How to tell the difference between PMS and the perimenopause

Being a woman is a laugh, hey? Not only are our symptoms routinely explained away or misdiagnosed by medical professionals, but we’re frequently left worrying over huge questions about our reproductive systems. Have I got any eggs left? Why are my periods so painful? And, if you’re in your mid-thirties and beyond, that old classic: am I feeling these symptoms due to pregnancy, PMS or the menopause?

PMS – short for premenstrual syndrome – is the name for symptoms women can experience in the weeks before their period. Perimenopause occurs in the months or years before the menopause, which is when menstruation actually stops. The tricky thing is, there are plenty of symptoms that cross over between the two, including mood swings, difficulty sleeping, headaches and changes to your libido.

pms or menopause

That’s why we spoke to Claudia Pastides, a Medical Advisor at Flo Health, to get more insight into how to tell the difference between PMS and the menopause.

Q&A: PMS or the menopause?

What are the main symptoms of PMS?

  • Mood changes (such as mood swings, feeling more irritable or anxious than usual, or upset)
  • Feeling more tired or finding it difficult to sleep
  • Tummy pains or feeling bloated
  • Sore tender breasts
  • Headaches
  • Greasier hair than usual or spotty skin
  • Changes to your appetite or libido.

What are the main symptoms of perimenopause?

Other than a change to the pattern of your periods, main symptoms include:

  • Hot flushes
  • Difficulty sleeping and night sweats
  • Reduced libido
  • Vaginal dryness
  • Headaches
  • Mood changes and problems with memory and concentration (sometimes referred to as a feeling of  ‘brain fog’.)
pms or menopause

Given the overlap between some PMS and perimenopausal symptoms, how can you tell the difference, particularly in your 30s and 40s?

PMS typically happens in the week (or two weeks for some) before your period. Symptoms improve around the time your period starts and are often gone by the time your period has ended.

The age at which perimenopause starts varies between women. The average age of menopause in the UK is 51 and perimenopause (the time leading up to the menopause) can last from a few months to a few years. It isn’t common to experience perimenopausal symptoms in your 30s, although for 1% of women menopause can happen before the age of 40, when it is referred to as premature menopause.


Perimenopausal symptoms happen because your oestrogen levels are fluctuating unevenly in the run up to your periods eventually stopping completely. The symptoms could be present throughout your cycle (which is likely to also be becoming less regular or different from before) and the symptoms aren’t entirely focussed in the week before your period in the way they are with PMS.

Tracking your period and symptoms is a good idea if you’re unsure if it is PMS or perimenopause. Tracking can help you to see if there is a clear pattern and document what’s changing.

If you are hoping to conceive and experiencing symptoms such as hot flushes, should you be concerned?

If you’re having hot flushes and trying to conceive – it is a good idea to speak to your GP about it. Although hot flushes are commonly linked to perimenopause – you can also have hot flushes for other reasons, such as thyroid problems or as a side effect of taking certain medication – so it is best to go get it checked out to find out why it is happening.

pms or menopause

Is there anything you can do to ease symptoms of PMS?

Yes, there are lots of evidence-based things that can help. And like most things in healthcare, it can take a bit of trial and error to discover what works best for you. Also what might have worked before may not work any more and it is time to try something new.

Options include lifestyle changes (regular exercise, a healthy balanced diet, plenty of sleep and keeping stress levels down through yoga or meditation), plus medication (painkillers for pain, hormonal medicines) and cognitive behavioural therapy too.

Some find that complementary therapy and dietary supplements help – the evidence isn’t as strong but it is worth discussing your options with a healthcare professional to find what’s best for you.

pms or menopause

Is there anything you can do to ease symptoms of the perimenopause?

As with PMS, the options are varied and there’s no ‘one size fits all’, but more a case of trying out what you think might suit you and if it doesn’t – trying something else. The trial and error can feel frustrating, but it does sometimes take time to find what suits you and works.

There are lifestyle changes which help, and medication too. Options depend on which symptoms you have, for example there are a variety of things you can do to help ease hot flushes (wearing light clothing, avoiding potential triggers such as alcohol or spicy foods are just a few examples) or manage vaginal dryness (oestrogen pessaries, creams or vaginal rings, and lubricants you can buy over the counter). The list really does go on here, so whatever your troublesome symptom may be, there are likely to be a few options out there to help. A great resource when it comes to exploring what options are available depending on your symptoms is the NHS’s Menopause information webpage.

And of course there is hormonal replacement therapy (HRT) which is extremely good at relieving menopausal symptoms. HRT comes in a variety of forms (from pills, to gels and patches). Many think HRT can only be used after you’ve been through the menopause, but this isn’t true. You can usually start taking HRT from when you start having symptoms, so have a chat with your GP or whoever in your practice manages menopause (sometimes it might be your practice nurse for example).

Another common misconception is that HRT is very dangerous, but we know from research that for many women the benefits of HRT often outweigh the risks. Of course this depends on each individual and any other health conditions or contraindications – but if you’ve got bothersome menopausal symptoms – don’t hesitate to chat to your GP about it and get help so you feel better.