Perimenopause Meets Early Parenthood—What Happens When These Two Big Transitions Coincide?

I knew that I was living in a different timeline when my best mom friend pulled me aside after Kindermusik class and let me in on a secret.

“I’m pregnant again!” she whispered, after glancing around furtively.

“What!? How??” I responded. “And congratulations! But, like, physically—how did you do that?”

Our babies were 9 months old at the time—both girls, both born in December, both still breastfed. I was still in the throes of early motherhood, when you can’t imagine how you’re going to keep taking care of this child on a day-to-day basis, let alone ever feel ready to add another into the mix. But I also hadn’t even gotten my period back yet.

Is that not normal?

To be honest, I was still nursing my daughter a lot. Like round the clock. (I call her my Milkmaid to this day.) So it kind of made sense.

The other difference: I was 45. My friend was 31. It hadn’t mattered much up until then or after, really. We were going through all the same new-mom stuff together, and both had an irreverent sense of humor, which we applied to our struggles with sleep deprivation and irritability. On social media, the concept of mom-rage was all the, well, rage. So, if shifting hormones might have been behind my shifting emotions, I never thought to connect them to anything other than the postpartum effect.

Until… Flo never returned. My daughter is almost 4 now, and I’ve got nothing. And as it turns out, my hormone levels, according to my doctor’s interpretation of recent test results, are “consistent with menopause.”

Welp. No “I’m a big sister” T-shirt for you, little Milkmaid. (Also, sorry I’ve been slightly out of my mind your entire life; it turns out it might have been perimenopause the whole time.) If I’d known, I could have done something about it. But most of us just aren’t keeping an eye out for “the change” while we’re also changing diapers. Maybe we should be.

Why Perimenopause and Early Parenthood Are Coinciding More Often

You guessed it: We’re having babies later. “I’ve been seeing more women with young children experiencing perimenopause,” says Heidi McBain, LMFT, PMHC, a family therapist in private practice in Flower Mound, Texas, specializing in maternal mental health. “This may be because these moms have chosen to have kids in their late 30s and early 40s, or they ended up having kids later than expected because of infertility or other life circumstances.”

In fact, the percentage of births to women over 35 in the US more than doubled between 1990 and 2023, from 8.8 percent to 20.9 percent. That puts about one in five moms in this cohort on track to potentially start perimenopause within just a few years of having a baby.

And that can make this transition so much harder to recognize. The symptoms of postpartum and early motherhood overlap almost perfectly with the symptoms of perimenopause: poor sleep, anxiety, mood swings, brain fog, weight gain, even hot flashes and, of course, missed periods. At some point, the subtle changes that you didn’t realize could be perimenopause, especially the insidious little ones like sub-level libido and overflowing rage, just become internalized as part of your identity. At best, you think: Well, I’m overwhelmed; this is just what motherhood is. And at worst: I’m just a bad mom.

“There’s often so much crossover between symptoms, it can be hard to differentiate where they’re stemming from: Is it perimenopause or postpartum or something else altogether?,” says McBain. “And if you have unmet needs like lack of sleep, dehydration, not feeling connected to others, not moving your body—your feelings surrounding mom guilt and mom shame may be exacerbated.”

“This was me 100 percent,” says Amanda F., mom of one currently living in Singapore. “I found parenting so triggering for my anxiety, until I got on hormone replacement therapy at 48 and figured out I’d been suffering for years without realizing it.”

It was similar for Erica T., a mom of two toddlers: “My doctor said I’m young for perimenopause (at 42), but I felt like a psycho. I couldn’t focus, was irritated, had zero patience, just struggling to get things done and have energy. I tried working out, getting ‘me’ time… nothing worked. A GLP-1 medication helped some, but when I added a birth control patch used to treat perimenopause, I really noticed things got better. It’s been a lifesaver.”

Given how little menopause is talked about, missing the symptoms isn’t unique to new(ish) moms. But even if you do connect the dots, navigating the transition with little ones is a totally different beast than the traditional empty-nester experience.

“All the hormonal shifts following a pregnancy and during lactation amenorrhea (when menstrual cycles are suppressed during the earlier months of nursing) can create a confusing hormonal landscape,” says Robin Noble, MD, an ob-gyn in Portland, Maine, and chief medical officer for the nonprofit organization Let’s Talk Menopause. When perimenopause hits simultaneously or soon after, you’re not necessarily getting a double dose of the drop in estrogen that’s at the heart of both phases. But the timing can make it feel like the postpartum roller coaster never let up.

The good news: Those baby and toddler snuggles—and struggles—could help in more ways than one if you’re parenting little ones through perimenopause. Unlike women who had their babies 15 to 20 years ago, you aren’t managing this massive hormonal shift just as your kids are leaving the nest, when your sense of purpose and self-worth may already be poised to take a hit. With toddlers still in tow, you might feel officially “old” but (for better or worse) you’re still very much, viscerally needed.

And if nothing else, at least you’ll be done dealing with perimenopause by the tween years, so you won’t both be losing your minds simultaneously. “Peri meets puberty here,” says Kelly W., upstate New York mom of one. “My night sweats are now synced to her period.”

Speaking of mood swings, you might just be better equipped to handle your toddler’s big emotions, because you’re having them too. “When my 3-year-old suddenly doesn’t want strawberries cut the way they’ve been for three months and it’s a huge emotional experience, I get it, because that was me yesterday over how my partner put the toilet paper on the holder wrong,” says Maggie S., a San Diego mom of one. “I’m able to provide a ton of empathy and understanding, and to model recognition of emotions and how to apologize when you have a big one over nothing much.”

Tips to Cope With Parenting Through Perimenopause

If you too are juggling night sweats and night feedings, you’re not alone—and there are ways to make this stretch more manageable. Here’s how to get the support and relief you need.

Suss out your symptoms

Is it perimenopause that’s leaving you tired, bloated and cranky, or just the daily burnout of being a mom? “Often, it can be a very mixed and complicated picture, but there are treatment options that can be helpful in either or both cases,” says Noble. “Sometimes, hormone testing can help us identify important changes, but most of the time it isn’t needed to diagnose the situation. Careful history-taking is typically the key to finding answers and solutions.” If you’re not sure what’s behind your symptoms, make an appointment with your doctor to find out.

Find a qualified provider

Not every ob-gyn or primary care doctor has training in the treatment of perimenopause and menopause. “Finding a doctor who won’t dismiss this as some kind of normal postpartum hormonal change or residual IVF side effect has been difficult,” reports Brittany T., mom of a 3-year-old in Texarkana, Texas. “After going through four doctors who somehow managed to all give different but equally wrong diagnoses and advice, I was excited to find my insurance covered a telehealth menopause clinic. I started progesterone pills and estrogen patches about a week ago, and it’s helping already.”

Update your thinking on HRT

Hormone replacement therapy is recovering from a bad rap based on a flawed earlier study; the latest research shows that it’s safe and effective for women under age 60 who want to treat perimenopause and menopause symptoms that are bothering them. But what if you’re still breastfeeding—can you take hormonal treatments? “Yes, definitely,” says Noble. “We often suggest waiting to start combination oral contraception until baby is 4 to 6 months old, as it can change the protein and calorie make-up of your milk. [Menopause] hormone therapy is lower dose than oral contraception, so generally less of a concern.”

Give yourself some grace

Early motherhood is intense. Perimenopause is intense. So cut yourself some slack when you’re contemplating why you snapped at your partner again or why your toddler’s meltdown triggered one of your own. “Ask for help when you want it or need it,” advises Noble. “Talk to friends and family, to trusted menopause-informed providers and counselors—and know that there’s so much help available for this transition.”

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.