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I am angry. And the more I think about the current estradiol shortage, the angrier I become. Not simply because women are having difficulty obtaining a medication that helps them navigate perimenopause and menopause, but because this situation represents something much larger...something deeply embedded in the history of how women's bodies, psychological experiences, and healthcare needs have been understood, prioritized, and, far too often, dismissed.

As a psychologist, I have spent decades exploring the complex relationship between our biology, psychological development, relationships, culture, and the systems within which we live. And as a woman navigating this stage of life myself, I find it increasingly difficult to ignore the extent to which women's experiences have been minimized, misunderstood, or treated as secondary to the needs of others. The estradiol shortage brings many of these concerns into sharp focus.

For those who may not understand the significance of this medication, estrogen is not simply a reproductive hormone. It plays a role in neurological functioning, mood regulation, sleep, cognition, temperature regulation, bone health, and numerous other physiological processes. During perimenopause, estrogen levels can fluctuate dramatically, and for some women, those fluctuations are associated with considerable psychological and physical distress. Anxiety, depression, irritability, sleep disturbances, difficulty concentrating, brain fog, and a sense of emotional instability can become part of daily life. These experiences vary considerably from woman to woman, but for those significantly affected, the consequences can be profound.

Research has demonstrated that women with a history of perimenopausal depression may be particularly vulnerable to abrupt estrogen withdrawal. In other words, suddenly losing access to prescribed estradiol is not necessarily a minor inconvenience. For some women, it can mean the return of symptoms that interfere with their relationships, their work, their sense of well-being, and their ability to function as they ordinarily would. And while hormone therapy is neither necessary nor appropriate for every woman, those who have been prescribed it deserve reasonable continuity of care and meaningful assistance when their medication becomes unavailable.

What I find particularly troubling, however, is the expectation that women will simply figure it out. Find another pharmacy. Call another provider. Investigate another formulation. Make another appointment. Manage the physical symptoms. Manage the psychological symptoms. And somehow continue managing everyone and everything else in their lives. As though women have an endless reservoir of emotional, psychological, and physical resources from which to draw.

This brings me to the work of Nancy Chodorow, whose groundbreaking book The Reproduction of Mothering profoundly influenced feminist psychology. Drawing upon psychoanalytic object-relations theory, Chodorow examined how caregiving roles and gendered expectations are reproduced across generations. She challenged the notion that women naturally assume responsibility for the emotional and relational needs of others simply because they are biologically female. Rather, she demonstrated how family structures, early attachment experiences, and cultural expectations contribute to the development and perpetuation of these roles.

Think about that for a moment. How many women have spent their lives learning to anticipate the needs of others, manage emotional tension, preserve relationships, and assume responsibility for the well-being of their families? How many have internalized the belief that being a good mother, wife, partner, daughter, or professional means being available, responsive, accommodating, and self-sacrificing? And how many continue carrying these responsibilities through midlife, precisely when their own bodies may be undergoing profound physiological changes?

What happens when the woman who has spent decades caring for everyone else suddenly needs care herself? What happens when she is exhausted, struggling to sleep, experiencing cognitive changes, or finding it increasingly difficult to regulate her emotions? Does she receive the same consideration, patience, and compassion she has so freely extended to others? Or is she expected to continue functioning, to remain pleasant and productive, and to find another way to accommodate the demands placed upon her?

These questions lead naturally to the work of Jean Baker Miller and the extraordinary feminist psychologists associated with the Stone Center at Wellesley College. Miller's Toward a New Psychology of Women, along with the subsequent contributions of Judith Jordan, Janet Surrey, Irene Stiver, and others, challenged traditional psychological theories that emphasized separation, autonomy, and independence as primary indicators of healthy development. Their work eventually evolved into Relational-Cultural Theory, which recognizes that human beings develop through meaningful relationships characterized by mutual empathy, authenticity, respect, and connection.

What I have always appreciated about this perspective is its recognition that psychological well-being cannot be fully understood outside the context of our relationships and the social structures that shape them. We do not exist in isolation. Our emotional experiences are influenced by how we are treated, whether our voices are heard, whether our needs are recognized, and whether the relationships and systems within which we live allow for mutual responsiveness.

And this is where I believe the issue becomes particularly important. When women repeatedly report symptoms only to be dismissed, minimized, or told that what they are experiencing is simply part of getting older, the consequences extend beyond a missed medical intervention. There can be a profound experience of invalidation. A woman may begin questioning her own perceptions, wondering whether she is exaggerating her symptoms or simply failing to cope. She may become increasingly disconnected from her body, distrustful of healthcare providers, or reluctant to seek help. Of course, not every woman responds this way, but these are meaningful psychological consequences worth considering.

From a relational-cultural perspective, such experiences also reflect an imbalance of power. Healthcare professionals hold considerable authority, and when that authority is exercised without adequate curiosity, empathy, or respect for the patient's lived experience, the therapeutic relationship can become another place where women learn that their needs are less important than the judgments of others. This is especially troubling in the context of women's health, where a long history of gender-based assumptions has influenced research, diagnosis, and treatment.

I am also concerned about the ways hormonal changes can be misunderstood within mental healthcare itself. Women experiencing perimenopause may present with symptoms that closely resemble anxiety disorders, depressive disorders, or difficulties with attention and emotional regulation. Certainly, women can develop these conditions independently of hormonal changes, and menopause should never become a convenient explanation for every psychological difficulty that emerges during midlife. But we must be willing to consider the possibility that biological changes are contributing to what we are observing.

How often do we ask about menstrual cycles, hormonal fluctuations, night sweats, sleep disturbances, or changes in reproductive health when evaluating a woman in her forties or fifties? How frequently do we collaborate with medical providers to examine the relationship between endocrine functioning and psychological symptoms? And how often have women been prescribed psychiatric medications without a sufficiently comprehensive exploration of the biological, relational, and environmental factors contributing to their distress?

These are not arguments against psychiatric medication or psychological treatment. Both can be tremendously beneficial, and for many individuals, essential. Rather, they are arguments for a more thoughtful and integrated approach to mental healthcare...one that recognizes that the brain is part of the body, that the body exists within an environment, and that our experiences are shaped by an ongoing interaction between biology, psychology, relationships, and culture.

There is also a larger conversation to be had about the allocation of resources toward women's health. The federal government does fund research related to women's health, and important advances have been made over the years. Nevertheless, significant gaps remain in our scientific understanding of menopause, the relationship between hormonal changes and mental health, and the development of accessible, individualized treatment approaches. We should be asking whether federal and state funding priorities adequately reflect the importance of women's midlife health, whether medical and mental health professionals receive sufficient education in this area, and whether healthcare systems are equipped to respond effectively when medication supplies are disrupted.

And we must be careful not to speak about women as though we all have the same experiences or access to resources. A woman with comprehensive health insurance, financial stability, and access to knowledgeable medical professionals may experience this shortage very differently from someone who lacks insurance, lives in a rural community, works multiple jobs, or has limited access to transportation. Race, socioeconomic status, disability, sexual orientation, gender identity, and other dimensions of identity can further shape healthcare experiences. Not everyone who experiences menopause identifies as a woman, and an equitable healthcare system must also recognize and address the needs of transgender and nonbinary individuals.

Feminist psychology has long challenged us to examine the relationship between individual suffering and larger social structures. What may appear to be an isolated psychological struggle can sometimes be understood more fully when we consider the environments in which people live and the expectations placed upon them. A woman who feels overwhelmed may not simply lack adequate coping skills. She may be carrying an unreasonable burden of responsibility. A woman who feels emotionally depleted may not simply need to become more resilient. She may need greater support, more reciprocal relationships, and relief from demands that have exceeded her resources for years.

And this brings me to something I believe we need to examine more critically: our cultural glorification of women's resilience.

We celebrate women for being strong, for holding families together, for managing crises, for caring for others, and for persevering through adversity. And certainly, resilience is a remarkable human capacity. But I wonder whether our admiration for women's strength has sometimes become a convenient way of avoiding responsibility for the conditions that require so much of it.

We tell women how extraordinary they are for doing everything, while rarely asking whether they should have to. We praise their selflessness while failing to recognize the emotional and physical consequences of chronic self-sacrifice. We admire their ability to endure while overlooking the systems, relationships, and cultural expectations that contribute to their exhaustion.

And when women finally reach a point where their bodies are demanding attention, where hormonal changes are affecting their sleep or emotional functioning, or where they simply no longer have the same capacity to accommodate everyone else's needs, we too often frame their distress as an individual problem to be managed.

Resilience should never become the justification for inadequate care.

I keep returning to that thought because it captures something fundamental about the work of Chodorow, Miller, Jordan, and the other feminist scholars who helped transform our understanding of women's psychological development. They encouraged us to recognize that women's experiences are not adequately understood by examining individual characteristics alone. We must also examine relationships, power, socialization, and the ways in which cultural expectations become internalized. And perhaps most importantly, we must reconsider what genuine care actually means.

Care is not simply something women provide. It is something they need and deserve to receive. Mutuality is not achieved when one person continually accommodates the needs of others while suppressing her own. Healthy relationships, whether between partners, family members, healthcare providers, or institutions and the people they serve, require responsiveness in both directions.

I believe this is where the estradiol shortage becomes emblematic of something much larger. The immediate problem concerns medication access, but the broader issue concerns how seriously we take women's health, how readily we respond to their suffering, and how willing we are to examine longstanding assumptions about what women should be expected to tolerate.

The shortage itself should not be attributed to inadequate government research funding without evidence establishing that relationship. Current supply difficulties have been associated with increased demand and challenges meeting that demand. But that does not diminish the importance of asking whether our healthcare infrastructure, research priorities, professional education, and public health policies are adequately addressing women's needs.

We need better research into the psychological consequences of hormonal fluctuations. We need more comprehensive education about perimenopause and menopause for both healthcare professionals and the public. We need more effective collaboration between medicine and mental health. We need treatment options that are accessible, individualized, and grounded in evidence. And we need systems that recognize the importance of continuity of care when prescribed medications become difficult to obtain.

Perhaps we also need to begin asking women different questions. Rather than simply asking how they are managing their symptoms, perhaps we should ask what they need. Rather than assuming that their exhaustion, irritability, or emotional distress represents some personal deficiency, perhaps we should become more curious about what their bodies are experiencing and what their lives are demanding of them. Rather than celebrating their ability to endure, perhaps we should begin questioning why so much endurance is required.

As a psychologist, I believe deeply in personal growth, self-awareness, responsibility, and the capacity we each have to transform our relationship with ourselves and the world around us. But psychological growth does not occur independently of the environments in which we live. We cannot continue encouraging women to develop greater self-compassion while simultaneously accepting systems that fail to extend that same compassion toward them.

And as a woman, I am increasingly unwilling to accept the notion that suffering is simply part of being female, that menopause is something we should quietly endure, or that accessing appropriate healthcare should require extraordinary persistence.

We deserve better. Not because women are inherently more deserving of care than anyone else, but because equal dignity requires that our health needs be taken just as seriously as those of others.

The estradiol shortage will eventually ease. But my hope is that the conversation it has prompted will not disappear along with it. Because the real issue extends far beyond a medication patch. It is about how we value women, how we understand the relationship between physical and psychological health, and whether we are prepared to challenge the cultural and institutional patterns that have too often left women's needs at the margins.

Women's health is not an afterthought. And neither are women.

Tiffany Griffiths, Psy.D., is a licensed psychologist and founder of Tiffany Griffiths, Psy.D. & Associates, a group mental health practice serving Northeastern Pennsylvania. Her clinical philosophy emphasizes the integration of biological, psychological, relational, social, and cultural influences on mental health.

If you are having difficulty obtaining prescribed estradiol, speak with your pharmacist and prescribing medical provider about availability and appropriate treatment alternatives. Do not independently change or discontinue prescribed medication without medical guidance.