In 1985, when Barton was 15, two of her music-academy classmates, Aruna and Rupa Anantaraman, died in the Air India bombing. Barton spent the following year listening to her idol, cellist Jacqueline du Pré, playing Sir Edward Elgar’s haunting Cello Concerto in E Minor on repeat.

Looking back, I’m not sure why I never connected my Elgar ritual to the loss of Aruna and Rupa. All I knew was it made me feel better. Now I understand why: People struggling with depression often gravitate to melancholy music. And it turns out we have healthy reasons for choosing sad songs when we’re down.

Psychologists used to consider this behavior maladaptive, a form of wallowing. But Jonathan Rottenberg, director of the mood and emotion laboratory at the University of South Florida, didn’t believe people would choose music that compounded their depression. “Their mood state is extremely unpleasant,” he pointed out. “They go [into] therapy and say, ‘I want to snap out of this.’”

He and a graduate student, Sunkyung Yoon, tested this hunch in a 2020 study using music rated by Western audiences as neutral, happy, or sad. Tracks ranged from Jacques Offenbach’s peppy “Infernal Galop” to Samuel Barber’s doleful “Adagio for Strings.” Overall, people with clinical depression showed a strong preference for somber music, saying it made them feel calmed, soothed, and “even uplifted.”

This won’t surprise anyone who has found comfort in Mozart’s Requiem or Lady Gaga’s “I’ll Never Love Again.” Sad songs never pressure us to snap out of it. In a survey of adult listeners, one described how downer tunes helped her “cry a little and then feel relieved, and move on.” Another said she felt “befriended” by the music.

Like an empathic friend, sad songs meet us where we’re at. And when we’re in a funk, chirpy lyrics can feel like annoying platitudes. How many people in a blue mood walk around singing “Don’t Worry, Be Happy”? To paraphrase an Internet meme about calming down, never in the history of “Cheer up!” has anyone cheered up by being told to cheer up.

Certain songs always make me misty-eyed, like the late singer Eva Cassidy’s soaring cover of Sting’s “Fields of Gold.” Another is Tracy Chapman’s “The Promise.” When she sings the words “I’ll find my way back to you,” she gets me every time.

Poignant music invites us to savor emotions that can be painful but also intensely beautiful. In fact, sad songs may stimulate our body’s pleasure responses, including “goose-bumps” and “chills,” as much as or more than happy music. And as noted in Japanese research, when songs make us weep or put a lump in our throat, music can trigger a cathartic release.

Even in moments of extreme suffering, music offers solace. A journalist friend, Jennifer Van Evra, told me about visiting her neighbor Roy in palliative care as he lay dying of bone cancer. Doses of morphine made him drift out of consciousness, but at times he’d revive in agonizing pain from the disease. On one visit, “he was inconsolable.” Knowing he loved music and had once been a churchgoer, Jennifer pulled out her phone and asked if he knew any hymns, “but he was too out of it to name any.” She played “Amazing Grace” followed by “Silent Night,” and to her amazement, he began to sing along. “You could just see this calm wash over him.”

Music reaches us at a level beyond conscious thought. More than any other artform, it is both “completely abstract and profoundly emotional,” wrote the late neurologist Oliver Sacks. “Music can pierce the heart directly; it needs no mediation.”

Early psychiatrists had an intuitive grasp of music’s mood-enhancing effects. In the mid-nineteenth century, specialists in Baden, Germany, believed individuals with mental illness healed best in a pastoral setting with plenty of music— especially Mendelssohn. The local asylum, Illenau, urged patients to sing in the choir, join the in-house band, and try writing their own compositions. Music and singing, Illenau officials wrote, were “indispensable” to patients as “therapeutic instruments.” Months after her stay, one former patient sent a letter requesting copies of her three favorite Illenau songs, saying they reminded her of her restored health and of “feeling all singing-like.”

Through the ages, though, no one knew what was happening in the brain when music calmed an agitated patient or roused a listless soldier from a catatonic state. At last, near the turn of the twenty-first century, a critical mass of scientists began to shed light on the mind-boggling chemicals and electrical patterns activated by music.

One of these scientists grew up in Argentina listening to pop music and tango like everyone else. But at age thirteen, Robert Zatorre got his hands on a vinyl recording of music by the Hungarian composer Béla Bartók. He started playing it out of curiosity—and was blown away. “I had chills down my spine. I had goose bumps,” he said. “I just felt this unbelievable sensation that I really couldn’t explain.” That day, he decided he would learn to play music and study it scientifically, too.

Zatorre trained as an organist while earning degrees in experimental psychology. When he joined the Montreal Neurological Institute (the Neuro) in 1981, it was one of a handful of centers in the world doing brain imaging in humans. Zatorre, still at the Neuro, explained to me how music gives us joy, and even euphoria, through some of the same pathways stimulated by chocolate, cocaine, and sex.

Zatorre and Valerie Salimpoor, a McGill graduate student, became the first to prove that music triggers dopamine in the brain. Dopamine is the main driver behind addictive behaviors such as gambling, compulsive shopping, and recreational drug use. Dubbed the “Kim Kardashian of molecules” by a British psychologist, this racy chemical prods us to get more of what we want and crave.

When music builds to a peak moment during, say, a drawn- out drumroll, we get a surge of dopamine. Then, if the climax exceeds our expectations—with, perhaps, a spectacular crash of cymbals—dopamine spikes again.

Dopamine isn’t the only chemical involved in musical pleasure, though. The brain makes its own versions of heroin, morphine, and cocaine. Known as “endogenous opioids” (“endogenous” meaning “of internal origin”), these chemicals give us everything from a “natural high” to a mild tranquilizing effect. Endorphins, for example, are short for endogenous morphines.

Whether extracted from poppies or made in the brain, opioid molecules behave in similar ways: They attach to tiny receptors throughout the brain and other organs, including the stomach, nervous system, and lungs. Plugged into our opioid receptors, these molecules can trigger a whole-body response to music, like the wave of euphoria fans have at rock concerts.

Along with his colleagues in Spain and France, Zatorre theorizes that music gives us two kinds of delight: intellectual enjoyment and physical pleasure—goosebumps, chills, prickles down the spine. In one study, listeners given a dopamine-enhancing drug said they liked the music significantly more than when they took a dopamine-blocking drug. Dopamine changed their reported enjoyment.

Next, in a prepublished study, Zatorre and colleagues repeated the experiment with an opioid-enhancing drug. This time, music listeners showed strong physical pleasure—goosebumps and chills—yet the drug had little effect on how much they said they enjoyed the music. An opioid-blocking drug didn’t change their reported enjoyment much either. Clearly, their bodies responded to music differently than their minds.

While the roles of dopamine and natural opioids remain “very much under debate,” said Zatorre, he believes dopamine may be responsible for our mental or aesthetic enjoyment of music, while opioids enhance physical pleasure in music.

This theory makes sense considering how the brain’s pleasure-and-reward pathways evolved. Early on, physical pleasures, from sweet foods to sex, helped keep us alive. As the human brain developed, though, we learned to find pleasure in things that required higher-level thinking, such as basking in Brahms. Cocaine and sex give us a rush of pleasure, but we also get hits of bliss from what neuroscientists call “aesthetic” or “cognitive rewards.”

Pleasure is life-affirming. In contrast, a lack of pleasure in normally enjoyable things is a hallmark of clinical depression. But tinkering with the brain’s pleasure chemicals in a lab isn’t enough to prove that music can lift depression or soothe anxiety. For this, we need documented mood changes in real people. Fortunately, we do have studies like these. Loads of them.

Over coffee with a new friend, I asked what she’d want to learn about in a chapter I was writing on music and mood.

“Anxiety,” she said, “because I have it.”

Despite holding a driver’s license for nearly two decades, up until four years ago, Liliana Moreno seldom got behind the wheel. As a child in Colombia, she was riding in the back of the family car when her father rounded a sharp corner—and collided with a bus. No one was injured, but the accident made her so skittish that she avoided driving until her son outgrew the after-school programs they could reach by bus. Luckily, she found something to soothe her nerves: music. Whenever she puts the key into the ignition, she plays chill tunes from artists such as Rüfüs Du Sol, an Australian group, or Nora En Pure, a deep-house producer born in South Africa. “It helps,” she said. “It’s my therapy.”

When I mentioned that her remedy has a scientific basis, she beamed.

The evidence comes from surgical wards, where patients with acute anxiety end up with more pain, a higher risk of infection, and longer recovery times. Although sedatives calm most patients, they also carry the risk of breathing problems, blurred vision, dizziness, and agitation. Anesthesiologists searched for alternatives.

At a Barcelona hospital, one group of surgical patients received a standard dose of Valium. A second group listened to half an hour of classical or new-age music, both the day of the procedure and the night before. Just before the surgeries, researchers measured patients’ blood pressure, heart rate, cortisol, and anxiety levels. They found no difference between the two groups. As a treatment for preoperative anxiety, they concluded, music was “as effective as sedatives.”

A lone study, however, shouldn’t convince anyone to swap Valium for Norah Jones. That’s where Cochrane comes in. This global network of evidence-based research conducts stringent reviews of dozens of studies to weed out dodgy health information. In four separate reviews of music for preoperative anxiety—the most recent covering twenty-six studies—Cochrane confirmed that music offers a “viable alternative” to standard sedatives.

Music may not soothe every soul, as some may be less responsive to its calming effects. Those suffering from severe anxiety, from phobias to post-traumatic stress, should seek professional help. Still, if music can compete with tranquilizers in a nerve-wracking hospital environment, in my eyes, it’s potent enough to take the edge off garden-variety anxieties, such as preflight jitters.

Then there’s stress. We tend to lump anxiety and stress together because both cause sleepless nights, fuzzy thinking, headaches, and irritability. Anxiety encompasses everything from acute fears to persistent phobias. Stress, on the other hand, starts as a physiological response. When we’re under threat, cortisol raises blood sugar levels for quick energy, while adrenaline causes our heart rate to quicken, readying us for “fight, flight, or freeze.” If the threat persists, our bodies stay on high alert, keyed-up in a state of chronic stress.

Here, too, music can dial us down. A Dutch review of 104 clinical trials described music’s “moderate tranquilising” effects as “very significant” for preventing and treating symptoms of stress. It didn’t matter whether people worked with a music therapist, heard live music in a group, or listened to recorded music alone. Based on results in a total of 9,617 participants, music lowered heart rate, blood pressure, and cortisol levels, along with nervousness, restlessness, and feelings of worry.

After a rough day at the office, though, how to choose the ultimate chill tune?

Music at 60 to 80 beats per minute, the pace of a resting heartbeat—a rhythm we hear in the womb—appears to lower stress best. Just 20 to 30 minutes of slow-paced music, noted the Dutch review, has “a direct stress-reducing effect.”

On YouTube and Spotify, playlists arranged by beats per minute are easy to find: slow tracks range from Otis Redding’s version of “My Girl” to “Take Five” by the Dave Brubeck Quartet. That said, dopamine increases most when we enjoy the music. And a listener’s preferences—not the music genre—has the greatest impact on brain connectivity in our default mode network, involved in empathy and self-awareness.

What if we loathe the tunes? Hypothetically, if we find them irritating (like the new-age Muzak I can’t stand) even so-called “relaxing” music could ramp up stress.

One listener’s medicine is another’s poison.

—

As a child, I learned a piece that sprinted up and down the cello in runaway triplets, exhilarating to play. Maybe it was the odd mix of a jolly tune in a foreboding minor key, but I never tired of this “Tarantella.” Not until decades later did I learn that the composer, William Squire, took his inspiration from a mysterious illness that had plagued the Mediterranean for several hundred years. While tending rows of tomatoes and spicy peppers, peasants developed sudden breathing problems, melancholy, and a “sensation of dying.” They blamed their symptoms on the venom of the European tarantula spider. Frenetic dancing to tarantella music was the only cure.

At harvest time in southern Italy, this musical antidote was in such demand that fiddlers reportedly wandered the fields like mobile first-aid units, ready to strike up a rousing tarantella at first bite. In Spain’s La Mancha region, eighteenth-century physicians treated more than fifty cases of “spider sickness” with everything from bloodletting to viper’s grass. In the majority of patients, however, only tarantella music restored the will to live.

But this remedy makes no sense. Vigorous dancing should cause the toxin to spread through the bloodstream faster, worsening symptoms instead of relieving them. Adding to the puzzle, many victims showed no sign of spider bites. What to make of this dubious illness and its musical cure?

Modern scholars have described tarantism as a “mass psychogenic illness” triggered by mental distress and spread to large numbers through “social contagion.” Belief in the spider sickness gave depressed peasants a socially acceptable culprit for their miseries under feudalism. More importantly, it gave them an excuse to get out of the field ruts and join in a mood cure that literally put a spring in their step.

I’ll bet the peasant remedy actually worked. In a large 2017 review, German researchers noted “highly convincing” evidence that music improves symptoms of depression and quality of life.

The poet Emily Dickinson described depression as “a funeral” in the brain. Interfering with work, school, and social relationships, this mood disorder brings persistent feelings of sadness and low self-worth, along with sleep problems, lack of energy, and, often, thoughts of suicide. While up to two-thirds of clinically diagnosed people may improve with antidepressants and talk therapy, in a Cochrane review, music therapy offered an extra boost compared to standard treatments alone.

Of course, music therapy isn’t the same thing as moping around listening to sad cello concertos. Music therapists have extensive university-level training in using music to treat physical, cognitive, and emotional issues. To improve hand- eye coordination, for example, a music therapist might ask a patient to play notes on a xylophone. Depending on the condition, from brain injury to extreme grief, people working with a certified music therapist might show improvements beyond what other treatments can offer. With depression, though, it’s unclear whether music therapy relieves symptoms any better than music listening “prescribed” by a doctor or nurse (known as “music medicine”). This puzzled me, because more often than not, a health strategy that involves human connection wins out.

In a study of cancer patients with low mood, music therapy and solitary listening offered similar benefits. Many patients preferred working with a music therapist, saying they liked the feeling of camaraderie and support. But others felt anxious or even hostile when a therapist handed them an instrument or asked them to sing. Left alone with headphones, one patient said, “You can concentrate more on your music, and it’s like it relaxes you more.”

Music, as Oliver Sacks said, “needs no mediation.” Our pleasure-and-reward pathways are easily stimulated by rhythm and song. Moreover, some scholars suggest the brain’s endogenous opioid system may also be directly involved in regulating mood. While the details are still being worked out, music is proving to be a fast-acting antidepressant. A 2020 analysis reported a “significant reduction” in depression symptoms from twenty- to forty-minute sessions of either music therapy or music medicine. And shorter treatment periods—twelve sessions or fewer—showed the most benefit.

Just about any music can offer temporary relief. Studies have used everything from European classical to Indian ragas, Irish folk to reggae, and lullabies to rock. The genre doesn’t seem to matter, as long as people have a choice. The more we like the music, the better our chances of experiencing a mild, depression-lifting euphoria. Depending on our tastes, the most effective musical antidepressant might be anything from a showstopper from Hamilton to the golden oldies Grandma used to sing while making pie.

Adapted with permission of the publisher from the book Wired for Music: A Search for Health and Joy Through the Science of Sound written by Adriana Barton and published by Greystone Books in October 2022. Available wherever books are sold.

Next: Looking to Improve Your Workout Performance? Change Your Music

Celeriac (also known as celery root or turnip-tipped celery) is a cousin of celery, but it’s grown for its gnarly, bulbous root instead of for its stalks. Botanically, celeriac is closely related to celery, but they are not interchangeable in cooking. Celeriac has a rough, light brown exterior while the interior flesh is firm and creamy white and has a parsnip-like texture. While celeriac looks nothing like celery, it maintains a bold celery flavour that is also faintly nutty with hints of fennel and parsley. Celeriac is widely available year-round, but is at its best between September and April.

Apart from being tasty, celeriac is a good source of fibre and vitamins B6, C and K. One cup of celeriac has around 75 percent of your daily recommended intake of vitamin K, a fat-soluble vitamin with a range of health benefits. It also contains about a third of the carbohydrates as potatoes per portion.

Vitamin K is the umbrella term for a family of compounds: There are two main types, vitamin K1 and vitamin K2. The main source of K1 are vegetables, especially dark leafy greens, while K2 is found in fermented foods like yogurt and is also manufactured by lactic acid-producing bacteria in the gut. Vitamin K1 is principally transported to the liver, where it regulates the production of blood-clotting proteins. Vitamin K2 moves to tissues such as artery walls, where it goes on to make other vitamin K-dependent proteins that work closely with vitamin D, another fat-soluble vitamin, in calcium metabolism and to support vascular health. The protein that K2 produces in your bones, osteocalcin, promotes bone mineralization, which improves bone density and strength, two things that typically decrease with age, especially post-menopause. In vascular muscles, which make up the walls of blood vessels, vitamin K2 produces matrix Gla-proteins, which prevent the calcification and hardening of arteries, helping to reduce risk of heart disease.

While vitamin K deficiencies are uncommon, eating vitamin K-rich foods will maximize vitamin D’s health benefits, like building bone strength, maintaining muscle and nerve function and boosting immunity. Seek out vitamin K-heavy veggies like kale, broccoli, cabbage and celeriac, and look for a vitamin D supplement that contains vitamin K2 to optimize the health benefits.

When picking a celeriac at the grocery store, seek out roots that are firm, unblemished and heavy for their size. Avoid roots with a greenish blush. They have been sitting out for longer and are less fresh. For easiest prep, lob off the bottom and top so that it sits flat on your cutting board, then remove the outer peel using a knife. Once cut, celeriac discolours easily, so store in a bowl of water with lemon juice or vinegar to prevent browning. To maximize freshness, store unpeeled celeriac in a sealed plastic bag in the fridge for up to three weeks, or peel, cut into chunks and freeze.

Celeriac pairs well with other fall flavours like apple, fennel and sage. Like other root vegetables, it’s wonderful when roasted, which brings out its natural sweetness. Mix cooked celeriac with other starchy vegetables, like potatoes, to create a lower-in-carbs mash to serve alongside sausages and top cottage pie, or blend into a pureed soup—it will add a silky texture without the need for dairy.

To maintain celeriac’s crunch, try it out in raw dishes like a slaw or salad. Cut peeled celeriac into thin matchsticks, then use it to create celeriac remoulade, a creamy, mustard-y slaw popular in France. For a crunchy, refreshing and unexpected fall salad, shave off into wider strips using a vegetable peeler and toss with apple and fennel.

Next time you hit the grocery store, seek out celeriac, the unsung hero of the root vegetable world, because sometimes ugly is also next-level delicious.

Laura Jeha is a registered dietitian, nutrition counsellor and recipe developer. Find out more at ahealthyappetite.ca.

Next: A Recipe for Celeriac Gnocchi with Brown Butter and Sage

Celeriac Gnocchi with Brown Butter and Sage

Makes: 2 servings
Prep time: 30 minutes  
Chill time: 30 minutes    
Cook time:  15 minutes   
Total time: 1 hour, 15 minutes

Ingredients

Gnocchi

• 1 medium celeriac (about 1 kg), peeled and cut into 1-inch pieces
• 1 egg yolk, beaten
• ½ tsp kosher salt
• ¼ tsp black pepper
• ½ cup grated parmesan cheese
• ¾ cup all-purpose flour

Brown-Butter Sage Sauce

• ¼ cup unsalted butter
• 3 garlic cloves, minced
• ¼ cup sage leaves
• 2 tbsp lemon juice
• ⅓ cup grated parmesan

Directions

1. Line a large baking sheet with parchment paper and sprinkle parchment with flour. Place celeriac in a large pot and fill with water until celeriac is covered. Bring to a boil, cover and cook until very soft, 15 to 20 minutes.
2. Drain and transfer to a food processor or blender and blend until smooth. Transfer pureed celeriac to a fine-mesh strainer lined with cheesecloth or a clean dish towel and once cool enough to handle, draw in the sides of the cheesecloth or towel and wring out as much liquid as possible. Leave to drain over strainer in fridge for 30 minutes.
3. Transfer celeriac to a medium bowl. Add egg yolk, salt, pepper, grated parmesan and stir together. Fold in flour until just combined.
4. Transfer celeriac to clean, floured work surface. Divide dough into eight equal pieces. Roll each piece into a rope, about 1-inch thick, adding more flour as needed to prevent sticking, then cut ropes into 1-inch long gnocchi. Transfer gnocchi to parchment-lined baking sheet and sprinkle with flour.
5. Bring a large pot of salted water to a boil. Working in two batches, drop in gnocchi and cook until gnocchi are puffed and float to the top, 3 minutes. Remove gnocchi with a slotted spoon. Reserve 1/2 cup of cooking liquid.
6. Heat butter in a large non-stick skillet over medium-low heat. Once melted, add garlic and sage leaves and cook until butter is golden and garlic and sage are fragrant, about 5 minutes.
7. Increase heat to medium. Add cooked gnocchi to skillet along with grated parmesan and lemon juice and toss gently, adding cooking liquid, a little at a time, as needed, to bring the sauce together. Divide among two bowls and top with more black pepper.

Tip: Double the batch and freeze cooked gnocchi in a sealed freezer bag for quick dinners down the line. Thaw in the fridge overnight or for a few hours at room temperature before proceeding with the rest of the recipe.

Next: Celeriac May Just Be Our New Favourite Vegetable for Fall Dishes

“Most Black women have never heard the term triple negative breast cancer, and most young women aren’t aware that there’s a strain of breast cancer that affects them more than others, namely TNBC,” says Leila Nicholls-Springer, breast cancer survivor and founder/president of Olive Branch of Hope, a Toronto-based organization that’s been supporting Black women with breast cancer and their families for over 20 years. “Representation gives the opportunity to highlight these two areas in our own words; it allows us to speak for ourselves. It’s key for women of colour because it brings the awareness piece to the forefront and reminds us that we’re serving all women, not just one type. Representation also means our whispers are beginning to get louder and finally our voices are being heard.”

TNBC accounts for approximately 15% of all breast cancer cases.¹ It’s called triple-negative because the cancer cells test negative for estrogen receptors, progesterone receptors and a protein called HER2 (human epidermal growth factor receptor 2).¹ TNBC has a generally poor prognosis with a higher chance of coming back and spreading to other parts of the body than other types of breast cancers. Unfortunately, approximately 40% of people with primary TNBC will see their cancer recur following initial treatment.¹ Unlike other breast cancer subtypes, it typically impacts women in the prime of their career and family life.

Anyone can be diagnosed with TNBC, but it’s more common in women under 40, and Black and Hispanic women.^1,2

In fact, African American/Black women are two times more likely than Asian and White women to be diagnosed with the disease.² Hispanic women are also more likely than white women to be diagnosed.²

The Olive Branch of Hope brings awareness to communities facing greater risk of diagnosis. “Through our ongoing campaign Think Beyond Love Pink, our organization has been instrumental in opening up conversations among women in their homes and this includes elders talking about cancer and other illnesses to the younger generation,” says Leila. “We provide different educational sessions and workshops across the Greater Toronto Area. Survivors are becoming more comfortable sharing their journeys and are encouraging others to do the same. It all begins with a conversation to help break the code of silence that still exists in our community.”

The recently released video Reflections: A Journey Through Triple Negative Breast Cancer gives a voice to young women of colour affected by TNBC.

https://vimeo.com/756811338/1619d60c57

Directed by Teaunna Gray, an Afro-Indigenous director and film photographer based in Toronto, the video features two incredible women of colour: Laura and Kristal, who share their respective lived experiences with breast cancer. Through their unique perspectives, we get a glimpse of some challenges they faced — fear, uncertainty, guilt, cultural barriers to talking about personal health, skin tone changes, and the impact of hair loss in a community with significant history and politics around hair. Their diagnoses made them re-examine their relationships, views on womanhood, body image and what beauty is. Their valuable life lessons are ones that many women strive to learn: confidence, body appreciation and self-love.

When Leila first watched the video, she felt a sense of empowerment and courage. “Here are two amazing women who aren’t afraid to share their story. Finally, we’re using our voices to bring hope to others. Our voices have power, and it is the power of many voices that brings change. I hope viewers learn that our experiences in life aren’t just for us, they’re to help and encourage someone else.”

Most importantly, the video shows us that TNBC isn’t just a disease that affects one’s health. It also affects the mind and the relationship that a woman has with her body.

It highlights the importance of safe spaces, such as those provided by The Olive Branch of Hope, where women of diverse cultures can freely express themselves with others they can relate to, and where they can be informed, empowered, and inspired.

There’s a large unmet need in the triple negative breast cancer treatment space.

Women with TNBC have fewer treatment options than those with other invasive breast cancers because hormone therapy and anti-HER2 drugs aren’t typically effective on the disease.¹ Early diagnosis is key, and women should be having conversations with their doctors about their breast health. The Olive Branch of Hope programs help identify and remove barriers that prevent individuals from accessing the available healthcare they need.

Dawn got involved with The Olive Branch of Hope because it was the only organization she knew in Canada that focused on Black women. “I want to be the change I wanted to see when I was going through my diagnosis. I want to stand in the gap for women diagnosed with breast cancer who feel like giving up. I want to be the voice for those who do not have one.”

The Olive Branch of Hope is always looking for volunteers and recently diagnosed Black women to share their experience and be an encouragement to others. “Visit our website or any of our social media outlets for more information and the programs we offer. I believe there’s room for board members and committee leaders,” says Leila.

Find breast cancer resources and support at theolivebranch.ca

This article and the video were made with support from Gilead Sciences Canada.

References:

¹ American Cancer Society. (March 1, 2022). Triple-negative breast cancer. Retrieved September 22, 2022, from https://www.cancer.org/cancer/breast-cancer/about/types-of-breast-cancer/triple-negative.html

² Plasilova, M.L. et al (August 2016). Features of triple-negative breast cancer. Medicine, 95(35): e414. https://doi.org/10.1097/MD.0000000000004614

Listen up! The best beauty advice you’ll ever receive is likely to come from someone close to you. That’s certainly been the case for Emily MacCulloch and Ingrie Williams, two friends and former beauty editors who’ve teamed up to create The T-Zone, a platform dedicated to feel-good beauty tips for all.

“The best advice Ingrie’s given me is don’t make things complicated,” says MacCulloch. “I tend to overthink everything, in beauty and in life, whether it’s what lipstick shade to wear with a new colourful eyeliner or planning our next big project together. She’s always there to remind me that simple is usually best.” And Williams’s top takeaway from MacCulloch, a trained makeup artist, can be summed up in two words: more blush. “I trust her eye completely,” says Williams. “When I’m doing a final check after putting my face on I hear her guidance ringing in my ears and double down on a healthy flush. The extra boost works wonders.”

To tap into more universal truths, we collaborated with The T-Zone to gather the best beauty advice shared among stylish families and friends.

Donna & Doran

Beauty advice flows both ways for this mother-daughter duo.

“Before, I used to tell her what to do, but we’ve sort of switched positions, which is really cool, and she keeps me current. Doran has introduced me to brow maintenance. Now, in the mornings, I brush them and apply brow gel to keep the hairs in place. I’ve always told her, ‘Don’t over pluck your eyebrows!’ I have a picture from the ’70s where mine were as thin as a pencil line. I painfully plucked them once, and I swore I would never do that again. I thank Brooke Shields every day.” – Donna Ramsbottom, 61, model

“My mom would always sing to us, ‘You can do anything that you want to, you can do anything because you are you.’ And that embodies her essence. Anything that she’s wanted to do, like becoming a model on her 60th birthday…she’s done. Not many people could go out and do that.” – Doran Reed, 25, kindergarten teacher

Lisa & Bunmi

As former co-workers turned best friends, these two are bonded by wanderlust and a love of all things French.

“We’ve had a lot of beauty discoveries together when travelling. The latest is to book a spa appointment when you land overseas—it’s the perfect solution for what to do before checking in. We went to the Le Bristol Paris for facials—the most expensive hotel that had availability—and it was like we just discovered oxygen for the first time. You get a cozy robe and slippers, and we both napped during our treatments. We just felt clean and relaxed afterwards and didn’t have to walk around with our luggage all day. Arriving in Paris and having that fresh, beautiful start was genius.” – Lisa Hannam, 48, editor

“In every aspect Lisa encourages me to go for it. She took me to Officine Universelle Buly, the most beautiful parfumerie in Paris. It’s filled with gorgeous scents and balms, as well as objects like combs and body brushes that can be personalized with calligraphy. At first I was hesitant to buy something, but she convinced me. Her reasoning was that this is special. You can’t get this just anywhere, and to have that whole experience of smelling all the scents and talking with the shop people is a really great memory. I appreciate her willingness to splurge on things that are meaningful to her, whether it’s a hair product or a face cream, because it gives me permission to take care of myself.” – Bunmi Adeoye, 40ish, publicist

Mia & Luisa

Thirteen years ago, as lonely teens who were new to Canada from the Philippines, these close-knit sisters bonded over watching YouTube beauty tutorials.

“Because of Mia’s influence, and her generosity with letting me use her tub, I will now take a bubble bath at every opportunity I get. When I’m in there, my hand isn’t automatically reaching for my phone, like when I’m watching TV. I use essential oils that smell wonderful, turn off the lights and use candles for moody lighting. It’s so peaceful. I can sometimes even hear the bath bubbles popping. It’s a great way to relax and switch off my brain for a bit.” – Luisa David, 29, consumer researcher

“Luisa has always been very intentional when it comes to her skincare routine and makeup, and that’s what I’ve taken from her. It’s the philosophy that your skin is worth taking care of, and it’s worth it to invest in certain products—not just with money, but also with time. She’ll put the effort into researching methods, like heatless curlers to wear to bed, and she’s the first to splurge on something. She introduced me to Dior Nail Glow, a sheer polish with a pinky hue that makes nails look healthy. It’s so good but not a product I ever would have thought to spend money on.” – Mia David, 30, content marketing manager

Hilary

A fixture in Canada’s fashion scene who is known for bold colours and luxe textiles, this detail-oriented powerhouse has an all-encompassing approach to beauty.

“Don’t neglect the neck! That’s the best advice about skincare my mother told me, and she’s aged so gracefully. Most people only focus on their face but you have to remember your neck, too, and as I’ve gotten older I’ve noticed this to be true. Those that know me know that I’m completely obsessed with my skin and I’m always on the hunt for new tips and products. When I discovered a sculpting wand years ago it became part of my routine instantly and I’ve been using it ever since. A friend’s mom actually said my neck looks really youthful. That’s the weirdest compliment I’ve ever received, so clearly it must be doing something!” – Hilary MacMillan, 35, fashion designer

Colin & Jordan

Embodying the ultimate creative collaboration, this mentor-mentee twosome lean on each other to redefine beauty norms and make art that fuses their boundless creativity with optimism.

“Jordan has passed on makeup artist techniques and unconventional products. She has really helped me develop Rosacea’s look to make it different from other queens in [Toronto] by encouraging me to not be formulaic and to be open to alternative ways of doing drag makeup. I’ve learned to map out shapes on my eyes with pencil and how to sheer out a cream highlighter, using it all over my face which has been powdered to filth along with a dash of glitter. I’m obsessed with the final look.” – Colin Gaudet, 31, photographer and drag artist Rosacea Cheeks

“Colin and I share an openness to creative experimentation that extends to everything we work on, including Rosacea. We bounce our most interesting and unusual beauty ideas off of one another, from neon pigment pressed onto eyelids to a red lollipop used as an unexpected stain on the tongue. We also set aside studio days to photograph concepts without an intended outcome. These are days solely focused on play. The results are the work I’m most proud of, much of which hasn’t been shared yet with anyone other than ourselves. It’s the most pure example of creation for the sake of exploration.” – Jordan King, 40, makeup artist and performer

Tania, Olivia & Ella

Leading by example, this mother of two knows that a beauty statement like rocking a red lip can be equally as powerful as embracing a bare face. But the strongest message she’s passing onto her daughters is that true beauty shines from within.

“There are certain beauty essentials I’ve picked up from my mom, like her love of rose water for toning and cleansing at night with a hot flannel, but she didn’t really wear much makeup. Instead, she instilled in me the value of self-care and being comfortable in my own skin. With my girls, the focus on external beauty is just starting—I’ve allowed them to wear makeup for special occasions, like a dance recital—but I try to emphasize a similar idea of self-love. As they get exposed to social media platforms like TikTok, I actually think it helps them see that beauty is not one-size-fits-all. It’s not a certain look or ideal anymore, like magazines prescribed when I was growing up. I always make a point of celebrating their uniqueness as beauty.” –Tania Kwong, 41, associate director, public relations, with daughters Olivia, 11, and Ella, 9

Next: The Best Skin Care Routine for Your Age, According to Dermatologists

“A billion husbands are about to be replaced,” wrote Chuck Palahniuk in his 2014 novel Beautiful You. The book told a tale of what could happen when women abstain from daily life in order to spend night and day alone with…their vibrator. Now, this is ridiculous on many levels, but let’s unpack one particular myth here that’s been lurking around since the ’80s, when sex toys went mainstream: The idea that frequent use of a vibrator can make sex with a partner less pleasurable, as it could cause what has repulsively been called “dead vagina syndrome.”

If you’ve ever found—and I hope you have—a device that vibes you exactly how you like, and have found yourself using it frequently, perhaps you too have contemplated if you could be using it “too much.” According to plenty of Reddit threads, many people are asking this very same question. They wonder: Have their bodies been conditioned to only be able to reach completion with their little device?

Before answering that, it’s helpful first to understand exactly how a vibrator does what it does. When you’re aroused, blood flow rushes to the genitals, and the clitoris and vaginal walls (or the penis) swell with blood. This means the tissues become engorged, and more nerve endings (the pleasure signifiers) are exposed, which can lead to greater sensitivity and one hell of an orgasm.

(Related: Why Squirting Orgasms Are a (Really) Good Thing—And How to Have One)

“Your clitoris is the sole organ in your body whose only function is totally for pleasure,” says Gabrielle Landry, a Montreal-based doctor who specializes in sexual wellness. “It has about 8,000 nerve endings, which is twice as much as the penis—that’s a lot of nerves, all reacting to different stimuli.”

Is it possible for all these little nerves to be desensitized by a vibrator? I’m happy to tell you, no. Landry says not a vibrator nor sex with a partner can desensitize you. In fact, desensitization is a serious condition that involves permanent nerve-ending damage. Although you may feel numbness for a few minutes after stimulation, a vibrator can’t cause that kind of injury, says Toronto-based sexologist Jess O’Reilly.

There’s data to back it up: According to a 2009 Journal of Sexual Medicine report that examined vibrator use among 2,056 women in the U.S., about 72 percent said they’d never experienced desensitization, and about 17 percent said they’d noticed just a mild and brief desensitization.

So, what if, as you’ve come to use your vibrator more often, you’ve found it more difficult to orgasm without it? Well, that’s not your body developing an addiction to it or a distaste for your partner. That’s just you figuring out what gets you off better.

(Related: Where Did My Sex Drive Go?)

“It may be that you simply prefer the sensations of a vibrator and find vibrations more conducive to orgasm,” says O’Reilly. “I often compare vibrators to contact lenses and glasses; you may feel as though you see clearly without them, but once you start using them to enjoy 20/20 vision, you may find that seeing without them simply isn’t as clear.”

Landry often hears this concern from her patients but agrees with O’Reilly. “It’s about understanding the way you need to be touched and how your body reacts to certain stimuli,” she says. “What I’ve found is sometimes women feel they have more time and comfort in using toys on their own, and that gives them the space to know exactly how to please themselves.”

One 2017 study found that using a vibrator has positive sexual benefits. It can help you relax and inspire creativity in the bedroom, which can lead to higher levels of desire and arousal, improving sexual function, satisfaction and distress.

Now if that’s the case, how did the myth that vibrators can “ruin” sex with a partner for you come to exist? As with many fears and phobias surrounding women and sex, there may be misogyny at play.

“I wonder if this [idea] is rooted in expectations of what sex ought to be—penetrative, orgasm-focused, always a perfect 10, exhilarating,” says O’Reilly. “Some of these expectations are tied to a heteronormative gender binary that suggests our bodies must respond universally to specific acts.”

But there’s no one specific way to have sex. You know what gets you off, and what or who does it best. If that’s your vibrator, by all means, go at it as often as you like—and definitely consider using it when you have sex with your partner, too. Besides, the better you get to know your handy little device, the better your sexual function and satisfaction.

Next: Are You Cleaning Your Sex Toys the Right Way (and Often Enough)?

In Canada, breast cancer is the most common cancer and the second-most common cause of death from cancer among women. On average, 75 Canadian women are diagnosed with breast cancer every day.

Despite how common breast cancer is, the early signs and symptoms can be hard to spot. While every province has a breast cancer screening program, they don’t always catch breast cancer early. (This is especially true if your province only mandates screenings every two years—a lot can change in that time.) And we know that the earlier breast cancer is detected, the higher the likelihood of survival and recovery.

Regular screenings and attending all your physical check-ups are the most important tools for detecting breast cancer, but at-home breast exams are also a useful way to catch any abnormalities. Here is why regularly examining your breasts is important, as well as how to do a breast self-exam.

(Related: How to Embrace Your Sexuality After a Diagnosis)

Why are at-home breast self-exams so important?

Gaining awareness of what’s normal for your body and noticing (either on sight or by feel) when there’s been a change means you can promptly report it to your healthcare provider. “You can’t know there’s been a change unless you know what your normal breast tissue feels like — and you’d only know if you’re doing breast self-exams often,” says Dr. Paula Gordon, a clinical professor at the University of British Columbia.

That said, Gordon also emphasizes that there are many cancers that aren’t detectable by a self-exam and that at-home breast examinations should augment regular mammograms and other tests. “Understanding your entire body and anything that changes is important, but first and foremost, discuss any changes with your doctor who is familiar with your risk factors,” adds Cathy Ammendolea, the Chair of the Board of the Canadian Breast Cancer Network.

How do I examine my breasts at home?

Before jumping into the how, it’s good to set up the when: your breasts’ size, texture and lumpiness fluctuates depending on where you’re at in your menstrual cycle, making it tricky to know what your norm is. If you’re still menstruating, Gordon recommends doing your breast self-exam a few days after your period. Before your period, it’s normal for your breast tissue to feel lumpier and sore. “This ensures you’re comparing apples to apples each time,” says Gordon. If you’ve gone through menopause, give yourself an exam periodically.

To perform a self-exam, start with the visual check. Stand in front of your mirror, topless, and turn side to side, checking for lumps and changes in your nipples. Then, lift your hands above your head. After that, place your hands on your hips and flex your chest muscles. Both moves can help you see lumps that you wouldn’t otherwise see.

(Related: Sofia Vergara’s Thyroid Cancer Experience Is an Important Reminder for All)

Next is the feel test. Unless you have really small breasts, you should be doing your self-exam like a breast surgeon does it: lying back at about a 30-degree angle (for example, lying down in bed with your head propped up on a few pillows). Keep your fingers flat and bent slightly at the knuckles, use the undersurface of your fingers to squish your breast tissue against your ribcage. Then, feel for lumps and any changes by going around the circumference of your breast to the nipple and then feeling the nipple as well. Finally, check your armpits, where there may be enlarged lymph nodes. Reach your hand over to hold onto the opposite shoulder and then, using your other hand, squish the tissue and fat of your armpit against your rib cage and feel for any lumps.

Gordon suggests checking out this video by breast surgeon Dr. Liz O’Riordan as a guide:

What sorts of breast changes should I be looking out for?

Generally, when doing a visual examination (ie., looking at yourself topless in a mirror) you should check for any lumps, redness, dimpling, skin sores, growing veins, thick skin and pores that look more prominent—“we call it ‘skin of an orange,’ because your skin looks like an orange peel,” says Gordon. Notice if your nipple is sunken or if there’s a crust on the nipple. Also, look out for any discharge that comes out on its own. Clear or bloody discharge that spontaneously seeps without your intervention should be checked out by your doctor, says Gordon. If you have discharge, but you really need to force it in order for it to come out, that usually isn’t a cause for concern.

Then, when you’re touching your breast, feel for any abnormal textures, lumps or areas of unusual firmness. “Everyone has texture or lumpiness in their breast, but it’s unique to us,” says Gordon. “People who do periodic breast self-exams are experts in what’s normal for them. We intuitively remember what the normal texture feels like and if we notice a slight change, that’s when the alarm bells go off.”

(Related: What Doctors Want You to Know About Breast Cancer)

What should I do if I do discover a concerning change in my breast?

If you notice something different in your breast tissue, contact your healthcare provider and ask for a mammogram or another form of testing. If you have dense breast tissue (which you can find out when you get a mammogram), it’ll make it harder to detect some forms of breast cancer. So, make sure you ask your doctor for an alternate form of breast cancer screening (like an ultrasound) in addition to a mammogram, depending on your age. Ultrasound would be a reasonable first test for women younger than 30-35.

Next: The Canadian Provinces with the Highest Rates of Cancer

In a traditional temple dish, blanched cabbage leaves are stuffed, wrapped individually, steamed, and served in a clear sauce. I love the filling but usually roll the leaves into a sushi-style log instead, for a more finger-friendly version that preserves the cabbage’s bright, jewel-like colors. Each bite begins with crisp-tender, sweet cabbage, followed by chewy, savory mushrooms and tofu skin, threads of caramelized sweetness from the carrot, and a gentle crunch from peanuts and cilantro. Enjoy the sliced rolls on their own or with soy sauce and a dab of wasabi (jie mo).

Stuffed Cabbage Rolls

Bāocài juˇan

包菜卷

Serves 4 to 6

Ingredients

• Kosher salt
• 1 pound (450 grams) green cabbage, preferably flat-head cabbage, leaves separated (about 20 leaves)
• 2 tablespoons vegetable oil or Scallion Oil
• 1 tablespoon minced garlic
• 1 medium king oyster mushroom (6½ ounces / 180 grams), both caps and stems thinly julienned
• 1 small carrot, thinly julienned
• 2 teaspoons soy sauce
• 4 ounces (112 grams) fresh or frozen and thawed tofu skin, cut into thin shreds
• ½ teaspoon ground cumin
• ½ teaspoon sugar
• ¼ teaspoon ground white pepper, or to taste
• ½ cup coarsely chopped fresh cilantro
• ¹⁄₃ cup crushed Fried Peanuts
• 1 teaspoon toasted sesame oil

Directions

Bring a large pot of generously salted water to a boil. Add the cabbage leaves and blanch until they are softened and vibrant green, about 1 minute. Refresh in cold water and drain in a colander.

Heat a wok over medium heat. Add the vegetable oil and swirl to coat the sides of the wok. Add the garlic and cook until aromatic, about 15 seconds. Add the mushrooms, carrot, and soy sauce. Stir-fry until the mushrooms have softened and released their liquid, about 3 minutes. Add the tofu skin, cumin, sugar, white pepper, and ½ teaspoon salt and stir until the tofu skin is heated through, scraping down any parts that stick to the wok. Remove from the heat and stir in the cilantro and crushed peanuts. Taste and add more salt, if needed. Transfer the filling to a bowl.

Lay one cabbage leaf on a cutting board and shave off its thick stem, trimming it as thin as possible without cutting into the leaf. The pared-down spine will make the leaf flatter and easier to bend. Repeat with the remaining leaves. Toss them in a large bowl with the sesame oil to lightly coat, giving the leaves a shine and aroma.

Lay out a bamboo sushi mat (or cover a tea towel with plastic wrap). Place a third of the leaves across the mat and flatten them. Place a third of the filling on the cabbage leaves, spreading it evenly and leaving an inch of the leaves exposed at the top and bottom. Hook your thumbs under the mat and lift the edge closest to you up and over the filling in the center. Press gently with curved hands along the length of the “log,” then pull the edge of the mat toward you and continue to roll the cabbage up and away from you. When you reach the far edge of the cabbage leaves, press the roll tightly once more, then remove the mat. Repeat with the remaining cabbage leaves and filling to make 2 more rolls. With a sharp serrated knife, slice the rolls into 2-inch-wide segments.

Enjoy immediately or chill before serving.

Excerpted from The Vegan Chinese Kitchen by Hannah Che. Copyright © 2022 Hannah Che. Photographs by Hannah Che. Published by Appetite by Random House®, a division of Penguin Random House Canada Limited. Reproduced by arrangement with the Publisher. All rights reserved.

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“Midlife is magical: a time of endless possibility.”

“Midlife is miserable: a time of relentless decline.”

You could give yourself a bad case of cognitive whiplash trying to make sense of those two contradictory narratives about what it means to be a woman at midlife. Sure, the so-called “successful aging” narrative is a whole lot more inspiring than what gerontologists describe as “narratives of decline,” but the idea that midlife is sheer magic is not without its pitfalls either.

It’s not surprising that so many women head into midlife burdened by a vague sense of dread. So many of the messages that we’re given by our culture encourage us to look to the future with fear. We’re told, time and time again, “The best is now behind you. It’s all downhill from here.”

That’s the biggest problem with so-called narratives of decline: they cause us to underestimate ourselves. As Margaret Morganroth Gullette notes in her book Agewise: Fighting the New Ageism in America, “Feeling compelled to tell a decline narrative about your one and only life is a stressor, a depressant, a psychocultural illness… Ageism, middle-ageism, sexism, and ableism can make those aging toward old age or chronically ill likelier to feel unwanted—unloved, sad, outcast, isolated, ashamed, helpless, and depressed, and unable to tolerate such distress.”

All this is made worse by the so-called social clock, the idea that you’re supposed to accomplish specific social milestones, like getting married or having children, at a particular time. Research has shown that feeling like you’re not “on time” in terms of the ticking of the social clock can fuel feelings of self-doubt, incompetence and loneliness.

Elsa, 52, admits to feeling seriously weighed down by what she was hearing about midlife. “I’m a Jamaican, and when I turned 50, I was really depressed. I kept thinking about something my dad used to say to me when I was a kid: ‘It’s 50 up and then 50 down.’ And so, when I went to my birthday party, I just kept thinking to myself, ‘Oh my God, right now I’m at the pinnacle. It’s all down-hill from here.’”

At the root of the problem, of course, is the fact that mainstream Western culture is obsessed with youth. And if you’re treating youth as the standard, the further you move away from that standard, the less relevant you feel. It’s hardly surprising that women start to feel invisible as they heed that call to take a step back and make way for the young. Culturally, you are being treated like you’re invisible.

Julia, a 47-year-old freelance musician and the mother of two teenagers, has picked up on that invisibility vibe too. “From the moment you turn forty, you’re given the message that you need to be quiet, and you need to disappear. That’s how I feel, anyway, and I’m actively working against it. I think it’s harmful to society because midlife women have a lot to offer.”

Emily, a 42-year-old professional and mother, describes it as a narrowing of possibility: “There’s a narrowing there of the ways in which society allows you to be a human being, the older you get as a woman. When you’re a young, single woman, there’s plenty of cultural narratives out there about you. Mind you, some of them are terrible, but there are still a bunch of different ones. But the older you get, the more limited those narratives are. At this stage, it’s like, ‘You’re a mom. That’s it.’ You’re not given all those other ways of being. And it’s very strange to me. It’s just this total erasure.”

“There’s this sense of women at midlife losing their purpose,” adds Andrea, a forty-nine-year-old writer and mother of two. “The culture tells us that we’re not fertile anymore, we’re not sexual anymore, we’re not mothers anymore (because maybe we don’t have to be mothering 24/7 at this point). There’s this sense of being set adrift.”

In other words, you’ve outlived your usefulness to the patriarchy by fulfilling your reproductive duty; now won’t you please just go away? Some of the most common midlife myths seem tailor-made to support the idea that women’s lives become less important—or completely irrelevant—the moment their children leave home. Take the “empty nest” myth, for example—the idea that parents are universally miserable when their offspring leave home. In fact, research shows quite the opposite: parents in general, and mothers in particular, actually report increased well-being and increased satisfaction with parenting once their kids exit the nest.

And it’s not as if every midlife woman’s work as a parent is anywhere close to being done. Despite what midlife myths and narratives and our culture’s ticking social clock might tell us, the fact is that there’s no such thing as a one-size-fits-all road map for midlife parenting (if, in fact, you end up becoming a parent at all). Some women at midlife have children who are getting ready to leave home; others have very young children who will require considerable support for many years to come. Laura, 47, who is currently on leave from her job as a radio host, is definitely in the latter category: “When I turn 50, I’ll have a seven-year-old, not a twenty-one-year- old who is getting ready to leave home. I have girlfriends who are the same age as me whose kids are in their third year of university right now. And meanwhile, when I hit 50, my son will be in grade 3.”

There’s also an assumption that, by midlife, the really hands-on years of parenting will be behind you and you’ll be reaping the rewards of all that earlier hard work. “But sometimes things don’t turn out quite that way. Sometimes there are factors that come up that derail those best-laid plans,” says Sadie, fifty-three, speaking from first-hand experience. “When my kids were going through their childhood and their teen years, I think I expected that, by the time I reached this stage, there’d be some sort of payoff, for putting in all the hard work.” For Sadie, parenting has required a heavy investment, both emotionally and financially. “Just in terms of the financial piece, when people start saving for their kids’ future, no parent is actually thinking, ‘I have to start saving because one day my child might need addiction treatment.’” And yet that’s the reality for many families, including hers.

Just as frustrating as those life-limiting social scripts are the messages that tell midlife women that they no longer have anything meaningful to contribute at work—that they should just step aside and let the younger generation take over.

Lori, 54, has picked up on some of those messages and she resents them. Back when she was younger, she looked forward to reaching an age when she’d finally be taken seriously. She remembered thinking, “By the time I hit midlife, I’ll have earned some respect. I’ll have built up the credibility that will allow me to do all the things I want to do.” The organizer and activist was surprised and disappointed to discover that, when she actually arrived at midlife, her opinions simply weren’t valued the way she’d hoped. “I think there’s a very brief window of time when women actually have the ear of society: when they’re no longer considered to be too young and before they’re considered to be too old.”

Ageist stereotypes about technological ineptitude only serve to make matters worse, which is why Emily, forty-two, has made a concerted effort to push back against those messages whenever she encounters them. “I was reading a book to my daughter when she was younger. It was a picture book, and it featured a mother or grandmother who couldn’t figure out how to use a computer. And I felt a sudden need to stop reading the book and say to my daughter, ‘Listen, I need you to know something, which is that your mother and both your grandmothers are quite capable of using a computer. I don’t really know what the deal is with the woman in this book, but I just need you to know this is not typical.’”

Julia, a 48-year-old small business owner and part-time university student, is convinced that these narratives of decline have gotten in the way of understanding the ability of midlife women to make meaningful contributions. “Society seems to think that midlife is when women start going downhill, physically, mentally, career-wise and in terms of participation in society. My experience has taught me quite the opposite: midlife is when women finally have an opportunity to start doing things for themselves after years and years of putting ourselves last (or at least low) on the list. There is a lot of new mental space to figure out what we want to do and how we are going to do it. Society mistakenly underestimates women at midlife.”

That’s one of the many reasons why Shay, 48, refuses to buy into this narrative—because she refuses to sell herself short. “I don’t want to be erased,” she explains. “I actually like my middle-aged self better than I liked my younger self.”

Navigating the Messy Middle, by Ann Douglas was released on October 1, 2022, and is available wherever books are sold.

Excerpt from Navigating the Messy Middle: A Fiercely Honest and Wildly Encouraging Guide for Midlife Women, by Ann Douglas©. Published 2022, by Douglas & McIntyre. Reprinted with permission of the publisher.

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When Samantha Pines* was in her early 30s, she decided to quit the birth control pill. She’d been on it for several years, and was experiencing weight gain and depression. She had since been prescribed antidepressants, but she still wasn’t feeling good. At that point, she wasn’t sure that being on birth control was worth it anymore. “I felt like birth control was contributing to my depression, and it just wasn’t making me feel great,” she explains. After getting off the pill, Pines says she “felt less low, and knew it was the right decision.”

Now, Pines is 49 and she’s back on the pill, this time to help with heavy, erratic periods, hot flashes and night sweats. Despite her prior experience, Pines was willing to try the pill again because her perimenopause symptoms were so disruptive. On top of her physical symptoms, Pines’s mental health was declining, too. Plus, she remembers how awful menopause was for her mom. “That was my biggest fear. I was like, I can’t go through that. She was such a terrible person to be around.”

Pines’s doctor prescribed her a low-dose birth control pill. But after just six months, Pines was feeling extremely anxious—and wasn’t getting much relief from her other symptoms. So, she did what many people with a health problem do: She turned to Google. “I had a really hard time finding anything about [anxiety and the pill], but some people on Reddit said they were also experiencing anxiety,” she recalls. She went back to her doctor and got on a different brand. And while the new pill is now providing some relief, she finds herself experiencing breakthrough bleeding and severe migraines every six weeks. The anxiety hasn’t let up. She plans to ask her doctor for a non-pill alternative soon.

Unfortunately, Pines’s experience isn’t uncommon. Mood-related issues like anxiety and depression are all too familiar to people on the pill. The thing is, it’s extremely safe and, when taken correctly, spectacularly effective at preventing pregnancy—factors that might help to explain why mood changes are brushed off as unimportant or not real.

“The pill has been around now for so long, it’s one of the most researched medications,” says Cynthia Graham, a professor of sexual and reproductive health at the University of Southampton in the U.K. “It’s the behavioural effects, how people feel, that we’re lacking research in.” More extensive research is imperative: Several recent studies have shown that hormonal contraceptive users have higher rates of depression, anxiety, fatigue, sexual disturbances and anger. They confirm what Pines and many other women experience. But compared to the efficacy and physical safety of the pill, cognitive and sexual side effects often aren’t taken seriously, says Graham, even though they’re one of the biggest predictors of quitting the pill.

Since the pill was first made legal, we’ve witnessed how much better the world is when people have access to safe and effective birth control. And yet, despite its long history, we still don’t know much about the pill’s effects on mental health, mood and libido. How, more than 60 years on, is that possible—and how can we make the pill even better?

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The pill is the most popular form of hormonal contraceptive in Canada: About three-quarters of Canadian women have taken it at some point in their life and, globally, 151 million people are on the pill. Its popularity can be attributed to its effectiveness: When used perfectly, it’s 99 percent effective, and even with imperfect use, efficacy still hovers around 91 percent. And despite the rise of newer hormonal contraceptive options like IUDs, the patch and the implant, which are also highly effective, the pill is still very popular, especially for young people. In Canada, about 30 percent of teens between the ages of 15 to 19 are on the pill.

It’s called birth control, but many people are prescribed the pill for non-contraceptive reasons. A 2011 study found that more than half (58 percent) of pill users don’t use it exclusively to prevent pregnancy. The same study found that the most common non-contraceptive reasons for going on the pill are menstrual regulation, reducing cramps or menstrual pain, alleviating acne and treating endometriosis. And there are more benefits—the pill can even reduce the risk of uterine and ovarian cancers and prevent the development of breast cysts.

Of course, there are downsides. Nuisance side effects like breast tenderness (which makes running even more painful) and spotting (RIP cute underwear) are quite common, especially when you first get on the pill. And then there are the rare and potentially fatal side effects, like blood clots: 10 in 10,000 people will develop them as a result of being on the pill.

In the ’60s, when the first pills were being developed, they contained high doses of estrogen, which is associated with ischemic stroke and heart disease, explains Ashley Waddington, an associate professor of obstetrics and gynecology at Queen’s University in Kingston, Ontario. The first brand on the market had 10,000 micrograms of progestin and 150 micrograms of estrogen; today, all the pills available in Canada are considered “low-dose,” meaning they contain 35 micrograms or less of estrogen—and even lower doses are being experimented with right now. “Adjusting doses and getting into these really ultra-low-dose estrogen pills is a trend we’re seeing,” says Waddington.

Newer forms of estrogen that may be safer for blood clotting risks, like estradiol and estradiol valerate, are also hitting the market. “It’s an interesting and exciting development in birth control,” Waddington says. “For the last 60 years, the pills that were available all contained some dose of the same estrogen, and now we’re seeing different types of estrogen, which may bring in different side effect profiles.”

Waddington also points to improved progestin-only pills (also called the “mini-pill”) as another innovation. Without the estrogen, there’s less risk of clotting or cardiovascular problems, but they need to be taken within the same, precise three-hour window every day to be effective. A new progestin-only pill now available in Canada, Slynd, offers a different progestin and dosage than the mini-pill, which makes it safe but more forgiving (if you miss it by a couple of hours, it’ll still be effective). “I think we might see a shift towards more people going directly to a progesterone-only pill and not taking the risks associated with estrogen,” Waddington says.

There’s been great innovation to improve the physiological side effects of the pill, so why hasn’t there been more action to address the mood-related ones? Given the long history of reproductive injustice and the struggle for accessible birth control, some might argue that looking for problems with the pill could come off as anti-pill, anti-feminist or anti-choice. Especially when the problems are, well, not fatal.

Contraceptives (and, in turn, reproductive choices) don’t improve if no one thinks they need to be better, says Rebecca Sullivan, a professor at the University of Calgary who specializes in gender and sexual politics and culture. But arguing that there’s something “wrong” with the pill feels fraught, especially as the U.S. strips away federal protections for abortions and puts access to contraceptives on the line. “The thought of losing access to the pill is terrifying,” says Sullivan, “and rightly so.”

According to Tory Eisenlohr-Moul, an assistant professor of psychiatry at the University of Illinois at Chicago who studies sensitivities to hormonal shifts, another reason why there’s a lack of research in mood and libido effects from oral contraceptives is the separation between gynecology and psychiatry as medical practices. “The people who develop the pills are usually gynecologists and researchers focused on physical health outcomes like blood clots or cholesterol problems,” she says. “To my knowledge, there’s no scientific group working on a new birth control method that’s better for mood.”

And when it comes to the sexual side effects of the pill, there’s been even less work done. In an editorial written for BMJ, Graham notes that “sexual side effects have been deemed ‘extremely difficult to assess’ and described in the literature as ‘trivial’ or a ‘nuisance.’” Later in the article, Graham writes that one of the most consistent findings has been how varied people’s experiences on the pill are—some show increased libido, some show a decrease and others show no change. “It will not be easy to establish whether, how and in whom the pill produces adverse sexual effects; carefully planned, adequately funded research is needed,” she concludes. “But as the ultimate value of a contraceptive method depends on its acceptability and usage, it is important that it is done.”

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When the pill was first legalized in the ’60s, it underwent a small number of randomized, placebo-controlled trials (the gold standard for medical research) on its effects on mood and sexuality. These allowed researchers to rule out the “placebo effect” (thinking that a medication is affecting you even if you’re taking a sugar pill), which can skew the results of a trial—especially when researching something as hard to quantify as mood and libido. However, according to Graham, most of the pill research conducted now is in the form of cross-sectional studies. These compare those who are on the pill to those who aren’t, but don’t account for the fact that established, long-time pill-users are generally happy on it, which can skew the results in a positive direction. Plus, funding in this area is woefully lacking, says Graham, who has done research on the pill and how it affects users’ libido and mood. Long studies that follow users are expensive and difficult to conduct. And no one seems to want to invest the time or money.

People who do take the pill, however, are deeply invested in the matter. According to Graham, finding willing study participants has never been a challenge. “I remember some women saying that they didn’t want [to be paid]. They wanted the money to be put back into research,” she says. “They said they wanted their daughters to have more options.”

Of course, the lack of funding and support for this kind of research is symptomatic of a health-care system that overlooks anyone who isn’t cis, white, straight and male. For decades, women were excluded from clinical trials. The FDA in the U.S. even issued a guideline in 1977 that recommended excluding most women of “childbearing potential” from participating in phase I and early phase II drug research trials. There’s far less representation in clinical trials if you’re not white—even today.

There’s also the lack of women in the pharmaceutical and medical fields. “We continue to have a largely male-dominated industry and government where this just isn’t a priority,” says Sullivan. “There are a whole bunch of factors that make it difficult to impossible to have a sustainable, flourishing research career coming up with a contraceptive that is safer and even more effective.”

Laura Symul, a postdoctoral fellow who studies cycle-related symptoms at Stanford University’s department of statistics—often using data from cycle tracking apps—points to a lack of female lab directors, hospital CEOs and heads of clinical research as factors behind the lack of data. Those who are guiding the research, she says, “don’t have first-hand experience with [birth control].”

Structural issues within medical research circles also move careers in particular directions. For researchers to gain promotions and salary raises and to continue to have a thriving career, they need to bring in their own funding—leading to acute pressure to secure that funding. Often, this means going after designated grants even if they’re not totally interested in the topic. Then, once a researcher does gets their foot in the door, they can fall into a pattern of pursuing similar research topics to secure more funding, sending them down a particular research and career route while their interests fall to the wayside. So, topics that aren’t popular, or for which there isn’t express interest from others higher up, don’t get investigated.

Then there are the social mores around birth control. People are still uncomfortable, says Waddington, with the idea that women can have total control over their fertility. “Many still believe that it should be left up to fate or left up to God,” she explains. And such moralizing about fertility can mean that advances in reproductive health become subject to questions of ethics—rather than of medicine. “It just doesn’t exist in other disciplines,” Waddington says. “Like, when somebody sees their endocrinologist about diabetes, they don’t have a whole discussion about whether or not it’s ethical to treat it.”

Lately, there’s been more scientific attention paid to the ways that hormones affect mental health. A randomized study out of Sweden used brain imaging to study the hormone levels and depressive symptoms of healthy women who had previously experienced negative effects related to oral contraceptives. The researchers found a causal link between the administration of synthetic hormones and connectivity in the salience network (as in, the parts of our brain that detect significant stimuli and the integration of sensory, emotional and cognitive processes). There’s also a study out of Denmark that looked at more than 1 million Danish women and found that being on the pill was associated with a diagnosis of depression. At the University of British Columbia, Frances Chen is researching how being on the pill as a teenager might lead to a higher risk of developing MDD (major depressive disorder). While this research is still preliminary, studying the links between hormones and mental health generally will lay the groundwork for a pill designed to avoid detrimental mental health side effects.

The recent growth of personalized medications, especially customized hormone therapy to treat menopause symptoms, might also point to developments for contraceptives.Another major gap in contraceptive research is the inability to figure out how someone will react to the pill: Finding the right pill for you comes down to the imperfect science of trial and error. It’s common for people to try two or three brands before settling on one that works. “The big problem that we have is that we can’t predict which women are going to respond in which way [to the pill],” says Graham. “That to me is striking after 60 years.”

However, Waddington notes, there are already so many formulations and brands out there that compounded and customized birth control pills won’t likely be coming to a pharmacy near you. Eisenkohr-Moul in Chicago reiterates that “the companies working on [birth controls] tend to focus more on secondary health effects like blood clots and lipids—not on mood.”

Stanford’s Symul says that research and development on new birth control pills and formulations is underway, but it’s been slow going. There are start-ups working on very innovative birth controls that aren’t hormonal, but research takes a long time, she explains. “There hasn’t been as much money or top-down approaches or a consortium working on this,” says Symul. “It’s a lot of people trying to make their own research move forward.”

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While scientists are working to develop better birth control pills, especially ones that have fewer negative effects on mood and mental health, there’s still a long way to go. In the meantime, the pill continues to be popular, both as a contraceptive and as a therapeutic for a number of painful ailments. It’s still an important pillar of reproductive health.

Now, more than ever, the conversation around reproductive justice and increasing safe options is vital. We don’t just need a pill that’s safe and effective—that should be the bare minimum. We need a pill that makes us feel good. Or, at least, makes us feel like ourselves.

“Yes, pills are used to prevent pregnancy, but they’re also used because people want to have sex,” says Graham. “So if you have really bad side effects from the pill, including a loss of libido…well, as a patient once said to me, it defeats the entire purpose.”

Next: What’s the Best Way to Switch Birth Control Pills?