When the symptoms started, I had no idea what was wrong. I was experiencing heart palpitations and my joints and muscles ached. Even easy runs felt laborious, as if I was carrying an unseen weight. I felt low, too. Where had my mojo gone?

Unsurprisingly, these symptoms wreaked havoc on my running performance, so I began to race less often, then not at all. I saw my GP, hoping to identify this mystery run-wrecking disease and was sent for tests: thyroid function, iron levels and so on. Nothing appeared to be wrong with me. I’m just past it, I thought.

Now I know different. I wasn’t ill, or old – I was menopausal. Of course, the ageing process does impact performance, but menopausal years are particularly ravaging, mentally and physically. In a Runner’s World UK poll, 83% of female runners said menopause had affected their running. So, it’s important both we and our loved ones understand what we’re up against.

What everyone’s reading

Menopause has only recently begun to get the attention it deserves, after decades of being disregarded by the medical establishment and belittled with terms like ‘women’s problems’ and ‘the change’. In a 2022 survey by the Fawcett Society, 44% of working women reported that their ability to do their job had been affected by menopause and its symptoms, yet 41% had witnessed it being treated as a joke in the workplace. The upsurge in interest is thanks, in part, to public figures like Davina McCall, Michelle Obama and Mariella Frostrup talking openly about their experiences. A TV documentary McCall made in 2021, Sex, Myths and the Menopause, had such an impact on British women – including a 30% increase in demand for HRT – that it was dubbed the ‘Davina effect’.

‘It’s great that there’s finally a conversation about menopause, so women are educated and informed and can make the right choices about how to navigate it,’ says Dr Sam Brown, a menopause specialist and co-director of the Bronte Clinic in London.

Kate Muir, producer of the McCall documentary, went on to write Everything You Need To Know About the Menopause (But Were Afraid To Ask), a book that taught me many things I wish I’d known sooner. What was happening to me? Was it normal? How long would it go on? How could I mitigate the symptoms? It wasn’t so much a matter of being too afraid to ask as simply not knowing I needed to.

Once I started to discuss what Muir calls the ‘sledgehammer’ of symptoms with other runners, I realised that there was an army of us struggling with joint pain, extreme fatigue, the sudden onset of soft tissue injuries, sleeplessness, heart palpitations, weight gain, loss of motivation and more. ‘Longer runs have become a real struggle,’ said one. ‘I’ve had to pull out of races because I found the training so tiring.’ Another, who had previously run marathons and ultras, said she sometimes found it difficult to shuffle around the block due to extreme tiredness, dizziness, nausea, hot flushes and excessive sweating.

The official definition of menopause is when a woman has gone twelve months without a menstrual bleed, signifying that her ovaries are no long producing oestrogen or progesterone. The average age of menopause in the UK is 51, with the normal range considered to be 45-55. The extended period that leads up that point (known as perimenopause or menopause transition) averages four to seven years and is a time when fluctuating hormone levels can knock you for six mentally, physiologically and in terms of musculoskeletal health.

The overwhelming majority of women (approximately 75-90%) experience menopausal symptoms. According to the British Menopause Society, around one third suffer symptoms lasting seven years or more, while the Fawcett Society survey found that 77% of women had at least one symptom they found ‘very difficult’ and 44% described three or more this way. Any common menopausal symptoms – bloating, hot flushes, heavy or erratic periods, brain fog or sleepless nights – can affect your running, but some are likely to have a more direct impact.

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Perimenopausal

Back in my perimenopausal days, I pulled out of a 10K race, convinced that there was something wrong with my heart. The beating was fluttery and irregular and I felt weak. The St John’s Ambulance team monitored me briefly, but saw no cause for concern. It was only recently I learned that 41% of women experience heart palpitations during menopause transition. ‘Declining oestrogen can increase heart activity and lead to erratic beats,’ says Brown. ‘It can also raise levels of the stress hormone cortisol, leading to palpitations.’

Aching joints and sore muscles – sensations you might associate with DOMS – are also common (again, thanks declining oestrogen), with the Fawcett survey showing 67% of menopausal women experience them. ‘Too often, this kind of pain isn’t identified as being menopause-related,’ says Brown. ‘Partly because it’s one of the earliest symptoms, so there aren’t other tell-tale signs.’ This is even more likely if you’re a fit, healthy runner, as you may not be experiencing weight gain, hot flushes or sleeplessness, causing you to dismiss menopause as a reason. If you’re in the ballpark of perimenopause or menopause and start experiencing what Dr Brown describes as ‘feeling old in the mornings’, it’s worth addressing.

Then there’s that overwhelming fatigue. A staggering 84% of menopausal women experience exhaustion and/or sleeplessness. ‘Constant sleep problems can lead to a vicious circle of fatigue and subsequent inactivity,’ says Muir, a lifelong runner. You’re too tired to run, your fitness slides and when you try getting back out there, perhaps having gained weight, it’s even harder. It’s enough to dent the most committed runner’s dedication, but when accompanied by depression or anxiety (69% of menopausal women) or brain fog (73%), it’s no surprise that motivation goes AWOL. ‘I’ve gone from running five times a week to once,’ one woman told me. Another said: ‘On a good day, only one thing hurts.’

Weight gain is a fact of ageing, irrespective of menopausal status. However, research published in the journal JCI Insight revealed that, while women were gaining weight at 0.25kg per year before perimenopause, this almost doubled to 0.45kg during perimenopause. Their loss of lean muscle mass also accelerated.

These bodily changes and their effect on our physical prowess can have significant psychological impact, especially on those who’ve always invested in being fit. ‘We’ve got the physiological changes, musculoskeletal changes, neurological changes – but we also need to talk about the emotional side,’ says Amanda Thebe, a personal trainer and affiliated member of the North American Menopause Society. ‘Women can lose belief in themselves when a 10K race suddenly takes four days to recover from [plummeting oestrogen levels affect muscle recovery and repair], or running at the same effort produces a slower pace. The effect can be huge.’

Light at the end of the tunnel

It’s worth pointing out – and bear with me here – that there’s a certain comfort in knowing just how debilitating and widespread menopausal symptoms can be. You’re not going mad. You’re not becoming decrepit. You’re not all washed up. You are menopausal.

What’s more, it won’t last forever. Polish research shows that while the risk of depression is two to five times greater during menopause transition, this is no longer the case post-menopause. As for cognition, a large long-term US study found that disturbances to memory, information-processing speed and attentional focus (in other words, brain fog) during perimenopause resolved post-menopause. Hot flushes and night sweats, collectively known as ‘vasomotor symptoms’, typically last around seven years in total, persisting for an average of 4.5 years post-menopause.

Plus, while weight gain and muscle loss accelerate during menopausal transition, the JCI Insight study mentioned above found that this slowed post-menopause. ‘The menopause isn’t a cave, it’s a tunnel – with light at the end of it,’ says Thebe, author of Menopocalypse: How I learned to Thrive During Menopause and How You Can Too. Thebe admits to eight ‘shitty’ years , with depression, migraines and a nagging achilles injury. But four years post-menopause, she’s now symptom-free. ‘I’m back,’ she says. ‘It’s different, but I’m running again. I’m stronger than ever.’

Many women – both with and without Hormone Replacement Therapy (HRT) – talk of having come out the other side of menopause, feeling better and rediscovering their running mojo.

The fact that you’re already a runner means that you enter menopause in a positive state of health and fitness, which not only seems to have a mitigating effect on symptoms but is also crucial for long-term wellbeing. A study published in the journal Menopause found that sedentary women experienced more severe menopausal symptoms than active women, while other research suggests exercisers suffer less sleeplessness and sleep disturbance, less mood disruption and less weight gain during menopause transition.

Research also shows that regular exercise not only combats midlife weight gain, but attenuates the characteristic shift from gynoid (hips, thighs and buttocks) fat storage to visceral fat storage, which is associated with increased incidence of metabolic, cardiovascular and other chronic diseases. The evidence is equivocal regarding hot flushes and night sweats – some studies report that regular exercisers suffer fewer of these, while others find no difference. (My night sweats were horrendous, but I’ve never experienced a hot flush to this day.)

Of course, the health benefits of exercise extend beyond menopause. In a 2020 study, post-menopausal women with high levels of physical activity reported better mood, greater life satisfaction and fewer depressive symptoms than their low physical activity counterparts. So, you definitely want to keep your running habit as you transition through menopause. But how?

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Listen to your body

‘Learning to work with your menopausal body is key,’ says Thebe. ‘Runners love structure, but there’s a tendency to stick doggedly to a programme, regardless of how you’re feeling. While your plan might say three 10K runs a week, your body might be screaming.’

The most problematic time for symptoms is perimenopause, when oestrogen and progesterone levels are erratic. ‘You never know what each day will bring,’ says Thebe. This is what prompted her to introduce ‘structured flexibility’ into her training, which prompts you to grade your energy level from 1-10 and adjust your workout accordingly. ‘It might mean a walk instead of your planned 5K after a sleepless night, or running drills on days when you’re too exhausted to run,’ says Thebe. ‘When we work with the body, rather than when we fight against it, we start to see improvements. We no longer feel like we’re failing.’

We need to work with our bodies when it comes to nutrition, too. ‘In the past, you might have got away with a scattergun approach, but now, appropriate nutrition and rest to support your workouts are non-negotiable,’ says Thebe. ‘That means not being fearful of carbs – the body’s preferred fuel source for long-distance runs – and ensuring that you get adequate protein in your overall diet, especially post-exercise, for repair and recovery.’

The body becomes less efficient at muscle protein synthesis during menopause, which is why European guidelines recommend that women over 50 consume slightly more – 1-1.2g of protein per kilogram of body weight per day. They note that optimal protein intake combined with exercise three to five times a week produces a greater degree of muscle protein synthesis than either one alone. For post-menopausal musculoskeletal health, the guidelines also recommend 1000mg of calcium and 800 iu of vitamin D.

Women who experience heavier or more frequent bleeds as their hormones fluctuate in perimenopause can become low on iron, adding to fatigue. ‘Women should look out for symptoms of iron deficiency, which include chronic low energy, irritability and trouble thinking, which may be put down to brain fog,’ says Elizabeth Ward, a registered dietitian and co-author of The Menopause Diet Plan: A Natural Guide to Managing Hormones, Health and Happiness. However, don’t take iron supplements ‘just in case’. ‘Iron status is most accurately measured through a blood test,’ says Ward.

Post-menopause, research also suggests that iron levels tend to increase, since there’s no longer any blood loss through menstrual bleeds. ‘Experts advise postmenopausal women to avoid taking supplemental iron because iron needs decrease after menopause,’ adds Ward.

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Resistance and strength training during menopause

While aerobic exercise, like running, plays an important role in menopausal health (and midlife sanity), there’s compelling evidence that strength training is also vital. ‘Strength training enables us to hold on to, or even increase, muscle mass,’ says Thebe. ‘This helps to maintain healthy body composition, reduce injury risk and aid recovery.’ A recent study published in Climateric also found that regular resistance training reduced hot flushes and improved quality of life in menopausal women.

Strength training is also key for bone health, as researchers describe the three-year period spanning the final menstrual period as the ‘phase of rapid bone loss’. Though not as beneficial as strength work, running also has a positive effect on bone density. In fact, it has recently been shown that high-intensity work is far more beneficially impactful (pun intended) on bone health than long steady runs.

Dr Brown is another keen advocate of strength training and other activities that maintain flexibility and balance, such as yoga and Pilates. Rather than seeing these as yet more things on your to-do list, consider them tools in your armoury. When long runs don’t feel doable, focus on short sprints or strength training – which stimulate muscle growth – rather than endurance work, which depletes energy and requires extended recovery. When you’re too exhausted to run, build core strength with a Pilates session.

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Injury risk during menopause

It was as a running coach that I first noticed women of menopausal age seemed to be getting more than their fair share of injuries. My own menopausal transition was accompanied by nagging high-hamstring pain and intermittent plantar fasciitis. A third of the women I spoke to also said that they’d experienced unaccustomed injuries, most commonly tendinous ones, such as the hamstring, gluteal and achilles tendons.

Until recently, evidence of a correlation between menopause and more frequent injuries was mostly anecdotal – something I’d heard physios and runners talking about but not seen supported by science. That’s beginning to change. ‘There is a growing body of evidence linking reduced levels of circulating oestrogen levels in postmenopausal women with increased risk of tendinopathy,’ says Dr Rachael Mary McMillan, a lecturer in physiotherapy at La Trobe University in Australia. ‘Research has linked reduced oestrogen levels in postmenopausal women with declines in collagen synthesis and tensile strength.’ The prevalence of Greater Trochanteric Pain Syndrome (pain at the side of the hip or buttock, often relating to one of the gluteal tendons) has also been shown to be higher in postmenopausal women.

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Dealing with menopause symptoms

We’ve covered the importance of exercise, good nutrition and listening and responding to your changing energy levels, body and mood. But what if you’re doing all of that and still suffering some, or God forbid, all 32 menopausal symptoms listed on the Menopause Support Symptom Checker?

‘Don’t suffer in silence,’ says Dr Brown. ‘I always recommend looking at lifestyle first – nutrition, exercise, sleep, self-care – but women should definitely consider whether HRT might be a good additional option.’

The Fawcett Society survey found that of women who go to their GP and are confirmed as being menopausal, only 39% are offered HRT, even though current National Institute for Care and Health Excellence (NICE) guidelines recommend offering it for some specific menopausal symptoms. The guidelines, however, do emphasise the importance of an individualised approach – something Brown fully agrees with. ‘It’s a very individual decision whether to take HRT and if so, for how long,’ she says. ‘Women need at least an annual review to check on dose, symptom relief and to optimise their lifestyle. We need to review any changes to their medical or family history and ensure that we are practising according to the most up-to-date research, which is likely to change in the years to come.’

It’s worth taking the NICE guidelines with you to a doctor’s appointment about menopause treatment. A list of your symptoms is also useful. Apps, such as Balance, allow you to log and track your symptoms and download a report. Ask if the practice has a menopause specialist, or check the British Menopause Society website, which lists accredited professionals working within the NHS and privately.

It was sleeplessness (accompanied by crushing night-time anxiety) and perpetual exhaustion that compelled me to bring up HRT with my GP. I was prescribed oestrogen as a patch and progesterone as a pill and my symptoms are now all either much reduced or gone completely. My experience is mirrored by many runners I spoke to. One said that when perimenopause hit, aching joints and weight gain stopped her running altogether. ‘Now I’m on the right dose of HRT, running again and feeling better.’

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To HRT or not to HRT?

There’s still a lot of confusion and negativity surrounding HRT, much of which stemmed from the results of the 2002 Women’s Health Initiative Study, which found that breast cancer risk was doubled among HRT users, causing widespread panic and abandonment. However, critics have argued that the synthetic hormones used in the study are different from those now prescribed and that the average age of subjects was 63 – long past menopause and, due to advancing age, more susceptible to breast cancer. In addition, many were overweight, which also raises breast cancer risk.

Most modern HRT is ‘body identical’ rather than synthetic. Derived from yams and with the same molecular structure as hormones produced by the ovaries, it’s considered safer. ‘Body identical HRT uses transdermal oestrogen – in other words, it’s applied to the skin, either in the form of a patch, gel or spray,’ explains Brown. If you still have a uterus, transdermal oestrogen is accompanied by micronised progesterone (Utrogestan), also derived from yams and taken orally.

HRT patches that contain both hormones – body identical oestrogen plus synthetic progesterone – are also still prescribed, but, says Brown, this doesn’t suit all women and won’t allow the individual hormone levels to be manipulated separately to tailor to each woman’s needs.

Dr Brown says that HRT has been a game changer for her own menopausal symptoms and among her patients, she has seen improvements in brain fog, sleep, joint pain, hot flushes, libido, training capacity and motivation. ‘The benefits outweigh the risks for most women,’ she says.

Not all women want or are able to take HRT, however. Thebe found that it made her symptoms worse. There are many non-hormone prescription medicines available for vasomotor and psychological symptoms, as well as herbal remedies (though you should discuss using these with your doctor). A high dietary intake of phytoestrogens, which occur naturally in soya products, has also been shown to be effective in reducing vasomotor systems, but the evidence isn’t strong enough for it to be recommended in the NICE guidelines.

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Post-menopause and running

The rocky road of menopause doesn’t go on forever, but post-menopausal absence of the associated hormones does, with an unequivocal impact on cardiovascular and bone health. Increasingly, there’s discussion about the potential role of HRT in mitigating these risks in the long term. For example, nine out of 10 studies reviewed by NICE showed a lower risk of fracture, or increased bone mineral density with HRT use. Meanwhile, a study published in the Journal of Women’s Health, looking specifically at the effect of transdermal oestrogen, found some evidence of a possible protective cardiovascular effect.

‘Most of us will live for more than 30 years post-menopause,’ says Muir. ‘We need to be much better informed about hormones and safe hormone replacement and not let the medley of symptoms or the long-term health effects of menopause bring us down.’

Thebe, however, rejects the portrayal of menopause as a ‘long-term hormone deficiency’, framing it instead as a natural life transition. This is echoed by the recent Joint Position Statement from the British Menopause Society, Royal College of Obstetricians and Gynaecologists and Society for Endocrinology on optimising menopause transition which states: ‘For most women, initiating HRT has a favourable benefit/risk profile. However, HRT should not be used without a clear indication and should not be used for the sole purpose of disease prevention. Menopause is a life stage and does not represent a deficiency state.’

‘It’s so important to stress that women can live long, healthy, vibrant lives with or without HRT,’ says Thebe. ‘There are amazing athletes out there in their 50s and 60s nailing it in marathons and ultras.’

While the debate continues about how best to deal with the symptoms of menopause and its effects on long-term health, one thing is clear: physical activity is one of the most important tools we have in weathering the storm, playing a pivotal role in maintaining health and preventing disease after menopause. It reduces the likelihood of cardiovascular disease, breast cancer and diabetes, increases muscle and bone mass and improves mood, cognitive functioning and overall quality of life.

That doesn’t mean you should – or will be able to – keep running in the same way as you transition through menopause and beyond. One friend of mine says that she can no longer run in the mornings because her energy levels are too low – she’s had to adapt to running later in the day, while another has switched her focus from racing to simply ‘getting out there’ and has, at last, regained her enjoyment of running.

While I’m back in my racing shoes now, I have a less rigid attitude to running than before. I work with my body, rather than seeing it as an enemy or a let-down. If I’m having a bad day, I’m more accepting of it. I find that knowing what’s behind it really helps to reduce the angst and self-flagellation. In fact, that’s one of the best things about post-menopause life: a more reflective and balanced attitude, following a period of turmoil and change. I’ll run if I feel like it and I’ll race when I feel like it. If I don’t, then I’ll savour whatever I do instead, be it a lie-in, cake and coffee, Pilates or a dog walk – with equal relish.

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How to approach training

Use Amanda Thebe’s chart to rate your energy levels from 1 (bone tired, depressed) to 10 (firing on all cylinders) and adjust your workout accordingly.

1-2

Go for a walk, even if you don’t feel like you can. Just ten minutes of walking typically improves your mood.

3-4

Do some light activity, like an easy swim, bike ride, jog or mobility session – some type of activity that feels good but isn’t a ‘workout’.

5-6

Do a reduced version of a planned workout, concentrating on form.

7-8

Attempt a planned workout. Sometimes it’ll go to plan, while at other times you might have to reduce the volume.

9-10

Seize the day!

To cope with hot flushes during a run, dress in layers so you can adjust body temperature. Drinking cold water or splashing it on your face also helps.

Allow more time to warm up before a workout. It might take 15-20 minutes of light running to ease stiff joints and sore muscles.

Drink more water. Night sweats and hot flushes – together with reduced fluid intake, owing to fears about urinary incontinence – can leave you dehydrated. This can increase the incidence of heart palpitations.

To help an HRT patch stay on through sweaty workouts, warm it for a few seconds with a hair dryer before applying it. Then, hold it firmly against your skin for at least 10 seconds.

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Runners’ stories

‘I now look out of the window thinking, I could go for a run’

Kerry Barnett, 51, County Durham

‘I started running at 41. I’ve never been fast, but I enjoy the social aspect and the fresh air. After my first marathon, which I loved, I embarked on a challenge to run 50 marathons and ultras before my 50th birthday. I did it – then perimenopause hit. Hot flushes, tiredness, weight gain, fatigue, brain fog… Sleep also became a problem, as I would wake with night sweats and a racing mind. I developed bilateral knee pain, too, which made running uncomfortable. I struggled to keep up with my younger friends and worried about holding them back, losing confidence and motivation. Running became an occasional activity, limited to 5K efforts where I would simply try to run without walk breaks.

I started HRT in early 2022, with a 50mcg oestrogen patch. This was gradually increased to 100mcg. My mood improved, my sleep was better and I wasn’t so achy, but I still had to have a nap every day and even reduced my hours at work. Now I’m doing much better. I’m no longer exhausted and now look out of the window thinking, “I could go for a run”, which is a great feeling to have again. The combination of HRT, gaining knowledge and respecting my body’s changing ability have helped me to navigate my menopausal transition.’

‘Running helped me through menopause without HRT’

Helen Nash, 59, Oxfordshire

‘I started running in my mid-forties, aware of menopause looming and wanting to give myself the best chance of getting through it well and into heathy old age. My menopause started when I was 51 and, apart from my periods stopping, my only other symptom was hot flushes, which were minor compared to those experienced by some non-running friends and my mother. I’ve avoided menopausal weight gain, which I definitely attribute to running. A few years ago, my energy levels dropped and I assumed it was menopause-related, but I was diagnosed with an underactive thyroid. So, I would recommend anyone struggling with energy to get that checked.

Running gives me energy and joy and helps me to work off the day’s stresses, whether it’s a chatty run with friends or some me time. It also gives me confidence, which I know can decrease around menopause. After my first marathon in 2018, I felt that I could achieve anything (although stairs were a challenge for a day or two). I’ve gone on to do more marathons and ultras. I’m not the fastest, but I love running and I’m 100% convinced that it helped me through menopause without HRT.’

Underneath a mom who’s doing it all may be a mom who’s also teetering on the edge of burnout. Call it the dark side of multitasking.

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Women can be the ultimate multitaskers, but this great strength also means they can have the highest risk of exhaustion. And moms, who are taking care of not just themselves but a family, too, are especially at risk.

“I always say that the mind gives out sooner than the body,” says clinical health psychologist Amy Sullivan, PsyD. “This can be true in exercise and also in mental exercise — and especially when we multitask.”

Dr. Sullivan explains why mom burnout is so prevalent and what you can do to cope — for your sake and your family’s.

What is ‘depleted mother syndrome’?

”Depleted mother syndrome” isn’t a recognized medical diagnosis. But it’s a term that’s become popular on social media to describe the very real burnout that parenthood can bring, especially in women.

“Women experience higher levels of stress and anxiety than men in their day-to-day decision-making,” Dr. Sullivan shares.

Men are more likely to base decisions on the facts and leave emotion out. Women, she says, typically make decisions based on both facts and emotion.

The emotional toll is compounded by trying to balance success at work, often being the primary caretaker for any children in the household, managing other family-related tasks and staying on top of housework… Mom burnout is real.

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“Holding your to-do list in your head is exhausting, too, so the act of managing all of these tasks can be overwhelming, leading to burnout,” Dr. Sullivan states. “All that juggling and those mental exercises — and the guilt from not doing it perfectly — results in women experiencing burnout more often than men.

Still, it’s important to recognize that any caregiver can experience these feelings of burnout. After all, raising little people can be really, really hard, especially when you’re also trying to manage your relationships, career, health and home. None of us is exempt from feelings of stress and overwhelm.

So, if you’re feeling these things but you’re not a mom? It’s OK. This article — and Dr. Sullivan’s guidance — are still intended for you.

Symptoms of mom burnout and how to recognize it

“Trying to do everything all the time leads to an imbalance that throws everything — including your emotions — out of whack,” Dr. Sullivan states. “If it goes on for long enough, it leads to burnout.”

The concept of burnout originally applied to job stress with three hallmark symptoms:

Lack of energy or exhaustion Feelings of negativism or cynicism Poor performance

But it might be a little tough to figure out how to apply those work-related burnout symptoms to your own life and the possibility of mom burnout. Here’s a look at how those symptoms could apply to you.

Lack of energy or exhaustion includes symptoms like:

Physical exhaustion

Mental fatigue

Low energy

Sleep problems

Feeling like you’ve run out of bandwidth, like having anything else added to your to-do list might break you

Feelings of negativism or cynicism could include:

Emotional ups and downs, like feeling sad, anxious and irritable

Feeling short-tempered or angry, whether or not you express it to others

Feeling resentful (toward your children, partner, etc.)

Experiencing the stress and shame of “mom guilt”

Poor performance may include:

Disconnecting from your social network or support system

Losing interest in things you love

Worrying a lot or feeling like you’re inadequate as a parent

Withdrawing or disconnecting from other people

Feeling like you’re “dropping the ball” in certain aspects of your life and responsibilities

How to deal with mom burnout

The first step to combating burnout, says Dr. Sullivan, is awareness.

“If you realize you have burnout — or are on the road to it — you need to find ways to manage it.”

Learn to live with the mess

“Social media gives us the idea that our house should look like an Instagram post,” recognizes Dr. Sullivan. “But sometimes, you have to accept that the dishes or vacuuming can be put off for a day, or that your child can just be comfy instead of stylish.”

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As you put off sleep to fold yet another load of laundry, try to pause and ask yourself: Does this actually need to be done right now? Or in this moment, is prioritizing yourself and your needs more important?

Here’s another example: It might feel “messy” to host your child’s birthday party at the bowling alley rather than creating a supposed Pinterest-worthy superhero-themed bash with custom tee shirts. But let’s be honest: Your kid is going to have a ton of fun either way, and you’ll save yourself hours of unneeded stress.

Quit playing the comparison game

Just because your neighbor has a three-course meal on the table by 5:30 doesn’t mean you’re a failure if you serve cereal for dinner sometimes.

“Let go of the ‘Superwoman’ label,” advises Dr. Sullivan. “You’re spectacular in some areas of life, but accept that other areas are a work in progress — just like all of us.”

Guilt is what happens when we judge our lives based on what others do (or at least, pretend to do on social media), she adds. “In reality, we only need to do what’s right for us and our family.”

And sometimes? That means serving cereal or PB&J for dinner — yes that’s ok, and probably preferred by your child.

Just say no

The more you say “yes” to others, the more you’re saying “no” to yourself.

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“Learn to re-evaluate your responsibilities and become OK with letting things go,” Dr. Sullivan encourages.

If you’re maxed out at work, let something else go, like not participating in this month’s book club or turning down a request to volunteer at an event at your kid’s school. At home, reevaluate your to-do list and consider outsourcing some of the house tasks to your partner, kids or a service, if that’s an option.

Remember: “No” is a complete sentence in and of itself. You don’t need to qualify your answer or give any rationale.

Breathe and move

The constant pressure from doing it all can result in too much of the stress hormone cortisol wreaking havoc on your body. This can cause memory deficiencies, mood swings and weight gain.

“Oxford’s 2024 word of the year was ‘brain rot,’” Dr. Sullivan shares, “referring to the fog that we feel because we use our phones too much.”

Counteract all of these negative effects through:

Deep breathing. Take slow, deep, grounding breaths throughout the day. Breathwork techniques can help move your body into a more relaxed and stress-free state, too.

Take slow, deep, grounding breaths throughout the day. Breathwork techniques can help move your body into a more relaxed and stress-free state, too. Exercise. Whether you set aside time to go to the gym or just take the stroller around the block a few times, getting moving can help you destress, among other health benefits.

Whether you set aside time to go to the gym or just take the stroller around the block a few times, getting moving can help you destress, among other health benefits. Meditation. If you’ve never meditated, it might sound daunting or time-consuming. But there are so many types of meditation that one is sure to resonate with you. You can even do it as you fall asleep!

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“These practices can all be very simple to bring into your everyday life and can go a long way for stress management,” Dr. Sullivan states.

Learn about conscious parenting

Conscious parenting is a practice that relies on mindfulness — being aware of who you are as a person and as a parent so you can act with intentionality.

“Mindfulness is a stress management technique where the goal is to stay in the present moment,” Dr. Sullivan explains. “You try not to look ahead to the future, where there could be anxiety, fear and uncertainty, or to the past, where we could see regret or remorse. It keeps you right where you are right now.”

Conscious parenting — and mindfulness practices in general — can help you feel less overwhelmed. If you’re not spiraling out about that to-do list, you can spend a moment … well, in the moment.

Take time for yourself

“Time?!” you’re thinking. “What time?!” But if you don’t carve out time to take care of yourself, burnout will only persist — and worsen.

As a parent or caregiver, you’re responsible for a lot of scheduling and activities for others. Which can make it far too easy to make yourself the last priority.

“I remind patients that the flight attendant tells you to secure your mask before helping someone else,” Dr. Sullivan illustrates. “If you don’t take care of yourself, you’ll implode. You can’t do anything or take care of anyone if you’re passed out from exhaustion.”

Not sure where to start? Try these 17 tips for prioritizing self-care. Yes, even if you feel like you don’t have time. Especially then.

When to reach out for help

It’s time to put an end to your depleted mother syndrome. And often, that means asking for help.

That could include getting the family involved, especially if they don’t recognize the signs of your burnout. Get your kids to chip in with chores and assign your partner the grocery shopping. Take the burden off your shoulders and spread out the work.

It’s also important to develop and maintain meaningful relationships with family or friends — and not just on social media. Dedicate time to quality, face-to-face interactions, too.

But if you can’t figure out where to start, or if you can’t overcome burnout on your own, consider meeting with a professional. You can even look for a therapist who specializes in working with parents.

“A psychologist or social worker can help you put one foot in front of the other,” Dr. Sullivan affirms. “They can also more easily recognize signs of stress in women and guide you on how to recover from mom burnout.”

We have become a society that prioritizes material success and achievement in our children and ourselves over time spent “being” with them and caring for ourselves.

Maybe it’s time to take a step back and take a good long look at what we are doing to ourselves with our do-everything, have-everything parenting styles.

According to U.S. Surgeon General Vivek Murthy’s new advisory, parents are struggling to cope with stress caused by shifting societal norms, pressures, and environmental factors that impact their mental health and, in turn, their children’s mental health. In fact, 48% of parents say that most days their stress is “overwhelming.” Even before Covid-19, parents reported a reduced ability to cope with the stress of parenting. What is indisputable is that children’s mental health depends on their parents’ mental health, parents’ mental health is in decline, and as a society, we have failed parents by promoting the myth that we can do it all and have it all, all at the same time.

Modern parenting isn’t easy. It has become increasingly difficult to manage a one-income working family due to economic and societal pressures on women to participate full time in the workforce. Two, full-time, intensely-working parents mean more stress, not only on the children but also on the parents. It means more juggling and balancing of child care arrangements, less time for self care, and more guilt. What we are not talking enough about is the fact that stressed-out and preoccupied parents, who are busy working outside the home and distracted by technology, have less time to spend with their children in a calm and relaxed state, raising children who are also more stressed and difficult to manage. It is cyclical: when children do not get their emotional and physical needs met by parents who are exhausted, depressed, anxious, and distracted, they become the squeaky wheel, expressing their pain through aggression, distractibility, and depression, just to name a few symptoms. When parents reorient themselves toward embracing their children’s needs, making the necessary sacrifices, and stepping off the merry-go-round of trying to balance it all, their children’s symptoms often diminish quite quickly.

In my opinion as a mental health professional, the origin of our stress as parents comes down to shifting our priorities away from focusing on children and their health toward a more self-centered approach and the belief that we can have it all without sacrificing anything.

The Surgeon General cites several reasons for this trend: social media, gun violence, child safety, poverty, economic strain, academic pressures, and parental isolation and loneliness. All of these factors certainly impact the stress levels today’s parents are reporting. But in my opinion as a mental health professional, the origin is deeper. It comes down to shifting our priorities away from focusing on children and their overall health toward a more self-centered approach and believing that one can have it all without sacrificing anything. This leads to excessive conflict, guilt, and anxiety—which can cause more stress. Parents often become excessively controlling and perfectionistic to compensate for these feelings, causing even more stress.

Children do not need perfect parents, perfect scores, or a perfect path to a perfect future. They don’t need fancy schools, expensive vacations, or a larger house. What they need are parents who are physically and emotionally present, relaxed, and unconflicted about where they should be. They need parents who feel joy in being with them rather than obligation and fatigue. Even when many parents are with their children today, they are not fully present due to technology, concerns over work commitments, or exhaustion from trying to do it all. The old saying “You can do it all, just not at the same time” rings true here.

We have become a society that prioritizes material success and achievement in our children and ourselves over time spent “being” with them and caring for ourselves. Even when we are with them, according to the Surgeon General, we are plotting out, strategizing, and planning their future success, whether it’s the next academic achievement, scheduled extracurricular activity, or social engagement.

We have failed our children and ourselves. We have bought into the myth that we don’t have to sacrifice anything to raise healthy children and to be healthy ourselves. To flourish, children need healthy parents, and, as the saying goes, a parent is only as happy as their least happy child. So maybe it’s time to take a step back and take a good long look at what we are doing to ourselves with our do-everything, have-everything parenting styles. Instead, we should focus on being with those we love, even if we must live a smaller life when raising small children. Maybe then, we can get back to a world where parents have time and space to parent, care for themselves, and ensure a future of health and happiness for their families.

Erica Komisar, LCSW is a psychoanalyst and author of Being There: Why Prioritizing Motherhood in the First Three Years Matters and Chicken Little the Sky Isn’t Falling: Raising Resilient Adolescents in the New Age of Anxiety.

Editor’s Note: The opinions expressed in this article are those of the author and do not necessarily reflect the official policy or views of the Institute for Family Studies.

If you’re a people-pleaser, you might be known for doing whatever it takes to make others happy. Although being kind and helpful is generally a good thing, going too far to please others can leave you emotionally depleted, stressed, and anxious.

This article covers the traits, causes, and negative impact being a people-pleaser can have. It also discusses tips to help you stop putting others before your own well-being and ensure that you take care of your own needs.

Press Play for Advice On How to Stop Being a People-Pleaser Hosted by therapist Amy Morin, LCSW, this episode of The Verywell Mind Podcast shares why people become people-pleasers and how to stop. Click below to listen now.

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What Is a People-Pleaser?

A people-pleaser is a person who puts others needs ahead of their own. This type of person is highly attuned to others and often seen as agreeable, helpful, and kind, but people-pleasers can also have trouble advocating for themselves, which can lead to a harmful pattern of self-sacrifice or self-neglect.

People-pleasing is associated with a personality trait known as “sociotropy,” or feeling overly concerned with pleasing others and earning their approval as a way to maintain relationships.

This behavior can be a symptom of a mental health condition. Some of the mental illnesses that are associated with people-pleasing include:

Signs You Might Be a People-Pleaser

People-pleasers tend to share a few common behaviors, such as:

You have a difficult time saying “no.”

You are preoccupied with what other people might think.

You feel guilty when you do tell people “no.”

You fear that turning people down will make them think you are mean or selfish.

You agree to things you don’t like or do things you don’t want to do.

You struggle with feelings of low self-esteem.

You want people to like you and feel that doing things for them will earn their approval.

You’re always telling people you’re sorry.

You take the blame even when something isn’t your fault.

You never have any free time because you are always doing things for other people.

You neglect your own needs in order to do things for others.

You pretend to agree with people even though you feel differently.

People-pleasers tend to be good at tuning in to what others are feeling. They are also generally empathetic, thoughtful, and caring. These positive qualities may also come with a poor self-image, a need to take control, or a tendency to overachieve.

While people might describe you as a giver or generous person, when you’re a people-pleaser, all of this work to keep others happy may leave you feeling drained and stressed.

Causes of People-Pleasing

To stop being a people-pleaser, it’s important to understand some of the reasons why you might be engaging in this kind of behavior. So what is the root cause of people-pleasing? A number of factors might play a role, including:

Poor self-esteem : Sometimes people engage in people-pleasing behavior because they don’t value their own desires and needs. Due to a lack of self-confidence, people-pleasers have a need for external validation, and they may feel that doing things for others will lead to approval and acceptance.

: Sometimes people engage in people-pleasing behavior because they don’t value their own desires and needs. Due to a lack of self-confidence, people-pleasers have a need for external validation, and they may feel that doing things for others will lead to approval and acceptance. Insecurity : In other cases, people might try to please others because they worry that other people won’t like them if they don’t go above and beyond to make them happy.

: In other cases, people might try to please others because they worry that other people won’t like them if they don’t go above and beyond to make them happy. Perfectionism : Sometimes people want everything to be “just so,” including how other people think and feel.

: Sometimes people want everything to be “just so,” including how other people think and feel. Past experiences: Painful, difficult, or traumatic experiences may also play a role. People who have experienced abuse, for example, may try to please others and be as agreeable as possible in order to avoid triggering abusive behavior in others.

The motivation to help others can sometimes be a form of altruism. A person might genuinely want to make sure that other people have the help that they need. In other cases, people-pleasing can be a way to feel validated or liked. By making sure that people are happy, they feel as if they are useful and valued.

Effects of Being a People-Pleaser

People-pleasing isn’t necessarily a bad thing. Being a concerned and caring person is an important part of maintaining healthy relationships with loved ones. It becomes a problem, however, if you are trying to win approval to shore up weak self-esteem or if you are pursuing the happiness of others at the expense of your own emotional well-being.

If you are devoting all of your time to making others happy and win their approval, you might experience some of the following consequences.

Anger and Frustration

While you might actually enjoy helping, you are also bound to experience frustration when you are doing things reluctantly or out of obligation. These feelings can lead to a cycle of helping someone, feeling mad at them for taking advantage, and then feeling regretful or sorry for yourself.

One study found that people with a strong need to please others were also more prone to overeating in social situations.

Anxiety and Stress

Efforts to keep other people happy can stretch your own physical and mental resources too thin. Trying to manage it all can leave you plagued with stress and anxiety, which can have detrimental effects on your health.

Helping other people can actually have a number of mental health benefits. But not leaving time for yourself means you might end up experiencing the negative health consequences of excess stress.

Depleted Willpower

Devoting all of your energy and mental resources toward making sure that others are happy means you are less likely to have the resolve and willpower to tackle your own goals.

Some research suggests that willpower and self-control may be limited resources. If you are using your mental resources to make sure that other people have what they want or need, it might mean that you simply have little left to devote to your own needs.

Lack of Authenticity

People-pleasers will often hide their own needs and preferences in order to accommodate other people. This can make it feel as if you are not living your life authentically—it may even leave you feeling as if you don’t know yourself at all.

Hiding your true feelings makes it difficult for other people to get to know the real you. Self-disclosure is important in any close relationship, but it isn’t effective if you aren’t disclosing your true self.

Weaker Relationships

If you are putting all of your efforts into making sure that you meet other people’s expectations, you may find yourself feeling resentful. While people might appreciate your giving nature, they may also begin to take your kindness and attentiveness for granted.

People may not even realize they are taking advantage of you. All they know is that you are always willing to lend a hand, so they have no doubt that you’ll show up whenever you’re needed. What they may not see is how thin you are stretched and how overcommitted you might be.

Niceness vs. People-Pleasing There is a distinction between doing things to be nice and doing things because you’re a people-pleaser. People often do nice things for a range of reasons: to feel good, to help, to return a favor, or to earn a favor. If you’re doing something because you are afraid that you’ll be disliked or rejected if you say “no,” there’s a strong chance that people-pleasing is at work.

Tips to Stop People-Pleasing

Fortunately, there are some steps that you can take to stop being a people-pleaser and learn how to balance your desire to make others happy without sacrificing your own.

Establish Boundaries

It’s important to know your limits, establish clear boundaries, and then communicate those limits. Be clear and specific about what you’re willing to take on. If it seems like someone is asking for too much, let them know that it’s over the bounds of what you are willing to do and that you won’t be able to help.

There are also other ways to create boundaries in your life to help reign in your people-pleasing tendencies. For example, you might only take phone calls at certain times to set limits on when you are able to talk.

You might also explain that you are only available for a specific period of time. This can be helpful because it ensures that you have control of not only what you are willing to do, but also when you are willing to do it.

Start Small

It can be hard to make a sudden change, so it is often easier to begin by asserting yourself in small ways. Changing behavioral patterns can be difficult. In many cases, you not only have to retrain yourself—but you also have to work on teaching the people around you to understand your limits.

Because of this, it can be helpful to start with small steps that help you work your way to being less of a people-pleaser. Start by saying no to smaller requests, try expressing your opinion about something small, or ask for something that you need.

For example, try saying no to a text request. Then work your way up to telling people “no” in person. Practice in different settings or situations such as when talking to salespeople, ordering at a restaurant, or even when dealing with co-workers.

Every time you take a small step away from people-pleasing, you’ll gain greater confidence that will help you take back control of your life.

Set Goals and Priorities

Consider where you want to spend your time. Who do you want to help? What goals are you trying to accomplish? Knowing your priorities can help you determine whether or not you have the time and energy to devote to something.

If something is sapping your energy or taking too much of your time, take steps to address the problem. As you practice setting those boundaries and saying no to things you don’t really want to do, you’ll find that you have more time to devote to the things that are really important to you.

Try Positive Self-Talk If you start to feel overwhelmed or tempted to cave, build up your resolve with positive self-talk. Remind yourself that you deserve to have time for yourself. Your goals are important, and you shouldn’t feel obligated to give away your time and energy on things that don’t bring you joy.

Stall for Time

When someone asks for a favor, tell them you need some time to think about it. Saying “yes” right away can leave you feeling obligated and overcommitted, but taking your time to respond to a request can give you the time to evaluate it and decide if it’s something you really want to do. Before you make a decision, ask yourself:

How much time will this take?

Is this something I really want to do?

Do I have time to do it?

How stressed am I going to be if I say “yes?”

Research has also found that even a short pause before making a choice increases decision-making accuracy. By giving yourself a moment, you’ll be better able to accurately decide if it is something you have the desire and time to take on.

Assess the Request

Another step toward overcoming people-pleasing is to look for signs that other people are trying to take advantage of your generosity. Are there people who always seem to want something from you but are suddenly unavailable if you need them to return the favor? Or do some people seem to be aware of your generous nature and ask because they know that you won’t say “no?”

If it feels like you’re being manipulated into doing things, take some time to assess the situation and decide how you want to handle the request. For repeat offenders or people who keep insisting that you should help, be firm and clear.

Avoid Making Excuses

It’s important to be direct when you say “no” and avoid blaming other obligations or making excuses for your inability to participate. Once you start explaining why you can’t do something, you are giving others a way to poke holes in your excuse. Or you may be giving them the chance to adjust their request to ensure that you can still do what they are asking.

Try using a decisive tone when you decline something and resist the urge to add unnecessary details about your reasoning. Remind yourself that “no” is a complete sentence.

Remember that Relationships Require Give and Take

A strong, healthy relationship involves a certain degree of reciprocity. If one person is always giving and the other is always taking, it often means that one person is forgoing things that they need to ensure that the other person has what they want.

Even if you enjoy pleasing others, it is important to remember that they should also be taking steps to give to you in return. If you are always giving and they are always taking, you might be in a one-sided relationship.

Help When You Want to Help

You don’t need to give up being kind and thoughtful. Those are desirable qualities that can contribute to strong, lasting relationships. The key is to examine your motivations and intentions. Don’t do things only because you fear rejection or want the approval of others.

Keep doing good things, but on your own terms. Kindness doesn’t demand attention or rewards—it simply requires a desire to make things better for another person.

The Takeaway

If being a people-pleaser is making it difficult to pursue your own happiness, find ways to set boundaries and take back your time. Remind yourself that you can’t please everyone. If it’s interfering with your well-being, talk to a mental health professional. A trained therapist can help you manage your behavior, prioritize your own needs, and establish healthy boundaries.

Eldest daughter syndrome is a colloquial term used to describe the complex experience of being the eldest female-identifying child. If you are a big sister or the oldest girl in your family, you probably already have a sense of what we’re talking about.

This experience stems from birth-order dynamics that tend to occur in families; in this case, eldest daughters are often given outsized responsibility for caregiving, household responsibilities, and emotional labor. Eldest daughters often assume these duties at an early age, a burden that can shape personality, behaviors, relationships, and well-being throughout childhood, adolescence, and adulthood.

According to San Francisco therapist Dr. Avigail Lev, the dynamics within a family depend on factors such as the number of siblings. Suppose she is put into a parentified role where she has to mother, nurture, or take responsibility for these younger siblings. In that case, it can have a significant impact on her relationship and interactions with them.

Remember that eldest daughter syndrome isn’t a condition recognized by the official “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5-TR). Instead, it is a pattern many people have noticed in their lives, either from first-hand experience or by witnessing these effects in their own families.

At a Glance Eldest daughter syndrome may not be a formally recognized term, but it’s an experience that is familiar to many girls and women. This role often comes with burdens and challenges that can have a lasting effect on behavior, relationships, and emotional well-being. Keep reading to learn more about why first-born daughters often become ‘parents in training’ and the complex ways this can affect relationship dynamics.

Understanding Eldest Daughter Syndrome

Both traditional gender roles and birth-order effects influence the pressures felt by eldest daughters. Gender stereotypes suggest that women should be nurturing, natural caregivers, making the eldest daughter one of the default caregivers in the family. Among siblings, eldest siblings tend to face higher expectations when it comes to achievements, behaviors, and responsibilities placed by parents.

“The eldest daughter or eldest siblings, in general, are kind of like the ‘test’ siblings because they are the first child. The next child gets better treatment, benefiting from the learnings from the first child,” Dr. Lev says.

This two-fold threat means eldest daughters often face incredibly high expectations from family members. These daughters are expected to set the ‘gold standard’ example that other siblings will follow. They also experience parentification from an early age, where they are expected to take responsibility for their younger siblings, acting almost as a defacto parent when mom or dad aren’t around.

From setting a good example for siblings to follow to being expected to step into a parental role at a moment’s notice, eldest daughters often grapple with responsibilities far beyond their years and developmentally appropriate abilities.

Parentification is a phenomenon in which children are forced to assume roles similar to those of an adult or parent long before they are developmentally prepared for such responsibilities.

Even still, eldest daughters are often tasked with taking on household tasks and chores that younger siblings are never given. This can also put first-born girls in the position of playing the villain or scapegoat in the family. They are often described as bossy or domineering by younger siblings, but also face the blame from parents when things don’t go according to plan.

This creates enormous pressure to succeed, contribute to the family’s success, and ensure everyone is cared for, happy, and content.

Scientific Evidence of Eldest Daughter Syndrome

Eldest daughter syndrome has received considerable attention on social media in recent years, but researchers have also found solid evidence to support this tendency. In one 15-year longitudinal study conducted by researchers at the University of California-Los Angeles, researchers found that first-born daughters mature faster and are more likely to experience adrenal puberty.

Adrenal puberty involves changes such as the growth of body hair and certain aspects of cognitive maturation without other aspects of puberty, like breast development and menstruation. The study found that adrenal puberty was more common in eldest daughters whose mothers experienced high levels of prenatal stress.

The researchers suggest that such early maturation enables eldest daughters to help their mothers raise subsequent children.

The Psychological Impact

Being the eldest daughter in the family can come with additional emotional stress. Research has shown that parentification is associated with a range of negative consequences, including increased anxiety, depression, eating disorders, and personality disorders. While it can help children become more efficient in terms of task management and school achievement, this can contribute to problems like compulsive overwork.

The eldest daughter usually has the most expectations or responsibilities placed on her, feeling pressured to succeed, achieve, or take care of the family. They’re more likely to feel shame and guilt but also tend to be more independent. — AVIGAIL LEV, PSYD

Girls who experience eldest daughter syndrome may face challenges with:

Perfectionism

Research suggests that first-born children tend to have more advanced cognitive development, which may help them become more prepared for school. This can be advantageous, but it can also contribute to high expectations and perfectionism.

Eldest daughters may experience tremendous pressure to meet their parents’ and other family members’ high expectations. This can lead to high achievement, but it can also contribute to high levels of perfectionism that can damage mental well-being.

Anxiety

This tendency toward perfectionism combined with the high level of responsibility that eldest daughters are given can become a recipe for anxiety and stress. Trying to fulfill many roles, take on too many tasks, and meet everyone’s expectations can cause the eldest daughters to feel overwhelmed.

Identity Challenges

Girls may also find themselves struggling to create an identity outside of the roles imposed on them by their families. This can make it hard to identify and pursue personal goals that are separate from their family’s expectations.

Relationship Problems

Dr. Lev notes that sibling relationships can vary depending on the siblings’ gender. With younger brothers, there is often less competition and less resentment. Relationships with younger sisters may be more complicated, she notes.

“Usually, with two female daughters, the younger sibling is more carefree and confident, while the older sibling tends to be more responsible, more successful, and sees the family dynamics more accurately than the younger siblings,” Dr. Lev says.

The parentification that eldest daughters experience within their own families can carry over to later adult relationships, including romantic relationships and friendships. It isn’t uncommon for eldest daughters to take on a similar role of responsibility within their friend groups or with their partners.

This can make it hard for them to assert their own boundaries, and they may find themselves drawn to people who rely on them for support and care.

Self-Esteem

High expectations and perfectionism often leave eldest daughters feeling like nothing they do is good enough. This can have a damaging effect on self-concept and self-esteem.

Lack of Support

Eldest daughters often find themselves tasked with solving problems and caring for others on their own. Because they always feel like they need to be strong and self-reliant, they may struggle to ask for help when they need it. This can create feelings of isolation and loneliness and make it hard for people to get the support that they need.

Eldest daughters need to find a way to balance their own needs with the family’s needs. But this isn’t always easy, particularly when you’ve been conditioned to take on more responsibility.

Unless they learn to find a balance between these competing demands, girls and women may find themselves struggling with feelings of guilt, anxiety, poor boundaries, and excessive pressure.

Cultural and Societal Factors

Cultural and societal norms can also contribute to eldest daughter syndrome. Cultural norms may dictate that elder siblings fulfill certain roles in the family, particularly when those children are girls.

These norms also intersect with traditional gender roles and expectations. Because stereotypical norms suggest that women and girls are nurturing caregivers, eldest daughters are often tasked with living up to these roles.

Social and economic inequities also impact eldest daughters in various ways. When families face economic hardships, the oldest daughter may need to work to provide financial support or give up other opportunities to care for siblings while her parents work. These inequalities can impact other areas of her life, including access to education, work advancement, and healthcare.

Eldest daughters from marginalized backgrounds also face the compound effects of parentification, discrimination, and systemic barriers that further harm their opportunities and access to resources.

Breaking the Cycle

Dr. Lev explains that the single most important thing you can do to cope with being the eldest daughter is to let go of the need to have your family see your reality. “If you’re in the villain role in the family, see if you can just accept it and not try to change the family system’s perspective,” she says.

“The eldest daughter usually views the family system very differently if she has siblings. The younger siblings tend to idealize the parents and see the better parts of the parents and the family system. The eldest daughter needs to let go of any desire to shape the perspective or get them to see reality,” she explains.

Other strategies that Lev suggests include the following:

Learn Assertiveness Skills and Develop Strong Boundaries

Because eldest daughters are often conditioned to take responsibility for others, it’s important to create strong boundaries and learn how to assert one’s needs when such lines are crossed.

Dr. Lev notes that eldest daughters are sometimes more susceptible to getting into relationships with people who are needy, codependent, or who push her into a caretaker role.

“She needs to have very good boundaries, assert her needs, and stand up for herself,” she says.

However, eldest daughters should be patient with themselves if they struggle with this process. This is because they’ve learned to feel loved through this parentified role and may feel a lot of guilt setting boundaries because they have grown up believing they are responsible for the duties they were assigned.

Differentiate Between Independence and Excessive Self-Reliance

The sense of independence you might have gained as the eldest daughter can be a strength, but it can become a hindrance if it leads to your becoming so self-reliant that you cannot ask for or accept help when needed.

Consider situations where you might be taking on too much and look for opportunities to get help and nurturing from others instead of being the one always to give it, Dr. Lev says.

Practicing Self-Compassion and Self-Care

Dr. Lev also recommends strategies like practicing self-compassion and loving-kindness meditations. This can be a powerful tool for learning to give yourself the sort of kindness, compassion, and care that you might not have received as a child.

Other self-care strategies that can help: Dr. Lev also recommends learning: Nonviolent communication

Self-compassion tools

Emotional regulation skills

Mindfulness exercises

Consider Therapy

If you are struggling with the effects of eldest daughter syndrome, consider talking to a licensed mental health professional. Psychotherapy can be a great way to process your experiences and develop new coping skills to improve your behaviors, thinking, emotions, and relationships.

“Learning tools from schema therapy to reparent herself and heal her inner child involves giving herself the things she was not given as a child and learning to meet the needs that were not met,” Dr. Lev says.

The Best Online Therapy Programs We’ve tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain.

Personal Stories and Perspectives on Eldest Daughter Syndrome

Kristen Jacobsen, LCPC, a licensed therapist and owner of Cathartic Space Counseling, has personal experience with the heavy toll that being the oldest daughter can bring. She notes that as the eldest daughter in her family, there was constant pressure to set the right example, put her sibling’s needs before her own, and act as the mediator in disputes.

Kristen Jacobsen, LCPC While this nurtured a sense of responsibility and empathy, it also left little room for vulnerability or personal struggles. I found myself adopting a ‘strong facade,’ even when I felt overwhelmed. — Kristen Jacobsen, LCPC

In her own life, she noticed that this early conditioning led to people-pleasing tendencies. “In friendships and romantic relationships, I’d automatically assume the role of the listener, the supporter, always ready to offer advice or a shoulder to lean on, sometimes forgetting that it’s a two-way street,” she explains.

For Jessica Plonchak (LCSW, MBA, LCADC), the Executive Clinical Director at ChoicePoint Health, being the eldest daughter meant guilt trips and a prevailing feeling of being insufficient.

In addition to protecting and caring for younger siblings, she also describes the need to protect parents from seeing these struggles. Plonchak explains that this often means needing your parents but feeling like you can’t ask for help because they are busy tending to the needs of younger siblings. This can create an upside-down dynamic, where you feel you can’t express discontent with the situation or allow parents to see your struggles for fear of hurting them.

Jessica Plonchak(LCSW, MBA, LCADC) As the eldest daughter, I am always looking for ways to make sure that my parent’s needs are put above mine, no matter what emotional turmoil I am going through myself. — Jessica Plonchak(LCSW, MBA, LCADC)

The emotional burdens of being the eldest daughter can interact with other aspects of identity for women and girls from marginalized backgrounds. One TikTok creator noted the challenges of being the eldest daughter in an African household. The result, she notes, was becoming “a chronic people pleaser who takes on more than they can handle.”

Keep in Mind

If you are the eldest daughter in your family, you probably know exactly how challenging (and often draining) it can be to juggle all of the myriad expectations and demands placed upon you by parents, siblings, and society. So when viral social videos and articles refer to this phenomenon as “eldest daughter syndrome,” you likely recognize these symptoms in yourself.

It’s important to remember that every family is unique. Being the eldest daughter can also create strengths, including autonomy, resilience, and the ability to take charge when needed. The key is to establish healthy boundaries, take time to care for yourself, and don’t shy away from asking for a helping hand when you need it.