The responsibilities of running a household and raising a family can sometimes feel overwhelming. Typically, the burden of these things falls on women and mothers, many of whom suffer in silence without recognizing the toll it’s taking on their mental and physical health. Monitoring your blood glucose using a continuous glucose monitoring device (CGM) can be a way to spot increased stress levels before they become unmanageable.

THE INSIDER talked to expert Dr. Simone Koch to find out how women can see the signs of mental load, and take action to stop it in its tracks.

Dr. Simone Koch started suffering from exhaustion when she was a student. She’d fall asleep during lectures, she’d fall asleep in the middle of writing notes, but she never understood that there might be something seriously wrong.

When Dr. Koch qualified and started working as a doctor and found herself working over 100 hours a week, the problem became much worse. When she had her first child and her insomnia got so bad that sometimes she would only sleep one hour a day, she decided to get medical help.

As a young, working woman who’d just had her first child, Dr. Koch’s doctor told her she must have postpartum depression. Yet somehow that diagnosis just didn’t seem right to her: “I knew I wasn’t depressed. I was a happy person. I had a wonderful child. I loved my husband. I just couldn’t sleep, and nobody would listen to me.”

Dr. Koch started taking her own blood work, and found out that she had a thyroid disorder. By that point, she had lost 9 kilos of weight, her hair was falling out and her insomnia was getting unmanageable. Once she had her diagnosis and could start treatment, she decided she wanted to help other people find out the “root cause” of their problems.

“It’s not just that if you’ve had a baby, you must have postpartum depression, or if you can’t concentrate it must be something psychosomatic. I started researching and learning a lot then trying to figure out that root cause with my patients, and still with myself.”

The mental load, also called cognitive labor, refers to the invisible, non-tangible tasks involved in running a household, which typically falls on women’s shoulders. Also sometimes referred to as “worry work” or “cognitive labor,” mental load is not about the physical tasks but rather overseeing and delegating them. It’s being the one in charge of the never-ending to-do list constantly running in your head, remembering what needs to get done and when, delegating all the tasks to respective family members, and making sure they actually get done.

The mind share versus time share equation is at the heart of the mental load—the requirement on women to not just be parents and caretakers but also unofficial keepers of where the entire family needs to be and when and perpetual guardians against anything falling through the cracks.

Research conducted by Ciciolla and her colleagues has shown that the mental load is linked to strain on mothers’ well-being and lower relationship satisfaction. Nearly nine in 10 mothers in committed partnerships say they feel solely responsible for organizing the family’s schedules, for example, and the burden left them feeling overwhelmed, exhausted, and unable to make space for their own self-care. The Bright Horizons report similarly found 72% of working moms feel it’s their job to stay on top of kids’ schedules, and 52% are facing burnout from the weight of these responsibilities.

Although small bouts of stress have been shown to be protective and advantageous to health^[1], chronic or prolonged stress elicits adverse physiological responses such as increased blood pressure, compromised immune system, inflammation, and diabetes^[2], all significant risk factors for coronary heart disease (CHD). 

The term ‘mental load’ entered popular discourse after a comic by French illustrator Emma Clit went viral, called “You should’ve asked”. The comic shows how women often find themselves burdened with a disproportionate share of housework and parental responsibilities, while their male partners seem almost oblivious to the extent of the strain this is causing in their lives.

Dr. Simone Koch agrees that while mental load can be a problem for both genders, it remains in essence more of a female problem. 

“There are some men doing high stress jobs with a lot of responsibility who can suffer from mental load as well, this is not just a problem for women. But I think it’s more common in women, especially in the family context. We were raised feeling that suffering and being responsible for other people and giving them everything is a good thing that is expected from you.”

The 2017 Bright Horizons Modern Family Index found that 86% of working mothers say they handle the majority of family and household responsibilities. Then 69% of working mothers say that their household responsibilities are creating extra mental load, while 52% of them say that they are already burnt out from the pressure of it all. 

Anyone with a heavy burden of mental load will experience even higher levels of stress than normal, which brings with it a whole host of nasty side-effects. These can include the onset of anxiety and depression, insomnia and sleep deprivation, memory gaps, and even headaches and migraines.

In search of a coping mechanism, this can drive many people to increase their alcohol intake or use other substances as a way to unwind. As this spirals, this can lead to cognitive impairment, and make it even harder to stay on top of those tasks that are feeling like they’re just getting too much, as well as causing friction, conflict and emotional disconnection within families.

The effects, as well as the causes, can often be hard to pinpoint precisely because mental load is such a subtle, and societally accepted phenomenon amongst women. Yet as Dr. Simone Koch points out, that doesn’t mean that it should be taken any less seriously:

“There’s so much going on in the background. So much noise in the brain. It’s disturbing the whole body and its immune system and releasing a lot of stress and that can lead to burn out, severe fatigue and exhaustion because there’s never quiet, there’s no possibility to really regenerate. Even if you have three minutes for yourself to do some breathing work and try to relax, if all the stuff in your brain is still going on, it’s nearly impossible to find that moment of regeneration and respiration. That’s what mental load really means.” 

 While societal expectations of gender roles may hold a lot of the answers as to why women tend to suffer from mental load more than men, according to Dr. Simone Koch there are also biological reasons why that may be the case.

Firstly the hippocampus, which connects both parts of the brain, is often larger in women which means that things tend to be more wired together. Dr. Koch says that’s one reason why women are less able to calm down and “go into that ‘nothing’ space” when they need to. This is also why she believes that “for men, it’s easier to shut the noise out”.

But women also are more prone to stress as they have higher levels of estrogen. As Dr. Simone Koch told us: “Estrogen is broken down with the same enzyme as stress hormones dopamine, noradrenaline and adrenaline by methyltransferase. If you have a lot of estrogen, that enzyme is already quite busy. So when other things enter our system like stress, it can easily be overwhelmed.”

The enzyme Methyltransferase or COMT also prevents biotransformation of  estrogens to damaging metabolites (quinone-DNA adducts and development of reactive oxygen species (ROS) ) capable of damaging cellular macromolecules such as DNA, lipids, and protein. This leaves women at much higher risk of getting overwhelmed by stress hormones and metabolizing metabolites, which work like stress hormones.

Little research has so far been done into how mental load might be shared between same-sex couples or parents, yet some studies suggest that in a household where the two partners are of the same gender or identify as non-binary or gender non-conforming, there is less pressure to conform to societally prescribed roles in that regard. This, in turn, can reduce the imbalance between same-sex couples.^[3][4]

Your body will let you know in a variety of different ways that something’s not quite right. This may come in one or more of the physical symptoms of mental load that we mentioned earlier: anxiety, depression, insomnia, memory gaps, headaches, and migraines. However, Dr. Simone Koch points out that there are also a number of other ways in which your body might tell you that it’s not coping with any additional stresses and strains that you’re placing on it, particularly if you’ve just started a restrictive dieting regime or intermittent fasting.

Should you start noticing any of these signs, the most important thing is to take them seriously, and proactively seek help or make a plan to ease your mental load. While many of us may try to keep calm and carry on, according to Dr. Simone Koch that might be the worst thing you could do.

“Don’t push through it. If your body is sending you signals that it’s not a good idea, don’t push it. Sometimes our body is just trying to let us know.”

One of the most reliable ways to spot mental load is by using a Continuous Glucose Monitoring device (CGM). Stress leads to increased cortisol levels as your body tries to deal with that stress. When you have increased cortisol levels, you will also be able to see higher glucose levels in your blood.^[5] 

By monitoring these levels, you will also be able to find patterns and triggers that lead you to have higher levels of cortisol. These might include specifically stressful situations, which you can then work to mitigate or avoid completely.

By using a CGM, you will be able to reliably and consistently identify any spikes in glucose levels that may be caused by stress or other environmental factors, so that you can take action to bring them back to safe levels and boost your overall health and cognitive functioning.

According to Dr. Koch, efficiently dealing with mental load and preventing it from spiraling into a much bigger problem is about a lot more than just making to-do lists, although these can also help. The most important thing to do is to really learn how to unwind, so that you can give your body a chance to recover from any stress that it’s been under.

“Sometimes my husband would try to help me by taking the kids for a bit, but it was like they were always hammering on my door. They always wanted something from me. Whenever I made some free time for myself, the mental load was always still there. You need to take action to really get some short time frames when you know all that mental load and responsibility is somewhere else and you can really just be yourself, try to regenerate and calm down.

“A lot of people deal with stress by jumping on the sofa, turning on the TV and eating something. It’s much better to take some time to unwind by going to the sauna or doing some short breathing exercises or meditation. It’s OK to watch TV but we know that it doesn’t really calm your body down like a five minute breathing exercise does.”

Dr. Koch also believes that cutting out stimulants like caffeine could be a huge boost: “I gave up caffeine a year ago, and that’s really done the trick for my stress. My sleep is better too. I’m no longer on edge or jumpy. I’m much more resilient to stress in general.

“Caffeine is the most accepted drug we all use. Try living without it, and you might feel more energetic and like yourself than ever.”

Find out more about acknowledging and dealing with mental load on the HELLO INSIDE Science Talk Podcast with Dr. Simone Koch and our host, Chief Medical Officer Dr. Anne Latz.

^[1] Davenport MD, Tiefenbacher S, Lutz CK, Novak MA, Meyer JS. Analysis of endogenous cortisol concentrations in the hair of rhesus macaques. Gen and Comp Endocrinol. 2006;147: 255–261. pmid:16483573

^[2] McEwan B. Allostasis and allostatic load: Implications for neuropsychopharmacology. Neuropsychopharmacol 2000;22(2): 108–124. pmid:10655030

^[3] Tornello SL (2020) Division of Labor Among Transgender and Gender Non-binary Parents: Association With Individual, Couple, and Children’s Behavioral Outcomes. Front. Psychol. 11:15. doi: 10.3389/fpsyg.2020.00015

^[4] Patterson, C.J., Sutfin, E.L. & Fulcher, M. Division of Labor Among Lesbian and Heterosexual Parenting Couples: Correlates of Specialized Versus Shared Patterns. Journal of Adult Development 11, 179–189 (2004). https://doi.org/10.1023/B:JADE.0000035626.90331.47

^[5] Kuo T, McQueen A, Chen TC, Wang JC. Regulation of Glucose Homeostasis by Glucocorticoids. Adv Exp Med Biol. 2015;872:99-126. doi: 10.1007/978-1-4939-2895-8_5. PMID: 26215992; PMCID: PMC6185996.