The Elephant in the Room: Why So Many of Us Feel Like Frauds
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Show Notes
Twelve people said it was excellent. One mentioned the timeline. You know which one you're still thinking about at eleven at night.
Dr. Siân West, board-certified OB-GYN and menopause specialist, takes apart imposter syndrome in midlife women: where the research started, why it tends to come back in your forties and fifties, and how perimenopausal changes in focus and word retrieval can feel like proof you're slipping when they're really part of a hormonal transition.
She also talks about her own year of starting things in public, and what it took her months to see, that being new at a format isn't the same as being new to the work. You'll leave with three practical tools, including an evidence file that works because the feeling runs on vague dread.
What you'll learn
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.
Questions this episode answers
What is imposter syndrome?
Imposter syndrome, originally described as impostor phenomenon, is the experience of being privately convinced you are not as capable as others believe, despite real credentials and accomplishments. It was first described in 1978 by psychologists Pauline Clance and Suzanne Imes, whose research subjects were high-achieving women, not underachievers.
Do women experience imposter syndrome more than men?
A 2024 meta-analytic review of more than 100 studies and over 40,000 participants found women scoring higher than men on measures of imposter feelings. The gap is modest and varies by field, but it is consistent and has not narrowed over time. One survey of women executives found 75 percent reported experiencing it, and in a survey of UK orthopedic surgeons, 92 percent reported moderate to intense imposter feelings, with women scoring significantly higher than men.
Why does imposter syndrome get worse in midlife?
Midlife combines peak experience with fresh reasons to doubt yourself: watching younger colleagues get the title or the stage, returning to work after time away, or wondering whether your moment already passed. Imposter syndrome does not reliably disappear with seniority. It tends to get quieter and better disguised.
Does more confidence fix imposter syndrome?
Confidence was never the missing ingredient, and competence was not the problem to begin with. What is missing is an accurate read on your own evidence. Over-preparing to compensate for the feeling does not resolve it, and advice to believe in yourself harder tends to make it worse.
Is imposter syndrome the same as being new at something?
No. Being genuinely new at something means you are not good at it yet, which is an accurate assessment and applies to everyone starting out. Imposter syndrome is an inaccurate assessment, where real expertise is present and goes unrecognized by the person who has it. Being a beginner at a format is not the same as being a beginner at the work, and confusing the two is one of the most common ways midlife women talk themselves out of opportunities.
Can perimenopause brain fog make imposter syndrome worse?
Yes. Perimenopausal cognitive change is measurable, and the SWAN study documented it. Women were given the same cognitive test repeatedly across four years. Premenopausal and postmenopausal women improved with practice, which is the normal pattern at that age. Women in late perimenopause did not improve. Their scores did not decline, the expected practice effect was simply absent, and it resolved after the transition. For someone already primed to doubt her competence, a blanked-out word in a meeting registers as confirmation rather than as a symptom. It reflects a hormonal transition affecting focus and word retrieval, not a change in professional ability.
What actually helps with imposter syndrome?
Three things from this episode: apply the friend test, asking whether you would believe a friend with your exact resume who said she did not belong; replace the internal script with "I am prepared, that is why this is going well"; and keep a written file of specific, concrete evidence, because the feeling runs on vague dread and cannot survive specifics.
Resources and research mentioned
Clance and Imes, 1978, the original impostor phenomenon research
Price, Holcomb and Payne, 2024, Gender Differences in Impostor Phenomenon: A Meta-Analytic Review, Current Research in Behavioral Sciences
KPMG, 2020, Advancing the Future of Women in Business, survey of women executives
Greendale et al., 2009, Neurology, SWAN cognitive performance through the menopause transition
SWAN, the Study of Women's Health Across the Nation: swanstudy.org
Survey of imposter phenomenon in UK trauma and orthopedic surgeons
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About Dr. Siân West
Dr. Siân West is a board-certified OB-GYN and menopause specialist. She hosts This Meno Life, a weekly podcast for women in midlife that covers perimenopause, menopause and MHT with the evidence first and no fear tactics.
Follow This Meno Life on Apple Podcasts, Spotify or YouTube so the next episode finds you.
I'm a doctor, but not your doctor. Everything here is for education, not medical advice. Stay curious, stay evidence-based, and always talk to your clinician before making changes.
