What "I Haven't Spoken to Them in Ages" Means for Your Health

Nov 2

Tell me if this feels familiar. You have chronic pain or fatigue, and your capacity fluctuates unpredictably from day to day. You hate to be a burden, so at some point you stopped making plans with friends and started waiting for a "good day" when you feel up to socializing. It's a reasonable adaptation to make when committing in advance can feel like setting yourself up to cancel. But, before you know it, "I'll reach out when I have energy" turns into, "I haven't spoken to them in ages."

What "I Haven't Spoken to Them in Ages" Means for Your Health

Why this matters more here

If you're hypermobile, this tends to happen gradually and without anyone deciding it. People with hEDS or hypermobility spectrum disorder (HSD) describe their social circles shrinking after diagnosis — not because anyone pulled away on purpose, but because invitations stop coming once friends expect you to cancel, and going out less makes it harder to meet new people or keep up with the friends you have. Close friendships tend to survive; looser ones fade, and people describe that loss as its own kind of grief. In a separate study of adults with hEDS, loneliness turned out to be the most robust and consistent predictor of poor outcomes the researchers tracked — more consistently than how much support family or friends actually provided.

If POTS or dysautonomia is part of your picture, the isolation often comes from a different angle: feeling fundamentally misunderstood. People living with POTS describe the exhaustion of explaining an invisible illness to people who can't see it, feeling like a burden when they need accommodations, and being judged for using supports like a disabled parking badge because they "look fine." Mast cell activation syndrome (MCAS) adds its own version of this — in one study, loneliness was among the strongest things linked to depression in people with MCAS, on par with optimism, and it remained a significant predictor even after accounting for the stress of the disease itself. Part of that isolation may also come from how hard MCAS is to diagnose in the first place: the symptoms are nonspecific and overlap with many other conditions, and clinician familiarity with it still varies widely — which means even people who do have it may never have knowingly met anyone else who shares the diagnosis.

If you're one of the many hypermobile people who also has ADHD, there's a documented link to loneliness there too — in older adults, an ADHD diagnosis was associated with more emotional loneliness, and a recent meta-analysis found young people with ADHD report higher loneliness than their peers. And perimenopause adds a compounding layer on top of all of it: a 2026 study found that loneliness and social isolation were each independently linked to worse self-reported cognitive symptoms in perimenopausal women, and having both at once raised the odds of landing in the more severe decline group roughly eightfold compared with having neither — a group that included just over half of participants, so this isn't a rare tier reserved for the worst cases.

None of this means you're bad at friendship. It means the usual way people maintain connection — spontaneously, whenever the mood strikes — depends on a kind of reliable energy and predictability that this population often doesn't have. The fix isn't trying harder to feel like reaching out. It's taking the decision out of the moment entirely.

What Planned Connection actually means

Planned Connection means scheduling a recurring touchpoint with another person or group ahead of time, at a level matched to your actual capacity, instead of waiting until you feel both energetic and social enough to make it happen spontaneously. The contact itself can be small — a text check-in, a phone call, a shared walk, someone to sit with while you both do your own thing. What matters is that it's on the calendar before the day arrives, so showing up doesn't require you to first generate the motivation to reach out.

This is a deliberate trade: you give up some spontaneity in exchange for connection that actually happens. For a population whose energy is unpredictable, a loose plan you can scale up or down beats a perfect plan you keep not getting around to.

What the evidence says

This mirrors a core idea from behavioral activation, one of the best-studied approaches to depression and withdrawal: low mood and low energy make people pull back from the activities — including social ones — that would actually help them feel better, and that withdrawal deepens the low mood, which drives more withdrawal. The way out isn't waiting to feel motivated; it's scheduling the activity regardless of motivation and letting participation come first. A 2020 Cochrane review of this approach found it outperformed usual care in people with depression over the short and medium term, though the evidence was only moderate certainty and didn't hold up long term. Planned Connection borrows the same underlying logic and applies it to the social withdrawal that the hypermobile population describes: pre-committing to contact so it doesn't depend on momentary desire.

What this looks like, practically

Pick one person, or group, and one recurring slot — the same evening every week, or the same day every other week — and put it on your calendar before you need the motivation to set it up. Attach it to something that's already happening if you can: a call during a walk you already take, a standing coffee date that falls on a day you're usually near the coffee shop anyway.

If you want a slot that pulls double duty, consider a recurring class built around slow, breath-coordinated movement — tai chi, qigong, or a gentle yoga class. These target two things that matter specifically here: balance and nervous system regulation. Women with hypermobile EDS have been shown to have measurably worse balance and gait than matched controls, with more than half falling at least monthly — and separately, a meta-analysis of 11 trials in adults over 55 found tai chi produces moderate-to-large improvements in lower-limb joint position sense, the kind of input balance depends on. Both tai chi and yoga also show effects on heart rate variability, a marker of how well the nervous system shifts between stress and calm: a meta-analysis of randomized trials found both improved it and lowered perceived stress. None of this research was done in hypermobile people specifically, so it's borrowed evidence, not a tested treatment for this population — but the mechanisms line up with what this group is already working with.

Tai chi in particular also has decent evidence behind it for mood: a meta-analysis of 12 trials in middle-aged and older adults found a large reduction in depression scores, with longer programs (24+ weeks) outperforming shorter ones. Some researchers studying tai chi have suggested part of the benefit comes from the social contact and sense of belonging a recurring class builds, though that specific piece hasn't been directly tested. If hEDS or HSD is part of your picture, look for an instructor willing to individualize and build strength and joint control rather than push everyone toward more flexibility.

Build in a pre-agreed downgrade instead of an all-or-nothing plan. Decide in advance what the low-capacity version looks like — a dog walk becomes a phone call, a dinner becomes a text thread, or yoga is done seated — so a hard day doesn't mean canceling, just scaling down. The plan survives the flare because it was never rigid to begin with.

Consider making at least one of these slots someone who shares your diagnosis, if that's available to you. In the De Baets hEDS study described earlier, people who had friendships with others living with the same condition described feeling less alone and better understood than general social contact tends to provide — and the Nicoloro SantaBarbara and Lobel MCAS researchers specifically named peer connection, including online peer communities, as a promising (though not yet tested) way to address the isolation they found. If your local area doesn't have a matching chronic-illness group, Inspire hosts an EDS and HSD community in partnership with The Ehlers-Danlos Society — worth a look if you want this slot to be with someone who gets it.

A caveat worth naming

Scaling down isn't giving up, and it's not something to apologize for every time. If a slot keeps feeling thin no matter how much you scale it down — whether that's with one person or a group — it may be worth a gentle check-in about what connection could realistically look like right now, rather than letting it quietly go empty. And if what you're feeling is less "I don't have the energy today" and more a pervasive loss of interest in people you actually care about, that's worth mentioning to a provider — it can be a sign of depression that a habit alone won't resolve.

The bigger picture

The BENDY Method is a 12-week habit-based course for perimenopause and menopause in bodies with hEDS, HSD, MCAS, POTS, dysautonomia, and related presentations. Join the waitlist to be first to know when enrollment opens.

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