Understanding Female Hormones of the Menstrual Cycle: PMS, PMDD, or Perimenopause?

Jul 25

4 min read

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What is the Menstrual Cycle?

I’m often asked by women if I think they have ‘normal’ Premenstrual Syndrome (PMS) symptoms or if they are in perimenopause. Female hormones of the menstrual cycle naturally rise and fall throughout each month. PMS, PMDD (premenstrual dysphoric disorder), and perimenopause are quite different. PMS occurs for many women from a young age, while perimenopause is entered before menopause. PMDD is a serious but rare condition experienced by some.

One of the characteristics of perimenopause is heightened or magnified PMS in the run-up to menstruation or just after ovulation for up to two weeks. However, PMS can present as soon as a female starts menstruating. It usually lasts a few days with mild to moderate symptoms that disappear when their period starts. Perimenopause typically begins in your early forties but could start as early as your mid-thirties for some.

What is PMS?

PMS, or premenstrual syndrome, describes a variety of symptoms grouped into physical, physiological, and emotional categories. The severity of PMS varies among women. Some find gut health changes to be the main challenge. They may experience constipation leading up to their period, followed by diarrhoea or loose stools once their period starts, along with bloating throughout.

Food cravings, particularly for sugary or comfort foods, are also common. Others may experience heightened emotions, crying easily, feeling a little down or depressed, and experiencing fatigue. Libido can often peak around ovulation, with desire dipping around period days. Mood changes and irritability are also common in the lead-up to menstruation.

Abdominal cramps, backache, and heavy legs are often part of the experience, but these symptoms are usually short-lived. Relief is often found in the first few days of menstruation. PMS can affect women of any age up to menopause and doesn’t usually impact quality of life, work, or relationships significantly. We learn to accept and deal with this monthly inconvenience. However, when PMS is more pronounced, an underlying hormonal imbalance is often found. If you are younger than your mid-thirties and suspect what you experience isn’t ‘normal,’ seek specialist GP advice.

Common Symptoms of PMS

Physical Symptoms: Bloating, cramps, backache, and fatigue.
Emotional Symptoms: Mood swings, irritability, and heightened emotions.
Behavioural Symptoms: Food cravings and changes in libido.

What is PMDD?

PMDD, or premenstrual dysphoric disorder, is classified as a mental health condition. When PMS is severe for two weeks from ovulation, changes in sex hormones, cortisol, and serotonin can cause psychiatric symptoms. These may include paranoia, anxiety, and depression. The key thing to note is that PMDD is not simply a hormonal imbalance. It significantly impacts quality of life, leaving women unable to function for part of the month. In severe cases, self-harm and suicidal ideation can occur.

In these instances, the brain reacts abnormally to normal hormonal changes in the menstrual cycle. If you think you may have PMDD, speaking with your GP is essential. Treatments vary and can include prescription medicines, lifestyle and dietary changes, as well as supplement support.

Recognising PMDD Symptoms

Severe Mood Changes: Intense anxiety, depression, and irritability.
Physical Symptoms: Severe cramps and fatigue.
Functional Impairment: Difficulty in daily activities and relationships.

What is Perimenopause?

Perimenopause is the transition into menopause. This phase can last for months or even years, up to ten in some cases. There are around 50 recognised symptoms associated with perimenopause (see my perimenopause symptom checklist for more details). Most women do not experience all 50 symptoms at once, but many suffer from a variety that undeniably impacts their quality of life.

Research is uncovering the metabolic transition that women experience during this normal life phase, as well as neurological changes. This means the way we think, feel, eat, metabolise nutrients, repair tissue, store fat, sleep, and move can change drastically. The potential for a change in overall health status is far too common as a result.

Symptoms of Perimenopause

Physical Changes: Hot flashes, night sweats, and changes in menstrual patterns.
Emotional Changes: Mood swings, anxiety, and depression.
Cognitive Changes: Memory lapses and difficulty concentrating.

Track & Monitor Symptom Changes

One of the key aspects of awareness can be found in tracking and monitoring symptoms every day throughout the month. If you make this a daily habit, you’ll soon gather enough information to see any patterns or correlations to changes in how you feel. New symptoms or an increase in symptom severity may indicate hormonal shifts of oestrogen and progesterone. It can also highlight other aspects of health and wellbeing.

When you add to this a regular recording of lifestyle habits like exercise, alcohol or caffeine consumption, and your daily diet, the picture becomes more informative. Having a clear picture will help you (or a healthcare professional) develop a plan to tackle symptoms and work towards feeling great again.