When You're the One Who Supports Women Through Every Stage: Perimenopause for Midwives and Obstetricians

The Professional Paradox Nobody Warns You About

You have supported hundreds of women through the most significant hormonal events of their lives. You understand the physiology of birth, the cascade of oxytocin and cortisol, the hormonal shifts of the postpartum period. You can read a CTG trace at 3 a.m. after six hours on your feet.

And then perimenopause arrives, and suddenly you are the one in the middle of a hormonal transition that nobody prepared you for in quite this way. The irony lands hard. You know how female physiology works. But knowing the textbook and living in the body are two very different experiences.

This guide is for midwives, obstetricians, and other women who spend their professional lives holding space for women's bodies, and who are now navigating their own.

Why This Job Makes Perimenopause Harder

Obstetrics and midwifery are physically and emotionally demanding in ways that compound the symptoms of perimenopause.

Night calls and shift work disrupt the circadian rhythms that already become unstable during perimenopause. Estrogen and progesterone follow daily cycles, and when those cycles are repeatedly interrupted by irregular sleep, the hormonal instability you are already experiencing can feel more intense.

Long hours on your feet stress joints and muscles that perimenopause is already making more vulnerable. Declining estrogen affects cartilage integrity and tendon elasticity, and a twelve-hour shift standing at a delivery table or operating in theatre is not gentle on knees and hips under any circumstances.

The emotional weight of the work matters too. Obstetric environments include birth trauma, pregnancy loss, and medical emergencies, all of which demand sustained emotional regulation. Perimenopause can affect the emotional resilience and recovery capacity you have always relied on. When your reserves are lower, the cost of holding difficult situations rises.

Hot Flashes in Clinical Environments

A hot flash during a vaginal examination, a fetal assessment, or a surgical procedure is not a medical emergency, but it is a deeply uncomfortable experience in a setting that demands steady hands and clinical presence.

Operating theatre environments can help or hinder depending on temperature control. If you have any input into theatre temperature, even a degree or two cooler makes a measurable difference. Breathable scrubs, moisture-wicking base layers under theatre attire, and staying hydrated during long procedures all help manage the intensity of flashes.

For colleagues who work in birth suite environments with more movement, identifying cooling spots during brief breaks, keeping a small cooling spray accessible, and being strategic about caffeine intake before long shifts are practical adjustments that many women find useful.

Spicy food in the staff room before a long shift can be a reliable flash trigger. So can the stress spike of a sudden emergency. Knowing your personal triggers means you can manage around them more effectively rather than being caught off guard.

The Unique Challenge of Caring for Pregnant Women

There is something particular about navigating your own perimenopause while working in a professional world centred on fertility, pregnancy, and birth.

For some women, this creates an unexpected emotional dimension. If you chose not to have children, or could not, or had losses, the daily proximity to pregnancy and newborns during your own transition can stir feelings that deserve attention rather than suppression. If you are processing your own shift in fertility status while your work remains focused on fertility, that is worth naming, even if only to yourself or a trusted supervisor.

For other women, the juxtaposition is simply neutral, a job that happens alongside a personal life chapter. But either way, it is worth checking in honestly. Perimenopause can amplify emotional responses to situations that previously felt more neutral. Noticing that shift is useful clinical self-awareness.

Sleep, Night Calls, and Cognitive Function

Night calls are a feature of obstetric work that do not become more compatible with perimenopause over time. Night sweats already fragment sleep for many women. Add an on-call page at 2 a.m. and the requirement to be clinically sharp within minutes, and you have a real cumulative fatigue problem.

Brain fog is one of the most commonly reported cognitive symptoms of perimenopause, and it is driven partly by poor sleep and partly by the direct effects of fluctuating estrogen on brain glucose metabolism. For clinicians whose work requires sharp decision-making, accurate recall, and clear communication, the cognitive effects are not a minor inconvenience. They are a professional concern worth taking seriously.

Adjustments that help include protecting sleep aggressively on non-call days, limiting caffeine after midday even when you are exhausted, and being honest with yourself and your team about capacity. If you are running on consistently broken sleep for weeks at a time, that is a workload and rostering issue, not a personal failing.

Tracking your symptom patterns with something like PeriPlan over several months can help you identify whether cognitive dips are correlated with specific cycle phases, sleep disruption, or both. That data is also useful if you decide to talk to a provider about treatment options.

Disclosure at Work: Who to Tell and How

Whether to disclose perimenopause symptoms at work is a decision many midwives and obstetricians find harder than they expected. There is a culture in medicine of managing your own health quietly, and a professional identity built on being the one who is capable and present for others.

For most women, full disclosure to the whole team is not necessary or helpful. Selective, purposeful disclosure is a better frame. Telling a trusted line manager or clinical lead that you are managing a health condition that may occasionally affect your schedule gives them context without full detail. If shift swaps or temporary adjustments to on-call frequency would help you manage an acute phase of symptoms, making that request with appropriate context is both legitimate and professionally reasonable.

Disclosure to peers who are also in this life stage can be quietly reassuring and practically useful. You may find that colleagues are navigating the same thing without saying so. A single honest conversation can open up informal mutual support that makes a real difference.

Managing the Long Game

The perimenopausal transition is not permanent, though during the acute phase it can feel like a new normal. For most women, the most disruptive symptoms are concentrated in the years around the transition, and cognitive and emotional functioning tends to improve substantially after menopause is established.

Managing the long game in obstetric and midwifery careers means thinking about what adjustments are sustainable now and what your practice looks like on the other side. Some women find that the perimenopausal years are a natural time to reduce on-call commitment if their career stage allows it. Others find that with treatment support, things are manageable enough that major changes are not necessary.

Speaking with a menopause specialist or a GP with a particular interest in women's health in midlife is worth doing sooner rather than later. As a clinician yourself, you may find it easier to have an informed, detailed conversation about options than some patients do, but you still deserve the full range of treatment options, including hormone therapy if appropriate, explained to you in the context of your specific health history.

You have spent your career being the person who says: your body is doing something real, and you deserve information and support. That is exactly what you deserve now, too.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.