The tragic Lindsay Clancy trial is all over the news right now, and at the center of much of the conversation is postpartum mental health. Her case is raising difficult questions about postpartum depression, anxiety, intrusive thoughts, OCD and, at the most severe end of the spectrum, postpartum psychosis. The trial itself will determine the legal questions surrounding this particular tragedy, but it has also put a much-needed spotlight on how we recognize and care for women who are struggling after childbirth.
And perhaps one of the most important conversations coming out of this tragedy is this: Are we doing enough to help women before they reach a crisis?
Because there are times in a woman’s life when she may look completely fine on the outside—and feel anything but fine on the inside.
Pregnancy, postpartum, perimenopause and menopause are periods of enormous biological change. But hormones don’t operate in isolation. They intersect with sleep, stress, relationships, previous mental health history and everything else happening in a woman’s life.
In this episode of Becoming Real, I sit down with Dr. Lulu Zhao, an OB/GYN who specializes in women’s behavioral health and reproductive psychiatry, to talk about what can happen emotionally and psychologically as hormones shift across a woman’s life.
We talk about some of the things women often whisper about rather than say out loud: intrusive thoughts after having a baby, anxiety that seems to come out of nowhere, PMDD, postpartum depression and the fear that admitting you’re struggling could somehow make things worse. And we talk about why symptoms can be so easy to miss when a woman is still going to work, caring for her children and keeping the household running.
As Dr. Zhao says, women are great maskers and great minimizers. Looking functional on the outside doesn’t necessarily tell us how someone is doing on the inside.
And this isn’t only a conversation for women. Partners and families need to understand what can happen during these transitions too—because sometimes the person who is struggling may not know what to ask for or may be reluctant to ask at all.
We also get into treatment, including one of the questions I hear from women frequently: What happens if I already have depression, anxiety or bipolar disorder and I want to become pregnant? Dr. Zhao talks about why treatment during pregnancy is not a simple “medication is good or medication is bad” decision—and why untreated mental illness matters too.
And then we widen the lens beyond pregnancy and postpartum to the hormonal transitions women experience throughout their lives.
Because maybe the better question isn’t, “Is this my hormones or is this my mental health?”
As Dr. Zhao says, sometimes “it’s a this-and.” Hormones matter. The brain matters. What is happening in our lives matters. And women deserve care that is sophisticated enough to consider all of it.
If you’ve ever thought, I just don’t feel like myself anymore—or you love a woman who has—this is an important conversation.
This podcast is Part 2 of our 4 part series on Women Health.
