Symptoms of premenstrual syndrome (PMS) can be frustrating for women in their reproductive years. Some may even notice symptoms intensify as they age. This is not uncommon and may be related to hormonal changes during the menopause transition.(1)
Between 80% and 90% of women experience one or more symptoms of PMS.(2) This may include abdominal discomfort, lower back pain, breast tenderness, headaches, or increased anxiety.
This article will explore the connection between perimenopause and PMS symptoms that may worsen as women enter their late 30s and 40s, and will offer solutions for finding relief.
What is PMS?
PMS refers to a collection of physical and mental symptoms that develop approximately one to two weeks before a woman gets her period. Symptoms resolve within a few days following the start of menstruation. Women may first experience PMS during adolescence upon getting their first period. However, symptoms commonly emerge in their 20s. While some women may experience milder symptoms, others may find that PMS impacts their ability to function.(1)(2)(3)
Symptoms of PMS
Common physical symptoms of PMS include the following:(1)(2)
Bloating
Constipation
Diarrhea
Cramps
Weight gain
Abdominal pain
Back pain
Headaches
Nausea
Breast tenderness
Clumsiness
Women may also experience the following psychological symptoms of PMS:(1)(2)
Anxiety
Depression
Increased crying
Mood swings
Irritability
Sleep issues
Tiredness
Forgetfulness
Low libido
What is the cause of PMS?
The exact cause of PMS is unknown. However, it’s believed to be associated with changing hormone levels during different phases of the menstrual cycle. Hormonal imbalances between levels of estrogen and progesterone, changes in neurotransmitter activity, and certain lifestyle factors may all contribute to PMS.(2)
The Perimenopause Connection: Why PMS Can Intensify with Age
Perimenopause refers to the years before a woman’s final period. Most women enter this menopausal stage between the ages of 45 and 55.(4) Like the menstrual cycle, these years are marked by significant fluctuations in hormone levels. It’s around this time that women may notice an increase in the severity of PMS symptoms. For women who experience psychological symptoms, perimenopause may also exacerbate mood changes.(1)
How Hormonal Imbalances May Trigger More Severe PMS
The duration of the menstrual cycle is between 28 and 34 days. During a woman’s younger reproductive years, hormonal fluctuations follow a more consistent rhythm.
The following are the different phases of the menstrual cycle:(5)(6)
Follicular Phase: This phase is characterized by high estrogen and low progesterone levels.
Ovulation: There’s an increase in luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels during this phase.
Luteal Phase: This phase is defined by low estrogen levels and high progesterone levels that drop off at the end of the luteal phase.
Hormonal fluctuations during perimenopause aren’t rhythmic like those during the menstrual cycle.(1) As ovarian hormone production declines during this phase of life, the body’s balance of estrogen and progesterone is disrupted. Irregular hormonal fluctuations during perimenopause may cause PMS symptoms to worsen.
Increased Sensitivity to Hormonal Shifts
Some women may be more sensitive to hormonal shifts that occur during the following reproductive life events:(7)
First period
Premenstrual phase
Pregnancy
Postpartum
Menopause
However, why some women are affected by changes in hormone levels more so than others isn’t well understood.
Changes in Neurotransmitter Activity
Changes in levels of reproductive hormones may influence the activity of certain mood-regulating hormones. When estrogen levels drop, the body releases a neurotransmitter called norepinephrine. This reaction causes a decrease in levels of “feel good” hormones, such as serotonin and dopamine.(2)
Progesterone is also believed to have an effect on the neurotransmitter gamma-aminobutyric acid (GABA). Research indicates that low GABA levels may contribute to depression and anxiety. These shifts in neurotransmitter activity may play a role in PMS.(2)(8)
Shifting Menstrual Cycles During Perimenopause
One of the first signs of perimenopause is irregular periods. Bleeding may be lighter or heavier, or menstrual cycles may occur further apart or closer together. Women may also experience spotting between cycles.(4) Without consistent periods, PMS may feel more distressing due to its unpredictability.
Common PMS Symptoms That May Worsen or Change During Perimenopause
Some studies suggest that certain PMS symptoms may improve with age. However, other studies have shown that some symptoms may become heightened during the menopause transition.(3)
Intensified Mood Swings
PMS-related mood swings may persist or worsen during perimenopause, particularly among women with increased sensitivity to hormonal shifts.(1) Many women struggle with changes in mood during this phase of life. They may feel anxious, depressed, or irritable. In an international study of over 200,000 women between the ages of 18 and 55, rates of premenstrual mood swings remained high across all age groups, indicating that psychological symptoms of PMS may continue to affect women as they age.(3)
Physical Discomfort Amplified
Physical symptoms of PMS may become more severe during the menopause transition. The same international study showed that women experienced premenstrual headaches, weight gain, fatigue, swelling, and digestive symptoms more frequently as they aged.(3)
Changes in Sleep Patterns
Some women may find themselves sleeping more or less than usual when experiencing PMS symptoms.(1) The connection between sleep and PMS isn’t entirely clear. While sleep disorders can increase the risk of PMS, some studies indicate that PMS may also impact the quality of sleep.(9) Sleep problems may worsen during perimenopause, a time when hot flashes and night sweats can make falling and staying asleep more difficult.
Is it PMS, perimenopause, or something else?
Distinguishing between PMS, perimenopause, or an alternate health condition can be challenging. The following are ways in which symptoms may present similarly, as well as key differences.
Overlapping Symptoms of PMS and Perimenopause
PMS and perimenopause can share the following symptoms:(1)(10)(11)(12)(13)(14)
Headaches
Sleep issues
Constipation
Diarrhea
Body aches
Breast pain
Decreased sex drive
Clumsiness
Depression
Anxiety
Irritability
Mood swings
Mood symptoms related to PMS or perimenopause may be particularly difficult to differentiate. According to The American College of Obstetricians and Gynecologists (ACOG), approximately four out of every 10 women experience perimenopausal mood changes that resemble those of PMS.(15)
Key Differentiators
Symptom timing and duration may provide some clues as to whether a woman may be experiencing perimenopause or PMS. PMS symptoms develop within the two weeks before menstruation and improve in the days after the period starts.(1) Symptoms related to the menopause transition are less predictable and can persist irregularly for years.(15) The development of new symptoms can be another clue. Hot flashes are a common symptom of perimenopause but are not associated with PMS.
What about PMS symptoms after menopause?
Once a woman reaches menopause, her periods stop altogether, and PMS symptoms come to an end. Because PMS occurs in relation to the menstrual cycle, symptoms that occur after menopause may be related to an alternate health condition, medication use, or side effects of hormone replacement therapy (HRT).(16)
Conditions That Can Mimic or Worsen PMS-Like Symptoms
In some cases, PMS-like symptoms may be related to certain health issues, including the following:(17)
Premenstrual Dysphoric Disorder (PMDD)
PMDD is a condition in which women experience more severe symptoms of PMS. Just like PMS, symptoms develop one to two weeks before a woman gets her period and subside within two or three days after menstruation starts.(18)
Thyroid Disorders
Symptoms of thyroid disorders can look a lot like symptoms of PMS. Hypothyroidism occurs when the body is underproducing thyroid hormones, while hyperthyroidism is characterized by the overproduction of thyroid hormones.(19)Some of the symptoms PMS and hypothyroidism can share include the following:(19)
Constipation
Body aches
Depression
Fatigue
Hyperthyroidism and PMS can present with the following overlapping symptoms:(19)
Diarrhea
Anxiety
Irritability
Sleeping difficulties
Chronic Fatigue Syndrome (CFS)
CFS is a serious health condition causing severe, long-lasting fatigue that impacts a person’s day-to-day functioning. People between the ages of 40 and 60 are most affected. Similar to PMS, a person diagnosed with the condition may also experience headaches, sleep issues, memory problems, gastrointestinal symptoms, or body aches.(20)
Mental Health Disorders
Depressive symptoms or feelings of anxiety can occur in the weeks before a woman gets their period. However, these can also be signs of a mental health condition like major depressive disorder or an anxiety disorder.(17)
Managing Worsening PMS Symptoms
There are different ways in which PMS can be managed as women age. Some methods may be more effective than others depending on the severity of symptoms.
Lifestyle Adjustments
Certain lifestyle changes may be effective in reducing mild to moderate PMS symptoms. Weekly aerobic exercise through brisk walking, swimming, or cycling may help alleviate fatigue and mood symptoms.(1)(17)
Keeping sugar, salt, and fat consumption low as menstruation approaches is recommended. Steering clear of alcohol and caffeine can also help reduce symptoms. Eating food sources of calcium or complex carbohydrates like lentils, beans, and whole wheat bread may help relieve the discomfort of PMS.(1)(17)
Stress management is also important. Journaling, meditation, yoga, massage, and getting plenty of sleep are all practices that may help manage PMS symptoms.(1)(17) Additionally, tracking the severity and duration of symptoms each month can help women identify potential patterns and triggers to avoid.
Over-the-Counter (OTC) Options
Ibuprofen, aspirin, and naproxen are OTC nonsteroidal anti-inflammatory drugs (NSAIDs) that can be used to treat body aches, cramps, and other physical symptoms of PMS.(1)
More research is needed, but certain supplements such as calcium, vitamin E, vitamin B6, omega-3, omega-6, and magnesium have been purported to relieve symptoms of PMS. Some herbal remedies, including black cohosh, chasteberry, and evening primrose oil, have also been linked with improvement in PMS symptoms.(1)(17)
It’s important to consult with a doctor about benefits, risks, and potential drug interactions before taking any OTC medications or supplements.
Medical Interventions
A doctor may prescribe hormonal birth control to treat physical PMS symptoms. However, the treatment may not be effective in reducing psychological symptoms or may exacerbate other symptoms. Diuretics are another treatment option that may specifically be prescribed to reduce PMS-related breast soreness and bloating. Anti-anxiety or antidepressant medications may be recommended for some patients if psychological symptoms do not improve with other treatment approaches.(1)(17)
When to See a Doctor
It’s crucial to see a doctor if PMS symptoms are interfering with daily life, whether it be work, sex life, or overall mental health. It’s also important to reach out to a healthcare provider if new symptoms develop, such as bleeding after menopause. A doctor can rule out any underlying health conditions and discuss personalized treatment options.
Women don’t have to live with the discomfort of PMS.
While symptoms of PMS improve after menopause, they can worsen during the perimenopause stage as hormone levels begin to fluctuate. However, this doesn’t mean women have to muscle through the discomfort of PMS. Understanding the physiological changes the body goes through during the menopause transition is the first step towards finding effective solutions and improving quality of life. With the help of a healthcare provider, PMS symptoms can be effectively managed as women age.
