Is it Postpartum, Perimenopause, or Both?

By Suzanne Fenske, MD, FACOG, ABOIM, MSCP

Is it Postpartum, Perimenopause, or Both?

As women have children later in their reproductive years, postpartum challenges may compound in perimenopause. It can be hard to decipher if brain fog, anxiety, and vaginal dryness are postpartum or nursing-related or if they could mean the onset of perimenopause.

In today’s article, we’ll discuss postpartum and perimenopausal hormone changes, their overlap in older moms, and what you can do to support hormonal health no matter the scenario. You aren’t alone or crazy; you deserve healthcare that takes your symptoms seriously and offers actionable tools so you can feel your best, no matter the stage (or stages) you are in.

Keep reading as we explore:

• Definitions of postpartum and perimenopause
• The postpartum and perimenopause overlap
• Integrative action steps

Postpartum Vs. Perimenopause

Postpartum is the period after childbirth, where estrogen and progesterone that were at all-time highs during pregnancy crash to all-time lows. High levels of prolactin during breastfeeding continue to suppress ovulation and the menstrual cycle, keeping estrogen and progesterone low.

The postpartum period may be associated with symptoms related to low hormone levels. How your body responds during this time may provide clues about how it will respond to a similar low-hormone state in late perimenopause and menopause.

The duration of the postpartum period varies, and it may continue well beyond the physical recovery from childbirth. It may take some women two or three years to feel like themselves again, whereas other women may “bounce back” more quickly.

Perimenopause is the transition period to menopause, the one-year mark without a period, and may begin as early as your mid-30s and commonly in the early 40s. The transition may last for a couple of years or a decade, with the average age of menopause being 51. In the early stages of perimenopause, hormones may fluctuate wildly, but as perimenopause progresses, estrogen and progesterone levels fall, creating a similar hormonal landscape to postpartum.

When Postpartum and Perimenopause Collide

Because of careers, changing social norms, and the availability of fertility treatments, more women over the age of 35 and 40 are having babies compared to just 20 years ago. Some women who have a baby in their late 30s or early 40s may already be in perimenopause when they get pregnant. For others, it’s just around the corner after giving birth.

Both postpartum and perimenopause (especially later perimenopause) are life phases characterized by low reproductive hormones, including estrogen and progesterone, that affect every body system. Low hormones can give rise to mental and physical symptoms and disease.

Overlapping postpartum and perimenopause symptoms include:

• Fatigue
• Sleep disturbance
• Anxiety
• Depression
• Mood swings
• Irregular menstrual cycles
• Night sweats
• Brain fog
• Vaginal dryness
• Low libido

Estrogen shapes the brain, and changes in estrogen levels can affect the brain and mental health. For example, you may move from “pregnancy brain” to “postpartum brain,” where you forget words or why you walked into a room. These symptoms are also common in perimenopause. There are mental health correlations, too; any prior episodes of depression, including postpartum depression, increase your risk for depression in perimenopause.

As another example, new research describes the genitourinary syndrome of lactation, where the low estrogen status caused by breastfeeding contributes to vaginal dryness, tissue atrophy, increased urinary tract infections, and related systems. Genitourinary syndrome of lactation is similar to the genitourinary syndrome of menopause, where the same symptoms may arise, affecting sexual health and quality of life.

Further, both the hormonal swings of postpartum and perimenopause can correlate with autoimmune disease. During times of hormonal transitions, women are more likely to get a new autoimmune diagnosis or experience a flare of an existing condition.

Whereas the postpartum period will eventually end, perimenopause symptoms may persist and exacerbate as you get closer to menopause. After menopause, some symptoms may resolve, while others will likely persist. After menopause, age-related disease risk, including heart disease, osteoporosis, and dementia, increases.

Integrative Postpartum and Perimenopause Strategies

How you care for yourself during the postpartum period and through perimenopause can impact your future health, either contributing to chronic disease or reinforcing behaviors that support long-term health.

Whether you’re a new mom, in perimenopause, or in that tricky time where postpartum and perimenopause intersect, here are some integrative strategies to consider:

• Choose your provider well. Your provider should take your symptoms seriously. If they dismiss what you are telling them as “just getting older” or “just postpartum,” it should be a red flag, and you can take your business elsewhere. At TārāMD, we take the time to listen and understand what you are going through. If a symptom is causing you distress and you don’t feel like yourself, let’s introduce supportive measures through individualized, integrative care.

• Request lab testing. If your provider says they don’t test hormones during postpartum or perimenopause, that should be another red flag. We aim to identify the underlying causes of symptoms and distinguish between low estrogen levels and other hormonal changes that are common during these transitional periods, including thyroid hormone imbalance and insulin resistance.

• Dial in nutrition. Whether you are nursing or trying to maintain body composition in midlife, you need a personalized nutrition approach that helps you meet your nutrient needs, manage symptoms, and support your long-term health goals. Work with your TārāMD nutritionist for guidance.

• Double down on lifestyle strategies. Granted, it can be hard to sleep, and stress can be high when navigating a new baby and the changing dynamics of your family. Still, focusing on lifestyle foundations is excellent support during postpartum and perimenopause. Self-care may look different during this time, and you may need more support. Consider bringing a therapist, sexuality and empowerment coach, acupuncturist, or another practitioner into your team. If you need a referral, we can help.

• Use targeted supplements. Your supplement plan is as unique as your diet; there’s no one-size-fit-all approach. If you are nursing, you may need to supplement extra nutrients to support milk production and rebuild your stores after pregnancy. If you’re also dealing with perimenopause, you may have additional needs. Additionally, specific herbs can support low hormone states and the communication between the brain and ovaries. Your TārāMD team can help you implement the specific supplements you need.

• Consider BHRT. Bioidentical hormone replacement therapy may be supportive during any life phase where low hormones are causing mental and physical discomfort. It’s safe to use vaginal estrogen while breastfeeding, and it may also be safe to use systemic therapies depending on your situation. Working with a Menopause Specialist, like Fenske, who deeply understands the nuances of hormone therapy is essential.

Both postpartum and perimenopause are massive hormonal shifts, even more so when you experience them concurrently or together. There’s no need to suffer through these life phases. Seek a personalized, integrative approach for symptom management and long-term health. 

References

1. https://www.cdc.gov/nchs/data/nvsr/nvsr74/nvsr74-3.pdf
2. Venborg, E., Osler, M., & Jørgensen, T. S. H. (2023). The association between postpartum depression and perimenopausal depression: A nationwide register-based cohort study.Maturitas, 169, 10–15.
3. Perelmuter, S., Burns, R., Shearer, K., Grant, R., Soogoor, A., Jun, S., Meurer, J. A., Krapf, J., & Rubin, R. (2024). Genitourinary syndrome of lactation: a new perspective on postpartum and lactation-related genitourinary symptoms.Sexual medicine reviews, 12(3), 279–287.