Are Perimenopause Symptoms Worse During Your Period?
Are you someone who has always struggled with PMS (premenstrual syndrome) before your menstrual period? A week to ten days before your period, have you found yourself suffering through irritability and anxiousness, trouble sleeping, sore breasts, headaches, an insatiable appetite or bloating and cramping? What are your perimenopause symptoms like during your period?
Were you hoping that as you approached 50 and starting to put this stage behind you that things might start to get better? Well unfortunately, I am here to tell you that things might actually get worse before they get better. But don’t worry, you’re definitely not alone and there are things you can do to help relieve symptoms. Let’s take a minute to break this down.
What is Perimenopause?
Perimenopause is the transition period leading up to menopause. It can start as early as your 30s, but for most women, perimenopause usually begins in their 40s and lasts for around 4-10 years. During perimenopause, hormone levels begin to fluctuate, leading to a variety of physical and emotional symptoms such as hot flashes, night sweats, irregular periods, vaginal dryness, mood swings, and difficulty sleeping.
As perimenopause progresses, changes in hormone levels (declining estrogen levels and reduced progesterone) can lead to changes in your menstrual cycle. You may find your menstrual cycles may become lighter or heavier than usual; the length of your cycle may shorten or lengthen; you may skip periods entirely and you might experience more menstrual cramps than usual.
In some cases perimenopause can also cause reproductive health issues such as fibroids and endometriosis. As perimenopause progresses it can worsen existing reproductive health conditions or cause new ones to develop. It’s really important to keep track of any changes in your cycles using an every day calendar or one of the many period trackers in your app store.
Note: The North American Menopause Society (NAMS) warns it is important that women seek treatment if:
Your periods are extremely heavy
Your periods last for more than 7 days (or 2 days longer than usual)
There are less than 21 days from the start of one period to the start of the next
You have spotting in between periods
You have vaginal bleeding after sex
The Stages of Your Menstrual Cycle
Before we start exploring why symptoms might be worse during perimenopause, it’s a good idea to have a quick refresher on what is actually happening to our bodies during our menstrual cycle.
According to the Cleveland Clinic, “A menstrual cycle begins when you get your period or menstruate. This is when you shed the lining of your uterus. This cycle is part of your reproductive system and prepares your body for a possible pregnancy. A typical cycle lasts between 24 and 38 days.”+ The four phases to our menstrual cycle include:
The Menses Phase
Starts on the first day of your bleed and usually lasts 4 to 6 days. This is when we shed the lining of our uterus if a pregnancy has not occurred. +
The Follicular Phase
This phase typically takes place from days six to 14. During this time, the level of the hormone estrogen rises, which causes the lining of your uterus (the endometrium) to grow and thicken. In addition, another hormone — follicle-stimulating hormone (FSH) — causes follicles in your ovaries to grow. During days 10 to 14, one of the developing follicles will form a fully mature egg (ovum). +
This phase occurs roughly at about day 14 in a 28-day menstrual cycle. A sudden increase in another hormone — luteinizing hormone (LH) — causes your ovary to release its egg. This event is ovulation. +
The Luteal Phase
This phase lasts from about day 15 to day 28. Your egg leaves your ovary and begins to travel through your fallopian tubes to your uterus. The level of the hormone progesterone rises to help prepare your uterine lining for pregnancy. If the egg becomes fertilized by sperm and attaches itself to your uterine wall (implantation), you become pregnant. If pregnancy doesn’t occur, estrogen and progesterone levels drop and the thick lining of your uterus sheds during your period. +
As you can see, women undergo a lot of hormonal changes every month. It’s no wonder we experience so many changes in our moods and bodies as we ride this wild roller coaster of hormones. As we age and begin the menopause transition, many women experience irregular menstrual periods and may start finding that these changes are even more dramatic than before.
Perimenopause symptoms during your period?
These dips and peaks of estrogen and progesterone throughout our cycles particularly in the luteal phase are believed to be the cause of many of our PMS symptoms. We now know that progesterone, also known as the calming or feel good hormone, drops during the luteal phase and it’s no longer able to balance out the higher levels of estrogen that occur in mid-luteal phase. This hormonal imbalance can account for our anxiety, irritability, low moods, headaches / migraines, breast heaviness / tenderness and bloating we feel leading up to our period.
Are these different than menopause symptoms?
When women start into the menopausal transition in our 40s, our estrogen and progesterone fluctuations become more erratic and as our bodies struggle to adjust to these changes in the result is often excessive or prolonged periods with increased PMS. As perimenopause occurs many women start experiencing a whole new host of symptoms like hot flashes and night sweats, sleep problems, weight gain, vaginal dryness, abnormal bleeding, irregular menstrual cycles and even a thinning of our vaginal tissues which can cause a lot of discomfort and pain. Additionally, perimenopause can cause other hormonal imbalances including increased levels of cortisol, a stress hormone which is implicated in anxiety and mood swings.
How do hormones affect our sleep?
The fluctuating hormones associated with perimenopause can also affect your body’s ability to regulate temperature. This may lead to hot flashes and night sweats which can be more severe during the luteal phase than other times of the month. To add insult to injury, many perimenopausal women will experience a new PMS symptom, insomnia, making it difficult to fall asleep or stay asleep through the night.
How does perimenopause affect the libido
Finally, perimenopausal women often experience decreased libido due to lower estrogen levels that can reduce our desire for sex and also cause vaginal dryness that can lead to painful sex when we do finally get the urge.
It’s no wonder women are confused, uncomfortable, miserable in ways they never imagined.
What is PMDD
Thankfully most women won’t experience Premenstrual dysphoric disorder (PMDD) as it only affects about 3-8% of all women. The Mayo Clinic explains that PMDD is a severe, sometimes disabling extension of premenstrual syndrome (PMS). Although PMS and PMDD both have physical and emotional symptoms, PMDD causes extreme mood shifts that can disrupt daily life and damage relationships.*
It starts in the luteal phase and can last a couple days into your bleed (so like a really long time) with symptoms so severe that women miss work and have trouble managing their relationships. Sadly, PMDD often gets worse during perimenopause due to unpredictable cycles and hormone fluctuations. If you think you might be suffering from PMDD, it’s really important that you speak to your doctor.
How to deal with all these symptoms?
As uncomfortable and even debilitating as PMS and perimenopausal symptoms are, there are many things you can do to manage them and relieve them:
An easy one to start with is maintaining a healthy diet to make sure you’re getting the proper nutrition your body needs. The
North American Menopause Society recently reported “That diet is one of the many contributors to health outcomes that is often overlooked. Learning about different foods that increase and decrease inflammation, and subsequently increase or reduce menstrual pain.”~
Eating foods high in antioxidants like fruits and vegetables may help reduce inflammation in the body which can decrease perimenopause symptoms like fatigue or joint pain. Additionally, limiting processed foods and refined sugars can help stabilize blood sugar levels which may ease perimenopause symptoms like irritability or mood swings.
Adding more fibre to your diet like fruits, veggies, whole grains and seeds not only helps to maintain stable blood sugar, they also help estrogen levels drop by reducing constipation and supporting the elimination of excess estrogen.
It is also important to maintain an active lifestyle throughout perimenopause. Exercise helps reduce stress hormones (cortisol) while simultaneously boosting endorphins which can help improve energy levels and mental clarity. Regularly participating in physical activity such as low-impact aerobics or yoga can also help relieve some of the physical discomfort associated with symptoms of perimenopause such as cramps or joint pain.
Strength training is really important for women with perimenopausal symptoms, like gaining weight, for so many reasons:
- Muscle burns more calories than fat so it revs up our metabolism (which cruelly declines as we age)
- Increase muscle mass and bone density can help reduce bone loss and the threat of osteoporosis (which is common as women reach menopause and our estrogen production is reduced).
- Reducing cortisol levels and increasing serotonin and dopamine can help our moods and make it easier to deal with all our stuff.
Enjoying a healthy lifestyle is as easy as prioritizing sleep, drinking lots of water, reducing sitting and screen time, and eliminating cigarettes and going easy on alcohol and it can make a world of difference during the menopausal transition.
Menopause Hormone Therapy (MHT)
- Also known as Hormone Replacement Therapy (HRT) supplements declining levels of estrogen and progesterone in the body. Some women need estrogen therapy, while others take progesterone to help to reduce the uncomfortable physical symptoms associated with perimenopause. It is, however, not without risks, including an increased risk of breast cancer, endometrial cancer, blood clots and stroke. It’s important to weigh the potential benefits and risks before starting any hormone therapy. Talk to your doctor about what options might work best for you based on your age, medical history, and personal preferences.
Selective Serotonin Reuptake Inhibitors – SSRIs
- Your doctor might also recommend that you consider antidepressants which can help with the anxiety and depression that can be common with PMS and symptoms of perimenopause.
- Other treatments your doctor might recommend are birth control including IUDs or birth control pills. These treatments help to regulate hormones and reduce the fluctuations which might mean fewer or less severe hot flashes and night sweats, more predictable menstrual bleeding and reduced mood swings.
NOTE: These treatments are not without risks. For instance MHT is not recommended for women with hormone related cancers, like breast cancer, or women have undergone cancer treatment.
Some women prefer to start their journey with supplements and herbal remedies to help ease PMS and menopausal symptoms. A few common examples include:
- Black cohosh have been used for centuries for managing hot flashes and night sweats.
- Chasteberry may be helpful with irregular periods caused by perimenopause.
- Melatonin is a go to for many women with sleep problems.
- Magnesium can help with sleeping difficulties, depression, anxiety, and heart disease risk.
And the list goes on and on. It’s important to note that you should always consult with a Naturopathic Doctor (ND) before taking supplements because they can have potential adverse reactions or side effects, such as headaches, nausea, dizziness, and more. In some cases, there may be an increased risk of bleeding or clotting in women taking blood thinners. You should also ask your ND to recommend a reputable brand, because not all supplements are created equal. (Link to blog about Supplements)
Finally, seeking emotional support during this time can be critical to helping you cope with PMS, PMDD and other menopausal symptoms. Talking about your symptoms with friends or family members who have experienced similar issues can provide invaluable insights into what to expect and how to deal with the transition. You might even consider finding professional support from a licensed therapist to help with any emotional challenges. Talking to your family doctor is also important as they can help diagnose any underlying health conditions, and suggest treatments such as hormone replacement therapy (HRT) that may help reduce symptoms. Always track your cycle and report changes and abnormalities to your practitioner right away.
What we really need is a support group that connects women together because we’re all dealing with similar experiences. We need to start talking and to know we are not alone and that we don’t have to suffer in silence.
It’s time to get curious
It’s important to remember that perimenopause is a natural part of aging and just like puberty, fertility and pregnancy and PMS, everyone experiences it differently. It’s complicated, overwhelming, frustrating, confusing and sometimes even debilitating. The good news is that you’re already taking one of the most important steps – educating yourself about perimenopause and the symptoms so you know what to expect and how best to manage it.
Now more than ever it’s important for women to get curious, ask questions (lots of questions), do our research and talk to our friends, mothers, sisters, and partners, ask for help, prioritize yourself and your health, trust your intuition, be bold, learn to advocate for yourself, and become the hero of your own health journey.
Oh and my last piece of advice: Always have some vaginal lubricants handy. With all these fluctuating hormones, you just never know when your libido might come alive.
+ Cleveland Clinic – https://my.clevelandclinic.org/health/articles/10132-menstrual-cycle
*Mayo Clinic – https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/expert-answers/pmdd/faq-20058315
~NAMS – https://www.menopause.org/docs/default-source/press-release/diet-and-menstrual-pain-release.pdf