The Intersection of Postpartum & Perimenopause
As more women delay having children, the intersection of perimenopause and postpartum has become increasingly relevant in women's health. Both perimenopause—the transition before menopause—and postpartum are defined by significant hormonal changes that impact physical, emotional, and mental well-being. For mothers having children in their 30s and 40s, these two phases can collide, creating unique challenges that are often inadequately addressed by healthcare providers. Women can be left feeling confused and unsupported during this time. Luckily, there is new research and attention being given to perimenopause, menopause, and postpartum mental health. Increased understanding of this intersection and what researched based interventions are helpful, such as therapy and medication, are crucial in supporting this growing population of mothers.
The Shift: More Mothers in Their 30s and 40s
Over the past few decades, women have increasingly delayed childbirth for various reasons, such as career considerations, financial stability, and advances in fertility treatments. According to the CDC, the average age of first-time mothers in the U.S. rose from 24.6 years in 1970 to 30.7 years in 2023. In fact, births among women aged 35 and older have increased by 50% over the past decade.
Notably, the number of women giving birth in their 40s is also rising. Data from the CDC indicates that the birth rate for women aged 40-44 increased by nearly 3% between 2020 and 2022, while the birth rate for women aged 30-34 remained stable. While this trend reflects positive advancements for reproductive autonomy, it also introduces new complexities, especially as hormonal changes associated with perimenopause begin to appear.
Perimenopause and Postpartum: Hormonal Collision
Perimenopause typically begins in a woman’s early-to-mid 40s, but can start earlier. This transitional time can last upwards of ten, or more, years. During this time, hormone levels become labile, fluctuating with higher peaks and lows, and in more irregular patterns. One of the main reasons for this is due to declining egg counts leading to unpredictability of when ovulation will occur. As a woman’s egg count drops, follicle stimulating hormone (FSH) must work harder to produce an egg from either ovary for ovulation to occur. As FSH spikes it creates a cascade effect on all other hormones. There may be some months where an egg is produced normally (and thus your menses remains normal), others where it takes a very long time and FSH works tirelessly for weeks (a very late menses), and then another month FSH may gear up to work as hard as it had in the past and an egg is produced quickly and easily resulting in early ovulation and a sooner cycle. Estrogen and progesterone levels are impacted by this and fluctuate in more extremes as well, leading to hot flashes, mood changes, insomnia, increased anxiety, brain fog, bloating, and other physical symptoms. However, , women in perimenopause are still very much capable of becoming pregnant. At the same time, postpartum—the period following childbirth—is marked by a dramatic drop in estrogen and progesterone levels. These hormonal shifts can cause mood swings, fatigue, anxiety, and physical recovery challenges. If a woman is exclusively nursing, estrogen levels will continue to remain low to suppress ovulation, which can exacerbate or worsen symptoms for women in perimenopause, such as hot flashes and vaginal dryness. Understandably, the convergence of postpartum hormone changes with perimenopausal symptoms can feel especially intense.
While postpartum hormone levels typically stabilize within 6 to 12 months after childbirth, perimenopausal symptoms can persist (and they may even present themselves for the first time post childbirth), creating a prolonged period of hormonal imbalance. Not only can it be difficult to discern where symptoms are arising from, this overlap increases the risk of mood disorders, physical discomfort, and the mental health challenges associated with these life transitions.
The Mental Health Impact
Both perimenopause and postpartum bring an elevated risk for mood disorders, including depression and anxiety. Studies show that women who give birth after age 35 are more likely to experience postpartum depression compared to younger mothers. At the same time, perimenopausal women are twice as likely to experience depression as those in premenopause. The combination of these hormonal shifts can create a “perfect storm” of emotional distress.
Given the increased risk for mental health challenges, it’s essential to address the emotional impact that these overlapping life stages can have. That’s where therapy and medication come in.
Therapy: Supporting Emotional and Psychological Well-being
Therapy provides an essential outlet for women to process the emotional, psychological, and even physical challenges that arise from perimenopause and postpartum. It also offers the opportunity for normalization, education, knowledge, and an understanding of their symptoms. A few types of therapy that can be particularly beneficial include:
Cognitive Behavioral Therapy (CBT): This form of therapy helps identify and reframe negative thought patterns that contribute to depression and anxiety. It offers coping mechanisms that can reduce the impact of hormonal shifts on mental health.
Interpersonal Therapy (IPT): Focused on relationships and life transitions, IPT is useful for navigating the role changes and identity shifts of motherhood and perimenopause. It provides tools to manage stress in family and personal relationships during this period.
Mindfulness-Based Therapies: Practices like Mindfulness-Based Cognitive Therapy (MBCT) help women manage stress, anxiety, and emotional regulation. By focusing on the present moment, mindfulness can reduce emotional reactivity triggered by hormonal changes.
Trauma-Informed Therapy: For women with a history of trauma, childbirth and hormonal fluctuations can trigger unresolved emotional issues. A trauma-informed approach ensures that women feel safe and supported as they work through these experiences.
Supportive Psychotherapy: Simply having a space to talk about the challenges of balancing postpartum recovery with perimenopausal symptoms can bring immense relief. This approach validates women’s experiences, offering reassurance and guidance.
Medication: Managing Hormonal Imbalances and Mental Health
For many women, therapy alone may not be enough to manage the complexities of postpartum and perimenopause. Medication can provide vital relief for both mental health and physical symptoms:
Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to manage postpartum depression, perimenopausal mood swings, and anxiety. These medications help ease anxiety and stabilize mood by increasing neuroplasticity in the brain, which in turn helps patients to create a healthier mindset. Estrogen and serotonin are also connected, thus research shows that SSRI’s can be helpful in combating perimenopausal symptoms that stem from lower estrogen levels.
Hormone Replacement Therapy (HRT): HRT is particularly beneficial for managing perimenopausal symptoms like hot flashes, night sweats, and mood swings. It can also ease the hormonal transition for postpartum women who may be experiencing similar symptoms as their bodies adjust post-birth.
Anxiolytics (Anti-Anxiety Medications): For women experiencing severe anxiety or panic attacks, short-term use of anxiolytics can offer immediate relief. Managing anxiety effectively is critical, especially when sleep is already disrupted by both postpartum recovery and perimenopause.
Sleep Aids: Insomnia is common in both postpartum and perimenopausal women. Medications that promote sleep can help restore much-needed rest, which is vital for managing both physical and mental health.
Symptom-Specific Medications: For women dealing with specific symptoms, like migraines or muscle pain, tailored medications can offer relief and ease the overall physical burden of this time.
Combining Therapy and Medication for Holistic Care
A combined approach of therapy and medication is often the most effective way to manage the unique challenges that arise from the intersection of perimenopause and postpartum. While therapy provides women with the emotional and psychological tools to navigate this period, medication helps alleviate physical symptoms and stabilize mood.
For example, a woman experiencing severe postpartum depression might benefit from both SSRIs and Cognitive Behavioral Therapy to improve her mood and develop healthier thought patterns. A woman facing perimenopausal symptoms on top of postpartum recovery might find relief through hormone replacement therapy and supportive psychotherapy.
Navigating the Intersection with Support
As more women have children later in life, it’s essential to recognize the intersection of perimenopause and postpartum and how the overlapping hormonal changes can impact physical, mental, and emotional health. With proper support through therapy and medication, women can manage the unique challenges of this period and thrive.
At The Alliance Center, we offer a multidisciplinary approach that integrates both therapeutic and medical support, providing comprehensive care for women navigating this challenging time. If you’re experiencing postpartum and perimenopause simultaneously, reach out to us to learn more about how we can help you find balance and support on your journey.
References:
New report on women and depression: Latest research findings and recommendations
NVSS - National Vital Statistics System Homepage
Psychotherapy at midlife - Harvard Health
Perimenopause - Diagnosis and treatment - Mayo Clinic
Mood Changes During Perimenopause Are Real. Here’s What to Know. | ACOG
Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum | ACOG