Managing pregnancy and menopausal symptoms

Emily Courtney is a health visitor and former nurse who was diagnosed with premature ovarian insufficiency (POI) before having her children. Here, Emily shares her story and advice, as she aims to support mums of young children to be the best parents they can be while going through perimenopause.

Can I be pregnant and have symptoms of menopause?

Being pregnant while dealing with menopausal symptoms can happen as more women and birthing people have children later in life.

Menopause is when someone hasn’t had a period for 1 year, and the average age of menopause in the UK is 51. In the time leading up to menopause (called perimenopause), symptoms can start to appear as hormone levels in the body fluctuate and change. Periods can often change during this time. How someone's body reacts to these changing hormones is unique to each person.  

Perimenopause can start up to 10 years before menopause. Women and birthing people are able to conceive during perimenopause because the ovaries are still producing eggs and Hormone Replacement Therapy (HRT), a treatment used to help menopause symptoms, is not a contraceptive.

As well as the ‘normal’ menopause, often described as a midlife occurrence, people can experience an early menopause. Menopause is defined as early if it is before 45 years old and as premature ovarian insufficiency (POI) if it is before 40.  

It is estimated that 5-10 out of 100 people with POI conceive spontaneously and some women, like me, will have children before getting their POI diagnosis. Some people with POI have their family via egg donation, so will also be pregnant and having menopausal symptoms.

It is crucial that you have the right support and treatment, because this doesn’t only impact you, it also impacts your most important small people. Symptoms can have a huge influence on parenting, wellbeing, physical and emotional health.  

If you are pregnant and having menopausal symptoms or are an older mum and want to be aware of the potential of perimenopause starting after birth, there are a few things that you need to think about.  

Get a postnatal plan in place

This is key because when you have a baby, you often put them above your own needs. Menopausal symptoms such as hot flushes, difficulty sleeping and palpitations can be debilitating and have an impact on all aspects of your life.  

If you are struggling with your emotional and physical health this can have a knock-on effect on your parenting. It is so important that you get the right support so that you can feel well enough to parent and care for your child exactly as you wish.  

Hormone Replacement Therapy (HRT) is a treatment used to help menopause symptoms. It replaces the hormones oestrogen and progesterone, which fall to low levels as you approach menopause.

If you already have a diagnosis of POI, early menopause or perimenopause or were on HRT before pregnancy, speak to your health care professional (HCP) before giving birth to make a plan for you to start postnatally, should you need and wish to.  

If your doctor is unsure about whether you should take HRT, ask them to refer you to an NHS menopause specialist clinic so that you can have specialist input after your baby arrives.

Having a new baby is not the time to ‘wait and see what happens’. As I stressed earlier, it is important that you are feeling well. Time and sleep are limited after you have a baby, so do your research as soon as you can.

Know about breastfeeding and HRT

There is not much information on taking oestrogen for HRT while breastfeeding. Most of the information comes from the use of other types of oestrogen as a contraceptive.

Speak to your GP about being referred to a specialist if you want to discuss HRT and breastfeeding or are struggling to get HRT prescribed while breastfeeding.

I would also like to add, being an experienced health visitor, that although breastfeeding is well evidenced for its incredible benefits to you and baby, your wellbeing should be the priority.  

If you find that your menopausal symptoms are impacting your quality of life, your emotional wellbeing, your ability to care for or enjoy your baby, and you are unable to get HRT prescribed unless you stop breastfeeding, please don’t feel you have let anyone down by doing this.  

You are the most important person, and we need you to be emotionally and physically well to be able to care for your baby. Your local health visiting team should have access to breastfeeding specialists who can support you with any breastfeeding concerns you may have.

It can be difficult to know if the symptoms you are experiencing relate to perimenopause/menopause or to the general challenges of parenting. This is a concern for many mums that I speak to and support. It can be hard to know what is ‘normal’ mum tiredness, overwhelm, anxiety and rage, and what is hormonal. 

Keeping a diary of anything you do with your little one and how you feel is a good first step. It helps to see if there are any associations between your day-to-day life and your emotional and physical health.  

Be kind to yourself. Having a new baby is tough. There is lots of support available so speak to your health visitor or GP who will have information on local services.  

Track your postpartum symptoms  

This is very important. It means you can check that your symptoms are getting better, not worse. Perimenopause symptoms and postpartum symptoms are similar, including changes to your mood, vaginal changes, and hot flushes. This is due to the sudden drop in oestrogen post-birth.  

However, as you move further from pregnancy and birth, your hormones start to level out and you should begin to feel more like yourself again. If you know that you are perimenopausal or menopausal then you may find things don’t improve or get worse. It is really important that you seek help and advice so that you don’t have to struggle.

Tracking your menopause symptoms with a calendar can be helpful for your doctor. You should track your periods, including how long they last, how heavy they are, and whether they are regular or not.  

You could also think about tracking your pelvic floor and your vaginal health.  

Pregnancy and birth are known to have an impact on the pelvic floor, but so can perimenopause, it is just less talked about.  

The change in hormones during perimenopause can make everything feel looser and weaker, as well as causing symptoms like vaginal dryness, soreness and itching. This can be particularly difficult if you have recently given birth vaginally and have a wound or stitches that are trying to heal.  

Breastfeeding can also cause vaginal dryness; another thing that just isn’t spoken about.  

These symptoms can impact your quality of life, so it is important to seek help earlier rather than later or ensure this is in your plan prior to giving birth.  

Your midwife can refer you to a women’s health physiotherapist while you’re pregnant to help you get support postnatally for your pelvic floor.  

There are also vaginal moisturisers and lubricants that can help.  

Lean on your support network  

You should have a support plan in place that is not just focused on menopause care. Ensure that you have a support network to help you after you give birth.  

This can be made up of friends, family, paid help, and charities if required. Have a support in place not just for menopause concerns, but for helping around the house, cooking food, and supporting you and baby so you can both rest. 

You should have regular appointments with your health visitor and have a GP check at 6-8 weeks postnatally. It is important to be open and honest with professionals so that you can be referred for the correct support.

Coping with menopausal symptoms and caring for a young child is really tough. It is unfortunately not supported well and not spoken about, and it can feel incredibly isolating. 

You may not feel you can talk about menopause to your mum friends or take your baby along to a menopause support group, despite it being so much more common than we realise. But there is help available. Please seek help if you are struggling, you really aren’t alone in this!