When it comes to your monthly cycle, estrogen and progesterone aren’t the only ones to blame for wreaking havoc. Neurotransmitters like serotonin can cause emotional changes, such as mood swings, irritability, feelings of sadness, and difficulty with rejection that are just as prevalent as premenstrual syndrome’s physical symptoms: breast tenderness, bloating, breakouts, headaches, and fatigue. But it’s hard to explain exactly how hormones affect emotions, according to Brittney Johnson, MD, an OB-GYN at USC Verdugo Hills Hospital. “PMS can occur at any point in a premenstrual person’s lifetime and it may get worse with time because hormone production decreases as you get older and sensors in the brain may detect decreased hormone levels, which will cause the mood changes,” she says. Symptoms typically subside once period flow starts, but if they don’t, or if they are getting worse, perimenopause may be the culprit.
Menopause is technically reached when 12 months pass without a menstrual bleed. The average age for menopause is 51, but the stage before “the change” is called perimenopause and can last over a decade. “For a lot of people, PMS—especially an extended period of PMS—can be one of their hallmark symptoms of perimenopause,” says Suzanne Gilberg-Lenz, MD, an OB-GYN at Women’s Care of Beverly Hills, who sees patients showing perimenopausal symptoms as early as their late 30s. “As you get older, the menstrual cycle may become more irregular because ovulation becomes more abnormal, so periods become more infrequent—I have some people coming in saying they’re PMS-ing for a month!”
According to Gilberg-Lenz, perimenopausal PMS is not your run-of the-mill bad mood, “but a very specific anxiety, panic, and irritability,” which is why anti-depressant SSRIs such as Zoloft, Lexapro, or Celexa are often prescribed. She also describes digestion changes, metabolism slowdown, midsection weight gain, joint pain, brain fog, fatigue, and issues staying asleep as common symptoms. “Unpredictability combined with intensity can really mess people up,” says Gilberg-Lenz, who authored Menopause Bootcamp (Harper Wave, October 2022). She recommends regular exercise as well as Vitex (chaste berry extract), B complex, vitamin D, magnesium, and omega-3 fatty acid supplements to help ease symptoms. She is also a “huge fan” of acupuncture and CBD. “I’ve seen cannabis-infused vaginal suppositories be miraculous for women with vaginal dryness,” she adds. “But is it well studied? No.”
Hot flashes and night sweats are well-known complaints for women of a certain age, but they’re also susceptible to dryness of the eyes, throat, and skin. Genital tissue also becomes thin, dry, and stiff, so friction can cause trauma, pain, itching, and irritation that resemble a urinary tract infection. Johnson suggests regular sexual stimulation (independently or with a partner) to increase genital blood flow and ensure that tissue stays well vascularized and moisturized. She also recommends daily application of Vmagic, a hormone-free vulvar moisturizer. The Los Angeles–based company uses certified organic and sustainably sourced honey, propolis, beeswax, olive oil, and avocado to soften and soothe. (Vmagic Vulvar Balm, $30).