Wait — can postpartum and perimenopause hit at the same time?

When Jaclyn was in her early 40s, she decided to become a mom on her own. She did IVF and gave birth to her daughter at 44, going through the typical rollercoaster of new motherhood: little to no sleep, hair loss, pelvic-floor weakness, the works. But as her infant turned into a toddler, Jaclyn, now 47, started experiencing hot flashes, night sweats, and changes in her menstrual cycle, which had returned post-baby — and she realized that there might be something else going on. 

Jaclyn’s OB-GYN, however, insisted that what she experienced was due to nursing. “She said that, hormonally, I would be 100-percent better if I stopped breastfeeding — that nursing mimics perimenopausal symptoms,” Jaclyn says. But her doctor missed that Jaclyn was actually in perimenopause and it took her another year and a half to get to the bottom of her symptoms. “I felt medically gaslit,” she says.

Jaclyn is far from alone, as more and more women are having kids later in life. One report found that between 2016 and 2023, the number of first-time moms 35 and older increased by 25% — and, as of 2023, roughly 4% of babies total were born to moms 40 and older (a steady increase over the years). That can put some new moms squarely in the timeframe of perimenopause — and make it all the more confusing to figure out what, exactly, is causing them to lose sleep at night, struggle to maintain their weight, or experience hot flashes. Here’s what experts recommend to get to the bottom of it.

Looking at the numbers, the convergence of postpartum and perimenopause isn’t all that surprising. The median age of menopause — the moment at which you haven’t had your menstrual cycle for a full year — is 51. But “the average range is between 45 and 55,” says Dr. Monica Christmas, M.D., an OB/GYN and associate medical director at The Menopause Society. And then there’s perimenopause, which can occur up to 10 years before menopause and bring with it a lot of symptoms due to the unpredictable swings in hormones. 

“If you're an older person [in your 40s] getting pregnant, you may be getting pregnant during the timeframe where you might be in that menopause transition,” says Christmas. And that’s becoming more frequent as reproductive technology — freezing eggs to use them at a later time and IVF — has made older parenthood more accessible than ever. 

On top of that, “increased awareness and education around perimenopause and menopause mean that women are more able to recognize and name symptoms that may previously have gone unrecognized,” says Dr. Stephanie Hack, M.D., an OB-GYN based in Washington, D.C. It makes sense, then, that both Christmas and Hack report seeing more of their postpartum patients experience perimenopause symptoms.

Postpartum and perimenopause have one big thing in common: Your hormones are all over the place, says Hack. This is especially true for women who are still breastfeeding. While estrogen and progesterone drop for everyone after giving birth, nursing can influence other hormones can impact your menstrual cycle, effectively suppressing ovulation — which is why breastfeeding can make it harder (though not impossible) to get pregnant.

During perimenopause, meanwhile, hormones are also in constant flux. Estrogen and progesterone swing up and down at random, which is what contributes to things like hot flashes and mood changes. 

And that can make things confusing, as the hormonal changes from both postpartum and perimenopause can cause similar symptoms. “Was my postpartum depression related to being postpartum, or was that due to being perimenopausal? Probably a little bit of both,” Christmas explains. “Is my difficulty losing weight because I just had a baby and I'm only six weeks from delivery, or is it because I'm perimenopausal? Probably a little bit of both.”

With that in mind, these are the symptoms tend to overlap the most:

• Skipped or irregular periods: The impact breastfeeding has on hormones can delay the return of your period after giving birth. And “one of the first symptoms related to perimenopause is changes to the menstrual cycle because of the fluctuation in hormone levels,” says Christmas. So if you’re in your mid-40s and breastfeed for a year or more, then “before you know it, now you're 47 and the periods have stopped,” says Christmas. “What was postpartum versus what was perimenopause?” It’s virtually impossible to know for sure.

• Weight gain: It’s incredibly common to put on weight during menopause, as a result of multiple factors, including aging and change in fat distribution related to waning progesterone. And after delivery, baby weight tends to stick around (three out of four women still have some baby weight a year postpartum). When you are postpartum and have perimenopause, it can be a real double whammy. “It’s compounded because you have baby pregnancy weight — but you also have these metabolic changes that are happening in the body,” says Christmas.

• Depression: When you’re pregnant, your hormones — estrogen in particular — are very high to help you to sustain the pregnancy. And once you deliver your baby, “those levels precipitously drop very quickly,” says Christmas. This kind of variability in estrogen can create changes in the brain that impact your mental health, which is one reason why some women experience postpartum depression. And completely independent of pregnancy, up to 34% of women “will experience some sort of mood-related changes during the perimenopause transition,” Christmas says. “Both [can be] due to fluctuations in hormone levels.”

• Sleep issues: In retrospect, Jaclyn found that sleep — or the lack thereof — was one of the biggest areas of overlap between postpartum and perimenopause. “I figured it was just me dealing with a toddler and being constantly on edge,” she says. “I didn’t realize that perimenopause affects sleep.” The reasons sleep can be hard to come by for new moms are pretty obvious (why are newborns so awake at 3 a.m.?!). But menopause can impact sleep, too: You lack progesterone’s calming effect, which normally helps lull you to sleep, and night sweats can wake (and keep) you up.

• Hot flashes: Hot flashes are the symptoms most people link to the menopause transition, but they can also happen when you’re postpartum, according to Hack. Again, it’s that drop in estrogen that occurs after you give birth, and gets extended if you choose to breastfeed.

Many women in the grey area of postpartum and perimenopause may never get a clear explanation as to what’s going on. After all, there’s no good way to test for perimenopause. (If your hormone levels are constantly in flux, then there’s no way to get a baseline.)

Experts agree that the onus is really on providers to figure it out. “These are things that we should counsel people about beforehand and say, ‘Hey, you're of an age range where this stuff starts to happen. Are you experiencing any of these symptoms?’” says Christmas. And if the symptoms are impacting their lives, then treatment should be a part of the conversation.

If you need to give your provider a nudge, Hack recommends tracking your symptoms. That “can be very helpful in identifying patterns and determining whether symptoms are related to postpartum changes, perimenopause, or both,” she says. “Postpartum symptoms typically improve as ovarian function returns to its pre-pregnancy state [within a few months of having your baby], while perimenopause symptoms may persist or progress.”

What helped Jaclyn, too, was sharing her symptoms with her friends — in particular, other women who also did IVF in their early to mid-40s. They “were wondering why their sleep sucked and why they were having hot flashes and gaining weight,” she says. “Several of them did not connect the dots until we all did it together.” 

Hormone replacement therapy (HRT) is one of the most effective treatments for perimenopause symptoms, and can be used when you’re postpartum with one exception: If you’re breastfeeding. That’s because there’s limited data on the use and safety of HRT while breastfeeding, according to Hack. Plus, “systemic estrogen may affect milk supply,” she says.

But once you stop breastfeeding, you can talk with your clinician about whether or not HRT is a good fit for your symptoms and health history (for instance, those who have a history of estrogen-derived cancer or blood clots may not be good candidates).

But HRT is just one option. If you’re nursing or your clinician does not recommend HRT, non-hormonal treatments can be a good option. For instance, Veozah and Lynkuet are non-hormonal medications that can help with hot flashes and night sweats (but keep in mind there’s no safety data for breastfeeding, so your provider does need to weigh the benefits and risks). 

“Some people need multiple treatments — say they not only have hot flashes and night sweats, but they also are having debilitating mood-related symptoms,” says Christmas. This may mean a combo of medications, but there are certain antidepressants that have been shown to help minimize hot flashes and night sweats and help with sleep, she adds. 

This is all to say, the ideal solution can vary from person to person — so your provider is the best person to guide you to the treatment that will be safe and effective for your situation. “It’s just a matter of addressing the person in front of you, listening and understanding what their most bothersome symptoms are, and then offering treatment solutions just like you would for any other thing,” says Christmas. “What works for one person might not work for another.” 

It can help to find one who specializes in menopause and menopause treatments, like the clinicians at Weight Watchers Med+ Meno. In addition to getting access to medications, you also become part of a wonderful community of others going through the same life phase you are and have experts advising you on the optimal nutrition and fitness plan for you — something everyone can use throughout both postpartum and perimenopause. 

People are having kids later in life, thanks to reproductive technologies like IVF, but as a result, they may experience postpartum and perimenopause at the same time. Both phases entail a huge fluctuation in hormones, which can contribute to overlapping symptoms like weight gain, irregular periods, and mood swings. But even if you’re postpartum, you still have all the hormonal and non-hormonal treatment options for helping manage your perimenopause symptoms. (The exception is for moms who are nursing, since some hormonal treatments can impact milk supply.) Getting relief ultimately comes down to tracking your symptoms, talking to your doctor, and together figuring out which plan might work best for you.