What Virginia Woolf’s A Room of One’s Own can teach us about chronic stress, recovery, and the conditions necessary for women’s health.
Sadie Carlsen, NP
FunctNP Functional Medicine
A Room of One’s Own 97 years later.
On October 24, 1929, the British edition of Virginia Woolf’s A Room of One’s Own was published.
Woolf argued that women needed financial independence and a room of their own to write fiction. Her argument extended beyond the physical room itself. It challenged readers to consider how opportunity, resources, and social expectations influence a woman’s ability to create.
Ninety-seven years later, her work invites another question:
What do women need in order to be well?
For many women, the workday doesn’t end when they leave work.
It becomes dinner.
Laundry.
Appointments.
Childcare.
School schedules.
Groceries.
Cleaning.
Planning.
Remembering.
The responsibilities may be ordinary, but their cumulative demands deserve our attention.
Sociologist Arlie Hochschild popularized the term the second shift to describe the unpaid household and caregiving labor that often follows paid employment.
And while these responsibilities may be socially categorized as separate from professional work, the body’s physiological systems continue responding to demands throughout the day.
This is where the concept of allostatic load becomes relevant.
What Is Allostatic Load?
The human body is remarkably adaptable.
When we encounter a challenge, physiological systems coordinate to help us respond. Heart rate may increase, stress hormones may be released, attention may sharpen, and energy availability may change.
This adaptive process is called allostasis, often described as achieving stability through change.
Allostasis is not inherently harmful. It is essential to survival.
The difficulty arises when stress responses are activated repeatedly, remain elevated longer than necessary, or become poorly regulated.
Researchers use the term allostatic load to describe the cumulative physiological burden associated with these adaptations over time.
The concept was developed through the work of researchers including neuroscientist Bruce McEwen, whose research examined how stress mediators can be both protective and potentially damaging.
In other words, the problem isn’t that stress exists.
The concern is what happens when demands repeatedly exceed opportunities for recovery.
The Physiology of Chronic Stress
Stress is not simply an emotional experience. It involves communication among multiple physiological systems.
The HPA Axis
The hypothalamic-pituitary-adrenal (HPA) axis helps coordinate the hormonal response to stress.
Through a series of signals involving the hypothalamus, pituitary gland, and adrenal glands, the body regulates cortisol production.
Cortisol plays important roles in glucose regulation, immune activity, blood pressure, and normal circadian physiology.
It is not a hormone we should automatically seek to suppress.
However, prolonged stress exposure can be associated with changes in cortisol regulation, and these patterns vary considerably between individuals.
The Autonomic Nervous System
The autonomic nervous system regulates functions including heart rate, digestion, vascular tone, and aspects of the stress response.
Its sympathetic and parasympathetic divisions help the body respond to challenges and support recovery.
Repeated stress exposure, insufficient sleep, and other factors may influence autonomic regulation.
Heart rate variability (HRV) can provide information about aspects of autonomic function, but it is influenced by age, fitness, illness, medication, and measurement conditions. It is not a standalone diagnostic test for allostatic load.
Metabolic and Immune Health
Chronic stress can also interact with metabolic and inflammatory pathways.
Sleep disruption, altered eating patterns, reduced physical activity, and sustained physiological arousal may influence glucose regulation, blood pressure, and other cardiometabolic markers.
These relationships are complex and often bidirectional.
Importantly, no single laboratory test establishes that someone has excessive allostatic load. Research measures typically combine several biomarkers, and there is no universally accepted clinical diagnostic threshold.
Why This Conversation Matters for Women
Women’s experiences of stress are shaped not only by biology but also by their environments.
Employment demands, caregiving responsibilities, financial pressures, relationship dynamics, and unequal distributions of domestic labor can affect opportunities for rest and recovery.
A woman may complete her professional responsibilities only to begin several more hours of unpaid work.
Another may be caring for children, aging parents, or a family member with chronic illness.
Some women are navigating these responsibilities with limited financial resources, inadequate social support, or little control over their schedules.
These circumstances do not affect every woman equally, and they should not be treated as inevitable features of womanhood.
But they are relevant to health.
Research examining family caregivers has identified associations between caregiving burden, perceived stress, and higher measures of allostatic load.
These findings do not establish that every caregiver will develop disease. They do, however, reinforce the importance of considering the environments in which health and illness develop.
Not Every Symptom Is Cortisol
Fatigue, disrupted sleep, difficulty concentrating, and changes in energy are common concerns in clinical practice.
They are also nonspecific.
A woman experiencing persistent fatigue may have iron deficiency, thyroid dysfunction, sleep apnea, depression, medication-related effects, inadequate nutrition, or another medical condition.
She may also be experiencing prolonged psychosocial stress.
Sometimes several factors coexist.
This is why thoughtful evaluation matters.
Not every symptom is a cortisol problem, and not every tired woman needs an adrenal support supplement.
The goal should be to investigate symptoms appropriately rather than attributing them automatically to stress.
Allostatic load is a useful framework for understanding cumulative physiological demands. It should not replace an evidence-based medical assessment.
A Functional Approach to Women’s Health
Functional medicine, at its best, should examine the relationship between physiology, environment, behavior, and lived experience.
Depending on a patient’s history, symptoms, and clinical findings, evaluation may include assessment of:
Thyroid function and iron status
Sleep quality and possible sleep disorders
Nutritional adequacy and relevant deficiencies
Cardiometabolic health
Reproductive or menopausal concerns
Mental health, medications, and other contributors to symptoms
Testing should be guided by clinical indications rather than an assumption that every woman needs an extensive hormone panel.
And treatment should be equally individualized.
Sometimes the intervention is medical.
Sometimes it’s nutritional.
Sometimes it’s movement, improved sleep, or treatment of an underlying condition.
Sometimes appropriate supplementation has a role.
And sometimes a meaningful part of the treatment plan is identifying ways to create more capacity for recovery.
Recovery Is More Than Self-Care
We frequently encourage women to manage stress through meditation, exercise, journaling, or better sleep habits.
These strategies can be valuable.
But they have limitations when the underlying demands remain unchanged.
A woman cannot always meditate her way out of financial insecurity.
A more consistent bedtime may be difficult when caregiving responsibilities extend through the night.
An exercise recommendation may be unrealistic without childcare, transportation, or adequate time.
This is why discussions about stress should include both individual health behaviors and the conditions that make those behaviors possible.
Recovery may involve protecting sleep, sharing domestic responsibilities, accessing community support, addressing financial or occupational pressures, or setting boundaries where it is safe and feasible to do so.
These are not always simple changes.
And the responsibility for making them possible should not fall entirely on women already carrying disproportionate demands.
Good medicine should recognize that recovery requires more than another task on an already overwhelming to-do list.
Making Room for Health
Nearly a century ago, Virginia Woolf challenged readers to consider the material conditions necessary for women’s intellectual freedom.
Her argument was not that women simply needed to try harder.
It was that creativity required opportunity, resources, and space.
Perhaps healthcare should be willing to ask a similarly expansive question.
We can investigate thyroid function, iron status, metabolic health, sleep, and other contributors to symptoms while recognizing that laboratory results exist within a human life.
We can treat illness without assuming every difficulty is a medical disorder.
We can recommend meaningful lifestyle interventions while acknowledging that access to recovery is not distributed equally.
And we can recognize that the goal is not necessarily to help women tolerate increasingly unsustainable demands.
Sometimes the demands themselves need to change.
Functional medicine should not medicalize an unsustainable life.
It should help us understand the relationship between physiology, environment, and lived experience — and identify where meaningful intervention is possible.
Virginia Woolf asked what women required to create.
Ninety-seven years later, perhaps healthcare should also be asking:
Does she have enough room in her life to recover?
Sadie Carlsen, FNP-C
FunctNP Functional Medicine
Next-generation functional medicine for women.
References and Further Reading
Woolf V. A Room of One’s Own. Hogarth Press; 1929.
Hochschild AR, Machung A. The Second Shift: Working Families and the Revolution at Home. Viking; 1989.
McEwen BS. Protective and damaging effects of stress mediators. New England Journal of Medicine. 1998;338:171–179. doi:10.1056/NEJM199801153380307.
McEwen BS. Stress, adaptation, and disease: allostasis and allostatic load. Annals of the New York Academy of Sciences. 1998;840:33–44. doi:10.1111/j.1749-6632.1998.tb09546.x.
McEwen BS, Seeman T. Protective and damaging effects of mediators of stress: elaborating and testing the concepts of allostasis and allostatic load. Annals of the New York Academy of Sciences. 1999;896:30–47. doi:10.1111/j.1749-6632.1999.tb08103.x.
Educational information only. This article does not replace individualized medical evaluation or treatment.
Sadie Carlsen Sadie Carlsen Sadie Carlsen
Functional Medicine Meridian Functional Medicine Meridian
Insurance based Functional Medicine Meridian Idaho