International Women’s Day often highlights messages about strength, resilience, and leadership. And while those are all true, when I think about women and mental health or substance use, I don’t think first about strength.

I think about hesitation. I think about the pause before someone says, “I’m not okay.” The internal back-and-forth. The weight of what it might mean to admit you’re struggling. For many women, asking for help doesn’t feel simple. It feels risky. It can feel like pulling a thread that might unravel everything else - your job, your reputation, the way people see you.  We quietly wonder: Will I still be seen as capable? Will this follow me? Will someone decide I’m not as dependable as they thought?

The Hidden Nature of Women’s Struggles

We often talk about gender differences in diagnosis or patterns of substance use. And yes, there are differences. Men’s struggles can sometimes show up more visibly and behaviorally. Women’s struggles are often emotional, relational, and easier to conceal.  But the deeper difference isn’t just how symptoms present. It’s how long women carry them alone.

Women are extraordinarily high-functioning while struggling. From a young age, we are taught we have to do it all. We continue to show up, meet deadlines, care for our families, and lead teams. But just because we can “hold it together” doesn’t mean we should have to. Too often, what we’re carrying is minimized - in workplaces, in healthcare systems, and sometimes by ourselves.

The Invisible Mental Load

This raises a harder question: How are women supposed to prioritize their health when the world around them rarely speaks openly about the day-to-day realities they are navigating?

The invisible mental load.
Hormonal shifts.
Caregiving expectations.
The pressure to excel professionally while remaining emotionally steady for everyone else.

When these experiences are normalized but not acknowledged, they become something women are expected to manage quietly. Silence becomes the standard.

The Biological Layer We Often Overlook

We also cannot celebrate all that women are without acknowledging the biological realities that shape many stages of life. Hormonal transitions - including pregnancy, postpartum, and perimenopause - can significantly affect mood, sleep, focus, and stress tolerance.

Up to 1 in 5 women experience a diagnosable mental health challenge during pregnancy or the postpartum period, and perimenopause is strongly associated with increased anxiety and depressive symptoms.

These are not subtle changes. Many of these symptoms - sleep disruption, heightened anxiety, irritability, and difficulty regulating stress - overlap with the very factors that can increase vulnerability to substance use.

When Life Transitions Become Pressure Points

Over the years, I’ve noticed something consistent in the women I’ve supported. Substance use often surfaces during major life transitions - the seasons that stretch us.

• Before and after having children
• Marriage or divorce
• Career acceleration that looks exciting on paper but feels unsustainable in practice
• Caring for aging parents while leading at work
• Hormonal transitions that shift how our bodies handle stress

These are rarely dramatic breakdowns. They are cumulative pressures. During these periods, pausing doesn’t feel possible. Rest feels undeserved. So we adapt. We normalize exhaustion. We tell ourselves it’s temporary. And sometimes we reach for something that helps steady us just enough to keep going.

Why Many Women Reach Out Late

By the time many women seek help, the struggle has often been present in the background for quite some time. What usually brings them forward is anxiety, low mood, sleep disruption, or feeling overwhelmed. These symptoms often become the entry point because they feel easier - and more socially acceptable - to name.

Substance use may be part of the picture, but it doesn’t always lead the conversation, even when it is quietly shaping it. What I see most often is not recklessness. It’s responsibility.

Women who have been holding everything together for so long that asking for help feels like an admission of failure. And when they finally do speak up, there is often shame - not just about the coping behavior, but about “not managing better” or “not being able to handle it all.”

Rethinking Resilience

Perhaps this International Women’s Day is not only about celebrating resilience. Perhaps it is about asking why resilience has had to look like endurance for so many women. In workplaces, that means more than awareness campaigns. It means building environments where asking for help does not feel like a career risk. It means grounding decisions in functional clarity rather than assumptions. It means recognizing that high performance can coexist with quiet struggle.

Creating Healthier Systems of Support

It also means applying what we already know. When someone presents with anxiety or depression, substance use screening should be part of the conversation, approached with compassion and without judgment.

Supporting the women in our lives - colleagues, leaders, peers, and friends - requires acknowledging how hormonal transitions, chronic stress, and systemic pressures intersect. These are not personal weaknesses. They are predictable human responses within systems that often expect women to absorb more than what is sustainable.

If we want healthier workplaces, honesty must feel safe - for everyone. No one should have to weigh professional or personal consequences before asking for support. Women are resilient. Deeply so. But resilience should not require silence. And it should not require carrying everything until something gives way.

The quiet weight of waiting is real - and it should never be the price of being seen as capable.

About The Author

Alex Perry works in the field of mental health and substance use, supporting individuals navigating complex personal and professional pressures. Her work focuses on understanding the functional role that coping behaviours can play in people’s lives and helping individuals access support without judgment. Alex has extensive experience working with high-performing professionals facing mental health and substance use challenges and is passionate about creating environments where honest conversations about wellbeing feel safe.  Get in touch with Alex.