Why do I feel worse before my period?
This is a common experience for women, especially in their late 30s or 40s.
Women who have previously been untroubled by symptoms may notice changes including:
Low mood before a period
Increased anxiety or irritability
Poor sleep in the days leading up to a period
Brain fog, fatigue, or feeling overwhelmed
These symptoms are often:
Put down to stress or a busy, overwhelming time of life
Treated as separate non-hormonal symptoms (such as depression or anxiety treated with antidepressants or anxiety medications)
Or sadly most often are just endured
What is happening?
During the perimenopause, hormone levels don’t simply decline, they fluctuate, sometimes quite dramatically.
Ovulation becomes less regular, and the balance between oestrogen and progesterone can vary from cycle to cycle.
For many women, this leads to:
A more symptomatic premenstrual phase
Shorter or more irregular cycles
More noticeable changes in mood and energy
Periods are often heavier, but may also become lighter
Even women who have never struggled with PMS before can notice these changes. For some women, it’s not just the level of hormones, but how sensitive their body is to these fluctuations.
While symptoms may feel similar, what’s happening in the perimenopause is often different from the PMS experienced earlier in life.
Hormonal fluctuations can amplify:
Anxiety and low mood
Irritability or anger
Sleep disturbance
Physical symptoms such as breast tenderness or bloating
For a small number of women, premenstrual symptoms can be more severe and may require more specialist support. However, for many, these changes sit within the spectrum of perimenopause and can be effectively managed with the right approach.
Recognising the pattern
Hormonal changes in the perimenopause can have a significant impact on how you feel. Understanding the pattern is often valuable.
Do the symptoms:
Appear in the days or week before your period?
Improve once bleeding starts?
Repeat in a similar way each cycle?
If so, this cyclical pattern can provide an important clue that hormones are playing a role, although in the perimenopause this pattern can sometimes feel less predictable.
What can help?
Support is very individual, but may include:
Hormonal treatments, such as HRT or certain types of contraception
Non-hormonal options where appropriate
Lifestyle approaches to support mood, sleep and energy
The right approach depends on your symptoms, cycle pattern and overall health.
When to seek support
If this is you, please do not just put up with these symptoms, but seek support as effective treatments are available.
If you would like an holistic review of all your symptoms, please book an appointment.
Or, if you aren’t sure how we can help you, or have any questions then please contact us.
Article written by Dr Emma Ginns and Dr Mari Walling, British Menopause Society Registered Specialist GPs, Co-founders of Lemala Health, May 2026
This information is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for personalised guidance.