for even talking about this. I’m grateful for my husband, my kids, and my home, and my health. I’m really very lucky, but…”
“I’m glad my kids are away. I like having my house back. Is that terrible?”
“I know I should workout or at least go meet some people, but I just don’t have the energy…I feel like I’ve given up.”
“That goes for sex too… he’d love more, but between UTI’s after intercourse and a terrible body image I’m in no mood. I wouldn’t blame him for having an affair.”
“My husband has this master plan for us that I’ve gone along with for years. To be honest I’m kind of done with it now. I feel like he doesn’t care about my desires. I know that sounds bad… ”
“I’ve been thinking a lot about my mom and dad and how they were as parents. My mom (or fill in the blank relative) still drives me crazy. She’s always found something to criticize me for. I know I wasn’t the best parent, but compared to my mom I think I did really well. I’m not sure why I’m dwelling on my parents now. I’m having all these juvenile emotions… I’m a grown woman!”

Ladies, you need a place where you can “should all over yourself” during the early part of the Mom Reboot. Think Space is that messy should sandbox. Let all the “shoulds” flow into your journal. Let them flow with a counselor. Let them flow with me. Just get them out, so you can move forward.

Moms sacrifice energy, libido, brain power, creativity and careers to successfully raise their family. Sadly, too many chalk up the post-mom fatigue to, “you should feel burnt out honey, you’re a 48 year old mom.” There is a better path. You have a Reboot option.

I’m here to help women have a better response to the maelstrom of emotions and physical changes that roll in during the peri-menopausal, post-parenting phase of life. I’m here to say that midlife discontent is far richer and more important than a transient crisis. It is normal, common, and logical to put the whole of your life under evaluation before making the turn for the back nine. Do yourself a favor and accept this process. Don’t fight it. And don’t minimize it. Your life depends on you owning it with faith and hope.

If this is speaking to you, pause right now and say,

“I accept the process that is unfolding. I accept that my Midlife Reboot may take twelve months until I feel like my new normal has been established. And I choose to enter into the rest of my life believing that the second half can be my best half.”

Moms, for the past 15 years or more you have been needed in three places by three different people every minute of every day. You’ve continually “found a way” despite a time and energy aow account that doesn’t add up. You’ve been pooped-on in the middle of the night by a screaming child. Despite that heroism you’ve had people close to you criticize your parenting style or challenge you for not being more socially connected. And yet most of the time you still muster an on-demand smile with family, friends, and colleagues when it matters most. Moms, most of you are – as I see it – magicians. I have total confidence that you can successfully handle the Reboot process. But, pitfalls abound.

The Mom Reboot is going to include some surprising emotions and I want to preemptively bolster you as best I can. So, grab a pen and let’s jam…

CLICK HERE to listen to the audio version of this blog by Dr. Adam Miller.

First, don’t expect your husband to be hand-in-hand with you down the Reboot path. As the Think Space becomes filled with “new you” energy, you’ll wonder why your partner isn’t enriching his life with the same process. Remember, it’s like a second puberty. He’ll get there in his time. For now, own the emotional labor that’s calling your name and leave the rest to God. Many of you ladies have conditioned your man to think the way he thinks. He will need some reconditioning before he embraces his own transition. I’ll coach you on how to deal with your hubby soon.

Resist the temptation to write this off as a “little phase I’m going through.” The world will offer you the midlife crisis box as a convenient receptacle to dump all your emotions, reflections, and questions into. It is the easier route, and makes sense to more people. But, you and I know this is more than a midlife crisis. This is the beginning of the second half of your life. Let’s treat it with respect.

Don’t feel bad about getting your home back either. Enjoy it. Do some re-decorating if you want. Create your safe haven. But, don’t feel guilty because you’re happy that your kids have moved on. Even the Bible states that it’s good for parents and kids to cleave.

Also, don’t feel bad about the resurfacing of old resentments linked to your parents, friends, or employers. A lot of stuff gets churned up in the Think Space. You will realize that a lot of junk you thought you’d “grown out of” actually just got buried. Get the counseling you need and stay in the process. Many are going through the same thing – just ask.

The following four questions from Marcia Reynolds, PsyD, author of Wander Woman: How High-Achieving Women Find Contentment and Direction, can aid you in talking with others and processing the midlife in your Think Space:

  • What do I feel I should have done by this time in my life?

  • Is there something more important and fulfilling that I can focus on now?

  • What do I want more of in my life? What have I imprisoned that is crying to be free?

  • How can I ensure my commitment to living a significant life?

It’s okay to flirt with external changes, but never kid yourself. The midlife transition is primarily an inside-out job. Take a wild trip. Buy a motorcycle if you want. Change up your wardrobe or hair style. Trade in the minivan for a Mini-Cooper. And for the love of this cosmetic surgeon get some skin rejuvenation going already! ( But, remember I said this: failure to own your emotional labor during the empty nest, peri-menopausal period will come out in unproductive ways later. You’ll suddenly starting poking holes in everything your husband says or does. Relatives and friends may fall victim to your discontented nature. And you could end up in a self-loathing state at one afternoon wine social after another.

Most women aren’t prepared for the rush of introspection and emotions in the early stages of the Mom Reboot. If you are in your thirties, I hope this article will save you from flying ahead blindly. You can accept the process with grace, knowing that it has a mental, physical, and metabolic component to it. If you are already in the post-mom transition, it’s never too late to do the Mom Reboot properly. Lean in.

Now that we’ve done a flyover of the complex nature of the empty nest, pre-menopausal midlife season, I’m going to drop a simple tactic into your Think Space. In a future article I will address the metabolic and physical changes that commonly trip up the midlife maiden. For now I will stick with the mind domain and offer you a paradigm that has been helpful to many of my female patients.

The first step in the Mom Reboot is acceptance. You have to accept that it’s a real thing; every woman goes through it; and to do it successfully you need to follow a process. After acceptance, you need to insert a new intention – a mental framework- for the second half of your life. If you don’t make this effort, the alternative in America is pretty ugly. You’ll end up comparing yourself to your younger self and to media divas. The high road, I believe, is to consider the midlife season as a transition from Mom to Matriarch.

CLICK HERE to listen to the audio version of this blog by Dr. Adam Miller.

Think elegant sexiness. Less girl and more woman. Imagine less chasing and correcting and more stillness and listening. I see the successful second-half woman as a lighthouse of elegance and strength. She is less reactive. And she offers more sensuality and less of the superficial sexual power struggles. The matriarch is royal, and she humbly commands respect from women and men of all ages. The Matriarch has a large reservoir of love, wisdom and joy to serve those who are smart enough to approach her lighthouse. The Matriarch paradigm was gifted to me during my six years in Asia.

I saw the Matriarch exemplified one day in the middle of running my cosmetic surgery center in Borneo. I had just finished my last case of the morning and was running behind. Typically, my nurses would be scurrying about finding charts and interviewing the pre-operative consult patients on my afternoon schedule. But, on this memorable Tuesday there wasn’t a nurse to be found. After a mini-meltdown, I peaked out to our plush waiting room and saw something unusual.

There in front of my first afternoon patient stood, like soldiers before their commander, my three nurses. Except my patient wasn’t acting like a drill sergeant. On the contrary, this late 50’s Chinese woman was holding court. She was regal, with a silk cheongsam and two inch heals. Her jet black hair was speckled with silver accents. The woman’s posture was impeccable as she sat on the edge of the leather club chair; legs crossed and her hands stacked on top of her knee. My nurses showed her the overwhelming respect and attention befitting a queen. And my patient received the attention with honor and ease, as she gracefully queried each nurse about the day.

This was not a politician or celebrity. And this was not an “old Chinese lady.” This was a very attractive Matriarch, without an ounce of conflict about her station in life. This matriarch accepted and reveled in her position. She understood that she is still a leader, but she’s graduated beyond “mom” to a higher, more powerful position. And you can too.

(The matriarch would later have “double eyelid surgery”,or what we call a blepharoplasty, to tighten up sagging upper eyelid skin.)

The Mom to Matriarch paradigm will help many of you—even if it’s just a borrowed vision—frame your future-self during Think Space moments. I pray you are already feeling a little strength, hope, and energy welling up. But, before I let you get too far down the Mom Reboot path I need you to understand the element that most often trips a woman up early in this process. Believe it or not, it’s her husband.

Ladies, many of you have conditioned your man to be a certain way during Mom Phase. He will need some re-training. But, now is not the time to play life coach. The pupil is not ready. And, he never will be ready in the way you want him to be. His re-training will happen by watching your new self come to life. You will shut your man down if you try to teach or preach to him.

Your guy is not used to having “me talk” from you (because you were too busy leading and protecting the nest). So, I beg you to resist the temptation to dwell in “He Should Land:”

“He should know me well enough.”

“He should understand without me explaining everything I’m going through.”

And, the granddaddy should sabotage

“He should be doing this same self-discovery work. In fact, we should really be doing this together as a couple.”

No you shouldn’t. At least not yet. Should all over yourself in a safe space. Get it out. Then move on.

Women, your precociousness does not stop in your teens. And I’ll give you a sneak peek at future articles : Your “new me” work will scare the boy out of your man if you’re not careful. So, be committed to your process, but give him grace and reassurance (despite his juvenile reactions.) It will pay huge dividends later.

You may be out of love with your guy. You may feel like he is holding you (both) back from your best life. But, after treating hundreds of midlife husbands, I promise you that – with a few exceptions – husbands want to understand, help and protect you. Men won’t acknowledge it on the surface, but their inner man is banking on you doing the Mom to Matriarch transition to the best of your ability. Remember, you are carving the path – for both of you. (Sigh if you must – I get it.)

What happens for your guy if you half-ass the midlife transition? Glad you asked. Your husband has had a black and white view of a successful life. And it’s clear in his mind how you fit into this successful life. Further, he’s assumed that his plan will make you as happy as it makes him. So, when you start pushing and pulling on his big life plan he will resist. Partly because he’s stubborn, and plagued with caveman-like myopia. But, his reaction is largely due to the caveman’s desire to protect you and the cave.

CLICK HERE to listen to the audio version of this blog by Dr. Adam Miller.

His mission for two decades has been to lead, provide and protect. At the mid-life stage he’s probably enjoying some of the finer things (without guilt) that he once only dreamed of. If you ladies start to shake up the paradigm with innuendoes of discontent it will feel like tectonic plate movement under him. He needs to be convinced that the midlife metabolic, physical, and psychological reboot really is a better path for you.

If he sees you fighting with your process; frustrated and confused; overly-emotional and distant; questioning everything from his love for you to why he never did this or that – all while struggling with insomnia and emotional lability – he won’t see a compelling trailhead to meet you at. In the male caveman mind he will think,

“she is asking me to change my golden plan so that I can enter into that misery? No thanks.”

Furthermore, he will actually feel the need to rescue you from that trail back to his golden path. Sometimes the husbands in my practice go as far as doing a google search about menopause and personality changes. They will reach out to me, the doctor, and say,

“We’ve got to do something. Is it her thyroid? Hormones?”

I say, “It’s all of the above, including the most important part – her mind.”

The first real midlife warning flare for men—though most fail to recognize it—comes when the kids start visiting colleges. That’s right, midlife angst for men often sets in before the wife. Dads suddenly realize that the kids they helped raise have grown into little adults and will soon be out of touch. Mom is counting the days until they’re gone. Dad feels disconnected, like his hour glass is running out. Guys say things to me like,

“I feel like my wife and the kids have their own program. I’m not keeping up with their inside jokes and I am the last to find out about significant events in my teenager’s life. I think we need counseling.”

I will expand upon the midlife male in a future article, but, for now ladies, be sensitive to the disconnect your husband may be feeling. You, ladies, tell me that “he has this whole program, and it’s like ‘get on board or get out of my way.” I know that’s an easy paradigm to react to. I will coach you on managing that more later. For now, trust me when I say that including him in the inside jokes and small events in your kids’ life will pay big dividends later. That effort on your part frees him to be less preoccupied with the dwindling “dad hour glass.” In turn, he can catch up to you through his dad reboot more easily.

By this point, you may have found some resonance and perhaps even some hope. In other words, you are compelled to explore a healthier midlife trailhead. Great! Now, where do we go from here? First, a disclaimer.

I’ve leaned on 15 years of cosmetic surgery experience and five years of Age Management Medicine experience in the US and Asia to guide women through a Mom Reboot process. I have had many midlife couples in my practice that have helped me shape these recommendations. And I’ve had a four-year relationship with a woman who went through much of this work from the age of 42 to 46 years. Beyond that I’ve read books that have influenced me and attended lectures both at church and in the secular setting. Although I’ve used counselors and have had counselors as patients in my practice, I am not a licensed counselor. But, I think you will find some useful navigation for the metabolic and physical aspects of the Mom Reboot in next month’s article as we continue our series on healthy aging. So, watch your email.

Oh, before I run off to clinic, let me address one thing. Much, but not all, of The Mom Reboot discussion also applies to midlife women who are not moms. The vast majority of middle-aged women in my Age Management practice are mom’s and therefore I write with that bias here. But, as a single middle-aged man, with middle-aged child-less female friends, I’m compelled to write about the unique Midlife Reboot of the always-been-an-empty-nest tribe in future articles.

Thoughts, questions, or criticisms? Please email me at

CLICK HERE to listen to the audio version of this blog by Dr. Adam Miller.

Like any good doctor I have to send you out the door with something. So here’s a little thought elixir. Drink it twice a day until we meet again:

  • You are on the right path, and it’s not a crisis path. This is a thing – don’t dance around it or blow it off.

  • This is your thing – don’t expect your spouse or your mom or even your priest to understand it or do the emotional labor for you. Own it.

  • This thing is a process with predictable phases, starting with Think Space.

  • I know that you appreciate all that you have and you should be grateful. And I know you feel guilty about focusing so much on yourself. But you are going to have to do it anyway.

  • Like it or not, you will have to deal with some junk from your past.

  • “Lonely moments” are a gift – use them wisely.

  • Get creative. Molt. Break through the mom carapace like a turtle escaping her shell. You’ll feel naked. There will be major failures – “oh my God! I didn’t realize there were women out there experimenting with drugs.” Get out there anyway.

  • You are the front runner in the family – again. Your husband will catch up.

  • Your husband, despite his rebellion, needs you to be all-in with your process. Because you’re carving this new path for both of you, right?

  • The hardest part may be figuring out what really makes you happy and letting that shine as bright, or brighter, than the joy your husband has after a weekend of golf with the guys.

With Love and Respect –


CLICK HERE to listen to the audio version of this blog by Dr. Adam Miller.

Dive deeper into the midlife transition by taking a closer look at your neurotransmitter and hormone levels. Sanesco offers an easy-to-follow, at home collection kit with detailed instructions so you can complete the test comfortably in your own home.

What are you waiting for? Let’s take this step forward in health, together.



Marcia Reynolds, Psy.D, What a Female Mid-Life Crisis Looks Like, Posted May 14, 2011.

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