Teaching through hormonal changes: postpartum, perimenopause, and beyond

This topic is definitely new territory for Truth for Teachers.

I was initially hesitant to include it because I didn’t want to overshare. However, as I began to talk to other women about this, I realized how many of us really didn’t have a good grasp on the way our hormones impact our daily function.

The experience is so individualistic, and no two experiences are alike, that I began to feel like the more stories we have, the better informed we would be.

In this podcast episode, I’ll share my own journey with perimenopause and brain fog. It took me many months to recognize what was changing in my body and why, and I misdiagnosed the brain fog stress from the pandemic. Once I sought guidance from my OB-GYN, I was able to find relief from my symptoms, and I wanted to help other folks understand their options, too.

I’ve also invited Dr. Jen Gunter to shed some light on this topic for us. Jen is an obstetrician, gynecologist, and author known for her advocacy work in women’s health and her efforts to debunk health misinformation. She is a prominent voice on social media and shares evidence-based information about women’s health issues and challenges pseudoscientific claims, and has authored several books, including “The Menopause Manifesto“, in which she addresses common myths and provides accurate information about women’s health.

In this interview, Jen and I discuss the impact of hormonal changes on energy and focus, throughout different stages of life, emphasizing that hormones should be viewed as a symphony of factors rather than isolated elements.

Jen also dispels negative stereotypes about hormonal changes and challenges patriarchal concepts around women’s competence related to hormones and aging. She encourages women to embrace their capabilities and make informed decisions about how and when to utilize medical experts for support.

Listen to episode 300 below,
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Sponsored by Erikson Institute

ANGELA: I’d like to talk about how our hormone levels in general impact our energy and our ability to focus on our work. What can you tell us about that?

JEN: Well, a lot of people here online and maybe from some providers about how well maybe this hormone is out of whack or that hormone is out of whack. And the truth of the matter is it’s better to think about hormones like a symphony, that there’s many different instruments playing their part. And so it’s not really about one thing, it’s about the sum of the parts. And so we know certainly for women that there are definitely conditions that are related to the menstrual cycle or related to having menstruation and all of the hormones that go along with that. So for example, autoimmune conditions start to rise about the time people go through puberty and the incident starts to decrease around the time of menopause, meaning that obviously, exposure to estrogen is a risk factor for some things for people. We know that people get menstrual migraines and that’s hormone-related.

We also know that there’s PMS, which can be hormone-related, and there’s also many other factors that can come into play. So I would say not to think about an individual hormone affecting your energy or your specific ability to do something, but rather the system, in general, may have an impact more so for some people than others. And for some people, it’s hormone changes that have a role. So for example, with PMS, premenstrual syndrome, we think that it’s the changes in hormone levels and specifically exposure to the hormone progesterone, that has an impact for some people. And so obviously for some people who have PMS, they may need to think about that a little bit more in family relationships at work about how that might be affecting their performance, how they feel about themselves, how they feel in general, because all of those things are involved.

Navigating perimenopause symptoms

So let’s talk about what this symphony of hormones looks like through various different phases. I’d like to hear a little bit about what educators can understand about their bodies and hormones when returning to teaching after maternity leave. I haven’t had children myself, but I know a lot of folks find that their energy levels have changed drastically postpartum. And that pregnancy brain fog then turns into “mommy brain”. It just feels like they’re constantly in a fog. So how can postpartum teachers adjust to these changes more smoothly and feel more at peace with the way that their bodies and their brains are now functioning?

So I always think it’s important to point out that with kids, you didn’t just go through hormone changes, you also went through something that’s pretty stressful to the body. And you’re also breastfeeding, that’s pretty metabolically stressful. You are also having to care for another human. And the truth of the matter is, and if you’re in North America, and specifically if you’re in the United States, you are almost certainly going back to work earlier than you might in another part of the world. So there are a lot of different stressors. There can also be relationship stressors on top of that. And all of those things come into play. So the other important thing to think about is there’s also a lot of kind of patriarchal language about “mommy brain” and about that type of thing. And there’s actually some data that shows that people are performing very well on the task that they need to do, which is caring for their newborn, and that they become basically hyper-focused at completing that job.

So you think about how does a mom know what her baby’s cry means? If I hear some other kid’s cry, I don’t know if they’re hungry or thirsty or whatever, but they know that, right? So they have these sort of uber skills now in another area. And so I think that we have a lot of pressures on people who are postpartum and coming back to work. And if you’re trying to juggle caring for kids, you’re trying to juggle the financial aspect perhaps of getting childcare or the emotional aspect of getting childcare. All of those things can affect how you feel. And then if you put postpartum depression on top of that or the baby blues, which is a less severe form, that’s also going to be a thing. So I would say to give yourself some grace to realize that you’re actually doing probably way more than you think. You might think that you have a lot of balls in the air, but you’re actually probably managing them better than you think. And to ask for help and support, especially around the house, so you’re not the person doing everything. And to understand that it’s a lot of work that as someone who has had kids, I had twins. Looking after living things is a lot of work. It’s a lot of work.

And often what happens is there’s no self-care and you don’t have any time for sleep or rest. I mean, just think about how you function when you’re sleep-deprived. So take any hormone changes and all that out of it, if you’re up at night with a baby, of course that’s going to affect your performance. So I would say the biggest thing would be to give yourself some grace. And the second thing is if you’re suffering, ask for help. I think that in our society, women especially feel that they have to do it all themselves. And if they don’t, there’s something wrong with them. And I would say that that is a patriarchal message, that’s not a healthy message. And if you’re struggling, most people are only too willing to help out.

Handling hormonal changes while teaching

Let’s move into the next phase where you may have some changes in your hormonal symphony, which is menopause. And I want to really prepare and inform listeners who haven’t reached this phase yet. A process of perimenopause or premenopause happens first. And it usually starts at a younger age than I think a lot of women are expecting to have symptoms. And that happened to me. Personally, I experienced brain fog and disrupted sleep, a really drastic change in my early forties. And I thought it was, this also happened to coincide with the early days of COVID. So I thought it was just stress and anxiety from everything going on with that. Then my periods became irregular about a year later, and that’s when I made the connection that all of this was a natural age-related hormonal shift. And I didn’t realize that any of those things happened in premenopause.

I thought it didn’t happen until actual menopause, which I wasn’t expecting until late forties or early fifties. So at that time, I read your book, the Menopause Manifesto, and learning about perimenopause was just a revelation for me. Even though it’s a very individual process, I found out I wasn’t the only one experiencing these symptoms. And in my case, there were some very simple adjustments that resolved my issues and I feel great now. So I want to kind of give some hope around that. I feel like a lot of the messaging that we hear about this phase of life is negative and there’s also a lot of positives that come with it. So let’s dive into that aspect. What should folks be looking for in terms of premenopausal symptoms that they might be just chalking up distress or something else, but could actually be premenopause?

Yeah, so you bring up some really good points. So first of all, I always tell people to think a little bit about puberty. So the day you got your period, that was just one part of puberty, and it was actually kind of maybe towards the back end of puberty, not the front end. But before you got your period, you were growing, you noticed changes in your breasts, maybe you got some pubic hair, other kinds of things, maybe you got some acne. All these things were happening to your body. And that is exactly the same thing that’s going on with menopause, except instead of things ramping up, they’re ramping down. And so there’s a lot of hormonal changes behind the scenes that work up to that last period. And just like with puberty, people can have a variety of symptoms. It’s the same for the menopause transition.

There are people who have periods almost like clockwork who feel nothing, and then their periods stop. And there’s people who can have very irregular periods and brain fog, hot flashes, joint pain, and other symptoms that go on for several years. So it’s really a variation in experience. And understanding why, we don’t really know. But it’s true that the most common symptom and the most reliable one is the change in menstruation. And so if you’re in your forties and you’re noticing your periods might be getting a bit closer together or they’re getting a little further apart, or they’re starting to get a little bit heavier, that’s probably the very early part of the menopause transition. And the menopause transition can go anywhere from four years to 10 years. So again, it’s a big swing in how long it can take.

Noticing those things, first of all, if you have regular periods, it’s always good to discuss with your doctor because there can be, first of all, other causes besides the menopause transition that might need to be investigated. But two, you don’t have to suffer. We have modern medicine. There’s treatments. If your periods are soaking your clothes, if they’re all over the place, there are treatments and you know what, no one feels good when they’re menstruating all over the place. So I add that in there. And brain fog is certainly a recognized symptom, and for some people, it can be really frightening because they think it’s a warning sign for dementia. I would say it’s rarely, if ever, that. It’s part of the menopause transition and why it actually happens, we don’t really know. But one theory is it’s related to the fact that your brain is pruning pathways.

So you have all these pathways in your brain that signal the hormone and changes necessary for your menstrual cycle. So you don’t need those anymore. So your brain’s cleaning house, and what happens when you clean a room, it’s often messier before it gets cleaner, right? You pull everything out. So that’s kind of my analogy for that. And what’s really fascinating is women perform better than they think on cognitive tests when they have brain fog. So what happens is verbal recall, remembering things tends to be the thing that suffers the most, but people actually still stay within the normal range. And for basically everybody this recovers afterwards. So it’s one of those things to be aware of. If it’s concerning, you should definitely talk with your doctor because again, other conditions can also produce brain fog, for example, sleep apnea, depression. So there could be other things going on. Depression can also be a symptom of the menopause transition, so that can make it even more complex. So I would say that if you’re having symptoms that are bothersome, it’s very good to check in with your provider. It’s also very good to learn what’s normal. And I’m so glad to hear that learning about that you weren’t alone and this was a normal process that I don’t know why we don’t talk about it, but I’m sure the answer is to do with the patriarchy.

That could be the only reason. So to talk about it, I’m so glad my book helped, and that also, I write a lot about it on my blog, The Vajenda as well. So I’m hoping that people, once they learn more about the process, it’s much less frightening when you know what’s happening than opposed to what is this sort of new thing and you wake up and your body is different.

Yeah, exactly. And I did have that sense that I felt like no one was talking about it. And so I started talking to my mom and to my aunts and found that they had actually a very different premenopausal experience than me and not very many symptoms. It didn’t last very long, and so they really didn’t notice it. So it wasn’t something that was really spoken about. But then when I went to my gynecologist, she explained everything I was feeling was very normal. I was starting at the same age that my mom had started, which I understand now is a really good predictor of when your own symptoms are likely to start. And she put me back on birth control pills, which I had gone off when my husband and I were trying to conceive. And I went back on, and that little low-dose boost of estrogen was mind-blowing. It changed everything for me, and I was so glad that I didn’t just suffer and stay with it and just assume that I had to kind of wait for this to pass.

Yeah, I mean the birth control pill on social media, it gets a lot of, I would say, negative comments mostly from people who are not educated in the field — naturopaths and chiropractors and people who are not experts in hormones. But if you want to control the irregularity and the menopause transition, the sort of the ups and downs, the hormonal swings, the only way to control that is with hormonal contraception because it kind of basically overrides the system and resets it. And for many people, it can be liberating. So I’m so glad that you were able to get that information and get the help that you needed.

Yep. It really did. I know it doesn’t work like that for everyone, but for me, it fixed the brain fog within days. It fixed their regular periods, and it enabled me to sleep again. I was waking up three or four times during the night and now I’m sleeping well. I just thought I’d share that everyone’s experience is different, but just to give folks some hope.

Yeah. Can I just add something to that? I don’t want people to think that estrogen treats brain fog because it doesn’t. Actually, we have good data there. Most likely what happened for you is it stopped your hot flashes at night, so you got to sleep. So then you were functioning now on an appropriate amount of sleep as opposed to waking up. In some studies, women can wake up 10, 15 times a night from hot flashes, and they may not appreciate their waking up that much. So I would say for someone who had that amount of improvement, it probably almost certainly related to be an improvement in your sleep.

Thank you for sharing that. That’s why I wanted to talk with you about this topic. Instead of doing a solo episode on this, you’re way more knowledgeable than I am. So tell us more about this. What else could a premenopausal teacher do to continue doing their best work and to keep having their best energy levels during that phase of life?

So the number one thing, and I always hate saying this because I don’t like the answer either, is exercise. There’s no other treatment that is beneficial for every single domain in the menopause transition and menopause. It improves brain function, it improves heart health, it improves bone health, it improves mood. It probably doesn’t help hot flashes. That’s probably the only thing it doesn’t help. But if you’re in a healthier life situation, if you’re healthier in general, you are also more able to deal with things that life throws at you. So I would say the number one thing is exercise. And that can be super hard. You’re running around after kids all day. If you’re a teacher of middle school, God bless you, because that’s just a unique time.

I think it’s really difficult to maybe get that into the schedule but think about it as medicine. Because if exercise were a pill, everybody would want it. Everybody would want to be on it. So I just think when you list up the benefits, that would be the first thing. The second thing would be if you’re bleeding all over the place, get evaluated. You might have anemia. It’s very common. Or even if you don’t have anemia, you could have iron deficiency. So it’s really important if you’re going in with period issues to insist on getting your iron level tested as well as being tested for anemia because they’re actually different tests. Women can have a normal blood count, meaning they don’t have anemia because anemia is a low blood count, but they can be iron deficient. Unfortunately, a lot of doctors mistakenly believe that the test for anemia means that you couldn’t be iron deficient, and that’s actually not the case.

And iron deficiency can cause a lot of symptoms. It can feel awful. It can make them feel tired, it can feel unwell. It can actually cause brain fog and other symptoms. So if you’re having menstrual disturbances that involve any kind of heavy or more frequent bleeding, you want to be tested both for anemia and for iron deficiency. Another thing is around the time in your forties is the time when thyroid conditions become a little bit more common. So if you’re also struggling in some ways, it might be an idea just to have that checked and to be screened for diabetes and get your lipids checked to do all these general health checks as well. And so I would say that’s kind of like if you’re thinking about building your menopause house, those things are your foundation.

Tips for thriving through menopause and perimenopause

So let’s talk about what happens when you’re in actual menopause. And this is one of the things that I really learned about from your book too, that premenopause is a time of changes, as you mentioned, like puberty, and that it only lasts a few years. Typically, menopause is the state that a woman can be in for decades and this is actually good news because menopause is a much more stable time hormonally. So what should folks who are teaching during menopause expect and how do we maximize our energy and focus during this stage of life?

So the great thing about menopause is you don’t have any hormonal fluctuations anymore, and you don’t have any more periods. And many, many women describe a clarity in menopause and whether it’s related to your brain having cleared away all those pathways that you don’t need anymore, whether it’s a combination of age and not really caring what people think, it’s hard to know. But I would say that we hear a lot of negative stories about menopause. And when I say that, I also mean the menopause transition. But there are also lots of people who are thriving and doing great, and those voices tend to not get heard because when people have a great experience, they don’t really talk about it, right? It’s like, Oh yeah, it was fine. So in menopause, the one thing that I would say sort of medically is hot flashes can last for years for some people.

So some people can suffer for 5, 10 years, a small percentage even longer. And if your symptoms aren’t going away, they’re still valid to be treated. And that’s something to discuss. Something that may be less related to your daily job but could potentially have an impact is the use of vaginal estrogen. So vaginal estrogen is not traditional hormone therapy because it doesn’t get into the bloodstream. It’s just a local therapy. And that can be really important for people to be able to continue enjoying the sexual life they want to enjoy, because over time, people will get vaginal dryness, and probably about 80% of people will need vaginal estrogen. It could potentially be higher, but there’s always some people who remain not sexually active. So we can’t really study that population to see if it improves their sexual function. And the other thing is vaginal estrogen reduces the risk of urinary tract infections, which starts to rise after menopause and really starts to rise about age 60. So if you’re somebody in your late fifties, your early sixties, and you’re still working, you’re getting a lot of bladder infections. That’s a major impact on your ability to function during the day while you wait to get the antibiotics. It’s a pain. If this is happening over and over again. It’s very uncomfortable. And so I think it’s really good for people to know that vaginal estrogen is a preventative medication for bladder infections.

I’m really glad you mentioned that because a lot of teachers suffer from UTIs from having to hold it all day. You can’t just go to the bathroom whenever you want to. So that’s super, super important to mention.

And one of the problems is not all the products are well covered by all insurance plans, which is terrible. So there are a variety of different estrogen products out there and a great thing for vaginal estrogen, and it’s generally possible to find one that works for you. There’s vaginal rings, there’s vaginal creams, there’s vaginal tablets, and there’s suppositories. And so there’s a whole wealth. It’s like the Cheesecake Factory. You’ve got a lot of choices.

I really appreciate the work that you have done to normalize these kinds of discussions, and that’s my aim for this episode. Obviously, we’ve just barely scratched the surface here, but this is something that I wish that I had heard more casually among women and that I had learned more about, that I was more aware of, and I knew what to expect. And I think it’s really powerful to talk about these things without shame. This is a natural experience. It’s a natural part of aging for women, and there’s nothing wrong with it. And in fact, there’s lots and lots of benefits. And the more that the more informed you are, the more empowered you are to make sure that you’re getting your best quality of life and that you’re prolonging your health as long as possible. So thank you for that work, and tell folks where they can go to learn more about balancing their changing hormones over time

So you can learn a lot more about hormones in my new book coming out, it’s called Blood: The Science Medicine and Mythology of Menstruation. That comes out on January 23rd. So if you’re somebody under age 50, that would be a book that would definitely apply to you. Or if you have family members or children under that age. If you’re someone interested in more menopause-specific related facts, then there’s the Menopause Manifesto. And I also have a blog called TheVajenda.com. That’s with a “j”, thevajenda.com. And I write a lot about different things related to women’s health but with a big focus on the menopause transition and menopause and impacts of things on menstruation. So for example, vaccines and other types of things. So I would say that if you’re interested in anything menstrual-related, menopause-related, menopause transition-related, I hope that I can be your one-stop shop there too.

Awesome. So I’d like to close out the show with what I call a takeaway truth. What’s something that you wish every teacher understood about doing their best work throughout different phases of life and the accompanying hormonal changes?

I would say that I think people should be aware of the idea of women being incompetent related to hormones, or aging out of work related to hormones is a largely patriarchal concept. And that we have incredible historical information that shows that women in menopause were incredibly useful to the collective. And there are studies that show that when children lived closer to their parents, they were more likely to have more children. And if we look at some data from traditional hunter-gatherer societies, those who have a grandmother in the collective, or family unit, the grandmother is collecting the majority of the calories while her daughter is pregnant. And so I would say, yeah, right? Isn’t that really impressive?

Yes. You think that it’s the men out hunting? No, no, they’re not. That’s occasional, occasionally bringing food home. It’s the grandmothers, it’s the elder women who supplied the majority of the calories.

And they provide the knowledge, the tribal knowledge about, “Hey, when we had a drought 60 years ago, my grandmother told me…” We don’t respect that because we’re in this patriarchal society, which is uniquely ageist for women. And so I would say, think about the orcas, all the orcas bringing the boats down. They’re the ladies. They’re the lady orcas because male orcas die at 50. It’s the women that keep on living the female orcas. So it’s a very matriarchal society. They’re passing on the knowledge. And so to think about that, you are far more capable than society would have you believe. And just think about that thing I said earlier about even when you have brain fog, you’re still outperforming men on those types of tests. But I would say the takeaway truth is that you are far more competent and far more amazing than our society wants you to believe.