
Everything Looks Fine. Except You.
I had my back pricked more than a hundred times. It was supposed to be the appointment that finally gave me an answer. I’d been breaking out in hives, and I was certain it was an allergy. So I sat through the tests and waited. The doctor looked at me and said, “You’re not allergic to anything. You’re fine.” I walked out furious. I was covered in hives. Clearly, I was not fine. That was my late thirties. The heaviness. The lack of motivation. The brain fog. The weight that wouldn’t move. The hives lasted four years. Doctor after doctor, my labs came back perfect. All I knew was that I didn’t feel like myself anymore. Looking back, everything pointed to perimenopause. But I’ll never know for sure. I had a hysterectomy at 34, so at 39 I had no cycle to guide me. Even now, at 47, I can’t tell you exactly where I am in this transition. That’s the question my friend Dr. Erika Pimentel and I sat down to explore live: Why didn’t anyone tell us? What came out of that conversation wasn’t a list of symptoms. It was a reframe. And it starts with the frustrating word so many of us have heard: normal. When “normal” isn’t an answer Erika’s journey started at 36. It wasn’t one bad night of sleep. It was insomnia, day in and day out, with young kids at home and no room for a nap. She was crying over everything. Her cycles were off. She was sure it was her thyroid. When the endocrinologist called, Dr. Erika was ready for a plan. Instead, she heard that her thyroid was fine. And it was left at that. No guidance. No next step. Over the years, her symptoms were called rheumatoid arthritis, then fibromyalgia, then a long list of other things. In the back of her mind, one thought kept returning: this has to be hormonal. She didn’t trust it enough to push back. Here’s what struck me most. Dr. Erika explained that your labs can look normal during perimenopause and still not reflect how you feel. Hormones rise and fall across the month, and a single blood draw is a snapshot. A result can sit inside the “normal” range and still be a real drop from your normal. She was just as clear about the other side. Fatigue, hair loss and brain fog have many possible causes, so rule out things like iron deficiency and thyroid problems first. “This must be perimenopause” shouldn’t become a reason to skip the check. Her advice if you’ve done that work and still don’t feel right: * Track your patterns. Write down what’s happening and when. * Find a practitioner who listens. If one dismisses you, see another, especially if you’ve been told you’re “too young.” So here’s a question worth sitting with: How many times have you accepted “everything looks fine” as the end of the conversation? If you’ve ever been told “you’re fine” when you knew you weren’t, you’re in the right place. Subscribe for conversations that help you trust yourself again. Muscle is not about how you look For decades, women were told to stick to cardio. Lifting was for men. Weights would make us bulky. Dr. Erika called it plainly: that advice did women a disservice. Most of us think of muscle as something you see in the mirror. Dr. Erika said it’s an endocrine organ. Muscle sends signals that support the heart, the brain and the gut. Healthy muscle helps protect against type 2 diabetes and cardiovascular disease. It’s not just about living longer. It’s about how well you live in the years after menopause. Then there’s the simplest reason: strength keeps you steady. Climbing stairs. Getting up from a chair. Catching yourself before a fall. We lose muscle naturally as we age, starting as early as our 30s. For women, Dr. Erika explained, that loss speeds up between our 40s and 50s as estrogen declines. Weight training and enough protein are how we push back. When Dr. Erika mentioned hip fractures, I thought of my grandmother. She was in her 80s when she fell and fractured her hip. Then came the infections, the hospital stays, and eventually her passing. It all started with that fall. And I’ll be honest. I don’t weight train. The equipment is sitting right there, and I don’t make time for it. What I need to do is make a decision about it. I understand why muscle matters. Understanding was never the problem. What’s missing is a decision. What are you already sure of, but haven’t acted on yet? Sleep is recovery, not rest We all know sleep matters. But knowing that and understanding why are different things. Dr. Erika described sleep as the time the body repairs itself. In deep sleep, the brain clears out waste, which helps with brain fog now and supports brain health later. Sleep is also when muscle recovers. Lifting creates small tears in the muscle, and rest is what lets it rebuild. You can put in hours at the gym and still not build strength if you’re not sleeping. In perimenopause, falling estrogen can disrupt sleep. Stress and anxiety get harder to calm. The habits we got away with in our 20s stop working. Her starting point is the circadian rhythm, the internal clock that runs your sleep, your gut, your liver and your muscle: * Get sunlight early. Step outside in the morning before you eat. * Eat while it’s still light out. If that’s not realistic, finish two to three hours before bed, so your body can recover overnight instead of digest. * Be mindful of late workouts. Movement always beats none, but evening training can leave you wired. If you’re not sure where to begin, Dr. Erika’s answer is simple: start with sleep. It’s the foundation everything else builds on. We outsource our wisdom Dr. Erika teaches that we aren’t broken. Our physiology changed. When I asked her what she means by inner authority, she went back to her own story. “I’ve lived in this body for 54 years,” she said. “Who better to know and understand my own body?” And yet we hand that authority to someone else. We should see doctors. We need them. But Dr. Erika believes her journey would have looked different if she’d trusted the feeling in her body that said, this isn’t right , and pushed back. She doesn’t think the answer is endless research or falling down an internet rabbit hole. It’s curiosity. Notice what your body is telling you. Ask whether something else could be going on. Journal what’s happening so the patterns become visible, rather than relying on memory. We outsource our wisdom to trusted people, and often that’s right. But inside each of us there’s a quiet signal that knows when something is off. You’re allowed to request your records. You’re allowed to ask the next question. You’re allowed to question what you’re told. It’s your body. It’s your right. An explanation is not a plan What I wish someone had told me sooner is this: you are in control. I didn’t acknowledge it until four years into my journey. I finally got an answer from a holistic practitioner. My body had been living in survival mode for over a decade, and it was responding to the life I’d been living. I remember asking, “So I brought this upon myself?” Then I said, “If I caused this, I’m going to fix it in record time.” That was the moment. One decision. I would become Criss with a healthy body, and I would make every choice from that identity. That’s why I see perimenopause as an explanation, not a plan. An explanation helps you understand what you’re feeling. It doesn’t tell you who to become. That part is yours. When you step into the identity of the woman who is thriving and energized, the habits Dr. Erika talked about stop feeling like a to-do list. The woman who prioritizes herself just does them. She lifts. She protects her sleep. She asks the next question. Dr. Erika added the piece that makes it possible: permission. Most of us put everyone else first, and many women don’t give themselves a yes until midlife forces the issue. Her hope is that our daughters won’t have to wait that long. If they arrive at midlife with muscle, good habits and trust in their own bodies, the transition gets easier. That change can start with us. One decision away If you take one thing from this conversation, let it be this: perimenopause is an explanation. You get to decide what you do with it. The weight, the brain fog and the exhaustion aren’t inevitable. As Dr. Erika put it, there’s a place to start, and it doesn’t have to be everything at once. So choose yourself, even for a moment. Decide today that you’re going to prioritize you. That one choice ripples into everything else. You are one decision away from changing the trajectory of your life. Not sure where to start? Dr. Erika offers a free Midlife Reset Assessment to help you find your best first step. Keep the conversation going. Subscribe to both of our publications: * Criss Madrigal: Reinvention After 40 * Dr. Erika Pimentel: Midlife by Design This article is for education, not medical advice. Always talk with your own provider about your health. This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit crissmadrigal.substack.com/subscribe











