More women are having children in their late 30s and 40s, which means postpartum recovery often overlaps with the start of perimenopause. The symptoms can look nearly identical — irregular cycles, fatigue, mood shifts, and nutrient depletion — leaving many women wondering: Is this postpartum or perimenopause?
What matters most is that both stages are more than temporary hormone changes. They are the portal to the rest of your healthspan, influencing bone density, brain function, cardiovascular health, and long-term resilience.
At WeNatal, we believe women deserve better preparation and support through every stage — from preconception to pregnancy to postpartum and beyond. That’s why WeNatal for Her was designed to help build nutrient reserves and support recovery, especially for women navigating motherhood later in life.
Is it perimenopause or postpartum?
When my daughter Emma was born, I thought my postpartum journey would follow the usual path: sleepless nights, the chaos of adjusting to life with two kids, and eventually, my body finding its rhythm again.
What I didn’t expect was that at 43, my postpartum experience would collide head-on with perimenopause.
Dr. Suzanne Gilberg-Lenz has been my OB-GYN through it all. About a year after Emma was born, I went in for a routine appointment and casually mentioned that my cycle was becoming irregular. At the time, I wondered if it was something in my environment — maybe toxins in the house or even mold exposure.
She listened and then said words I never thought applied to me: “I think you’re in perimenopause.”
I laughed it off. How could that be? I had conceived Emma naturally on the very first try. I told myself: No way. I’m super fertile. This isn’t happening. I lived in denial for about a year.
When I finally returned to Dr. Gilberg-Lenz, I had to admit the truth: she was right. This time, I walked into her office saying, “Please give me all the HRT and tell me everything you recommend. I’m all in.”
That moment was a turning point — not just in my health, but in my understanding of what so many women in their 40s are experiencing. I’m profoundly grateful that my doctor was ahead of the game and also happens to be one of the leading menopause experts in the country.
Today, I’m honored to sit down with Dr. Suzanne Gilberg-Lenz to talk openly about this under-discussed reality: what happens when postpartum and perimenopause overlap, why it matters, and how we can better prepare and support women through it.
Why this overlap matters more than ever
Dr. Suzanne: In 2023, more women over the age of 40 had babies than did teenagers. What does that have to do with menopause? Everything.
These women are entering postpartum already in perimenopause — and most have no preparation for it.
The challenge is that fertility doctors, obstetricians, and menopause experts are all talking to patients, but not to each other. We don’t even have the language to describe this intersection.
Being postpartum in your 40s is not the same as being postpartum at 25 or 30. On top of the challenges every new mother faces, you may also be experiencing baseline hormonal fluctuations, mood shifts, hot flashes, disrupted sleep, fatigue, musculoskeletal symptoms, and genitourinary changes.
And here’s what’s critical: postpartum and perimenopause aren’t just about fertility. They set the stage for your entire healthspan — cardiovascular health, bone density, and brain function. The choices you make now are investments in your future. Building nutrient reserves, protecting your sleep, and finding providers who understand women’s midlife health are not optional; they’re essential.
Perimenopause is the portal to the rest of your healthspan. We need to start talking about this, destigmatizing it, normalizing it, and creating resources so women can experience both postpartum and perimenopause with empowerment.
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Q&A with Dr. Suzanne Gilberg-Lenz
Is it normal to experience perimenopause symptoms soon after having a baby?
Q: Ronit: When I had Emma at 42, I thought postpartum would just be about recovery and adjusting to life with two kids. I didn’t realize how similar postpartum symptoms could feel to perimenopause. So, is it normal to experience perimenopause symptoms soon after having a baby?
Dr. Suzanne: Yes — especially if you’re having a baby in your late 30s or 40s. Both stages involve massive hormonal shifts, and the symptoms often overlap. Fatigue, mood swings, irregular cycles — these can all be part of normal postpartum recovery, but they can also signal early perimenopause.
The difference is persistence. Postpartum symptoms often improve as your hormones stabilize, while perimenopause tends to bring ongoing changes that don’t resolve on their own.
What are the most common signs of postpartum versus perimenopause?
Q: Ronit: What are some of the most common signs of postpartum versus perimenopause, and how do women know which is which?
Dr. Suzanne: In postpartum, we often see hair loss, night sweats, mood changes, and nutrient depletion. In perimenopause, we see irregular cycles, hot flashes, weight shifts, and disrupted sleep.
The tricky part is the overlap: brain fog, anxiety, low libido, and fatigue can happen in both. That’s why so many women feel confused.
Does breastfeeding make it harder to recognize perimenopause?
Q: Ronit: For women who are breastfeeding, does that make it harder to recognize perimenopause?
Dr. Suzanne: Absolutely. Prolactin levels remain high while you’re breastfeeding, which can suppress ovulation and delay the return of your cycle. That can mask perimenopausal changes — or make it unclear whether irregular cycles are from lactation or ovarian aging. Sometimes it’s both.
That’s why it’s important to track symptoms beyond just your period.
How can healthcare providers better support women during this stage?
Q: Ronit: How do you feel healthcare providers can better support women during this stage?
Dr. Suzanne:First, by listening and validating. Too often, women are told, “It’s just postpartum,” or “That’s just aging.” We need to take symptoms seriously.
Then, by offering individualized care — ordering labs when appropriate, replenishing nutrients, and helping women understand what’s happening in their bodies. This isn’t about one prescription; it’s about whole-body recovery.
What tests should women ask about if they suspect perimenopause?
Q: Ronit: If someone suspects perimenopause after having a baby, what tests should she ask her doctor about?
Dr. Suzanne: The basics include:
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Hormones: FSH, LH, estradiol, progesterone, AMH
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Thyroid panel
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Micronutrients like iron, vitamin D, B12, and omega-3 index
How can women advocate for themselves if their concerns are dismissed?
Q: Ronit: What if a doctor brushes off a woman’s concerns? How can she advocate for herself?
Dr. Suzanne:Track cycles, mood, energy, and sleep. Bring notes. Ask specific questions like, “Could this be perimenopause?” or “Can we rule out thyroid or nutrient deficiencies?”
If you’re dismissed, bring research or guidelines to back yourself up.
What nutrients are most important in both postpartum and perimenopause?
Q: Ronit: What nutrients do you feel are most important for recovery in both postpartum and perimenopause?
Dr. Suzanne: Protein and amino acids are essential for healing and hormone support. Iron, B vitamins, choline, magnesium, vitamin D, and omega-3s all play a major role in energy, mood, and cellular health. Calcium and collagen are key for bone and tissue strength.
I always encourage food first, with targeted supplementation when necessary. And we can’t forget about the gut. Re-establishing gut health with fiber and prebiotics is critical. A sick gut won’t absorb nutrients effectively, and the gut is intimately involved not only in immune function and neurotransmitter production, but also in estrogen metabolism.
If the gut isn’t working well, none of the other nutrients can do their job properly.
RELATED: Gut health and fertility: How your gut impacts fertility
What role do nutrition and lifestyle play?
Q: Ronit: What role do nutrition and lifestyle play when these two phases overlap?
Dr. Suzanne: They’re foundational. Anti-inflammatory, blood-sugar-balanced eating is essential. Strength training protects bones and supports metabolism.
But none of it works without adequate recovery. Rest is not optional — it’s essential. Over-exercising and under-eating may feel like control, but in reality, they drive stress hormones higher, worsen fatigue, and make it harder for your body to heal. Sustainable energy, strength, and hormone balance come from fueling properly, moving wisely, and prioritizing recovery.
Stress management and sleep hygiene regulate hormones. And gentle cycle syncing — adapting nutrition and movement to your hormonal rhythm — can be powerful even in perimenopause.
RELATED: What to know about magnesium for postpartum
Why does it feel harder to lose weight or regain energy?
Q: Ronit: So many women say it feels harder to lose weight or regain energy during this overlap. Why is that?
Dr. Suzanne: It can be harder. Estrogen and progesterone shifts affect metabolism, and sleep disruption makes it worse. Nutrient repletion and thyroid support are critical.
This is where realistic expectations matter: focus on long-term health, not quick fixes. Energy, mood, and strength are better markers than the scale.
What should women having babies later in life keep in mind?
Q: Ronit: For women having babies later in life, what should they keep in mind for their long-term health?
Dr. Suzanne: Think big picture. Perimenopause is the portal to the rest of your healthspan. I can’t stress enough that postpartum and perimenopause aren’t just about fertility — they’re about setting the stage for cardiovascular health, bone density, and brain function.
The choices you make now — nutrition, movement, preventive care — are investments in your future. Build nutrient reserves, protect your sleep, and find providers who understand women’s midlife health.
Does pregnancy after 40 affect perimenopause?
Q: Ronit: From your experience, does pregnancy after 40 affect perimenopause?
Dr. Suzanne: That’s a great question and the truth is, we don’t have strong data on it. My suspicion is that pregnancy itself doesn’t change when perimenopause begins, but it definitely changes your experience of it.
I have many patients in their 40s who get pregnant often spontaneously. And there are two big misconceptions: “I can’t get pregnant at this age,” and “I know my cycle.” But your cycle is changing in your early 40s, and that’s when we see many unplanned pregnancies.
So, let’s say you have a baby at 42, breastfeed, and by 45 you’re parenting a toddler while squarely in perimenopause. That’s tough. Perimenopause alone is challenging. Adding a toddler to the mix? Exhausting.
But to be clear: pregnancy doesn’t cause perimenopause to start sooner. Unless you had a severe complication like a major postpartum hemorrhage, there’s no evidence it accelerates the timeline. What’s really happening is that the stress and sleeplessness of parenting in your 40s overlaps with the natural hormonal transition already underway.
Final thoughts from Dr. Suzanne: Postpartum in your 40s can feel like a double whammy, but it’s also an opportunity. If we normalize the conversation, destigmatize the challenges, and provide women with real resources, we can transform this season from one of confusion into one of empowerment.
RELATED: How we conceived our rainbow babies: Fertility after miscarriage and age 35+
A note from WeNatal on supporting women through postpartum and perimenopause
We know the line between postpartum and perimenopause can feel blurry, especially for women having babies later in life. As Dr. Suzanne Gilberg-Lenz shared, both stages bring massive hormonal shifts, overlapping symptoms, and unique challenges that deserve understanding and support.
Whether you’re navigating irregular cycles, fatigue, nutrient depletion, or simply wondering, “Is this postpartum or perimenopause?” — the truth is, both experiences set the foundation for long-term health. Cardiovascular wellness, bone density, brain function, and hormone balance are all influenced by the choices we make during these critical transitions.
That’s why WeNatal is committed to supporting women at every stage — from preconception planning to pregnancy, through postpartum recovery,
To help replenish key nutrients and strengthen your foundation:
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WeNatal for Her delivers essential vitamins and minerals tailored to women’s needs from preconception through postpartum.
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WeNatal Omega DHA+ supports brain, mood, and hormone balance during recovery and perimenopause.
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WeNatal Rest + Digest helps support gut health and improve nutrient absorption — critical for both postpartum recovery and the perimenopause transition.
Your body deserves care, resilience, and nourishment through every chapter. With the right support, this season can be one of empowerment, not confusion.
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Dr. Suzanne Gilberg: A disruptor, healer, educator and fellow of the American College of Obstetrics and Gynecology, Dr. Suzanne Gilberg earned her medical degree from USC in 1996 and completed her OB/GYN residency at Cedars-Sinai. Board certified in integrative and holistic medicine, she also holds a Clinical Ayurvedic Specialist degree. Dr. Gilberg is Chief Medical Correspondent for The Drew Barrymore Show and author of Menopause Bootcamp. She serves as Chief Clinical Officer at Monarch, transforming women’s healthcare, and co-founded Cedars-Sinai’s Green Committee. Based in Beverly Hills, she’s committed to healing individuals, families, communities, and the planet. https://gilberg.monarchmd.com/
