In my last post I shared something personal; my own experience navigating postpartum as a sex and relationship therapist who thought she knew what was coming, and the ways that lived experience both confirmed and completely undid what I thought I understood. If you haven’t read it, I’d recommend starting there. This post picks up from a different angle: not the personal, but the research, the clinical picture, and the bigger conversation I think we should be having, particularly during Menopause Awareness Month this October.
In one of my appointments during pregnancy, the casual mention from my obstetrician that as I was a “geriatric pregnancy”, it was possible I might come out the other side of pregnancy in perimenopause. These are two enormous hormonal transitions, possibly happening simultaneously, with almost no research to guide either of us through what that might actually look like.
That conversation has stayed with me. And this month, I want to dig into why.
What’s actually happening hormonally when postpartum and perimenopause overlap
Postpartum is, at its most fundamental level, a crash. During pregnancy, oestrogen and progesterone reach their highest levels in a woman’s lifetime. Within 24 hours of birth. Following the delivery of the placenta, they plummet. For breastfeeding women, they remain suppressed for longer: the more you breastfeed, the longer the suppression. Most women can expect hormone levels to begin returning toward baseline somewhere between six months and a year postpartum, with breastfeeding extending that timeline significantly.
Perimenopause, which can begin as early as the mid-thirties but more commonly in the early forties, is characterised by a different kind of hormonal instability. More of a fluctuation than a crash. Oestrogen and progesterone zigzag, often unpredictably, before eventually trending downward. Vasomotor symptoms such as hot flashes and night sweats last a median of 7.4 - 11.8 years.
Here’s where it gets clinically interesting, and as with much of women’s health, remains under-researched. A 2024 peer-reviewed study published in Frontiers in Global Women’s Health found that the individual hormonal fluctuations seen in the postpartum period closely mirror those described in the perimenopausal transition, suggesting a comparable underlying mechanism between these two hormonal transition states. In plain language: both involve the same hormonal system destabilising in similar ways, and the symptomatic overlap can be significant and genuinely difficult to disentangle clinically.
For women who give birth in their late thirties or forties, these two experiences aren’t necessarily sequential. They may be concurrent. And distinguishing between the two, without adequate research or clinical guidance, is genuinely difficult, even for the clinicians meant to be supporting them.
The research gap, and why it matters
What I find most confronting about this conversation is that clinicians and researchers have noted a significant gap in the medical literature at the intersection of postpartum and perimenopausal experiences. This gap matters because the population it affects is growing as the average birthing age increases. In the United States, for the first time in recorded history, births to women over 40 exceeded teen births in 2023, with women 40 and older accounting for 4.1% of all births compared to 4.0% for teenagers. This figure is a 193% increase in births to women over 40 since 1990, according to CDC National Vital Statistics data.
The research gap in women’s health more broadly is not a secret, but the scale of it still lands hard when you look at it directly. In Australia, a 2025 Monash University report found that only 3.3% of government research funding in 2023–24 was dedicated to women’s health. Globally, PMS, menopause, maternal health conditions, cervical cancer, and endometriosis together make up 14% of the total women’s health burden yet received less than 1% of cumulative research funding between 2019 and 2023, according to analysis by the World Economic Forum and McKinsey Health Institute. I could yap on about this all day because it’s fcking outrageous that women’s health is still not equally prioritised. Ultimately, the healthcare system is still not adequately preparing clinicians to support women through this unavoidable life stage.
The postpartum–perimenopause overlap: what we know and what we don’t
What the available research does tell us is that the overlapping symptoms of postpartum and perimenopause are not imaginary. They are physiologically explicable and clinically significant. Both transitions involve low reproductive hormones affecting virtually every body system. Both are associated with disrupted sleep, mood changes, changes in sexual desire and function, vaginal dryness, cognitive fog, and shifts in identity and emotional regulation.
Research tracking female sexual function from early pregnancy to twelve months postpartum shows a consistent pattern: scores low to no at six to eight weeks postpartum, and then increasing substantially, but ‘recovery’ is often incomplete. A 2026 prospective cohort study published in the Journal of Clinical Medicine found that 58% of women still met clinical dysfunction criteria at six to twelve months postpartum, and that outcome varied significantly by delivery type and psychological factors including sleep quality and depressive symptoms. For women who are also entering perimenopause, that recovery trajectory may look quite different, and we simply don’t have adequate research to know what to tell them.
There is also an emerging body of clinical discussion is the similarities between hormonal and body symptoms during breastfeeding, and menopause. This is something I shared in my personal experiences post-partum, and could include vaginal dryness, discomfort, changes in tissue health, and impacts on sexual function. Again, this is an area where research is only beginning to catch up with what women are reporting in clinical settings.
What better support could look like
The Australian Government’s response to the 2024 Parliamentary Inquiry into menopause and perimenopause did acknowledge the need for change, committing $25 million over four years from the Medical Research Future Fund specifically for perimenopause and menopause research. This is meaningful, and long overdue. But it doesn’t yet address the specific intersection of postpartum and perimenopause, and it doesn’t reach the women navigating both right now, without adequate information or support.
What I’d like to see, as both a clinician and someone who has lived inside this, is a healthcare system that routinely asks women over 35 in postpartum about perimenopausal symptoms, rather than treating the two transitions as entirely separate clinical territories. I’d love to see birthing folks being provided with evidence-based information about hormonal suppression during breastfeeding and its impact on vaginal dryness, pain, mood, cognition and desire. as a standard part of postpartum care. Routinely, conversations around sex are avoided because general health providers are embarrassed or feel ill-equipped to answer questions about sex and desire. Either that, or general health professionals deem sexual impacts as unimportant when compared to other mental and physical health symptoms.
A note on the social script
I want to return to something I mentioned in my first post, which is the fear that was underneath my reaction when perimenopause was raised during my pregnancy. The fear wasn’t really about hormones. It was about the story we’re still telling about what it means to be a woman who is ageing, who is postpartum, who is no longer in the phase of life where her body is primarily valued reproductively.
That story, that women become invisible once they are outside of child-bearing years, is a social script, not a biological truth. And it is a script that the lack of research has, whether intentionally or not, reinforced. When we don’t study women’s health across the full arc of their lives, we communicate something about whose experiences are considered worth understanding.
Menopause Awareness Month is a useful moment to name that loudly, not just to say “let’s talk about hot flushes,” but to advocate for the entirety of women’s hormonal and reproductive experience across a lifetime as important and deserving of the same rigour, funding, and clinical attention as every other aspect of human health. We are not a niche population, we are half of it!
Where to from here
If you are twelve months postpartum, not breastfeeding, and still experiencing symptoms including persistent brain fog, mood instability, vaginal dryness or low/no desire that isn’t resolving and is worrying you, talk to your GP. Your body may be navigating two hormonal transitions simultaneously, and you deserve clinical support that reflects that complexity.
At Good Vibes Clinic, we work with folks across all life stages, including postpartum and the perimenopausal transition, on the sexual health, relational, and identity dimensions of these experiences. If any of this resonates, we’d love to support you.
References
Dukic J, Johann A, Henninger M & Ehlert U (2024). Estradiol and progesterone from pregnancy to postpartum: a longitudinal latent class analysis. Frontiers in Global Women’s Health. https://doi.org/10.3389/fgwh.2024.1428494
Avis NE et al. (2015). Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Internal Medicine. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2110996
Boarta A, Stelea L, Craina ML et al. (2026). Trajectories and Determinants of Female Sexual Function from Pregnancy to 12 Months Postpartum. Journal of Clinical Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC13026215/
CDC National Vital Statistics Reports, Vol. 74, No. 3 (March 2025). Driscoll & Hamilton. https://www.cdc.gov/nchs/data/nvsr/nvsr74/nvsr74-3.pdf
Monash University / Sisterhood Foundation (2025). Women Deserve Better: New report reveals the silent health issues impacting Australia’s women and girls. https://www.monash.edu/medicine/news/latest/2025-articles/new-report-reveals-the-silent-health-issues-impacting-australias-women-and-girls
World Economic Forum / McKinsey Health Institute (2025). Blueprint to Close the Women’s Health Gap: How to Improve Lives and Economies for All. https://www.mckinsey.com/mhi/our-insights/blueprint-to-close-the-womens-health-gap
Nature Editorial (2025). Menopause research is globally underfunded. It’s time to change that. https://www.nature.com/articles/d41586-025-00150-y
Australian Journal of General Practice (2026). Menopause: Closing the knowledge gap. https://www1.racgp.org.au/ajgp/2026/april/menopause-closing-the-knowledge-gap
Australian Government (2025). Response to the Parliamentary Inquiry into issues related to menopause and perimenopause. https://www.health.gov.au/sites/default/files/2025-02/government-response-to-inquiry-issues-related-to-menopause-and-perimenopause.pdf