Giulio_Fornasar/Shutterstock.comMidlife can bring an unsettling realisation for many women: the years spent caring for others, raising children, managing work, running households and maintaining family life have taken a toll on their bodies.Women in midlife may face a greater risk of chronic health issues due to decades of what psychologists call “self-silencing” – putting others’ needs first and holding back your own feelings. This pattern prioritises caregiving and maintaining harmony in relationships, often leading women to suppress their own needs, avoid conflict and hold back their true feelings.Common forms of self-silencing include pleasing people, suppressing emotions, inhibiting self-expression and carefully monitoring what they say in order to avoid upsetting others.Midlife itself is a period of significant transition, involving physical, hormonal, social and psychological changes. For women who tend to self-silence, this stage of life can bring additional strain. Studies show they may report greater mental and physical health symptoms, such as low mood, fatigue, poor sleep and increased aches and pains. The years of looking after others eventually take their toll. Nicoleta Ionescu/Shutterstock.com A growing number of studies suggest that long-term patterns of emotional suppression and stress in relationships are associated with a range of health problems, including depression, heart disease and stroke. Some research has also associated these patterns with metabolic conditions such as diabetes and chronic inflammatory illnesses, including autoimmune disorders and cancer.Although these studies cannot show that self-silencing directly causes these conditions – only that the patterns tend to occur together – the findings have been consistent. A study from the University of Plymouth, for example, found that women with fibromyalgia were more likely to report a history of childhood trauma alongside lifelong patterns of self-silencing.For many people, these coping styles begin early in life. Children growing up in threatening or unstable environments may learn to minimise their own needs, hide distress or avoid conflict as a way of protecting themselves. Over time, this way of keeping safe becomes an ingrained way of relating to others.Midlife is often when women reach a crisis point and seek support – though accepting help can be difficult for those who are used to neglecting their own needs. They often become highly skilled at coping alone and may play down their struggles because they don’t want to burden others.Learning to put yourself firstResearch consistently shows that social support can have a positive effect on wellbeing. Sharing emotions with a supportive person can buffer against the physiological effects of stress, and practical support with everyday responsibilities can reduce feelings of being overwhelmed and the isolation that often comes with self-silencing. Health professionals and therapists can also play an important role. Trauma-focused therapies such as EMDR and IFS can help women process childhood trauma, ease depression, improve health and reduce chronic pain.Research in women’s health also recognises that when women do not assert their needs, it can generate anger and resentment. Left unexpressed, these feelings can lead to chronic depression. Assertiveness training – delivered by psychotherapists and coaches – supports women to express their needs, opinions and boundaries in a clear and respectful manner, developing strategies to communicate preferences, say no and protect their time and space. Building these skills can reduce psychological distress and improve confidence and self-esteem.Alongside assertiveness, psychologists recognise the importance of self-compassion – offering ourselves the same care, understanding and kindness we would extend to a loved one.Kristen Neff, a professor and pioneer in the field, recommends three key practices: recognising and validating feelings of pain and suffering; acknowledging that suffering is a shared human experience; and maintaining mindful awareness of emotions, rather than being overwhelmed by them. In practice, this means reminding yourself that things are hard right now, that you are not alone and that you will get through it.Further research has found real health and wellbeing benefits for women in midlife who practise self-compassion. Those who do tend to feel less stressed, and are more likely to maintain healthy habits that improve their health.Neither self-compassion nor assertiveness are quick fixes, but both can play an important role in protecting emotional and physical health. When women learn to recognise their own needs, assert their boundaries and offer themselves kindness rather than criticism, they reduce feelings of stress – and the negative effects this has on the body.For generations, women have been encouraged to care for others and maintain harmony in relationships – valuable and much-needed qualities. But they can come at a personal cost when women feel unable to express their own needs alongside them.Understanding the links between social expectations, emotional expression and health may open up important conversations about how we can best support women to care for others without abandoning themselves.Lowri Dowthwaite-Walsh does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.