"I haven't felt like this since right after my baby was born."
Tell me if you've heard this before. Maybe you've said it yourself. Teary for no reason. A fuse so short it scares you. Lying awake at 3am with a racing mind and a body that won't settle. Looking in the mirror and not quite recognizing the woman looking back.
I hear some version of this from women in their 40s all the time. And almost none of them have been told why it feels so familiar.
Here's why. Postpartum and perimenopause are two of the biggest hormone shifts of your life, and they hit your brain in surprisingly similar ways. In this article, I'm going to walk you through the hormone drop behind both, who's more likely to feel it, and what I look at first with my patients, so you can stop wondering what's wrong with you.
In this article, you will learn
Why perimenopause can feel like postpartum all over again
After you give birth, your hormones fall faster than at almost any other time in your life. Within days, the estrogen and progesterone that climbed through pregnancy drop sharply.
Perimenopause isn't as fast, but it's bumpier. For years, your hormones rise and crash, rise and crash, before they finally settle after menopause.
Your brain notices both. That's why so many women describe perimenopause as postpartum without the baby. Same brain, same hormones, same rollercoaster, twenty years apart.
Earlier this month, I joined CBS News Texas to talk about postpartum mental health and the warning signs women so often overlook. It reminded me how rarely anyone connects these two seasons of a woman's life. They belong in the same conversation.
The hormone drop behind both
Progesterone is your calming hormone. Your body turns it into a compound called allopregnanolone, which works on the same calming receptors in your brain that help you relax and sleep. When progesterone drops after birth, and again as it becomes erratic in perimenopause, that calm can disappear. Anxiety, irritability, and broken sleep often follow.
Estrogen supports your feel-good brain chemistry. It helps your brain make and use serotonin and dopamine, the messengers behind mood, motivation, and pleasure. When estrogen swings, so can your mood.
Sleep and stress pile on. Newborns wreck sleep. So do night sweats and 3am wake-ups. Add the stress of caring for everyone else, and your body's stress hormone, cortisol, stays high when it should be winding down.
If you want to go deeper on the hormone side of mood, my article on menopause and mood is a good next read.
The symptoms they share
The overlap is striking. Women in both seasons often describe feeling tearful or emotionally raw, irritable or quick to anger, anxious or on edge, unable to sleep even when exhausted, foggy and forgetful, disconnected from themselves or the people they love, and touched out, with a low desire for intimacy.
If rage is part of your picture, you're far from the only one. I wrote about it in menopause rage.
Who's more likely to feel it
Here's the part I wish every woman knew going into her 40s.
In a large study published in Maturitas, women with a history of postpartum depression were about 13 times more likely to be diagnosed with depression during perimenopause than women with no history of depression. (1) Women who'd had depression at other times in their lives carried a similar risk. (1)
Other research has found the same pattern. Women who've had postpartum depression or severe PMS are more likely to have mood symptoms in perimenopause. (2)
This doesn't mean it will happen to you. It means that if you struggled after a baby, or every month before your period, your body may be more sensitive to hormone shifts. Knowing that ahead of time is power. It means you and your doctor can watch for it early instead of being blindsided.
How it's different this time
After a baby, everyone expects you to feel off. People check in. Doctors screen you.
In perimenopause, almost nobody does. You might be juggling teenagers, aging parents, and a demanding job. You might not even realize perimenopause has started, because your periods are still coming. My guide to the signs perimenopause is here can help you spot it.
That's why so many women in their 40s are handed an antidepressant without anyone asking about their hormones. Sometimes that medication is the right call. But your hormones deserve to be part of the conversation too.
What I look at first with my patients
Her history. Postpartum depression, severe PMS, or depression at other times in her life all tell me her brain may be more sensitive to hormone shifts.
Her hormones. A hormone panel shows where she is in the transition. Progesterone often drops first in perimenopause, sometimes years before estrogen.
Her sleep. Mood and sleep feed each other. If she isn't sleeping, we start there.
Her stress and her support. Who's caring for her while she cares for everyone else?
Her labs beyond hormones. Thyroid, vitamin D, and iron can all affect mood, and they're easy to check.
5 ways to support your mood through perimenopause
None of these replace care from your doctor, especially if you're struggling. But they make a meaningful difference and support everything else you do.
1. Protect your sleep like it matters, because it does
Keep a steady bedtime, keep your room cool and dark, and put your phone down an hour before bed. If night sweats are waking you, read my article on menopause fatigue for what helps.
2. Steady your blood sugar
Blood sugar crashes can feel a lot like mood crashes. Start your day with protein instead of just coffee. On rushed mornings, my Keto-Green Shake gets protein in fast.
3. Support your stress response
Adaptogens are plants that help your body adapt to stress. Maca is my favorite, and it's the heart of my Mighty Maca Plus, now in a bright Mango flavor too. I explain how adaptogens work in Adaptogens 101: how maca helps you handle stress.
4. Check your vitamin D
Low vitamin D is common in midlife and can affect how you feel. Ask for a 25-OH vitamin D test. If you need a supplement, I take Ray of Strength, which pairs vitamin D3 with K2 to support bone and mood health.
5. Let people in
Postpartum taught many of us to suffer quietly. Don't do it again. Tell your partner, your best friend, your doctor. Connection is one of the most powerful mood supports there is, and it's free of side effects.
Dr. Anna's go-to support for this season
These are the products I reach for when women tell me they don't feel like themselves. They support your body's own systems and never replace medical care.
Mighty Maca Plus (Mango)
My daily foundational supplement, now in a bright mango flavor. The same superfood blend of certified organic Peruvian maca, turmeric, green tea, digestive enzymes, and more than 30 superfoods, made to support energy and stamina and to help your body adapt to stress.
Balance
My wild yam cream, formulated to support skin smoothness and hormone balance. Many women add it to their evening routine.
Ray of Strength Vitamin D3 and K2
Vitamin D3 paired with K2 to support bone and mood health.
These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.
Frequently asked questions
Can perimenopause feel like postpartum depression?
Yes. Both are times of major hormone shifts, especially drops in progesterone and swings in estrogen, which affect the calming and feel-good chemistry in your brain. Many women notice the same tearfulness, irritability, anxiety, and broken sleep.
If I had postpartum depression, will I have it in perimenopause?
Not necessarily. But research shows women with a history of postpartum depression, or depression at other times, are more likely to experience depression in perimenopause. (1) Knowing your history helps you and your doctor watch for it early.
Why does progesterone affect my mood?
Your body turns progesterone into allopregnanolone, a compound that works on calming receptors in your brain. When progesterone falls, that calming effect can fall with it.
How do I know if it's hormones or depression?
It can be both, and only your doctor can sort that out with you. Track your symptoms alongside your cycle, sleep, and stress, and bring that record to your appointment.
When should I get help right away?
If you feel hopeless, can't function day to day, or have any thoughts of harming yourself, reach out now. In the US, you can call or text 988 to reach the Suicide and Crisis Lifeline any time.
Does it get better after menopause?
For many women, mood steadies once hormones settle. In the meantime, sleep, steady blood sugar, stress support, and the right care can make this season much easier.
Final thoughts
If perimenopause feels like postpartum all over again, there's a reason. Your brain is responding to real hormone shifts, and you deserve to have that named.
You got through one hormone storm. You have more knowledge, more voice, and more support this time.
Start with the foundation: protect your sleep, steady your blood sugar, support your stress response, and tell your doctor your whole history, including what happened after your babies were born.
You deserve to feel like yourself again. That isn't too much to ask.
Not sure where to start? Take the quiz.
Answer a few questions and I'll point you toward what your body is asking for.
Or if you're ready to start today:
If you're having thoughts of harming yourself, please call or text 988 in the US to reach the Suicide and Crisis Lifeline.
References
Maturitas (2022). Association between postpartum depression and depression during perimenopause. doi:10.1016/j.maturitas.2022.12.001
Archives of Women's Mental Health (2025). Associations between lifetime reproductive events among postmenopausal women with bipolar disorder. https://pubmed.ncbi.nlm.nih.gov/39537796/
