I’d like to blame my hormones, please

Postpartum or perimenopause — does it matter?

People ask it in many different ways, but one question that seems to be frequently percolating among so many of the parents I know is: Why am I having so many big feelings, is it my hormones, and what am I supposed to do about it?

(OK, fine, that’s three questions — don’t tell my editor?)

Over the past year especially, I feel like I’ve heard more and more women ask how they are supposed to understand what’s happening in their bodies: What to chalk off to postpartum, what’s perimenopause, and if they are supposed to be doing something about what they’re feeling — yet alone which hormonal change to blame it on.

I hear you — and I also wanted to know the answers because these times of intense reproductive change can also be a time of big emotions. To understand our brains and our bodies a little better, I started making some calls.

Cue expert #1

First I called Anna Barbieri, MD, clinical strategy leader for the Rowan Center for Women’s Health and Wellness at Mount Sinai in New York City.

Traditionally, she explained, the postpartum period has been defined by the obstetrics and gynecology field as the first six weeks after childbirth, or the average time it takes for the uterus to return to its pre-pregnancy size.

But that’s just one part of a bigger story.

“If you look at some of the hormonal changes and postpartum symptoms like postpartum depression or postpartum hair loss, of course those extend beyond that six-week time frame, so the extended postpartum definition can even be up to 12 months,” Barbieri said.

It can vary based on a lot of factors, like your age when giving birth and whether or not you breastfeed.

Perimenopause varies, too — many people will begin perimenopause in their early 40s, but some will begin earlier and some later. And as people are waiting till later in life to have babies, the chances for an overlap between the postpartum period and perimenopause grow.

The postpartum period as a warning

Barbieri said she thinks a lot about how difficult the postpartum period can be for so many — and how limited screening for postpartum depression can be. We know there’s a link between postpartum depression and perimenopause depression and anxiety, too.

“Experiencing mental health challenges postpartum may again be a clue to how one is going to experience the transition of perimenopause. So, just like gestational diabetes increases the risk for diabetes later in life, just like preeclampsia or gestational hypertension increases the risk for chronic hypertension, same with postpartum depression and postpartum mood abnormalities,” Barbieri said.

On top of that, both the postpartum period and perimenopause are periods of transition. They often come with stress, lack of sleep and a shift in identity. Of course anxiety, depression or other mood or mental health disorders could crop up.

And, Barbieri said, while some of this can be treated, there’s no magical cure for the one constant: change.

“I think many of us spend a lot of time feeling very uneasy with these changes because we’ve been conditioned to believe that only a young body is beautiful, that only a fertile body is beautiful, and we need to look young to be worthy. I think my biggest message to patients is I can help a lot with sleep, with symptoms, with weight, with libido, with mood — but we cannot change the fact that our bodies are changing. Better health care starts with compassion, acknowledgement, awareness and interest.”

Cue the expert #2

Next, I called Dr. Lauren M. Osborne. She leads the PsychoneuroImmunology in Pregnancy and Postpartum (PIPPI) Lab at Weill Cornell Medicine in New York City, where she studies anxiety disorders at times of reproductive transition.

Osborne said that while often, patients may be searching for language — is this postpartum? Is this perimenopause? — those labels don’t matter much.

“Any reproductive transition for some people can lead to an instability in mental health, for both biological and psychosocial reasons. Some people are very vulnerable to hormonal fluctuations, and there’s no bigger hormonal fluctuation than pregnancy leading into postpartum,” Osborne said. “There’s a cliff that people go over hormone-wise, but every woman who gives birth goes over that cliff — and not every woman develops postpartum depression.”

Perimenopause further complicates things for so many people (because of course it does) by making those hormonal fluctuations more extreme and unpredictable. For some, those fluctuations can cause major mood symptoms: depression, anxiety, anger. You know how you feel the week before your period? Think that times a million — at least for some people.

Osborne, like Barbieri, pointed to nonhormonal reasons people can struggle at this time of life, too.

The fact is, the postpartum period, midlife and sandwich generation caregiving — these are times of big changes in identity, with lots of pressure and stress. They are times when relationships are often stretched, money is often tighter, and everyone is sleeping less. These aren’t your hormones, this is life — but yes, it can take a very real toll on your mental health.

And if you are feeling the impact of all these changes, physiological and otherwise, it’s not just OK to ask for help, but help is really critical to ensuring you can keep caring for yourself.

What you can do

Here are some of Osborne’s suggestions for exactly how you can in fact care for yourself:

• Find a therapist. Look into cognitive behavioral therapy (CBT), interpersonal therapy, and acceptance and commitment therapy (ACT): They’ve all been shown to help treat postpartum depression and mood disorder during perimenopause.
  

• Find a reproductive psychiatrist. Here’s a list of all the academic reproductive mental health programs in the United States, maintained by Marcé of North America, the professional group for health care providers focused on mental health care for pregnant and postpartum people.
  

• Know your medication options: Traditional antidepressants are very effective for both postpartum depression and perimenopausal depression, and a couple of antidepressants have been shown to be effective in reducing vasomotor symptoms (hot flashes and night sweats).
  

• Know what hormone therapy can and cannot do: There’s also evidence that for some people experiencing lots of vasomotor symptoms, menopausal hormone therapy can be really helpful — but it’s not indicated for people who are only experiencing mood symptoms without any vasomotor symptoms because though the risks of hormone therapy are not as great as once believed, they are still greater than for antidepressants.

Hormones can’t tell you everything

Another layer further complicating treatment of mood symptoms in midlife is the stigma around mental health disorders.

Osborne said so many women are begging their doctors to measure their hormone levels, looking for an answer in their labs to why they are feeling so bad.

“There’s no evidence that that’s helpful,” Osborne said of measuring hormone levels as a means of diagnosis. “It isn’t the level of hormone that’s the problem: It’s vulnerability to the fluctuation.”

There is some evidence, Osborne said, that the steepness of the decline in some of those hormones may be related to developing symptoms, but you would only be able to detect this if you were able to test multiple times over a number of different cycles: One blood draw at one random moment in time isn’t going to tell you that.

“I think people want it to make a difference because they want to have a hormone disorder. They don’t want to have a mental health disorder. Nobody wants to have a mental health disorder, so they latch on to the idea that, ‘Oh this is a hormone problem, therefore we must need to test my hormones.’”

Open that window

These are natural transitions — from pregnancy to postpartum, from ovulation to perimenopause — and a lot of us put a lot of pressure on ourselves to not only take care of others but make sure we still look fertile, young and virile while going through these transitions too.

Whether you’re postpartum or in perimenopause, the reality is that you are aging — your body may look different, your identity certainly may feel different. That’s part of getting older — and that’s OK.

While Osborne noted that most people go through menopause and do not develop disabling mental health disorders, it doesn’t mean they might not be affected by this transition. And key to getting through this is acceptance.

As Barbieri said when we spoke, “The body changes over time. It changes from the day that we are born, and the changes of pregnancy, postpartum and perimenopause are almost like accelerated phases of that change.”

Osborne stressed that feeling the impact and reality of that change is OK, too.

“It’s OK that it affects you. And it’s OK to have acceptance of that and say, ‘Oh I really need to open the window right now because I’m having a hot flash.’ That’s fine. Say that, do that, accept that as part of your life,” Osborne said.

But if it is all having a significant impact on your functioning, also ask for help.

“If you do only self-sacrifice, that’s not going to work out. Self-care is what we actually need,” Osborne said. “We need to prioritize women and their health, because women are the caregivers of the nation. … So, we have to cut ourselves some slack, I think.”

This and that

• “Antiheroine,” the new documentary about Courtney Love that just premiered at Sundance, has the Hole frontwoman proclaiming, “The most transgressive thing you can do in the world is be a female aging in public,” per The Washington Post’s Jada Yuan. Say less.

• Speaking of being hyperaware of your own aging, I loved former Sassy editor Jane Pratt’s ruminations on her Substack about all the things she’s done in the name of her health that have actually hindered it.

• Speaking of things you do for your health that maybe aren’t doing what you think, Liz Plosser’s deep dive on cold plunging and women on her Substack, Best Case Scenario, is a must-read.

• Speaking of staying warm, this essay by Suzanne Roberts about sweating to the oldies with her sister at a senior center in Oldster is downright heartwarming.

What counts as “oldies” on your playlist now? Write me.