Postpartum University® Podcast

Is It Postpartum or Perimenopause? | Lauren Tetenbaum EP 233

• Maranda Bower, Postpartum Nutrition Specialist

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As a postpartum professional you've likely seen the confusing overlap between postpartum and perimenopause, especially with women having babies later in life. 

Our conventional medical system treats these two distinct phases as separate, leaving women feeling lost and often misdiagnosed. This episode tackles the key signs and solutions that empower providers like you to offer truly informed root-cause care. We're joined by Lauren Tetenbaum, a specialist in maternal mental health and perimenopause, to break down the science, the shame, and the solutions, because we believe every woman deserves comprehensive care.

Check out the episode on the blog HERE: https://postpartumu.com/podcast/is-it-postpartum-or-perimenopause-lauren-tetenbaum-ep-233/

Key time stamps: 

  • 00:00: An introduction to the confusing overlap between postpartum and perimenopause.
  • 02:57: Breaking down how similar symptoms appear in both phases.
  • 05:25: Why lifestyle is the foundation for treating both conditions.
  • 07:11: The ongoing stigma around medication and quick fixes.
  • 09:16: Myth-busting the safety of hormone replacement therapy (HRT).
  • 15:31: Why our hormonal dips are natural but not always normal.
  • 17:50: The normalization of symptoms like postpartum depression and anxiety.
  • 20:34: The overlap of perinatal mental health and perimenopause.
  • 23:39: How to advise women who are unsure what's happening to their bodies.
  • 24:45: Maranda’s closing remarks on the importance of informed decisions.

Connect with Lauren

Lauren Tetenbaum, LCSW, JD, PMH-C is a licensed clinical social worker, women's rights advocate, and writer dedicated to supporting and empowering women through life transitions. With experience as both a lawyer and a psychotherapist, Lauren specializes in counseling women navigating identity shifts related to motherhood, career, and reproductive health. Lauren frequently contributes thought leadership to media and professional organizations; she is the author of the 2025 book Millennial Menopause: Preparing for Perimenopause, Menopause, and Life's Next Period. Learn more about Lauren at thecounseLaur.com. 

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Speaker 1:

The postpartum care system is failing, leaving countless mothers struggling with depression, anxiety and autoimmune conditions. I'm Miranda Bauer and I've helped thousands of providers use holistic care practices to heal their clients at the root. Subscribe now and join us in addressing what modern medicine overlooks, so that you can give your clients real, lasting solutions for lifelong well-being. Today, we are going to talk about something that's showing up more and more, especially as women are having babies later in life, and that's the overlap between postpartum and perimenopause. These two seasons are often treated as separate, but for many women they're happening at the same time, like one right after the other or sometimes right on top of each other, kind of like pregnancy and postpartum sometimes happen at the same time, and yet our medical system still acts like they're taboo topics. We don't talk about this. Postpartum care kind of ends abruptly at the six-week mark, and then perimenopause care is like hardly ever mentioned in the doctor's office, and, as a result, women are left confused and unsupported and often misdiagnosed. And so we're going to be changing that conversation. Today's guest is a specialist in perimenopause and maternal mental health, and we're diving into the key signs, symptoms and treatment options that providers, partners and even workplaces need to know to better support women, because if conventional medicine won't do it, then we will, so let's get into it.

Speaker 1:

Today we have Lauren Denton-Bowne. She is a licensed clinical social worker, women's right advocate and writer, dedicated to supporting and empowering women through life transitions. She's got experience as both a lawyer and a psychotherapist what an incredible blend and she specializes in counseling women navigating identity shifts related to motherhood, career, reproductive health. She frequently contributes through thought leadership to media and professional organizations. She's the author of the 2025 book Millennial Menopause Yay Preparing for menopause, paramenopause and life's next period. So we're going to learn more about her and her website in the show notes Welcome. Oh, my goodness, that was a mouthful. You are so accomplished and I'm so excited that you're here.

Speaker 2:

Thank you so much. It's a pleasure to be here.

Speaker 1:

Tell us why are postpartum and perimenopause often confused Like? How can we tell the difference between the two?

Speaker 2:

So they're often confused, I think, because too little attention is paid certainly to perimenopause, but also, as your audience knows, to the postpartum period as well, and it's time for change. And we see, as you mentioned, we're seeing a lot more women having babies later and later, and, given that perimenopause can actually start in one's late 30s, early 40s, which is when a lot of women are having babies, we are experiencing simultaneously postpartum and perimenopause.

Speaker 1:

Can you break down how, like some of those symptoms like anxiety, fatigue, mood swings, low libido, show up in like both phases? Like how do you tell if it's like one or the other?

Speaker 2:

So my philosophy as a psychotherapist is to treat the symptoms, not the diagnosis. So you could be postpartum or perimenopausal or both, but we do want to pay attention to the symptoms and then, yes, the treatment options. Some of the symptoms that overlap include the night sweats, the skip periods or the irregular periods, tender breasts, migraines, midsection weight gain, fatigue, but also the inability to sleep, urinary incontinence, hair loss is something we see time and again that women are often not warned about in either phase. And then, of course, the psychological symptoms the sadness or irritability and rage, the poor body image and low self-esteem, the worry and anxiety, the brain fog. Those are symptoms of both perimenopause and postpartum, and the main difference is that perimenopause can indicate that there is a need for certain types of treatment that are not necessary in the postpartum phase, and that primarily includes hormone therapy. But the point is that women should be heard and not dismissed by their healthcare providers or others in their life.

Speaker 1:

I'm curious like do you find that what's happening hormonally in perimenopause and how that and what happens in postpartum are they? Are they similar to what happens? I mean, obviously we have a few more options to treat perimenopause like hormone replacement therapies, but are they like, are you treating the rest of it very similarly therapies?

Speaker 2:

But are they like? Are you treating the rest of it very similarly? Yes, because a lot of the treatment options are lifestyle related, like proper nutrition, quality sleep, social support, getting outside, good bodily movement, you know, yoga, mindfulness, all of those things that we know are good for us and yet can be really hard to capture right, especially when we're dealing with the newborn and dealing with midlife and maybe all of the above. But those treatment options, plus psychotherapy of course, are helpful for both phases. And then medication is a tool in our toolbox and that can include an antidepressant for either phase and hormone therapy for the perimenopause phase.

Speaker 1:

This is so interesting because I think the lifestyle factor that you mentioned is absolutely massive and I'm so, so glad that you brought it up, because I feel oftentimes, especially as women, we feel and I'm speaking personally, but also as a professional who's been doing this for 15 years like, oftentimes I feel like medication was the only option or is the only option, and like if I go get help, like I know like we're going to, we're going to do psychotherapy, we're going to do talk therapy, we're going to, and then I'm going to get an antidepressant or an anti-anxiety med. Right, and some women are really like not wanting that in today's world. Maybe you can share a little bit more about what you're experiencing. Like are you seeing a lot more women say no? Little bit more about what you're experiencing? Like are you seeing a lot more women say no, I want something else? So that's one question for you. But also like just this idea of the way we live our life greatly influences the way we feel in life. Like how come we're not having that conversation more?

Speaker 2:

I think that our society of instant gratification and the way that we're living now, including the constant comparisons to others, that we do tend to want a quick fix. That all said, though, there's nothing wrong with medication, with needing an SSRI or some other form of medicine right, if you have a headache, you might take an Advil, you might not, but whatever works for you, in my opinion, is what you should be able to have access to. I do see women resist medication, whether that is the antidepressant or the hormone therapy. I think a large part of that is because it remains stigmatized, but I also think that it goes back to that. Well, I just want a quick fix, and, you know, don't tell me that sleep is going to help. How can I possibly get more than four hours a night? And that's something that we can and need to shift.

Speaker 1:

Yeah, absolutely. Like we live in this very fast paced world where we need results right away, and that kind of surprises me like the stigma still exists with a lot of these medications. I think in the SSRI world, like so many, especially in the US, like what is the stat? Like one in three human beings are on an SSRI, like it's absolutely insane to me to think about those numbers, and so the fact that that stigma might still exist is just like shocking. But I do know, like the stigma around hormone replacement therapy there is so much like I have been not necessarily looking at the key like components, but I keep my head in the game and like trying to see, like you know, hormone replacement therapies and what to do and what's the new latest research and it's so conflicting. So I would love to hear your opinion of like what's going on here, what's the stigma behind this, what do we not understand and what perspective should we have instead? Sure.

Speaker 2:

So I'll go back first to your note about how many people are prescribed SSRIs, and it is majority women and this sort of goes back to women being prescribed drugs in the 60s and 70s and kind of being told just take a pill, get numb and don't worry about the patriarchy right, and we're still seeing some of that. But again, ssris really can be helpful and they are a tool in our toolbox and I think it's important that we recognize when we are feeling resistant and what that is about, because I do see it with many of my clients actually where they really would benefit from an SSRI because it's medicine for what they need and yet they feel like, oh, I don't wanna go there because of misconceptions that they have. And similarly, we have been living really for 20 plus years with misconceptions about hormone therapy. So I go into this history in the book, but I'll give a quick recap here that in 2002, the Women's Health Initiative was a study that was stopped prematurely because the researchers claimed that hormone therapy primarily estrogen and progesterone, a combination was causing breast cancer, was endangering women with heart issues and was overall dangerous.

Speaker 2:

And that message was broadcast, press releases, news stories. It was pushed out and doctors and other health care providers were, as a result, not taught much about it. Healthcare providers were, as a result, not taught much about it, which is why today, when women in midlife complain about mood swings or fatigue or certain mental health struggles, they are quickly prescribed an SSRI instead of exploring more the hormone therapy options and also the other factors that we mentioned earlier. You know why can't you get good sleep? What else is going on? It seems like it's this quick fix when really hormone therapy may be helpful. Now the research today. I would always go to the Menopause Society it's menopauseorg For the listeners. You can go there. They have plenty of free resources. Bring them to your healthcare provider, because they do have very clear guidelines, and the conclusion that they draw is that hormone therapy is generally safe and effective for most women with menopausal symptoms.

Speaker 1:

When is it not, though, right For most women and for most issues like so? There's a nuance there which I think exists for everything and everything right, like no matter what it is, whether it's an alternative therapy versus you know a medicinal, uh, pharmacological, whatever like, whatever right. There's always like that little caveat. So what is that here?

Speaker 2:

What do we need? The contraindications are active breast cancer, that's, hormone receptive uterine cancer, unexplained uterine bleeding, active liver disease or a history of blood clots or cardiovascular disease or a history of blood clots or cardiovascular disease. But even with that list, the guidance is that providers should have comprehensive conversations with their patients, which we all want right, All the time. Informed consent, I know, is something that you feel strongly about and of course, we all should. I say that because some women who have had breast cancer maybe it's been a chunk of time, several years and now they're experiencing menopausal symptoms that are really disrupting their quality of life. Sometimes they choose to go on hormone therapy. So it is really nuanced and certainly this is not medical advice. Certainly, every woman goes through menopause in her own way and will want to pursue treatments in her own way, but the point is that those are the general guidelines from the leading professional organization and hopefully your provider is aware that they're guidelines and there are these different situations for every person.

Speaker 1:

Yeah, absolutely. I think the hard part I mean, most people who are listening in to this conversation are providers in some form or fashion and the hard part is just like trying to find that time to like gather all of that information of like what is going on in their life. Is this something that they would benefit from? And gathering that from them and having that conversation in a very informed consent kind of way, where their client is the one who's kind of leading the way of like, is this the right next step for your care? And doing that in a system and you know, the system that exists right now is really really difficult to do. Like we don't have the tools and the time to make that happen, right, and so a lot of people are going out on their own and they are looking at, you know, options for themselves, because it's hard to have those conversations with your provider. And so they're going to that influencer, which is really difficult, right. They're going to, you know, do their own research, which they're going to chat GPT now, which is crazy, I know. Oh, that worries me, it's so hard.

Speaker 1:

I will say, like one of the things that I hear so often is that hormone replacement therapy and in regards to like we have when you're entering into that perinatal phase, which I am in, I tell you guys, it's not great, it's not easy, everyone can say that right, but we're entering into this phase that it is actually kind of a biological normal that our hormones make this dip. Is that correct? Is that like a state like this is what happens as a woman in the perfect world? Our hormones are making this change right.

Speaker 2:

So, yes, biologically, as we age, our hormones are fluctuating wildly. That's why we get those symptoms, and that's the perimenopause phase and then ultimately decline. And when I'm talking about hormones here, I'm talking specifically estrogen, progesterone and testosterone will steadily decline. For a woman, that is what naturally happens. So one might argue well, it's a natural hormone change, why would I mess with it? But Getting sick could also be considered natural, and maybe you would take medicine when you're sick. And also, we haven't been living this long, for a long time.

Speaker 2:

This is a relatively new phenomenon that we're living into our 80s, 90s. The average age of a woman, I believe, is in one's early 80s in the US, and the average age of menopause is 51. In one's early 80s in the US and the average age of menopause is 51. So women are living about 40% or 30% of their lives post-menopause, and the hormone dips, specifically the lack of estrogen, can have profound impacts on their cardiovascular health, their cognitive health, their mental health, their bone health and so much like medicine it could be worth pursuing, even though it is I don't want to call it unnatural, but sort of produced, one could say. But that's why it should be your body, your choice. If that's something that you want to let happen to you, I say okay, that's your choice. And if it's something you want to take medicine for, I say too, okay, that's your choice.

Speaker 1:

And if it's something you want to take medicine for, I say too, that's your choice, a thousand percent.

Speaker 1:

It makes me wonder so often, like a lot of the things that we've normalized in postpartum, when it comes to we've normalized often postpartum depression and anxiety and major hair loss, you know, which is very different from like regular hair loss and so many other things just aching joints, extreme sleep deprivation Like these things we've normalized and they're not normal.

Speaker 1:

They're signs that your body is in need of support, in whatever way, shape, form or fashion that may be, you know, nutritionally, seeking psycho care, whether it's making sure that you're getting enough sleep, having somebody in the home come take care of your other kids and your toddlers running around, whatever the case may be right, like it means that your body needs new support, like other additional support that you are not receiving. And it makes me wonder the same about perimenopause, and I think you know maybe you can speak a little bit more to this because I feel like the conversation and the science is relatively new, right, just as it's not. It's almost non-existent and postpartum, like we're just now starting this, like a little baby right now, in terms of the science and what we know about perimenopause and menopause. I wonder if it's the same right. Is there something going on that we need to address? That maybe isn't exactly normal, maybe that hormonal flux should not exist right, but we don't know, because we don't know how to take care of our bodies during this time.

Speaker 2:

I think that in many cases, stress in life has become compounded and exacerbated, and that certainly doesn't help our physical or mental health. But, for example, being always on at work or socially, that can be really stressful, right? People don't have the same boundaries that they used to and they're not getting the sleep because they're on their phones, for example. So, yes, I think in many ways life has gotten harder. I think women have been told for decades, if not centuries, that they have to swallow their struggles and not get support, and I think that that is the conversation that's shifting a bit slowly, and I do think that our generation millennials have really been an active voice in destigmatizing tough topics like mental health, like maternal mental health, like the struggles of being a mom, et cetera, and so I'm hopeful that we'll continue to talk about our reproductive health in the context of perimenopause and whatever it is that we're struggling with, that we're able to get support.

Speaker 1:

That's beautiful. I'm really curious, like you work in mental health and so you're seeing postpartum, you're seeing perinatal mental health and so you're seeing postpartum, you're seeing perinatal mental health. Like, how is it? What's the overlap with mental health? You've touched on it very briefly in the beginning. I'd love for you to connect a little bit more with our audience on what that looks like and the struggles that women go through, not only in postpartum but also in perimenopause.

Speaker 2:

Yeah, absolutely. So many women are told oh, you're just postpartum if they're having certain mental health struggles. And first of all, what does that mean? Right, if I am postpartum and I'm pregnant, help me. But also, it might not be. It might also be perimenopause, and psychoeducation is hugely important in normalizing these issues, in saying, hey, here's a support group that might be helpful, or here are some resources like telehealth platforms that specialize in perimenopause, because OBGYNs are often not given that training in this issue, so just providing recognition and resources can go so far.

Speaker 2:

What I'm seeing in my practice among women in their early 40s who have very young babies and also are presenting with perimenopausal symptoms, are that their anxiety and depression symptoms are kind of popping up in different and new ways, and that's why it's really important to know yourself and to know when something is different and bothering you and then you can seek help for it.

Speaker 2:

So, for example, I have been working with a woman who I've been working with her since she was pregnant and seen her through postpartum depression and a lot of teariness, and then a couple of years have gone by, which she's arguably still postpartum, but she's technically two years out, and she came to me and said I've just been feeling so irritable I can't sleep. This doesn't feel like it used to. And then we did a little digging and it turned out her mom had been through early menopause, which is before the age of 45. And it just she totally was textbook perimenopause, all that is to say. Whatever is bothering you mentally if it is a mood swing that is coming out of nowhere, or an inability to stop worrying about something, whether it's a baby or your career, whatever it is, or you're feeling enraged, that can be a symptom of depression. Whatever it is, talk about it, get support, and individual treatment options might be slightly different, but the point is that you deserve support and not to be dismissed.

Speaker 1:

What would you say to women who are listening in, you know, who are in their 30s and their 40s, and they're wondering is this postpartum or is there something else that's going on here?

Speaker 2:

I would say start by talking to a professional who knows how to help, whether that's holding you accountable for good nutrition, good sleep, having social connections, all the lifestyle changes that we've talked about, engaging in cognitive behavioral therapy and really knowing what your baseline is. Because if you're doing all of those things and it's not helping, then I think you should consider hormone therapy or an SSRI and get some medical advice.

Speaker 1:

Yeah, yeah, beautiful. I love this conversation. I'm so glad that you were here to share this with us. Where can people find more information about you and your book?

Speaker 2:

My book and my website. It's available at millennialmenopausecom. I am traveling around the US, so come say hello or join me on a virtual event. It will take you to my book tour website and I am on Instagram as the counselor. But L-A-U-R for Lauren and I'm always happy to point people in the right direction, to the extent that I can.

Speaker 1:

I love this so much. Thank you so much for being here. I appreciate you, thank you. Before we wrap up, I just want to say this these conversations can feel uncomfortable, especially when we start questioning things that have been normalized, like the use of medications or interventions, or even symptoms that seem routine. That seem normal, but that's exactly why we have to talk about them.

Speaker 1:

The truth is, no one is gonna take care of your health, your body, your baby, your practice, more than you, and, as providers, we owe it to the people we serve to do better. That means asking hard questions. That means looking at the research, not just the recommendations. So if this episode sparked something in you, take that spark and follow it. Do the research, ask more questions, start the conversation. We don't need more blind trust. We need more informed decisions and empowered care. Thanks so much for being a part of this crucial conversation. I know you're dedicated to advancing postpartum care and if you're ready to dig deeper, come join us on our newsletter, where I share exclusive insights, resources and the latest tools to help you make a lasting impact on postpartum health. Sign up at postpartumu the letter ucom which is in the show notes, and if you found today's episode valuable. Please leave a review to help us reach more providers like you. Together, we're building a future where mothers are fully supported and thriving.

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Maranda Bower

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