Key takeaways

• Swollen legs, rapid weight gain, and lingering bruises can have more than one cause. Hormone changes are one worth asking about.
• The bill for chasing the wrong cause is paid in hours, sleep, and stamina long before it shows up as dollars.
• Track symptoms like a pipeline, and ask, “what else could this be?” at every visit.

In November 2019, I stood on stages at the REALTORS® Conference & Expo in San Francisco while a wheelchair waited for me at the airport. That week, I booked 100 speaking engagements for 2020. It also left me asking why my body kept changing the rules.

This is the first article in The True Cost, a six-part series on what perimenopause and menopause cost me, in real numbers. I’m not sharing it for sympathy. No one is coming to hand you the math, and you deserve to see it before the bill comes due.

So we start in 2019.

The signs I explained away

I was gaining weight faster than my habits could explain. My legs stayed swollen. I bruised, and the bruises lingered for weeks. I told myself I was busy, tired, and on the road too much.

Every explanation sounded reasonable. That is why it worked on me.

What I didn’t know: I had lipedema

Lipedema is a chronic condition of abnormal fat buildup, most often in the legs and hips. Mine started at puberty, when I was ten. I carried it for four decades without a name for it. I did not get one until 2021.

I am not the exception. Lipedema is estimated to affect about one in nine women, and many go undiagnosed for years, often decades. Researchers have noted that it tends to appear or worsen around big hormonal moments: puberty, pregnancy, and menopause. In my experience, perimenopause poured gasoline on it. That is the part I would give anything to have known sooner.Behind the laughter, the applause, and the energy was a woman learning how to keep showing up while her body changed the rules.

Chasing the wrong diagnosis at full price

In 2019, I thought my problem was my veins. So, I did what a high performer does: I attacked it. Vein surgery. Ablation in both thighs. Sclerotherapy, with more than one hundred injections in my legs.

Let me be clear. Vein treatment is the right call for vein disease. My point is different. Lipedema is often confused with venous disease and other leg conditions, and no one asked the next question. I was treating symptoms while the real cause kept compounding.

San Francisco, November 2019

Then came the REALTORS® Conference & Expo at Moscone Center. Twelve speaking engagements. Homes.com Booth Speaker. Induction into the ABR Hall of Fame. The launch of my first International Best-Selling Book, The Modern Real Estate Professionals Guide to Success.

I had a wheelchair on order at the airport, coming and going. I traveled with a jug of Advil and a steroid prescription. I took breaks wherever my body forced me to. And I stood in front of every single room and delivered.

Here is what nobody in those audiences saw: the woman teaching them how to grow their business could barely get herself through the terminal.

That week worked. It booked me 100 engagements for 2020. Then the pandemic rewrote everything. That is a later issue. When brain fog, sleep disruption, vision strain, hearing fatigue, and emotional load start competing with your calendar, productivity cannot depend on willpower alone.

The real cost of 2019

Sit with this part, because it is true whether or not you have insurance.

The money was never the headline. I’m self-employed. I bill by the hour, and I sell from a stage. When the clinic batched my treatments, that was not $400 in co-pays. That was ten hours pulled out of my business: ten hours not selling, not creating, not booking.

And I kept producing. That year, my work generated $585,000 in company revenue. I delivered every dollar of it under slept, with my legs throbbing through every keynote.

To stay upright, I bought my way through the day. Compression garments. Supplements to offset what the treatments couldn’t. Custom inserts. Shirts that buttoned and zipped, because with frozen shoulder I could no longer pull a T-shirt over my head.

I did not lose income. I paid for it out of my body, my sleep, and my time. That is the true cost no P&L ever shows. When women are misdiagnosed, underdiagnosed, or told to “just lose weight,” the cost is not only physical. It is time, pain, money, confidence, and trust in your own body.

Your version of the math: hours lost × your billable rate + out-of-pocket spend + recovery days = your real invoice.

What I’d tell my 2019 self

I am not attacking Western medicine. This is about accountability. No one connected my swelling, my bruising, my faster weight gain, and my hormones into one picture. I had to become the woman who asked the next question, and the one after that.

Here are five moves:

1. Track symptoms like you track your pipeline. Date, symptoms, what you tried, what happened.
2. Ask “what else could this be?” at every visit.
3. Get a second opinion before you start a series of procedures.
4. Walk in with a one-page timeline. Clinicians can use it in minutes.
5. Count hours, not just dollars.

You are the only guaranteed person at every one of your appointments.

Try this prompt in Claude or ChatGPT:

Turn my notes into a one-page timeline for my clinician. Columns: date, symptom, what I tried, result. Then list five questions I could ask. Do not diagnose or suggest treatment.

AI organizes your notes. Your clinician makes the diagnosis.

Frequently asked questions

Can perimenopause cause swollen legs, weight gain, and bruising?
Perimenopause brings shifting hormones, and many women notice changes in weight, fluid, sleep, and energy. Swelling, fast weight gain, and bruises that linger can also come from vein conditions, lymphatic issues, fat-distribution conditions like lipedema, medications, and more. Bring the full pattern to a qualified clinician and ask what else it could be.

What is lipedema, and how is it different from venous disease?
Lipedema is a chronic condition marked by abnormal fat buildup, most often in the legs and hips, and it often comes with tenderness and easy bruising. Venous diseases involve veins that do not return blood to the heart efficiently. The two can look alike and can exist together, so ask your clinician how they tell them apart in your case.

How long does a lipedema diagnosis take?
Many women wait years, and some wait decades, because lipedema is often mistaken for weight gain or other leg conditions. I carried mine from age ten to 2021 without a name. A clinician familiar with lipedema can evaluate it.

What should I track before a doctor’s appointment?
Dates and symptoms, photos of swelling or bruising, every treatment and its result, medications and supplements, and the hours each visit costs you. Keep it to one page, in date order, and add three questions.

How do I calculate the real cost of a health issue when I’m self-employed?
Add three numbers: out-of-pocket spend, hours lost times your billable rate, and recovery days. Co-pays are the small line. Hours are often the larger one.

Can AI diagnose what is wrong?
No. AI cannot diagnose or treat. It can turn your notes into a clean one-page timeline and a list of questions for your clinician.

Keep reading The True Cost

Over the next five weeks, I’ll walk you through the rest of the bill: the physical cost, the cost of guessing, the edge it nearly took, the full financial math, and the system I built with AI to overcompensate for everything menopause tried to slow down.

Start with the full hub at Menopause OS. Then read Lipedema and Perimenopause: One Diagnosis Can Hide Another.

The cost of silence is always higher than the cost of the truth.

Forward this to the woman who is pushing through something she can’t name yet. Then tell me in the comments: what don’t you know yet that is costing you?

This content is for educational and informational purposes only and is not medical advice. It is not a substitute for diagnosis or treatment by a licensed healthcare provider. Consult a qualified professional about your individual health.