When Perimenopause and Postpartum Intersect
- Outreach APW
- 16 hours ago
- 4 min read
With more women conceiving later in life, the demographic of moms who are experiencing both postpartum and perimenopause is growing. Anchor spoke with Ellen C. Byars, MSN, BSN, WHNP-BC, who specializes in hormone therapy, menopause, perimenopause, and sexual health, to learn more about perimenopause and how it impacts women's reproductive and mental health.
Perimenopause 101
To understand what it might be like to live in the overlapping space of postpartum and perimenopause, it's important to understand the basics of perimenopause. Perimenopause usually starts in a woman's mid-40s, though symptoms can begin in the late 30s for some people. It is a transitional time marked by fluctuation in hormone levels, particularly estrogen and progesterone. During this time, a woman's egg reserve is declining—some eggs have been lost through ovulation and some eggs are lost through a process called apoptosis, or "programmed cell death" where the body starts to get rid of cells it no longer needs. As the quantity of eggs decreases, the follicle-stimulating hormone (FSH), starts to increase in order to stimulate the ovary to produce more estrogen to ovulate those remaining eggs. As a woman gets to the end of her egg store, estrogen production becomes more erratic. Sometimes FSH will overshoot, and a woman will produce so much estrogen that she ovulates twice in a month. "That's why having twins is more common in your 40s," Byars explains.
It's these hormonal fluctuations that cause the symptoms of perimenopause, which can be emotional, physical, or behavioral.
When Perimenopause Meets Postpartum
Many hallmarks of perimenopause mirror the hallmarks of the postpartum period, like tearfulness and brain fog, for example. This means when a postpartum woman who may also be perimenopausal visits her medical provider, it can be a challenge to tease out what symptoms are triggered by postpartum hormone changes coupled with exhaustion from caring for a newborn versus perimenopause changes. There's no test for perimenopause, but rather, it is determined through a clinical diagnosis based on symptoms, Byars says. In order to decide which treatment options might make a patient feel better, it takes having a provider who will listen closely to gain a full picture. To find a provider who specializes in perimenopause, Byars recommends using the directory put together by The Menopause Society.
Perimenopause, Postpartum, and Mental Health
We know that, in terms of mental health, some women are more sensitive to hormonal fluctuations and hormonal changes. So, Byars explains, people who have a history of depression, including postpartum depression, and Premenstrual Dysphoric Disorder (PMDD) are more likely to have bothersome mood disturbances in the perimenopause period. It's crucial for those people to start speaking to their medical provider early on about a treatment plan in case their mental health starts to suffer during perimenopause. SSRIs or SNRIs coupled with counseling and therapy can help mood disturbances caused by perimenopause. Of course, for women who are also postpartum, they need to talk to a medical professional about medication if they are breastfeeding.
Treatments
Byars stresses that perimenopause treatments are varied and need to be individualized.
"Sometimes it's a low dose birth control pill," she says, which helps to even out hormonal fluctuations by suppressing ovulation and providing steady states of estrogen and progesterone. Sometimes providers suggest a Mirena IUD, which can help with abnormal uterine bleeding, a common experience during perimenopause.
There is also traditional hormone therapy, also known as Bioidentical Hormone Replacement Therapy (BHRT), which uses compounds designed to have the same molecular structure as the hormones naturally produced by the human body. BHRT has been historically used to treat hot flashes, night sweats, and sleep disturbances related to the menopause transition, Byars says, but that approach might not be best for people who are still having periods because it adds extra hormones on top of what the body is naturally making.
"It might make you feel better when you're low on estrogen and progesterone, but during the times of the month when your hormones fluctuate high, it might make you feel worse," Byars adds.
That's why it's so important to have a provider who will listen closely to what a person's symptoms are in order to pick the best treatment options. There are also non-hormonal treatments for symptoms like hot flashes, including behavioral lifestyle choices—these includes standards like exercising, eating well, and getting enough sleep.
Final Thoughts
When navigating the symptoms of perimenopause, whether they intersect with postpartum or not, Byars returns to the idea that treatment should be highly personalized. As such, she warns against anyone offering a one-size-fits-all approach or oversimplification of perimenopause treatment. There are safe, effective hormone therapies available that are FDA-approved and are covered by most insurances, Byars adds, so she suggests a healthy dose of skepticism towards anyone trying to sell alternative supplements to treat perimenopause. A treatment plan should be made with a qualified medical provider based on symptoms, health history, and personal preferences.
Ellen C. Byars, MSN, BSN, WHNP-BC is a Nurse Practitioner working in Obstetrics and Gynecology at Duke. She is a Menopause Society Certified Practitioner (MSCP) and an American Association of Sexuality Educators, Counselors and Therapists (AASECT) Certified Sexuality Counselor.
References
¹ Kundakovic, M., & Rocks, D. (2022). Sex hormone fluctuation and increased female risk for depression and anxiety disorders: From clinical evidence to molecular mechanisms. Frontiers in neuroendocrinology, 66, 101010. https://doi.org/10.1016/j.yfrne.2022.101010
Written by Bridget Bell
Reviewed by Ellen C. Byars, MSN, BSN, WHNP-BC & Roxanne Rosenberg, LCMHC, PMH-C
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