I spent years—a decade, maybe— ignoring the fact that I popped Tylenol or Ibuprofen like breath mints to treat daily headaches, ignoring the debilitating monthly migraine layered on top that sent me to bed for twenty- four hours (and simply blaming PMS), ignoring the chronic nagging muscle soreness in my neck and back from the hard, stiff knots that drew my shoulders up to my ears, ignoring the interrupted sleep and resulting chronic daily fatigue, ignoring that although I managed to navigate a husband and five children, a medical degree and part- time career, the running of an entire household, plus the one million things I must attend to every week, sometimes the idea of doing very basic adult things like finding a new address or making a few hard phone calls or buying a plane ticket sent me into a tailspin of anxiety and dread. I spent years ignoring all of it. I attributed my symptoms to life. I blamed hormones. I made endless excuses: I just need to exercise more! I just need to eat better! I just need to get off social media, organize my house, lose a few pounds, get out in nature, drink more water, take a power nap, practice yoga, and focus on self- care! I just need to get my act together! Get my life together! I didn’t have anxiety, I was fine.

I am FINE, I’d say. Of course, for my friends or my patients or my neighbors or for the other moms in playgroup or anyone else who might recount any combination of similar debilitating symptoms, I recommended therapy and a trial of an SSRI. I encouraged it, prescribed it, applauded it. But medication to treat anxiety for myself? Nah. Instead, my internal voice began its typical barrage of criticism: What is WRONG with you? Pull it together! You have a million things to be grateful for. So many other people in this world have it entirely worse than you. You’re weak. Plus, it’s probably just your hormones. You’ll get through it. It will get better. Maybe next month. Maybe when the kids are all in school. Maybe when you figure out what you’re doing in your career. Maybe once you start exercising regularly again. Maybe if you could just get rid of those last fifteen pounds.

Turns out, my anxiety is always right there, waiting to pounce. I thought I’d have more figured out by my forties. I thought I’d feel more settled as a wife and a mother and more confident in my career and within my close family and friend relationships. I thought I’d have more peace and clarity in my faith and religion, about my body, my purpose, my life. And in some ways, I do. But then these subtle and seismic shifts arise to shake things up and sift the contents of my life through the proverbial strainer:

What’s important?

What matters?

What can be let go of?

Or put away?

Is this serving my life right now or the cause of far too much anxiety?

Is it helping? Or hurting? Is this simply too heavy to carry forward?

Can I put another thing down?

When I’m with patients, I’m reminded with such assuredness that each beautiful human was made with deep, abiding love on purpose. And each person’s life has a great depth of meaning. They are a treasure to be adored! But then in the very next breath, I might turn and speak hatred to myself. I am full of compassion for others, but I am not always so good at speaking that same voice of love and care for myself. It’s the self- compassion I am working on these days.

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So, what about you? Did anything strike a chord? If so, could you swallow down your pride, shush that minimizing inner critic, embrace every ounce of self- compassion you can muster, then be proactive by making an appointment with your primary medical provider to discuss your mood and treatment options a little further?

More than anything I want to tell you it’s normal to feel up and down. It’s actually healthy to have feelings that fit your current situation. But if those sad or anxious feelings settle in and become more than that, it’s okay to get help.

This excerpt is from Mikala’s newest book, Everything I Wish I Could Tell You about Midlife: A Woman's Guide to Health in the Body You Actually Have. The book is available here for 30% off and wherever books are sold.

Mikala Albertson, MD is a board-certified family practice doctor and well-being advocate who is passionate about women's health and healing in the middle of our messy, ordinary lives. Author of Ordinary on Purpose, Mikala inspires readers to aim for wholehearted living through a gentle, achievable, sustainable approach. She and her husband have five children and live near Salt Lake City, Utah. Learn more at MikalaAlbertsonMD.com