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Can Perimenopause Make PMS Worse?

Alex Fulton

Over 90% of women have said they experience symptoms such as bloating, breakouts and mood swings a week or two before their period. Collectively, these symptoms are known as premenstrual syndrome (PMS).1

Given how common these symptoms are, women who are approaching perimenopause may find themselves wondering: What happens when the hormone fluctuations that trigger PMS blur with those of the menopausal transition? And can perimenopause make existing PMS symptoms worse?

Understanding the ways hormone changes affect the body during both PMS and perimenopause can help you understand what’s happening in your body—and when you should consider talking to a healthcare provider about it.

What is PMS?

PMS is a group of symptoms linked to hormone fluctuations experienced during the luteal phase of the menstrual cycle, which occurs after ovulation.2 These symptoms can be physical and/or emotional, and often include:

  • Anxiety
  • Depression
  • Irritability
  • Mood swings
  • Food cravings
  • Difficulty concentrating
  • Headache
  • Fatigue
  • Bloating
  • Acne
  • Breast tenderness
  • Digestive issues

Women may find themselves experiencing the same PMS symptoms in the 1-2 weeks before their period every month.3

For some women, PMS symptoms are barely noticeable; for others, they’re debilitating. The experience of pre-period symptoms that are so severe they disrupt a woman’s ability to function, is known as premenstrual dysphoric disorder (PMDD).4 While symptoms are similar to PMS, they are much more pronounced.

What is PMDD?

As mentioned, PMDD is like PMS, but much more intense. It affects 3-8% of women, many of whom also deal with mental health challenges such as anxiety and depression.5 There is a difference, however, in women who have received a clinical diagnosis of depression or bipolar disorder, vs. those with PMDD – as PMDD is cyclical by definition, while the other conditions are not.6

Women with PMDD have a heightened sensitivity to reproductive hormone shifts during the two weeks leading up to their period, which leads to alterations in their brain chemicals and neurologic pathways, specifically those that control mood and overall wellbeing.7

PMDD symptoms are severe enough to interfere with daily activities, relationships and quality of life. It’s important to note that PMDD is considered to be a chronic condition.

In addition to more common PMS symptoms, women with PMDD may also experience:8

  • Despair
  • Rage
  • Panic attacks
  • Lack of interest in daily life
  • Binge eating
  • Frequent crying
  • Low energy
  • Feeling out of control

Although these symptoms typically go away within a few days after a woman’s period starts, they can take a serious toll on her quality of life.

Antidepressants are often very effective for treating women who are dealing with PMDD.

The first choice for treatment is one of the selective serotonin reuptake inhibitors (SSRIs), such as sertraline or citalopram or fluoxetine.9 Treatment for PMDD does require the help of a healthcare professional, so be sure to check-in with your provider if you’re struggling with this condition.

Perimenopause and PMS Symptoms

As women enter perimenopause, the transitional period of time, typically the 4-8+ years leading up to menopause,10 the predictable hormone changes of a monthly menstrual cycle may become increasingly erratic. As estrogen levels fall and ovulation happens less regularly, women may find themselves more prone to or less able to tolerate typical PMS symptoms—even as new symptoms such as irregular periods and hot flashes arise.11

In a time when a woman could reasonably predict when in her cycle, she’d experience symptoms such as bloating and mood swings before perimenopause, she might find herself completely unable to foresee symptoms coming once entering perimenopause. For women with PMDD, who are extra sensitive to the ups and downs of their reproductive hormones, perimenopause can be exceptionally challenging.12

Interestingly, there appears to be a link between PMS/PMDD and early menopause. A recent study published in JAMA Network Open found women with either of these premenstrual disorders are 2.67 times more likely to experience early menopause (before the age of 45) including moderate or severe vasomotor symptoms.13 This finding is significant because transitioning through  menopause early can be connected to poorer heart, bone and brain health.14

Managing PMS During Perimenopause

Fortunately, there are steps women can take to manage perimenopause PMS symptoms. Lifestyle changes, such as getting enough exercise and lowering stress levels have been shown to help, as have some dietary supplements such as calcium and vitamin B6.15

A specific ingredient, known as royal jelly, may also be helpful. Made by worker bees to feed their queen, royal jelly is rich in vitamins, minerals and other nutrients. It has been shown to improve depressed mood and uneasiness.16, 17 Royal jelly, combined with a proprietary blend of Swedish flower pollen and chromium picolinate make up our plant-based solution SerenolTM, which is designed to relieve the emotional ups and downs often associated with hormonal fluctuations – like those experienced during PMS and perimenopause. As always, consider speaking with your healthcare provider first if you think supplementation may be right for you.

Antidepressants and other prescription medications may also be an option for women interested in exploring a more pharmacological route.18

 *Please note that Serenol is not designed to treat PMDD or its symptoms. If you’re dealing with PMDD, be sure to check in with your healthcare provider to understand the treatment options that are available for you.

If you find yourself struggling with worsening PMS symptoms during perimenopause, or if you’d simply like to learn more about how to manage the challenges that may arise during the menopausal transition, be sure to talk with your healthcare provider. If they’re not able to answer your questions, and you’re interested in looking into providers who specialize in menopause care, The Menopause Society offers a Find a Menopause Practitioner directory that can help you locate a qualified provider near you.



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* These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

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