HeraSphere #30: Burnout is not your fault

Hi Friends,

Happy International Women's Day! Women are extraordinary: we lead, we build, we hold everything together. I want to celebrate us - and for each of us to continue doing amazing things for a long time. So let's talk about what happens when we carry too much.

I took only six weeks of maternity leave after my third child. I came back to a CMO role leading a lean marketing team for a 500 location service business — it felt like there was crisis after crisis. This was during COVID WFH, so there was no childcare, and I had 9 and 11 year old kids doing remote school downstairs. I was running on almost no sleep, managing a team & business that needed me fully present, and caring for a newborn who didn't know how to sleep. I kept thinking: "I just need to push through this part. It'll get better."

And honestly, much of it was self-imposed. Nobody told me to answer emails at midnight or skip lunch or say yes to every meeting. I was the one pushing myself and not setting boundaries — because that's what I thought high performers do. We assume the problem is that we're not doing enough, when the real problem is that we're doing too much. I completely neglected my own sleep, nutrition, exercise and mental health. I'm sure every woman reading this has had a similar experience.

I didn't have a name for what was happening until I heard Dr. Neha Sangwan speak at the YPO Women's Wellness Summit earlier this year. She's a burnout & communications expert and the author of Powered by Me. She burned out herself — at 34, working as a hospitalist — and has spent two decades building a framework for understanding it. When she described what burnout actually is, I felt that I could finally stop blaming myself.

I think a lot of us need that same permission. So lets talk about it during International Women's Month.

The TL;DR

• Burnout is a clinical triad — exhaustion, cynicism, and ineffectiveness — that progresses through three phases most women don't catch until the last one.

• Dr. Neha Sangwan defines it as a net drain of energy across five levels: physical, mental, emotional, social, and spiritual.

• Research shows nearly half of midlife women are at high burnout risk, and the highest performers are the most vulnerable.

• The perfect storm of perimenopause, sandwich generation caregiving, and workplaces that haven't caught up deserves a systemic response, not self-blame.

What Burnout Actually Is

• The clinical picture has three parts: exhaustion, cynicism, and ineffectiveness. Most of us recognize the exhaustion. The cynicism — that creeping "why do I even bother" — gets mistaken for a bad attitude. The ineffectiveness gets internalized as losing your edge. All three are symptoms, not character flaws.

• Dr. Sangwan defines burnout as chronic stress that has not been successfully managed. She's direct about this: it's not the person's fault. Burned out people are often the highest performers. The same drive that builds careers builds burnout. It moves through three phases — Alarm (your coping starts to slip), Adaptation (you normalize feeling terrible), and Exhaustion (the system breaks). Most women catch it at Phase 3. Phase 2 just feels like everyday life.

• There's a stigma around burnout, and there shouldn't be. Too many accomplished women already carry imposter syndrome — the quiet fear that they don't really belong where they've worked so hard to get. Admitting to burnout feels like admitting defeat. So they push harder. They tell themselves: everyone is depending on me. I just need to power through.

• The mental load women carry is staggering and largely invisible. Camp signups, practice schedules, meal planning, school forms, the emotional temperature of everyone in the house — and increasingly, caregiving for aging parents. Coordinating medications, managing appointments, fielding calls. Doctors will tell you: it's almost always the oldest daughter, often the one who lives out of town, who knows every medication her parents are taking. I've talked to moms who can't put their feet up to read the Sunday paper because there's always a to-do list. I've never once heard my highly effective husband express that same guilt.

• We've all heard "put on your own oxygen mask first." The better goal is to build a life where you don't need the oxygen mask. I've met so many of these women — brilliant, capable, burning the candle at both ends — and I worry about their long-term health. Naming burnout doesn’t show weakness. It's the first honest thing you can do for yourself.

The Biology of Burnout

• Burnout has a biology, and it follows a predictable pattern. Your body runs on a stress response system called the Hypothalamic-Pituitary-Adrenalaxis (HPA) Axis — a chain reaction from your brain to your adrenal glands that releases cortisol when you're under pressure. In short bursts, cortisol is useful. It sharpens your focus and gives you energy. The problem starts when the stress never stops.

• First, cortisol stays elevated. You're wired, running on adrenaline, can't fully sleep, can't turn off. You might feel productive, but your body is already in alarm mode. Then your system adapts — your normal cortisol rhythm flattens. The morning spike that gives you energy and the evening dip that lets you rest both go blunt. You feel tired and wired at the same time. Eventually, the system burns out entirely. Cortisol production drops below normal. You're exhausted, foggy, and getting sick more often. It's a hormonal cascade.

• Brain imaging studies on people with clinical burnout shows consistent enlargement of the amygdala — the brain's fear and threat center — particularly in women. At the same time, there's measurable grey matter loss in the prefrontal cortex, the part of your brain responsible for decision-making, emotional regulation, and clear thinking.

• Burnout shrinks the part of your brain you need most to manage your life, while amplifying the part that makes everything feel like a crisis. And twin studies show that burnout is 33–36% heritable — meaning your genetic makeup partly determines how vulnerable your stress response system is to chronic overload.

• And if that wasn’t bad enough, chronic high cortisol levels are associated with hippocampal atrophy (shrinkage of the brain's memory center) and may increase the risk of neurodegenerative diseases like Alzheimer's.

The Warning Signs

• Physical: Fatigue that sleep doesn't fix. Headaches, digestive issues, getting sick more often. Your body is keeping score even when you're pushing through.

• Mental: Decision fatigue. Brain fog. Forgetting things you normally wouldn't. Thoughts stuck in comparison and judgment instead of curiosity.

• Emotional: Detachment from things you used to care about. Irritability that feels out of proportion. Doing good work and feeling nothing about it.

• Social: Pulling back from friends. Dreading interactions you used to enjoy. Relationships starting to feel transactional.

• The most dangerous sign: normalizing all of the above. "This is just how it is now" is the sound of Phase 2. It's where high performers get stuck, because they're very good at functioning through pain.

Why Midlife Women Are Ground Zero

• Research published this month shows nearly half of midlife women are at high burnout risk. For sandwich generation women — caring for kids and aging parents simultaneously — 64% are at breaking point. These are the women handling everything. That's the problem.

• As I wrote in a previous HeraSphere issue, menopause is a whole-body transition — it rewires your brain chemistry, metabolism, sleep, cardiovascular system, and stress response all at once. Perimenopause disrupts sleep, shifts hormones that regulate mood and cognition, and changes how your body processes stress. All of this hits in your 40s and 50s, right when professional and caregiving demands are at their highest.

• Many midlife women are being treated for anxiety when the real driver is burnout compounded by hormonal change. Understanding menopause as a transition — something you can navigate with intelligence — changes the conversation from "what's wrong with me" to "what do I need right now."

• Companies are losing their most experienced leaders and calling it attrition. Nearly half a million women left the US workforce in 2025 under caregiving pressure. Caregivers at high burnout risk run medical costs roughly 67% higher than lower-risk peers. One reason there are still so few women at the top — they're either opting out or burning out.

The Five Energy Levels — Where Are You Draining?

Dr. Sangwan breaks burnout into five energy levels. Burnout hits differently for everyone, and the key is figuring out where your specific drain is happening.

• Physical energy is the one we think of first — and the one we're best at ignoring. Are you sleeping well? Are you eating in a way that fuels you, or just grabbing whatever's fast? Are you moving your body, or has exercise become another thing on the to-do list you can't get to? When physical energy is draining, everything else gets harder. Your body is the foundation, and it's usually the first place burnout shows up — even if your mind hasn't caught on yet.

• Mental energy is about how your thoughts are running. Are you stuck in overthinking, comparison, or judgment? Can you hold a clear thought through a meeting, or does your focus scatter? When mental energy is low, decisions feel impossible, small problems feel enormous, and you lose the curiosity and creativity that used to come naturally.

• Emotional energy is where burnout gets personal. Where in your life do you feel angst — and where do you feel joy? Can you name both? When emotional energy drains, you stop feeling the highs. You go through the motions. You do good work and feel nothing about it. Irritability spikes and patience disappears, often with the people you love most.

• Social energy depends on who you're spending time with and how those relationships affect you. Who gives you energy? Who takes it? Dr. Sangwan maps relationships on a spectrum — from broken exchanges where someone isn't really with you, to sacred ones where they're fully present. When social energy is draining, you withdraw. You stop reaching out. The people who matter most start getting your leftovers.

• Spiritual energy is about alignment. What gives you purpose? Do you trust yourself? Are your daily actions connected to what actually matters to you? When spiritual energy is low, you can have a full calendar and a successful career and still feel hollow. Dr. Sangwan calls burnout a wake-up call for misalignment of energy. She told us that authenticity — hearing your own voice louder than everyone else's — is one of the strongest indicators of long-term wellbeing.

• Want to know where you stand? Take Dr. Sangwan's free Burnout Quiz — it helps you identify which of these five levels are draining you right now.

Menopause is a period of transformation — a transition you can navigate with information and agency. Burnout deserves that same reframe. It's a biological signal that something in the system needs to shift. Dr. Sangwan’s Me, We, She framework is simple: when you burn out, everything downstream suffers — your relationships, your team, your family. Fixing it starts with you, but the ripple effect goes everywhere. If you’re feeling drained by life, please don’t feel shame. It’s biology, and your body knows it before your mind does.

Share this with someone who needs to hear the message.

Let’s take care of ourselves,
Lilly

P.S. Forward this to the woman who does everything for everyone and hasn't asked herself "am I okay?" lately.

If you’ve received this email from a friend and want to receive it in your own inbox

Everything I share in HeraSphere comes from careful research and personal experience, but it's meant to inform and inspire, not to diagnose or treat any medical conditions. Your body is uniquely yours, and what works for one person might not work for another. Always consult your healthcare provider before making significant changes to your diet, exercise routine, or wellness practices, especially if you have underlying health conditions or take medications.

ICYMI, here are a few past issues that you may enjoy: