There is a particular kind of tiredness I hear about more and more in my practice. It does not look like a crisis. The woman describing it is usually well dressed and articulate. She has arrived on time and she makes a joke about the chaos at home. And then, somewhere in the first half hour, she says something like: I just don’t know how much longer I can keep doing this.
She is not falling apart. That is the problem. She is holding everything together, and has been for so long that nobody, including her, has noticed what it costs.
This is not only my impression. Earlier this year the British Association for Counselling and Psychotherapy surveyed 2,000 women over 50 in the UK. Nearly two in three said they were struggling with their mental health. Of those, nine in ten had never asked anyone for help. When asked why, the most common answer was that they felt they had to hold it together for other people.
Therapists across the profession describe the same thing in younger women too: an outward appearance of coping, and underneath it a steady build up of exhaustion, guilt and quiet resentment.
Why it happens
Part of it is simple arithmetic. Many women are carrying work, children, ageing parents and a household at once, and the planning behind all of it tends to sit in one head. That invisible work never finishes, so there is never a natural moment to stop.
Part of it is the world we are living in now. People everywhere report feeling more anxious about events they cannot control, from wars to the cost of living. When the outside world feels unstable, many women respond by working harder to keep their own small world steady. It is an admirable instinct. It is also exhausting.
And for women in their forties and fifties there is often a hormonal layer that nobody mentions. Perimenopause can bring anxiety, poor sleep and a foggy, flattened mood well before any of the better known symptoms. Many women assume they are simply failing to cope, when their body is changing underneath them.
What holding it together costs
The body keeps a record even when we do not. Sleep goes first. Then patience. Small things start to feel enormous, and joy becomes something you remember rather than feel. Relationships suffer too, because the person who looks after everyone is often the last person anyone thinks to look after.
The danger of quietly coping is that it can go on for years. By the time someone reaches out, the tiredness has often turned into something heavier.
Something you can do this week
You do not need to overhaul your life. Start smaller than that.
Tell one person the truth. Not the funny version, the real one. Choose someone you trust and say: I’m finding things harder than I let on. You may be surprised how often the reply is: me too.
Then take one thing off the invisible list. Not a chore you will feel guilty about later, but one piece of the planning: who remembers the birthdays, who books the appointments. Hand it to someone else and let them do it their way.
And notice when you say I’m fine. Just notice it. Awareness is where change begins.
When to talk to someone
If you recognise yourself here, and the tiredness has lasted for months rather than weeks, it is worth speaking to a professional. Therapy is not only for crisis. It is a place where, for an hour, you do not have to hold anything together at all.
I normally see clients online, but face to face meetings are possible in all my locations, depending on my travel schedule; please ask. If any of this sounds familiar, I would be glad to hear from you.
Katya Thain
Source: British Association for Counselling and Psychotherapy survey of 2,000 UK women aged 50 and over, January 2026.