30-day guarantee
PMS and the menopause
Summary
As hormone levels shift during perimenopause, PMS and PMDD symptoms can become more unpredictable - or even appear for the first time. This article explains the connection between PMS, PMDD, and menopause, why symptoms may intensify during hormonal transition, and how to tell whether you are experiencing PMS or perimenopause. It also outlines treatment and management options, from lifestyle changes to medical approaches.
Jump to a section
🌿 Key takeaways
PMS, PMDD and perimenopause: what to know
- Menopause is confirmed after 12 months without a period; perimenopause is the transition phase that precedes it, typically lasting around four years
- People with PMS or PMDD may find symptoms intensify during perimenopause due to increased hormonal sensitivity and more erratic fluctuations
- PMS symptoms follow a cyclical pattern tied to the luteal phase; perimenopause symptoms are more unpredictable and may occur at any time
- HRT - while helpful for perimenopause symptoms - can trigger PMS in some people due to the progesterone component
- Once through menopause, PMS and PMDD will no longer occur - as the cyclical hormonal shifts that drive them cease
What is menopause?
If you are aged 50 or older, menopause is defined as the permanent cessation of periods for at least 12 months. Because it cannot be confirmed until a full year has passed without a period, the diagnosis is always made retrospectively.
Menopause is a normal biological process. The average age in the Western world is 51. It occurs when levels of oestrogen, progesterone, and testosterone are low and the ovaries have declined to a point where an egg is no longer released each month. Around 5% of people will experience menopause before the age of 45, and in 1% it occurs before the age of 40 - known as early or premature menopause.
What is perimenopause?
Perimenopause is not as clearly defined as menopause, which can make it harder to diagnose. It begins when ovarian function starts to decline and hormone levels start to fall. During this transition, periods may become increasingly irregular before stopping altogether. The most common age for perimenopause to start is 47, and on average it lasts around four years - though some people experience symptoms for a decade or more.
Factors that affect timing and duration
- Age at onset - earlier onset may mean a longer perimenopause
- Genetics - the age your mother experienced perimenopause influences when you are likely to as well
- Ethnic background - on average, Black females reach perimenopause 8 to 9 months earlier than white females
- BMI - a higher BMI can mean the transition to menopause starts later
- Smoking - perimenopause typically begins up to two years earlier in people who smoke
With declining ovarian function, oestrogen and progesterone production becomes erratic. This can produce symptoms including:
- Irregular or heavier periods
- Night sweats
- Hot flushes
- Vaginal dryness
- Depressed mood
- Anxiety
- Difficulty concentrating
- Weight changes or appetite changes
- Changes in libido or painful sex
- Sleep disturbance or insomnia
- Lower energy and motivation
⚠️ Worth noting: For those who have PMS or PMDD, the overlap between symptoms can make it genuinely difficult to know whether perimenopause has begun. Careful symptom tracking - noting when symptoms occur in relation to your cycle - is the most useful diagnostic tool.
What are the differences between PMS and perimenopause?
Paying close attention to when your symptoms occur is the key to telling these two apart.
| PMS and PMDD | Perimenopause | |
|---|---|---|
| Pattern | Cyclical - symptoms worsen in the luteal phase and ease within days of the period starting | Unpredictable - symptoms may be persistent, constant, or occur at random |
| Cycle | Regular menstrual cycle continues | Periods become increasingly irregular |
| Relief | Symptoms typically resolve within a few days of the period starting | No predictable point of relief - symptoms may persist throughout |
Can perimenopause make PMS worse?
Yes - and this can be frustrating to discover. People with PMS or PMDD may be more sensitive to hormonal changes in general. During perimenopause, the fluctuations in oestrogen and progesterone can be more severe and erratic than in a regular cycle, amplifying the symptoms that PMS already produces.
It also means that strategies built up over years of managing PMS - knowing your triggers, knowing what helps - may need to be adapted during perimenopause, because the unpredictable timing of symptoms makes them harder to anticipate and prepare for.
🌿 Good to know: If you already manage PMS or PMDD, you have a head start. The tools that have helped you - nutritional support, exercise, stress reduction, cycle tracking - are all still relevant in perimenopause. Your GP can help you adapt your approach as your hormone pattern shifts. In some cases, HRT may be offered to steady levels and reduce the peaks and troughs driving symptoms.
Can you get PMS for the first time during perimenopause?
Yes. Despite never having experienced PMS or PMDD before, some people develop symptoms for the first time when perimenopause begins, driven by the same hormonal changes that affect those who have had PMS throughout their reproductive years.
If PMS or perimenopause symptoms are affecting your physical health, mental wellbeing, or quality of life for the first time, speak to your GP. They may recommend lifestyle adjustments or medical treatments to help manage new-onset symptoms.
Can perimenopause treatment cause PMS?
When going through perimenopause, your GP may prescribe hormone replacement therapy (HRT) - a combination of oestrogen and progesterone designed to smooth out the erratic hormonal highs and lows of the transition.
In some people, HRT can trigger PMS or PMDD symptoms. This is because PMS is thought (among other causes) to be driven by sensitivity to progesterone. When progestogen - a synthetic form of progesterone with the same effect - is used in HRT, it can cause symptoms labelled progesterone-induced premenstrual disorder. If you suspect this is happening, speak to your doctor - adjustments to your HRT regime may help.
Menopause as a PMDD treatment
For people with severe PMS or PMDD, doctors may recommend inducing a menopausal state as a treatment option. This can be done medically or surgically.
Medical (chemical) menopause
A gonadotropin-releasing hormone agonist (GnRHa) is given to temporarily switch off the ovaries and stop oestrogen and progesterone production. This mimics menopause, preventing the cyclical hormonal changes that cause PMS and PMDD symptoms. It is reversible.
Surgical menopause
The ovaries are surgically removed (oophorectomy), sometimes alongside the uterus, cervix, and fallopian tubes. Without oestrogen-producing ovaries, the menstrual cycle stops, and with it the hormonal fluctuations driving PMS and PMDD. This option is irreversible and results in permanent infertility. HRT is often offered afterwards to support long-term bone, heart, and brain health.
⚠️ Worth noting: Surgical menopause is an irreversible step and is only considered after all other treatment options have been exhausted. It should only be pursued after thorough discussion with a specialist.
PMS and perimenopause treatment options
If perimenopause has affected or triggered PMS or PMDD, a range of management options are available - from medical treatments and supplements to lifestyle changes and alternative therapies. A healthcare professional can help identify the right combination for your needs and stage of transition.
Can you get PMS after menopause?
No. Once through perimenopause and into menopause, PMS and PMDD will no longer occur. Without the cyclical fluctuations of oestrogen and progesterone, the hormonal triggers that drive both conditions cease entirely.
🌿 A silver lining: Despite the challenges of perimenopause, for those who have spent years managing PMS or PMDD, menopause brings with it a genuine freedom from cyclical symptoms. Many people describe this as one of the more unexpected upsides of the transition.
In summary
Perimenopause can be a difficult time for anyone - whether or not they have a history of PMS or PMDD. Understanding the difference between the two helps you know what you are likely experiencing, what treatment options to explore, and how to seek the right support.
If you are not getting the support you need from your GP, you can ask to see a different doctor, request one with a speciality in female health, or research specialist practices in your area. You do not have to navigate this alone.
Disclaimer: This content is for informational purposes only and is not intended as medical advice. Always speak to a qualified healthcare professional about any health concerns.
