Is PMS Worse During Perimenopause? Why It’s Not Just Your Imagination

by Charlotte

Kim experienced the worst cramps of her life on the day she turned 46. She’d never really dealt with PMS before—only the occasional moody afternoon or minor breakout, nothing debilitating. But from that cycle onward, she had all the symptoms she’d watched her “unlucky” friends struggle with: bloating, breast tenderness, cravings, irritability, and severe menstrual cramping that seemed to press pause on her entire life. Kim went to her doctor seeking answers and was surprised to discover that her PMS symptoms marked the beginning of perimenopause.

Is PMS worse during perimenopause? For some women, the answer is “yes.” The average woman enters perimenopause sometime in her late 40s and experiences hormone-related symptoms for up to ten years or more. The menopausal symptoms may end when you stop having periods, but some women will continue to have symptoms indefinitely. Many women feel mildly uncomfortable during perimenopause but experience a fairly smooth transition overall. For others, especially those whose bodies are already more sensitive to hormonal fluctuations, perimenopause can bring profound changes, including severe PMS symptoms.

Thankfully, if you’re struggling with worsened PMS during perimenopause, you don’t have to suffer alone. By learning more about what changes to expect and seeking help from a qualified hormone health practitioner, you can better understand your symptoms and find a treatment plan that provides relief.

What Changes You Can Expect During Perimenopause

When most people think of the menopause experience, what they’re really referring to is perimenopause—the period leading up to the actual halting of the menstrual cycle. During this time, you can expect your cycles to become irregular and eventually stop. But many women experience a roller coaster ride of hormonal symptoms in the years leading up to menopause itself.

Common symptoms of perimenopause include hot flashes, night sweats, low sex drive, and sleep disturbances. Some women may also experience nausea, migraines, sore breasts, and other symptoms commonly associated with PMS. Worsened PMS symptoms before each cycle are also common for women in this stage.

After menopause, those symptoms lessen. However, others often arise. For example, vaginal dryness and atrophy may make sex more painful, and you will be at a higher risk of developing osteoporosis or heart disease due to the absence of estrogen. Thankfully, there are treatments available to help alleviate both perimenopause and menopause symptoms and decrease related health risks.

Why Is PMS Worse During Perimenopause?

The cycle changes that happen during perimenopause may be the root cause of your worst PMS symptoms—and they can be quite surprising. As they age, many women expect their periods to grow less frequent until they stop altogether. But that’s not always the case. You could experience shorter total cycles, which means your period might come more frequently and you experience more frequent PMS symptoms. You could skip a period altogether and then have an exceptionally heavy cycle. You could miss periods for three months straight and then have your cycle run like clockwork once again. All of these experiences could make PMS seem significantly worse than normal.

You may also experience new or aggravated menstruation-related symptoms due to heavier bleeding. Women experience heavier flow during perimenopause primarily due to changes in the reproductive organs: the ovaries produce fewer ovulations, but the uterus continues to produce the same amount of lining. If you are menstruating less frequently, your body will have built up a thicker lining by the time your period finally arrives, resulting in heavier flow. In fact, some women bleed so much that they become anemic. If you’re concerned about heavy bleeding in addition to your severe PMS symptoms, consult a doctor immediately.

Significantly, it is also possible that PMS worsens during perimenopause because of your body’s enhanced sensitivity to hormone fluctuation. That’s why symptoms naturally arise during the perimenopausal period and cease after menopause. Many women find relief for this hormone transition through hormone replacement therapy—an effective way to address the symptoms of PMS and menopause at the same time.

Bioidentical Hormone Replacement Therapy Can Help

If you’re struggling with PMS, you may be looking forward to finding natural relief for your symptoms as your body get closer to menopause. You may choose to address the physical symptoms of PMS through strategies like pain killers and heat relaxation and use exercise, meditation, or SSRIs for mood-related symptoms. Or you could consider consulting an expert in hormone health to discuss more advanced treatment options, such as bioidentical hormone replacement therapy (BHRT). BHRT uses bioidentical hormones, some derived from plant sources to compensate for your body’s diminishing hormone levels. In doing so, hormone- related symptoms may be alleviated as your body is returned to a more comfortable hormonal state.

PMS is not simply a fact of life—there is help available. By reaching out to a practitioner who specializes in hormonal health and developing a treatment plan based on your needs and preferences, you can find meaningful relief and feel like yourself again.

Are you ready to address your PMS symptoms? The BodyLogicMD network is comprised of top medical professionals specializing in hormonal health and integrative medicine. BodyLogicMD-affiliated practitioners are passionate about helping women overcome the painful symptoms of severe PMS—including perimenopause-related PMS—through custom treatment plans that produce real results. Contact a local practitioner to learn more about BHRT, or take the BodyLogicMD Hormone Balance Quiz today. 

Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended diagnose, treat, cure or prevent diseases.


  • Charlotte

    Charlotte is a patient care coordinator specializing in bioidentical hormone replacement therapy. She is committed to helping patients who struggle with the symptoms of hormonal change and imbalance explore their treatment options and develop effective strategies to optimize wellness.