PMS, PME, PMDD and Entering Perimenopause

Just as many people learn to recognise patterns of PMS (Premenstrual Syndrome), PME (Premenstrual Exacerbation), or PMDD (Premenstrual Dysphoric Disorder) in their reproductive years, the transition into perimenopause can bring new layers of complexity. For some, symptoms intensify; for others, they shift shape in ways that are confusing or destabilising. Understanding how these conditions interact with perimenopause is key to managing health, relationships, and daily life during this stage.

Read Part 1 here: PMS, PME, and PMDD Explained →

The Shift into Perimenopause:

Perimenopause is the transitional phase leading up to menopause, usually beginning in a woman’s 40s but sometimes starting earlier, even in the 30s. This phase can last anywhere from 4 to 10 years, during which the production of estrogen and progesterone becomes irregular and unpredictable. Unlike the relatively stable hormonal cycles of the reproductive years, perimenopause is characterised by fluctuating levels of follicle-stimulating hormone (FSH), irregular ovulation, and periods of uneven oestrogen dominance. These hormonal ups and downs create an environment where symptoms associated with PMS, PME (premenstrual exacerbation), or PMDD can intensify or present in new ways, making this phase particularly challenging for many women. The unpredictability and variability of hormone levels during perimenopause require a nuanced understanding to support the body and emotional health effectively.

PMS, PME, and PMDD in Perimenopause

• PMS may shift from being a handful of physical symptoms (bloating, cramps, fatigue) to being heavily mood-driven due to changing estrogen/progesterone ratios.

• PME (exacerbation of an underlying disorder such as depression, anxiety, ADHD, or migraines) can worsen because perimenopausal hormone swings destabilise already sensitive brain pathways.

• PMDD, which is already tied to a heightened sensitivity to normal hormonal fluctuations, may become less predictable. Some report that PMDD episodes worsen in severity, while others notice their luteal phase symptoms begin to blur into the follicular phase, leaving fewer “symptom-free” days.

Perimenopause doesn’t erase PMS, PME, or PMDD, it changes the playing field. The hormonal baseline is shifting, which means triggers and coping strategies need to adapt as well.

The Role of Neurotransmitters

Research shows that estrogen and progesterone fluctuations in perimenopause significantly influence serotonin, dopamine, and GABA pathways. This overlap explains why some people feel “like a different person” during this time. If PMDD is rooted in heightened sensitivity to these changes, then the unstable hormonal signals of perimenopause can amplify its impact.

For example:

• Lower progesterone = less GABA calming effect → more anxiety, irritability, and insomnia.

• Erratic estrogen = unstable serotonin levels → mood crashes, depressive episodes, and brain fog.

• Dopamine dysregulation = reduced motivation, focus issues, or intensification of ADHD symptoms.

This neurochemical lens helps validate why perimenopause can feel overwhelming even for those who managed symptoms well before.

Tracking and Diagnosis Challenges

One difficulty during perimenopause is that cycle tracking becomes harder. Irregular or skipped periods mean it’s trickier to pinpoint whether symptoms are tied to the luteal phase, follicular phase, or random hormonal fluctuations. This makes the distinction between PMS, PME, and PMDD blurrier.

Healthcare providers sometimes misattribute these changes to “just perimenopause,” which can delay diagnosis and treatment. Clear symptom tracking, ideally alongside a healthcare professional, can help distinguish whether symptoms are cyclical or constant, and what interventions might help.

Support Strategies in Perimenopause

Managing PMS, PME, and PMDD during perimenopause often requires a multi-layered approach. Because hormones are less predictable, strategies need to be flexible, combining medical, lifestyle, and peer-based supports.

• Peer connections: Support Group (peer support for PMDD, PMS +PME) — sharing experiences with others facing both PMDD and perimenopause can reduce isolation and offer practical coping tips.

• Body-based resilience: Somatic Course (healing through body practices → PMDD support) — nervous system regulation tools like grounding exercises, breathwork, and gentle movement can help stabilize mood swings when hormones feel erratic.

  
  

  Medical and therapeutic options:

  • Cognitive Behavioural Therapy (CBT): Can improve emotional regulation and resilience against mood swings.

  • Medication: SSRIs and SNRIs remain evidence-based options for PMDD and PME, even during perimenopause. Some may also benefit from intermittent dosing (only during the luteal phase) if cycles are still somewhat regular.

    
    

• Lifestyle and self-care interventions:

  • Sleep hygiene: Prioritize consistent bedtime routines and consider magnesium or melatonin (with medical approval) to offset insomnia.

  • Nutrition: Stabilise blood sugar is really important to stop binge eating. Eating protein-rich meals, reduce alcohol and caffeine, which can worsen anxiety and sleep disruption.

  • Exercise: Gentle but regular activity (walking, yoga, strength training) helps regulate mood and bone health.

  • Stress reduction: Mindfulness, journaling, or time in nature can help support the nervous system during hormonal turbulence.

    
    

Because each person’s response to perimenopause is unique, it often takes experimentation to find the right blend of supports. What worked in your 30s may not be enough in your 40s, and that’s not failure, it’s a natural shift in how your body relates to hormones.

Reframing This Transition

It’s easy to view perimenopause as an intensification of struggle, and for many, it is. But it can also be reframed as a time of recalibration. If PMS, PME, or PMDD symptoms are surfacing more strongly, it’s not a sign of weakness but a call for deeper support, new strategies, and medical validation.

Awareness of these overlapping conditions empowers you to advocate for care, prepare for hormonal unpredictability, and protect your mental health. In many cases, addressing PMDD or PME in perimenopause leads to insights that improve overall wellbeing long after menopause is reached.

References

• Hantsoo, L., & Epperson, C. N. (2015). Premenstrual Dysphoric Disorder: Epidemiology and Treatment. Current Psychiatry Reports, 17(11).

• Schmidt, P. J., & Rubinow, D. R. (2016). Sex hormones and mood in the perimenopause. Annals of the New York Academy of Sciences, 1389(1).

• Gordon, J. L., et al. (2019). Symptom trajectories in perimenopause: depression, anxiety, and mood lability. Psychological Medicine, 49(11).

• Yonkers, K. A., et al. (2008). Premenstrual Syndrome. The Lancet, 371(9619).