How to Talk to Your OB About Hormonal Mood Symptoms
Written by
Phoenix Health Editorial Team
Expert health information, double-checked for accuracy and written to be helpful.
Last updated
Most postpartum OB appointments last fifteen minutes and are focused on whether your incision is healing, whether you're contraceptive, and whether you have any obvious red flags. Mental health and hormonal mood symptoms often get a brief Edinburgh scale, a quick question about how you're doing, and not much more — unless you actively redirect the conversation.
That's not a criticism of OBs. It's the structural reality of how postpartum care is typically organized. Knowing this ahead of time lets you come prepared to use that fifteen minutes well.
The Edinburgh Scale as a Starting Point
The Edinburgh Postnatal Depression Scale is a ten-question self-report tool that most OBs use as a standard postpartum screen. If you fill it out in the waiting room, your score shapes how much clinical attention your mental health gets.
Two important things about the Edinburgh: first, people routinely underreport on it. When a question asks how often you've been anxious or worried "for no good reason," many people answer lower than their actual experience because they can always find a reason, or because they're minimizing. Fill it out accurately. Second, the Edinburgh doesn't catch everything — it's designed primarily to screen for depression and doesn't fully capture anxiety or hormonal-specific mood disruption. Your score is a conversation starter, not a complete assessment.
If you filled out the Edinburgh and scored low despite struggling, say so: "I filled out the questionnaire but I think I underreported — I want to talk about what I've actually been experiencing."
What to Say: A Direct Script
You will make better use of a short appointment if you lead with specifics rather than waiting for the provider to ask the right questions. Here's language you can adapt:
"Before we wrap up, I want to make sure we talk about my mood. Since delivery, I've been experiencing [name your symptoms — for example: persistent low mood, anxiety that's affecting my sleep, brain fog that hasn't lifted, irritability I can't control, tearfulness]. It's been going on for [timeframe]. I want to get assessed properly and talk about next steps."
If the provider says it sounds like normal adjustment, you can respond: "I understand adjustment is normal, but I want to make sure we're not missing an underlying hormonal or nutritional cause. Can we order a thyroid panel — TSH, free T3, and free T4 — and also check my ferritin and vitamin D?"
This approach is direct without being adversarial. It frames what you want as responsible medicine. Most providers will agree.
Specific Tests to Request
By name, ask for:
Thyroid panel: TSH, free T3, and free T4 together. Postpartum thyroiditis — disruption of thyroid function after delivery — affects roughly 1 in 10 to 1 in 20 people and can produce symptoms including anxiety, heart palpitations, brain fog, weight changes, and depression. [ACOG's guidance on thyroid disease in pregnancy](https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/06/thyroid-disease-in-pregnancy) recommends considering thyroid evaluation for postpartum people with mood symptoms. TSH alone can miss dysfunction in the free T3 or T4 values, so requesting all three is worth doing.
Ferritin: Blood loss during delivery and the demands of breastfeeding deplete iron stores. Ferritin measures stored iron and is a more sensitive indicator than hemoglobin alone. Low ferritin is associated with fatigue and mood disruption even when a standard CBC looks acceptable.
Vitamin D and B12: Both affect neurological function and mood. Deficiencies are common in the postpartum period and are easily treated when identified.
Requesting a Referral
If you want to see a therapist and you're not sure where to start, ask your OB directly: "Can you refer me to a perinatal mental health therapist?" Most OBs have referral relationships with therapists who specialize in this population, or can point you to Postpartum Support International's provider directory.
You can also ask about a psychiatric consultation if medication is something you want to explore. A reproductive psychiatrist or perinatal psychiatrist has the most specialized knowledge about mood disorders in the hormonal context of the postpartum period.
What to Do If You Leave Without Answers
Sometimes an appointment doesn't go the way you hoped. You described your symptoms, the provider was reassuring, and you're leaving without a lab order, a referral, or a clear plan. This happens.
Your options:
Call back and ask specifically. "At my appointment, we didn't get to order the thyroid panel I mentioned. Can you add that to my chart?" Many practices can add a lab order by phone or through a patient portal without requiring another visit.
Use the patient portal. If your practice has one, you can often message your provider directly and request specific labs or a referral. Written requests sometimes get more traction than verbal ones because they require a documented response.
See a different provider. If you've raised this more than once and been consistently dismissed without investigation, a second opinion from a different OB or a primary care provider is entirely reasonable. You're not being difficult — you're advocating for care that you need.
Connecting with a Therapist Now
You don't have to wait for the medical track to be resolved before starting therapy. A perinatal therapist can support you while lab results are pending, while you're waiting for a follow-up appointment, and while you're figuring out whether medication is right for you.
A therapist who specializes in postpartum hormonal mood symptoms understands both the emotional and the physiological dimensions of what you're experiencing. They can help you articulate what you're going through in a way that's easier to raise with your OB, process the information you're getting from your medical team, and manage symptoms in real time while you're waiting for the bigger picture to clarify.
The therapists at Phoenix Health specialize in exactly this. Most hold PMH-C certification from Postpartum Support International — the clinical credential for perinatal mental health. They see patients via telehealth, which means you can have a first appointment without arranging childcare or driving anywhere. If you're ready to talk to someone, the starting point is easier than you might think.
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Frequently Asked Questions
Trust your experience. The Edinburgh is a screen, not a complete assessment, and people frequently underreport on it. If your score was low but your actual symptoms are significant, tell your provider directly: "I think I answered lower than my reality on the questionnaire — I want to describe what I've actually been experiencing." You can also ask for a more thorough conversation separate from the score. A low Edinburgh result doesn't close the door on investigation or treatment.
Yes. You can request specific lab tests by name, and most providers will order them if you have a reasonable rationale. You might say: "I've read that postpartum thyroiditis can affect mood, and given my symptoms, I'd like to check TSH, free T3, and free T4 to rule it out." If the request is declined without explanation, ask why and whether that reasoning can be documented. You can also request thyroid testing from your primary care provider if your OB doesn't order it.
Ask for specifics. "Normal" sometimes means the value is within the reference range — but where within that range matters. A TSH on the upper edge of normal may correlate with symptoms even though it's technically acceptable. Ask where your specific numbers sit. If everything is genuinely normal and you're still symptomatic, the conversation should shift to psychological support rather than more waiting. Normal labs don't mean you don't need help — they mean the cause isn't primarily endocrine.
You can say it plainly: "I think talking to someone would help — can you refer me to a perinatal mental health therapist?" Most OBs will respond positively. If they ask why, you can describe your symptoms or simply say "I want additional support while I'm navigating this." You don't need to justify the request in detail. If your OB doesn't have a referral, ask them to recommend someone through Postpartum Support International's directory.
Your OB manages physical recovery, can screen for postpartum mood disorders, and can prescribe medications including SSRIs. A reproductive or perinatal psychiatrist specializes specifically in the intersection of psychiatric conditions and reproductive transitions, including pregnancy, postpartum, and hormonal shifts. If your mood symptoms are complex, persistent, or not responding to initial treatment, a psychiatric referral gives you access to more specialized medication management and diagnostic precision. The two roles complement each other rather than replacing each other.
Ready to take the next step?
Our PMH-C certified therapists specialize in exactly this — and most clients are seen within a week.