22 Aug 2013

How to Tell the Difference Between PMS and Perimenopause

Most women know that menopause is defined by the end of the menstrual cycle and typically occurs between the ages of 45-55. But many women don’t know about perimenopause. Perimenopause is the stage in a woman’s life that prepares her body for menopause during the 5-10 years before menopause actually happens. During this stage, estrogen levels are rising and falling, progesterone is dropping, and testosterone may be increasing (chin hairs anyone?). All of this can add up to a host of unpleasant symptoms!

Symptoms of perimenopause often go undiagnosed because they can look a lot like premenstrual syndrome (PMS).  Anger, anxiety, backache, bloating, mood swings, fuzzy thinking, loss of sexual desire, and irritability are a few overlapping examples.

Women who don’t know they’re going through perimenopause may experience these symptoms for years and years without even considering that dropping hormone levels may be to blame. In the meantime, they may simply feel like there’s “something wrong” with them or that they’re going crazy.

PMS or Perimenopause?

So how can you tell if your bad mood is merely a by-product of a bad day or if it’s actually one of the symptoms of perimenopause? Track the frequency of your mood swings, food cravings and other related symptoms. If they happen in the 2 weeks before your period and then go away, it’s probably PMS. But if you’re experiencing the symptoms all the time and can’t figure out what they’re related to, it’s likely that you’ve entered perimenopause.

What’s a Girl to do?

Despite the fact that an estimated 35 million women are going through perimenopause, the medical community often fails to recognize what’s going. Walk into to your doctor’s office with complaints of anxiety and mood swings and you’re likely to walk out with a prescription for an antidepressant. Got hot flashes? You may get a prescription for estrogen that you don’t need. The first step is awareness. The second step is to get your hormones back in balance.

How do I get my hormone levels back in sync?

Once you’re pretty sure that your symptoms are related to perimenopause and a hormonal imbalance, it’s time to take action. It’s very helpful to know which hormones are out of balance so your action plan can target the specific problem. Testing can be done with saliva, blood or urine. Each method has its plusses and minuses. I use saliva testing because it’s easy, non-invasive and gives a “free” hormone level (that’s the amount of active hormone in your body).

Once you have your results, it’s important to find someone who’s knowledgeable to guide you through creating a plan. Lifestyle changes and supplements are a great place to start and can help about 80% of women find relief, but it’s important to choose products that fit your specific needs and don’t interact with other medications you may be taking. Many physicians are not familiar with the use of BHRT and supplements to manage menopause. Your pharmacist, an herbalist or a naturopath can be an excellent resource for this kind of information.

Your hormone levels may act up as early as 35 or as late as 55, but when they do, remember that perimenopause is an important, healthy and natural stage of your life as a woman. In short, there is nothing wrong with you or your body!

Dr. Anna Garrett


  1. Jan Wlodarski Says: August 22, 2013 at 9:41 am

    This is a great article. Very clear and understandable. Thanks for the info! 🙂

  2. Marta Alcala-Williams Says: August 22, 2013 at 10:10 pm

    Thank you Dr. A!!!

  3. I thought I was going crazy,thanx to you doctor I know now what’s happening to my body.

  4. […] weight gain and just generally feeling like she’s stuck. She’s done a lot of research on perimenopause but has yet to find any real help. We talked through her symptoms, goals and ways I could help […]

  5. I don’t know if you’re still reading comments, but I just found this article. I’m nearing my 31st b-day and I’ve begun having the worst periods ever. Severe pain, constant fatigue, nausea/vomiting, hot flashes and chills. Am I just having really bad periods or should I ask my OBGYN about perimenopause?

  6. Jeeeeez, I just said the most unreasonable stuff to my boyfriend….again. Then, I walk away wondering who in the hell that crazy person was speaking from my body! The reason I started researching this topic is because he mentioned that this happens every month. And he knows it will happen again within another month.

    He didn’t make the connection to this. I did. (Honestly, if he would have, I probably would have ripped off his head and spit down his throat.) That’s how crazy, weepy, NEEDY, and icky I feel. I was walking to my car wondering exactly when I lost my ability to communicate in a healthy manner???? I communicate for a living!!!!

    Thank you for the article. It helped a lot!

  7. I had a hysterectomy at age 27 with my ovaries left intact. I’m now 41 and experiencing symptoms similar to PMS. Since I don’t have a cycle to track, I’m not sure how I can tell if it is perimenopause or not.

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