It's Not a Discipline Problem

On Dr. Gillian Goddard's The Hormone Loop — and the science behind what I lived without knowing it.

I was presenting at a tech conference a few years ago. Klieg lights, white button-down, jacket on top. A hot flash hit. The guy next to me — someone who is very empathetic — leaned over and said, why don’t you just take the jacket off?

Uhm, no.

I obviously knew I was having a hot flash, which I couldn’t control. What I also couldn’t control was that my brain had decided this was also a great moment to check out. Hi, brain fog, nice of you to show up now.

Fan-freaking-tastic.

I had to present anyway. I couldn’t bail — especially as a woman in tech. You just don’t.

That’s perimenopause. You can know exactly what’s happening and still not be able to do anything about it. Treatment of the symptoms helps. It doesn’t always stop it. What I didn’t have at the time was the full picture of why — the biology behind what was happening to my brain and my body. Understanding that would have mattered.

That’s what Dr. Gillian Goddard’s book The Hormone Loop gives you. It’s not you. It’s not a discipline problem. There are changes happening behind the scenes that are worth understanding.

About Dr. Gillian Goddard

Gillian Goddard is an endocrinologist and the author of The Savvy Patient and the book The Hormone Loop. She is an adjunct assistant professor of medicine at NYU Grossman School of Medicine. She lives in Westchester, New York with her family.

The Science Nobody Explained to Me

Gillian was kind enough to have me on her show ‘The Savvy Patient’ a few months ago to talk about accountability coaching and time management. Early in our conversation, she laid out the biology: estrogen potentiates dopamine, and dopamine is key in directing attention. When estrogen drops during perimenopause, dopamine signaling changes — which is one of the reasons women in perimenopause feel their focus and concentration decrease. And she made a point worth sitting with: this isn’t only a story about women with ADHD. Every woman’s estrogen is falling during perimenopause, which means every woman’s attention is affected to some degree.

That’s the science. Here’s what it looks like on the ground.

Everything Is Urgent, So Nothing Is

I’ve been telling clients for years that it takes 23 minutes on average to refocus after an interruption. Most people hear that and think it’s a discipline problem. It isn’t. The always-on workplace — Slack, Teams, the reflexive calendar accept — has created an environment where everything feels urgent, so nothing actually is. And that environment lands especially hard on a brain that is already in transition.

Here’s what I see in practice: a woman runs through her list. College applications, youngest kid’s high school situation, doctor’s appointment she keeps pushing, house needs painting. And then, somewhere in the middle of all of it: she needs to figure out whether to leave her marriage. Dropped in like it belongs on the same list as the grocery run.

That’s not disorganization. That’s what happens when there’s no structure to sort what’s actually on someone’s plate — no way to distinguish what’s core from what’s noise, what requires her specifically from what can be deputized. The brain clutter isn’t random. It’s the predictable result of too many inputs with no system to process them.

What got you here is not going to get you through this next phase. I say that to clients constantly. Gillian’s book is the science behind why that’s true.

About The Hormone Loop

Gillian is an endocrinologist, and the book reflects that — it covers the entire hormonal system, from puberty through menopause, so you can understand what’s happening in your body and have better conversations with your doctor. You can read it cover to cover or use it as a reference for wherever you are right now.

You can get it here.

And if you want more from Gillian, start with these two pieces on The Savvy Patient:

• What is the Hormone Loop? — an excerpt from the book that explains the foundational concept

• Is The Hormone Loop for me? — Gillian answers the questions she heard most from readers before publication

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This Week, Try This

Identify your two or three table setters — the things that have to be in place before you can actually focus. Maybe it’s a clear desk. Maybe it’s lunch made. Maybe it’s your gym bag out the night before. Whatever they are, set them up before you sit down to work this week and notice what it does to your ability to get started.

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Two final things:

1. When Gillian had me on her show back in early March, I had never done a Substack collab so I inadvertently shared this post without any context back then. Then life got in the way with my mom. So I’m re-sharing this post during the week of Gillian’s book launch.

2. This post does not constitute medical advice or a provider-patient relationship of any kind with Gillian or myself. You should always check with your own doctor before starting any kind of health regimen.