When I had my first child at 43, I was surprised at how well I eased into parenting. I was the mother I’d always envisioned: calm, patient, loving and mindfully enjoying motherhood.
Now, as a 46-year-old mum of a three-year-old and a one-year-old, I feel like a different person. I’m exhausted, agitated, short-fused, fuzzy-headed, my mood is low and my body aches and cracks like I’ve aged a decade in the past year. I feel brittle, physically and emotionally.
While I recognise some of these feelings and symptoms from my first postpartum, this time has felt bigger, stronger, longer, heavier. My partner asks me what’s wrong at least four times a week, and all I can say is, “I just don’t feel like myself.” What’s more, I feel like a different mother.
Of course, some of it is due to the demands of having two very young children, but there is more to it. When I still hadn’t “bounced back” months after having my second child, I went to my GP.
After blood tests ruled out any medical reason – such as low thyroid or iron – and I’d been assessed for postnatal depression, it didn’t take me long to surmise that I was perimenopausal, and for the doctor to agree. I had simultaneously been experiencing two of the biggest hormonal periods in a woman’s life: perimenopause and postpartum.
Common symptoms of both conditions can include fatigue, mood disturbances such as anxiety and depression, mood swings, irregular periods, hot flushes and night sweats. Add to that headaches, muscle aches and joint pains, sleep disturbances, low libido and brain fog.
If that’s not enough, consider hair loss, acne, changes in body odour, vaginal dryness, itchy skin, bladder changes and weight gain (or inability to lose weight postpartum).
“The crossover of symptoms of perimenopause and postpartum is enormous,” says Dr Kelly Teagle, founder of the WellFemme telehealth menopause clinic.
Welcome to the perfect hormonal storm I call “perimeno-partum”. This phenomenon is not as rare as you might think.
“Perimenopause and postnatal have always coexisted,” says Teagle. “Women are having babies older in life, so the postnatal period coincides more frequently with perimenopause.”
Not only are more women aged 40 and over giving birth than ever before (4.1 per cent in 2010 compared with 5.2 per cent in 2023, according to the Australian Institute of Health and Welfare), the average age of menopause in Australia is 51, with perimenopause sometimes lasting up to 10 years, according to Teagle.
A study last year in the US even discovered that more than a quarter of 30-35 year-olds and 40 per cent of 36-40 year-olds in the study were perimenopausal.
Perimenopause (peri, meaning “around”) is the lead-up to menopause (12 consecutive months from your final period). The term was first used in 1962 by American physician JK Frost, but only achieved common parlance in the past several years as we grew to understand that there is a gradual progression to menopause.
The postpartum (postnatal) period, on the other hand, is defined as lasting six weeks after birth.
Talat Uppal, obstetrician, gynaecologist and director of multidisciplinary practice Women’s Health Road, considers this definition short-sighted.
“Many women do not remotely feel like themselves within the first year of having a baby,” says Uppal.
US-based Doctor of Osteopathic Medicine and functional medicine physician Lauren Davis says it can take up to 18 months for all the nutrients that have been used during pregnancy to be replenished and one to two years for a woman’s hormones to regulate, especially if she has been breastfeeding.
“I don’t consider a woman done being postpartum until her body is repaired, and she feels like herself again,” she says.
What’s more, postpartum depletion can also be present.
Coined by Dr Oscar Serrallach, postpartum or postnatal depletion is a syndrome of deep physical, mental and emotional exhaustion sometimes lasting close to 10 years after childbirth. It’s caused by nutrient depletion, stress and sleep deprivation, and can result in symptoms similar to perimenopause, like brain fog, low energy, loss of libido, mood swings, anxiety, frustration and overwhelm. Sound familiar?
“We can deal with perimenopause much better when all of our nutrients aren’t depleted,” says Davis. “You come out of pregnancy depleted. Depletion affects perimenopause. Whether it’s making the symptoms of perimenopause worse or it’s just postpartum depletion is even hard sometimes for physicians to figure out.”
In the trainwreck of both conditions, confusion reigns supreme. Blood tests for perimenopause are “mostly unhelpful,” says Teagle, meaning it’s diagnosed by symptoms and life stage. If you’re also postpartum, this can make diagnosis tricky as your hormones might not have levelled out.
With so much grey in this area, it’s of paramount importance to listen to and believe patients, says Uppal. “With more women having babies later in life, growing awareness of perimenopause, and recognising that symptoms of postpartum hormonal changes can extend beyond the traditional six-week academic definition, there can be an overlap between postpartum effects and perimenopausal symptoms, which may last longer and interact,” she says.
And there’s the rub. During a season of life when you are required to have an abundance of patience, love and understanding, the very hormones that help you feel joyful (oestrogen) and calm (progesterone) and help you mother well are wreaking havoc inside your body.
Knowing whether you are in a temporary life stage (postpartum) or beginning the transition to the end of your reproductive life, or both, is so emotionally important to how you psychologically navigate this time. It’s terrifying as an adult to suddenly feel foreign in your body and mind, and it really does need an explanation.
For me, it was both confronting to realise I was perimenopausal, and a relief: there wasn’t anything terribly wrong, and my symptoms weren’t just in my mind.
So how do we actually manage these conditions together? Treatment options vary according to Teagle, but the first place to start is arguably the hardest in the early years of parenting: sleep, nutrition, movement, stress reduction and connectedness.
Teagle recognises that this can be “particularly tricky if you feel bad because of symptoms”. Other options apart from lifestyle habits are psychological therapies, menopausal hormone therapy, antidepressants or a birth control pill to help with mood symptoms.
For Davis, she first focuses on replenishing the body postpartum.
“Hormones will be disrupted no matter what if depletion isn’t fixed,” she says. While menopausal hormone therapy can “shine” when it comes to alleviating perimenopausal symptoms, Davis cautions against a quickfire approach.
“If we step in too early and miss the depletion part and simply start giving hormones for hormones’ sake, we’re not really fixing all of the things that balance the hormones in the background.”
If symptoms persist after nutrients are repleted, Davis then starts digging into perimenopause.
With the majority of Davis’ patients being postpartum and 60-70 per cent aged 35 years and older, she sees women in both conditions daily. She focuses on three key areas: nutrition, cortisol disruption and gut microbiome.
Nutritionally, women need to ensure they are getting enough protein and micronutrients, such as potassium, vitamin D, magnesium, calcium, vitamin E and vitamin K. Davis recommends avoiding refined sugars and high glycaemic index (GI) foods to limit the impact of insulin resistance.
During pregnancy, hormones increase our insulin resistance and post-pregnancy, our bodies have often adapted to that state.
“With the stress of postpartum and hormonal changes, we often see a decline in metabolic flexibility (being able to adapt to higher or lower glucose levels),” says Davis.
By eating low GI foods, like slow-burning carbohydrates, we keep blood sugar levels from spiking, which can help the body adapt and recover its insulin sensitivity, she says.
Cortisol dysregulation is another area that needs to be prioritised, says Davis. “For women in perimenopause, the cortisol disruption brings out a lot of symptoms such as brain fog, fatigue, poor sleep and hot flashes,” she says. As a postpartum woman’s cortisol is already unbalanced due to the alertness they naturally have to attend to the baby, this is an area that needs special attention.
Davis also stresses the importance of replenishing the gut microbiome by eating high-fibre and fermented foods. Not only does the gut microbiome shift while pregnant (and can take up to 24 months to reset postpartum), the microbiome in perimenopause is incredibly important to help with insulin resistance, which can result in difficulty losing weight and weight retention, says Davis.
While Davis acknowledges the complexity of perimeno-partum, she wants women to know that support is available.
“There are solutions out there when we really understand what’s going on in the body,” she says. However, she stresses that women need to be their “best advocates” and seek out people who have built their expertise in this specific area.
Teagle wants women to remember that just like every woman’s experience and symptoms vary, so do the treatments that work for them.
“There is a lot of trial and error, and patience is paramount!” she says.
In my current state, patience is hard to muster.
I wish I could will my hormones to behave, but I’m having as much success getting them to behave as I am my children. I know I’m not alone (on either front), yet often I feel that way.
Not only is there a massive gap in knowledge, according to Uppal – women’s symptoms are often dismissed or blamed on the baby. She calls for more research to better understand and support women navigating these intersecting life stages. “For more women birthing after 40, we need to really give them the respect of more research.”