Twelve people tell you the presentation was excellent. One person mentions the timeline could have been tighter. It is eleven at night and you are still thinking about the timeline.

Dr. Siân West, board-certified OB-GYN and menopause specialist, takes apart imposter syndrome in midlife women: why it resurfaces in your forties and fifties, why perimenopause brain fog makes it worse, and what actually helps.

The pattern has a name and about fifty years of research behind it. Impostor phenomenon was first described in 1978 by psychologists Pauline Clance and Suzanne Imes, and their subjects were not underachievers. They were high-achieving women with real credentials who were privately convinced they had fooled everyone. A 2024 meta-analytic review of more than a hundred studies and over forty thousand participants found women scoring higher than men on measures of imposter feelings. The gap is modest and varies by field, but it is real and it has not shrunk over time. One survey of women executives put it at seventy five percent. In a survey of UK orthopedic surgeons, ninety two percent reported moderate to intense imposter feelings, women scored higher than men, and almost half said it had discouraged them from applying for leadership roles.

The episode separates two things that get confused constantly: being genuinely new at something, and being a fraud. Being a beginner at a format is not the same as being a beginner at the work. Siân talks openly about her own version of this, from a year spent opening a telehealth practice, posting online and launching this show in public.

It also makes the connection to what your body may be doing right now. Perimenopausal cognitive change is measurable. In the SWAN cohort, women were given the same cognitive test repeatedly over four years. Premenopausal and postmenopausal women improved with practice, which is what normally happens. Women in late perimenopause did not. Their scores did not decline, they simply stopped improving, and the effect resolved after the transition. If you are already primed to doubt your competence, a blanked-out name in a meeting does not land as a hormone thing. It lands as confirmation. That is a hormonal transition affecting focus and word retrieval. It is not a verdict on whether you know your job.

If you have been losing your train of thought mid-sentence, blanking on a word you have known for thirty years, or going back to work after time away and feeling like a visitor in your own career, this one is for you.

In this episode:

What the 1978 impostor phenomenon research found, and who Clance and Imes actually studied

What the 2024 meta-analytic review shows about the gender gap in imposter feelings

Why imposter syndrome spikes in midlife: returning to work, watching younger colleagues move up, wondering whether your moment passed

Why "fake it till you make it" makes it worse

What the SWAN study found about perimenopause and cognitive performance, and why the finding is more reassuring than the headlines

How brain fog feeds self-doubt directly

The difference between being new at the format and being new to the work

Why 92 percent of surgeons in one survey reported imposter feelings, and what it cost them

Three things to do: the friend test, a script for the moment it hits, and an evidence file on your phone

Feeling like you do not fully know what you are doing is usually a sign you understand how much there is to know.