After Dublin mother of one Lorraine Heffernan had her daughter, Ava, now three, at the age of 45, she didn’t think about perimenopause.
“I thought there’s no way I could be menopausal,” Lorraine says. “I’ve just had a baby. That’s years down the line.”
Yet, by the time Ava was two, Lorraine’s hormones were “all over the place”, though she was out of the new-baby phase. Her mood was not as good as it should have been.
“I wasn’t feeling as energetic or upbeat as I normally would. Ava has been a great sleeper since very young, so why was I feeling more tired than usual when I was sleeping well?”
Through research, conversations with friends, and the launch of a menopause policy in her Dublin City University workplace, the Stepaside-based mother realised she was most likely in perimenopause.
Lorraine came forward for interview for this feature after menopause workplace consultant Catherine O’Keeffe put out a call on her network for women prepared to talk about being in perimenopause soon after having a baby. Within days, 20 women had responded.
“It’s a big challenge for a lot of women,” says O’Keeffe. “Starting a family is happening later. And a lot of women are starting to feel perimenopausal before the average age of 45.”
Fiona Buckley, 44, a Dublin-based empowerment coach and keynote speaker, began having what she now knows were perimenopausal symptoms about a year after having her daughter, Sadie, seven.
She attributed the tiredness and brain fog to the postpartum phase. But the symptoms never went away.
“My GP and friends who’d had babies said 12 months postpartum these should be going away, but they weren’t. They were only getting compounded, new ones being added on. That’s how I knew.”
Emily Collins, mother to Ava, seven, and Niamh, five, was 36 when she attended the GP with her first symptom, six months after giving birth.
Her usual GP was away and the male replacement attributed what she was experiencing to thrush. “We never thought it was menopause, because I had a six-month-old. I was treated for thrush — it went on for nine months.”
“Between life, lockdown at the time, and children, I just ignored it. My second symptom came in summer 2021, just after I’d had the covid vaccine: Very heavy periods. I’d heard that the vaccine could cause changes to the menstrual cycle.”
But by October, sweat dripping off her as she packed to go home to Wicklow after a visit to her parents’ house in Clare, realisation dawned for Emily.
“My cousin, 10 years older than me, is a big menopause advocate. She’d just started her menopause journey and was very vocal about symptoms. I began to put two and two together: Maybe there’s another reason I’m sweating and anxious, have heavy periods, and extreme tiredness. Maybe it’s not just having a newborn.”
Discovering that her mother had been “in the throes” of menopause at 43, Emily says: “But when did her first symptom start?”
A visit to her own GP brought some relief. “She sent me for blood tests. They were normal, but because of my symptoms she wasn’t convinced I wasn’t in menopause.”
A stint on the Mirena coil didn’t help. An oestrogen patch brought a better result. “Within three weeks, I wasn’t sweating to the same level. I wasn’t anxious or tired and it just got progressively better.”
At her Ashe St Clinic in Tralee, Dr Karen Soffe, GP with an interest in women’s health and specialist with the British Menopause Society, has seen women who were in perimenopause soon after they had a baby.
A few issues are at play. “Women are having babies later and, therefore, the gap between their postnatal period and the start of perimenopause can overlap, making it difficult for women to realise what’s going on.”
In addition, some of the symptoms — fatigue, low mood, lack of sleep, and brain fog — can be put down to ‘baby blues’ or ‘baby brain’ and be misdiagnosed.
Deciding whether “this is post-natal depression, perimenopause, or just having a new baby can be a very big challenge”, says Lorraine.
“I don’t know if you’d know where one starts and the other finishes.” Recalling her return to work when Ava was seven months, she says: “Going into a room, I’d be saying, ‘What have I come in here for? I can’t remember’. Remembering people’s names, the title of something, my mind would go blank. And I’d be thinking, ‘Is it baby brain or brain fog?’ Now I’m realising it was a bit of both.
“Any mum will be anxious with a new baby: You’re on high alert. Anxiety symptoms are heightened in perimenopause: Waking up in the middle of the night, your mind racing, finding it hard to go to sleep. If you’re irritable or snappy, is it because you’ve a very active, strong-willed, fabulous little girl who’s trying and testing you, or is it because your hormones are acting erratically?”
Recalling the succession of symptoms, Fiona says: “One minute, you’re trying for a baby, then you’ve had the baby, and then you have all these symptoms coming at you in force. First, I thought it was part of being a new mom, just motherhood. I didn’t put it down to perimenopause.”
Whether “it’s my body settling down after having a baby, or I’ve gone full throttle into menopause” is a cloudy area, says O’Keeffe. “If you are in perimenopause, unless you have a good doctor you’ll probably spend a while thinking ‘Am I going mad?’”
Emily feels fortunate her doctor listened to her. “She didn’t say, ‘Look, the bloods indicate there’s nothing going on’.” But Fiona says women don’t always respond optimally to other women who are wondering if, post-birth, they’re in perimenopause. “A lot shut me down. They said, ‘Oh, you’re not, you’re just tired after having a baby’. Women can do that to each other, fob each other off. It made me question myself a lot.”
As a woman in her mid-40s having her first baby, Lorraine feels that more health-service awareness of her life stage would have helped. “Nobody said, ‘You’re at a certain age now, perimenopause might be kicking in’. Nothing like that was ever mentioned, not even at the check-ups. The community health nurse would ask ‘How are you feeling, how’s your mood?’ There was no mention of perimenopause. I think it’s another piece of information to make women aware of.”
Unsurprisingly, perimenopause can make new motherhood even more challenging than it already is.
One symptom that Emily says really upset her, prior to getting good treatment, was the anger she would sometimes feel: “The girls were two and four when I was going through that, and something as simple as them taking a while to put on their shoes going out, I’d get cross about, and there was no need to get cross like that. I think it impacted the relationship I had with them. And it was because I wasn’t myself.”
Lorraine says being a mother and having perimenopause is two conflicting elements in one. “You’re striving to be the best mom you can be. You don’t want to be reacting in certain ways. You want to have a certain tolerance threshold, regardless of what timeframe your body clock is working to.”
Fiona took a while to accept that perimenopause came so soon after her baby. “It feels like you have two stages of life overlapping. You’re trying to enjoy your baby and you’re hit with a complete other stage of life. It feels like you’ve been fast-forwarded and you’re trying to slow it down.”
Soffe says that perimenopause, at the best of times, coincides with a stressful phase of most women’s lives, what with elderly parents, career pressures, teenagers, and financial worries. “Perimenopause can make women struggle with mood, anxiety, multi-tasking, or juggling all the things they previously managed with ease. Adding a new baby or toddler in to the mix can be overwhelming.”
