Sister,

Something is shifting in how we are gathering this year. Two rites of passage — active motherhood and perimenopause — are arriving at the same time for our generation, and most of us are walking them without a map. Sisterhood Circle is the space we are building for that walk.

Through summer 2026, Sisterhood Circle is open and free to every subscri…

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I became a mother at forty.

I had wanted that. I had worked for it. And when my child arrived, I was a board-certified physician with over a decade of clinical experience. I knew things about the human body that most people will never need to know.

And I still could not figure out what was wrong with me.

The postpartum did not lift the way everyone said it would. There was a grief underneath the joy that I could not name. There was anxiety that arrived in the night and did not explain itself. There were weeks when I felt like I was watching my life from behind glass — present, functional, completely disconnected from myself.

I told myself I just could not hack motherhood.

I had friends. I had colleagues. I had a practice full of patients I cared for thoughtfully. And I was quietly drowning in something I did not have a word for.

What I know now, and did not know then, is that I was in two passages at once.

I had become a mother — matrescence, the identity upheaval that never gets named — at the exact moment my body was beginning early perimenopause. The feedback loop between my brain and my ovaries, which had been running reliably for decades, was already starting to fluctuate before I ever became pregnant. Pregnancy flooded my system with hormones. Delivery and breastfeeding bottomed them out again. And what came back online was not quite the same system I had before.

That is what the postpartum period that lasts more than a year actually is.

Not failure. Not weakness. Two rites of passage, running on top of each other, in a body that was given no map for either.

I am in my mid-fifties now. Still in it — late perimenopause, a teenager at home, the night sweats and the hot flashes and the particular kind of rage that catches me off guard even now, even knowing what I know. The floor does feel like it has been stripped out from under you. That is not a metaphor. That is the hormonal reality of estrogen dropping in a way your brain has no protocol for.

But something has shifted in how I hold it.

I do not carry the shame I used to carry.

Not because the transition got easier. Because I finally have a name for it. Because I understand what is happening in my body and why. Because I found, late and imperfectly, the thing I had been missing for fifteen years: other women who knew.

Women who could sit across from me and say — yes, I know that 3 am feeling. Yes, I know that particular brand of rage. Yes, I know what it is to hold your child through their own crossing while barely standing in yours.

That recognition is medicine. It does not appear on a lab panel. It cannot be prescribed. But I have watched it do things in women that antidepressants could not.

I built Women’s Well because I needed it first.

Not because I had it figured out and wanted to teach it. Because I had been the woman in the doctor’s office whose labs were normal, who was sent home with a shrug and a hope that menopause would come quickly. Because I had been the mother who thought she could not hack it. Because I had spent a decade and a half practicing medicine without the framework that would have changed everything.

Erica and I built this for the woman who is in one of those three phases right now — the one who thinks her postpartum lasted too long, the one managing impossible periods alongside grade-schoolers and a full life, the one waking up soaked at 3 am with a teenager down the hall.

We built it for the woman whose doctor said her labs were normal and offered nothing else.

We built it because we are her.

If this is landing anywhere close to your experience — the retreat is for you.

Five days at Sunrise Ranch in Loveland, Colorado. June 10 through 14. Twelve women. Circle, ceremony, embodiment, medicine. The clinical picture and the ancient map, held in the same room.

Applications close June 1. womenswell.co/my-retreat

And if you would like to learn more — the free masterclass is this Saturday, May 9, at 10 am Mountain Time. Erica and I will walk through everything I just told you, in more depth, live.

womenswell.co/masterclass

You do not have to keep calling it anxiety.

— Amy

Three mornings a week, I take my kids to school.

It was my choice. About eight months ago I rearranged my whole schedule to get it — those car rides, the giggling, the drop-off kiss before their day starts. I had been missing it. I wanted it back.

What I did not know when I made that decision was that some of those mornings were going to be the hardest thirty minutes of my week.

My three-year-old, Rixon, does not want to get in the car seat.

He never wants to get in the car seat. He wants to negotiate, delay, disappear into the back of the car like it is a personal kingdom he has recently discovered and does not intend to leave. And depending on where I am in my cycle — which for the last year and a half has been irregular in a way that makes tracking feel almost absurd, long bleeds, short cycles, a couple of skipped months thrown in for good measure — that negotiation can feel completely manageable. Or it can feel like the thing that breaks me.

That is not an exaggeration. That is the reality of early perimenopause meeting active motherhood in the same body, on the same Tuesday morning, at the same 7:45am.

What early perimenopause actually feels like

I am a PA. I work in behavioral health. I know the clinical picture.

What I was not prepared for was the way it actually lives in your body — the word I keep coming back to is disorientation. The irregular cycles that bleed for up to fourteen days at a time. Vaginal dryness and pain with intercourse that I initially dismissed as residual postpartum. A sudden loss of the sleep I had finally, finally clawed back after four years of a daughter who did not sleep and then a son who slept better but not well. One week the sleep was coming back. The next week, 1am, 2am, 3am, and I am awake for no reason I can name.

And the anxiety.

I have had anxiety before. This is not that. This is anxiety at a level that is — debilitating. Just sitting like a 25lbs weighted vest in the center of my chest. No tool in my toolbox touches it in the moment. Not the mindfulness practice I have kept for years. Not the yoga. Not the nervous system regulation I teach my patients. It is just there, and I am in it, and I have to be present for a three-year-old and a four-year-old who cannot understand the word perimenopause and do not know why their mom sometimes needs a minute.

What Rixon taught me

We found a compromise about the car seat.

Rix hops in the back of the car. We drive two or three blocks — we live in a neighborhood that is still being developed, almost no traffic — and just before the stop sign, I pull over and park. He crawls from the back of the car into his seat. Charley, not to be left out….has decided she would like to do this too. They think it is wonderful. A game. A gift I am giving them. And myself.

It takes the same amount of time as fighting them into the seat in the driveway. And it costs me nothing except the willingness to let go of how I thought it was supposed to work.

I have a lot of tools. I have training and practice and years of working with the nervous system. And in those mornings when the rage rises — and I want to be honest that it is rage, a particular flavor of it that feels older and deeper than anything I have felt before, like it is pulling up things from my own unfinished stories — those tools don’t always work. Sometimes I can move through it. Sometimes I have to repair afterward. Cause I can’t contain it. I sit down with my kids and I say: I was not my best self. I am sorry. I love you and I’m working to be better. They need to see that.

Two passages, one body

Here is what I keep thinking about.

My toddlers are trying to figure out a world they do not yet have language for. I am trying to figure out a version of myself I do not yet have language for. We are both in the middle of a passage. We are both learning our own autonomy in real time. We are both, on some mornings, just trying to get through the car ride.

The last year and a half — moving out of postpartum and into perimenopause, sometimes in the same week, sometimes in the same hour — has been the hardest transition of my adult life. I have had hard transitions. This one is different because it is happening alongside two little people who need me fully present in the exact moments when I have the least to give.

And also….

I am coming into the most honest relationship with myself I have ever had. I know myself more clearly right now than I did at thirty. I know what I need, what I can hold, where my edges are. I am less worried about how I appear and more interested in who I actually am. That is not in spite of this passage. It is because of it.

Why we built this

Women’s Well exists because Amy and I are both inside this convergence, and we could not find a room that held all of it — the clinical picture and the identity shift and the daily reality of mothering through it.

We built the room.

If you are in any version of this — postpartum that went on longer than you expected, cycles that have gone strange, anxiety that arrived without explanation, mornings that feel bigger than they should — the retreat is for you.

Five days. 20 women. Sunrise Ranch, Loveland CO. June 10–14.

womenswell.co/my-retreat

And if you want to understand the clinical picture first — what is actually happening in your body, across all three phases of this passage — come to the free masterclass this Saturday, May 9 at 10am MT. Amy and I both teach it.

womenswell.co/masterclass

The mornings are getting easier. Not because the perimenopause has settled, but because I have.

— Erica

Free masterclass — Mothering Through Menopause with Amy Maher, MD, and Erica Kafka, PA-C Saturday, May 9 + Saturday, May 23, 10 am MT — womenswell.co/masterclass

Retreat — Mothering Through Menopause: The Summer Visionary Retreat June 10–14, 2026 · Sunrise Ranch, Loveland, CO — womenswell.co/my-retreat

Maybe stress. Maybe getting older. Maybe just what this season of life feels like.

You have probably said some version of this to your doctor, who ran labs, found nothing, and sent you home.

I am a physician. I have been in practice for over twenty years. I have sat across from hundreds of women exactly where you are right now.

And I want to tell you something nobody told me — even though I had a medical degree.

What is actually happening

There is a conversation happening between your brain and your ovaries. Physicians call it the HPO axis — hypothalamus, pituitary, ovaries. For most of your reproductive life, this conversation runs like a reliable loop. Your brain signals your ovaries. Your ovaries produce estrogen and progesterone. The cycle repeats.

In perimenopause, the loop starts to go haywire.

And here is the part that most women — and honestly, most doctors — miss: it starts with progesterone, not estrogen. Progesterone is your calming hormone, your sleep hormone, your you-feel-like-yourself hormone. It drops first. Sometimes, years before anything else changes. Before your period changes. Before the hot flashes. Before anything on a lab panel.

So what does low progesterone feel like?

Anxiety with no clear cause. Irritability that arrives out of nowhere. Trouble falling asleep, or waking at 3am with thoughts racing and a heart rate that should not be elevated. Mood swings that do not seem to track with anything external.

This is what you have been calling anxiety.

It is your brain, confused, trying to regulate a system that is changing underneath it.

The phase you might be in

I think about perimenopause in three distinct phases, and knowing which one you are in changes everything about how to support yourself.

If you had a baby in your late thirties and your postpartum lasted more than a year — and you still do not quite feel like yourself — that is the first clue. You are likely in early perimenopause. The hormonal disruption of pregnancy and delivery arrived on top of a system that was already beginning to shift. Most women in this phase have no idea that this is what is happening. They think they just cannot hack motherhood. I thought that. I had a child at forty and spent years wondering what was wrong with me.

If you are in your early-to-mid forties with grade-schoolers at home, running everything — the job, the family, the household — and your periods have started to change, one month heavy and clotting and almost unbearable, the next month almost nothing, while anxiety has moved in like an uninvited houseguest who will not leave — you are in mid perimenopause. This is the phase that most often gets mistaken for depression or burnout, because it looks like both.

If you have a teenager at home and you are waking up soaked through the sheets, feeling the floor has been stripped out from under you — the weight gain that does not respond to lifestyle changes the way it used to, the hot flashes in the middle of meetings, the rage that surprises you, the brain fog — you are in late perimenopause. And you are likely holding your child through their own crossing while navigating yours, which is one of the most underacknowledged burdens a woman can carry.

What medicine missed

When I went to my own doctor recently, her exact words were: “Your labs are normal, it must be hormones and stress, I hope you get through it quickly.”

That was all she offered.

I left that appointment and thought: This is why Women’s Well exists.

Your labs being normal does not mean nothing is happening. It means the standard panel was not designed to catch what is happening in perimenopause. The hormonal fluctuations are precisely that — fluctuations. A single blood draw on a single day will miss them. What you are living is real. It has a clinical name. And it has a way through.

What helps — and what helps more than medication alone

Medication can be part of the answer. For some women, low-dose natural progesterone is a revelation. Hormonal support, when it is the right kind and the right timing, can make an enormous difference. I am not here to dismiss that.

But the research is clear that medication alone — including antidepressants, which are often the first thing prescribed — helps a minority of women, not a majority. And I have watched too many women spend years on medications that addressed a symptom but not the root, while the underlying transition went unnamed and unsupported.

What helps more is a framework that holds all of it. The clinical. The psychological. The communal. The embodied. The story you are carrying about what this stage of life means, which was probably written by a culture that does not have kind words for a woman in her forties and fifties.

That framework is what we built.

Come to the masterclass

This Saturday, May 9, at 10 am Mountain Time, Erica Kafka and I are running a free live masterclass called Mothering Through Menopause. We will walk through what is actually happening in your body across the three phases of perimenopause — the clinical picture, what the labs miss, and what actually helps.

It is free. It is sixty minutes. It is the conversation your doctor may not have had with you yet.

Register at womenswell.co/masterclass.

Medicine. And all that medicine forgot.

— Amy

Issue No. 1 · Welcome to Women’s Well

You are somewhere between 35 and 55. You are a mother. You are capable, accomplished, and exhausted in a way you cannot fully explain to anyone, including yourself.

Maybe you are in the early years — baby or toddler at home, still in the fog of what the world calls postpartum but what no one tells you can last two, three, even five years. The anxiety that has not lifted. The body that does not feel like yours. The hormonal storm no one warned you was coming.

Maybe you are in the middle years — grade schoolers, carpools, a career, a marriage you are fighting to keep alive. Your periods have become something unrecognizable: so heavy, with clots and cramping so intense, it feels like you are giving birth to an alien. And then the mood swings — arriving separately, out of nowhere, with a force entirely their own. You Google your symptoms. Nothing quite fits.

Maybe you are in the later years — a teenager under your roof navigating their own becoming while you navigate yours. Periods starting and stopping. Hot flashes waking you at 3am. Night sweats soaking the sheets. Trying to hold space for your child’s rite of passage while you are in the middle of your own.

Whatever stage you are in — this is for you. All of it. Every version of this crossing.

The rage that comes from nowhere. The fog behind your eyes. The face in the mirror that is yours and also not quite yours. The distance from your partner you cannot seem to close. The guilt about your children that runs on a loop all day.

You have tried harder. You have downloaded the apps, taken the supplements, done the yoga, told yourself to be more grateful. You are so tired of trying harder.

You went to your doctor. Your labs came back normal. You were offered an antidepressant or told it was stress. You left with nothing that touched the real thing. Because no one connected the dots. Because the system stops watching a woman after her first postpartum year. Because perimenopause and the identity transformation of motherhood are both happening at the same time and nobody — not your OB, not your therapist, not the wellness industry — is holding both at once. This is not your fault. It is a gap. And it is exactly the gap Women’s Well was built to close.

Here is what no one has told you: what you are living has a name. Two of them, in fact. And for a growing number of women — Gen X and older Millennial mothers who had children later — both are happening at the same time, in the same body, on the same Tuesday morning.

Perimenopause. The hormonal recalibration that can begin in your late thirties, last a decade, and produce symptoms that go far beyond hot flashes — rage, anxiety, brain fog, identity disruption, the feeling of not being yourself and not knowing how to say it.

Matrescence. What does this mean? I did not know either. The ongoing developmental transformation of becoming and being a mother — biological, psychological, identity-level — that never fully ends and that almost no woman is supported through.

When both arrive at once, we call it The Convergence. And it is what Women’s Well was built for.

You are not just messed up or a loser. You are not failing. You are standing at one of the most powerful thresholds a modern woman can stand on — and you have been standing there alone. That ends now.

We are Amy and Erica — a physician and a physician assistant who have studied this clinically and lived it personally. We built Women’s Well because when we needed it most, it did not exist.

Every month in the Sisterhood Circle, we bring you the truth — about your body, your hormones, your psychology, your relationships, and the cultural forces that set you up to struggle in silence. We teach. We answer your questions live. We make sure you are never again the woman who leaves the doctor’s office with nothing that touches the real thing.

You belong here. Welcome to the well.

Ready to understand what is actually happening?

Free Masterclass: Mothering Through Menopause · womenswell.co/masterclass

Apply for the Summer Retreat · womenswell.co/my-retreat

With love and in it with you,

Amy Maher, MD & Erica Kafka, PA-C

Women’s Well · womenswell.co · hello@womenswell.co

ABOUT AMY & ERICA

Dr. Amy Maher is a Dual Board Certified Physician specializing in precision medicine, integrated psychiatry, and functional medicine, a Visionary Craniosacral therapist, Somatic Experiencing and trauma healing practitioner, and a student of yogic philosophy for more than four decades. She became a mother at 40, navigated postpartum and perimenopause simultaneously without anyone connecting the dots for her, and is now at 55, navigating the final stages of this hormonal odyssey while parenting a teenager and redefining her marriage. She built Women’s Well because when she needed it most, it did not exist.

Erica Kafka, PA-C, is a Physician Assistant with a fellowship in Integrative Medicine from the University of Arizona, a Certified Yoga Therapist, Ayurvedic practitioner, shamanic practitioner, trauma healing specialist, and a PhD candidate in human anatomy and nanotechnology for childhood cancer. She became a mother at 23, and again at 43 and 45. Her firstborn just got married. Her youngest two are three and four years old. She went from postpartum directly into perimenopause and is standing in the middle of The Convergence right now — holding the oldest chapter of motherhood and the newest one simultaneously, in the same body, in the same week.

WOMEN’S WELL· womenswell.co·

Medicine, and everything medicine forgot to include.

Welcome to the Sisterhood Circle

Welcome home, sister.

We are so glad you are here.

The Sisterhood Circle is the foundational community of Women’s Well — a tender, intentional gathering place for women navigating the wild, sacred passage of perimenopause and motherhood. It is held by Amy Maher, MD and Erica Kafka, PA, two women walking these passages alongside you, weaving conventional medicine with the wisdom traditions medicine forgot to include.

This community lives entirely on Substack. Your subscription gives you full access to the Women’s Well publication — every essay, teaching, resource, and reflection we share. Once a month, we gather together on Substack Live for a themed group session: a teaching on a curated topic, followed by an open Q & A. Between sessions, the Substack community chat is your participant-only space to ask questions, share what is moving in you, and stay connected to the women walking this path with you.

Everything that happens here — the writings, the resources, the live gatherings, the chat — unfolds inside Substack. Nothing extra to download. No other platforms to manage. Just one quiet, well-tended home.

Before your first gathering, we ask one small thing of you.

Our Community Agreement

This Circle is a sacred container. The honesty, the tenderness, the unguarded sharing — none of it is possible without trust. The agreement below is what makes the trust real.

By completing the form below and maintaining your Substack subscription to Women’s Well, you agree to the following:

• Confidentiality. What is shared in this community stays in this community. I will not share the identities, stories, or personal disclosures of other members outside this space.

• Respect. I will engage with all members and facilitators with care, honesty, and respect — even in moments of disagreement.

• Personal responsibility. I understand that the content shared by Amy Maher, MD and Erica Kafka, PA is educational and community-based. It does not constitute medical advice, therapy, or a patient–provider relationship. I remain responsible for my own healthcare decisions and will continue to work with my own providers as needed.

• Boundaries. I will honor the boundaries set by the facilitators and by the group. I understand that violations of these agreements may result in removal from the Circle without refund.

• Presence. I will show up as honestly as I am able, and extend grace to others doing the same.

• Recording & sharing. I will not record, screenshot, or share content from Substack Live sessions, the Substack chat, or any private community materials without explicit permission.

• Subscription & access. I understand I may start or stop my subscription at any time through Substack. While my subscription is active, this agreement remains in effect.

One Quick Step Before Your First Session

Please take two minutes to sign the Community Agreement form below. We keep this on file as a record of your consent. Maintaining your Substack subscription also affirms your ongoing agreement to these terms.

Sign the Sisterhood Circle Community Agreement
https://forms.gle/3YjooJUbpxZMcAZt6

Questions?

Reach us anytime at hello@womenswell.co, or visit womenswell.co for more about our work.

— ✯ —

We are honored you are here.

With love,

Amy & Erica

Amy Maher, MD · Erica Kafka, PA

womenswell.co · hello@womenswell.co

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