Why PMS in Perimenopause Feels Worse (And How to Fix It)
If your PMS has gotten significantly worse lately, you're not going crazy. The mood swings, the hot flashes, the weight gain around your midsection… all classic symptoms when you hit perimenopause.
But even though these symptoms are common, I want you to know that PMS in perimenopause doesn't have to be the bane of your existence. I'm going to share some strategies to help you start feeling calm in your body again, more grounded, and really confident with the steps you're taking to reverse these symptoms.
This is a transition phase. I like to call it your "second puberty" or your "no BS phase." And just like puberty, it's not just a couple of weeks. We're talking multiple years here. But it doesn't have to mean suffering for all those years if you learn how to work with your body instead of punishing it.
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Why PMS in Perimenopause Feels So Much Worse
Let me explain what's actually happening in your body right now. As you head into perimenopause, your estrogen starts fluctuating wildly and your progesterone starts dropping. This hormonal shift is why your PMS symptoms feel like they've been turned up to eleven.
But there's more going on than just estrogen and progesterone. Perimenopause is actually known as the time of major metabolic upheaval. Noticing more weight around your waist? That's your fat shifting from what we call subcutaneous fat to visceral fat. Visceral fat can increase by up to 50% during perimenopause.
Perimenopause is also a time of androgen excess. Now, before you panic, this doesn't mean you're producing more androgens. It means your progesterone and estrogen are falling, and those hormones help keep androgens in balance. As estrogen lowers, it may also be lowering your sex hormone binding globulin, which impacts how much free androgens you have circulating.
This hormonal shift also brings along some friends you didn't invite, as your body adapts to lower estrogen:
decreased muscle mass
misaligned circadian rhythm
disturbed sleep
increased cortisol
decreased insulin sensitivity
That's why your PMS in perimenopause can feel so much more intense than it did in your 20s or 30s.
Your Tired Adrenals Aren't Helping Either
If you've spent your entire life going, going, going—busy all the time—and then you head into perimenopause wondering why you're so tired and why your PMS is so much worse, we need to talk about your adrenals.
At some point, your adrenals are going to look at you and basically say, "You've given me the short end of the stick this whole time, and now you want me to show up for you? No thanks."
Pregnenolone is the mother hormone that produces both cortisol and progesterone. If you've constantly been pushing your adrenals, where do you think your progesterone is supposed to come from?
All of these lifestyle habits affect your adrenal function:
not sleeping enough
drinking alcohol
doing tons of HIIT workouts
cutting carbs and calories to try to lose weight
Again, perimenopause is a transition phase. And if you haven't been supporting your body leading up to it, you're hitting this no BS phase where your body is done playing along. So instead of punishing yourself by working out harder and cutting more calories (which might be your first reaction), your body needs nourishment here.
One of my clients came to me in exactly this situation. She was a busy baseball mom, just go, go, go all the time. Her entire identity was wrapped up in being busy and taking care of everyone else.
When we started working together in the Hormone Reset Program®, she was dealing with “cortisol belly” from perimenopause and feeling self-conscious about the extra weight, but more than that, she told me she didn't feel like herself. She had all these mean thoughts about everybody. She was exhausted and didn't like how she was showing up for her family.
Through working with her cortisol levels and stress (AKA supporting those adrenals that had been pushed to their limit!) everything shifted.
She told me, "I feel so much calmer throughout the day. And on top of that, everybody likes me before my period versus me not even liking myself because of how I'm showing up."
That's what happens when you actually support your adrenals instead of continuing to push through. Your mood stabilizes. You feel like yourself again. People want to be around you, and more importantly, you want to be around yourself.
Is It Perimenopause or Something Else?
Before we get into strategies to manage your PMS in perimenopause, let's talk about what you should actually be checking. There are a few labs I recommend running to a) check if your body is truly entering perimenopause or if something else is going on and b) figure out where your body needs support.
Check Your Thyroid First
As you start getting heavier periods and worse PMS, it's worth asking: is it perimenopause or is it a thyroid issue? I always recommend getting a full thyroid panel that includes:
TSH
Free T3
Free T4
Reverse T3
Both antibodies: TPO and TG
You're going to see differences in the antibodies before you see changes in TSH. Remember, TSH isn't even produced by your thyroid. Reverse T3 typically starts to climb before you see issues in other numbers. And free T4 and free T3 give you insight into the active thyroid hormone you have, which tells you about your gut and liver function.
Run a Full Metabolic Panel
I also recommend getting a full metabolic panel to check:
Fasting insulin
Fasting glucose
A1C
These markers are so helpful because perimenopause means major metabolic changes. If we can see what's happening with your insulin sensitivity and blood sugar regulation, we can create a plan that actually works.
How to Feel Better Right Now
Now let's get into what you can actually start doing right now to feel better and ease PMS in perimenopause.
Focus on Blood Sugar Balance
This is number one for a reason. Remember how I mentioned that lowering estrogen and excess androgens lead to impaired insulin sensitivity? The more we can support blood sugar balance, the better off you're going to be.
Here's how to start balancing your blood sugar:
Build your plate with half non-starchy veggies, a quarter protein, and a quarter fat and carbs. Aim for a minimum of 30 grams of protein per meal. Get those non-starchy veggies in to support fiber intake.
Never eat a naked carb. If you need a banana, pair it with a hard-boiled egg or some nuts. This simple step makes a massive difference.
If you're new to blood sugar balance and don't know where to start, that's where I would start. Just focus on pairing your carbs with protein and fat, and building balanced plates.
Supplements That Support Insulin Sensitivity
Myo-inositol (or inositol) is one of my favorites for supporting insulin sensitivity during perimenopause. It's been shown to help with blood sugar regulation without the harsh side effects of medications. Create a free account at Fullscript and find my top recommended supplement brands.
Other supplements to consider:
Berberine
Alpha lipoic acid
Chromium
But remember, supplements work best when you're also addressing the foundational pieces like blood sugar balance through food.
If I had to pick just two supplements to support metabolic health in perimenopause, it would be myo-inositol and a good functional mushroom blend.
Maitake and Cordyceps are two of my favorite mushrooms for support during perimenopause.
Maitake has been shown in research to help lower fasting glucose, making them incredible for blood sugar support during this transition.
Cordyceps helps support your body's ATP (literally your body's battery). It also helps with libido (which tends to tank in perimenopause) and gives you energy without overdoing the caffeine, which would just stress your adrenals even more. Plus, cordyceps supports egg quality, which matters because the more we can support ovulation until you stop ovulating, the better off you're going to be.
Learn more about how functional mushrooms are the perimenopause supplement your doctor never told you about.
When it comes to mushrooms, quality matters. You want fruiting body only extracts at therapeutic dosages. My go-to is Eversio Wellness because they use fruiting body only extracts.
Their Five Mushroom Blend has both maitake and cordyceps so that’s a great option for perimenopause support and you will notice a difference when using them!
Use discount code LEAH for 15% off Eversio Wellness mushrooms!
Bring in Phytoestrogen Foods
As estrogen starts to decline, bringing in phytoestrogen-rich foods can help ease the transition. These aren't going to replace your estrogen, but they can help support hormonal balance during this time.
Phytoestrogen-rich foods include:
Flaxseeds (ground, organic)
Sesame seeds
Soy products (if you tolerate them well)
Legumes
Berries
Support Your Gut Health
When we're dealing with PMS in perimenopause, gut health becomes even more important. If you're not pooping regularly (at least once a day) you're reabsorbing hormones that your body is trying to eliminate.
You need to make sure you're getting enough hydration and fiber. Electrolytes, specifically sodium and potassium, are going to support stomach acid production as well.
You can optimize stomach acid with digestive bitters. Put them on your tongue before meals to stimulate your digestive juices. If needed, bring in a digestive enzyme, but I'd start with bitters first.
Optimize Your Minerals
Minerals are incredible for supporting a smooth perimenopause transition. Boron specifically is known as an anti-aging mineral and can be really helpful during this phase.
I never recommend supplementing with specific minerals unless you're testing.
More is not better. If you don't need it, supplementing with something like boron can throw other minerals out of balance.
This is why I love hair tissue mineral analysis (HTMA). It's one of the go-to tests we use in the Hormone Reset Program® because it gives you insight on what specific minerals you need and how to support your body at a cellular level, especially in perimenopause.
If you want to learn more about how testing can help you figure out exactly what your body needs, you can book a free consultation call.
Change Your Workout Strategy
Weight lifting and building muscle mass is one of the best ways to support anti-aging and overall health during perimenopause. You have to strength train, and you have to lift heavy.
If you're lifting weights and it feels like you could do 12 to 15 reps and keep going, you're not lifting anywhere near heavy enough to build muscle. Having a program to follow or working with a coach can be really useful here to help with form and make sure you're not hurting yourself.
I'm not talking about 45 minutes to an hour of just going hard. I'm talking about three to four days a week of good 35-minute strength training workouts to build muscle. That's all you need.
Then bring in some zone 2 cardio. This can just be walking, you don't have to bike your life away or go on runs. Just get consistent walking. If you want to support both goals, try a weighted vest walk.
You can also kill multiple birds with one stone by walking after your meals. That helps move the glucose you just ate and helps your muscles utilize it, so you're supporting blood sugar balance while getting in your movement!
Increase Your Oxytocin
Here's something you’ve probably never heard before: oxytocin has been shown to improve insulin sensitivity in perimenopause. We call it the love hormone, but it's also the joy hormone. And it's a powerful metabolic and hormone balancer.
Here are a few ways to bring in more oxytocin naturally:
Yoga
Meditation
Getting outside
Listening to music
Playing music
Playing with your kids or pets
Getting or giving a massage
Having a supportive community
Finding joy
I recommend writing your joy list right now. Write down 10 to 15 things that bring you joy, things that make you laugh or feel calm and happy. Pick one every single day. You have to do at least one.
If you say you're too busy, then don't complain about the hot flashes and mood swings. You can do this. Stop putting yourself on the back burner and then being upset with all these symptoms!
When you put your health first, everything else falls into place because you have the energy to help those around you. You have more love to give because you feel better, you're more energetic, you're calmer, you're more at peace.
Help Your Body Thrive in Perimenopause
Perimenopause is a transition. It's your body's second puberty. And just like you wouldn't tell a teenager going through puberty to just work harder and buckle down, you shouldn't do that to yourself either!
You need to support your body. Show it some love. Help it through this transition.
You will notice a massive difference in how you're feeling if you start implementing these strategies:
running your thyroid labs
getting your metabolic panel done
focusing on blood sugar balance
supporting your gut
optimizing minerals
changing your workout strategy
finding daily joy
Knowing is not the same as doing.
You can't just read this and think "that makes sense" and then do nothing. You have to actually implement these things. Pick one thing to start with. Make it a habit. Then add the next one.
And if you want to do a full hormone reset with guidance, labs, accountability, and support—someone to walk you through this entire process so you can actually thrive in perimenopause instead of just surviving it—that's what the Hormone Reset Program® is for.
You don’t have to suffer through PMS in perimenopause. You deserve to feel good. You deserve to have energy. You deserve to feel like yourself again!
Let’s Get Rid of Your PMS in Perimenopause!
Book your free call with my team for an inside look at the Hormone Reset Program®. She'll walk you through what it's really like to get support, answer your questions honestly, and help you see whether this is the right step for your perimenopause journey.
