In this podcast, we talk about the difference between PMS (premenstrual syndrome) and perimenopause. We get this question all the time, Doc, I think I am going into menopause.’ When really, they are nowhere near menopause, let alone perimenopause. What makes it so confusing is that there are so many similarities between PMS and perimenopause.
But some distinctions are important to point out, especially when it comes to testing and treatment. PMS (premenstrual syndrome) is pretty much as it sounds. Symptoms appear prior (pre) to the period (menses). But usually, the symptoms appear in a cyclical pattern.
The symptoms will appear anywhere from 14 days to just a couple of days before the period. The distinction between PMS and perimenopause, is the symptoms are present all month in perimenopause.
Perimenopause is NOT menopause. It is the time before a woman enters menopause. It can be anywhere from age late 30’s to late 40s. In perimenopause, you are still getting your period (it might be irregular, but you are STILL getting your period).
But the symptoms between PMS and perimenopause are similar.
So just to reiterate:
Symptoms that are similar in PMS and perimenopause:
Symptoms that are different between PMS and Perimenopause
Okay, we don’t want to bore you here. But we want to describe what happens in a female menstrual cycle. Just to give you an understanding of what might be happening hormonally in PMS and perimenopause.
In both PMS and perimenopause, unless you have had your uterus removed (hysterectomy), you will still be having a period. This part is written in a perfect 28-day cycle,” which we know that not everyone has a 28-day cycle. It is common and perfectly healthy to have anywhere from 25 to 35-day cycles.
For physiology sake, I am going to describe a 28-day cycle.
Issues that can go wrong with your cycle:
This is the interesting part. There are areas and places in the 28day cycle that things can go wrong.
Progesterone: In both perimenopause and PMS, the progesterone will drop in both PMS and perimenopause. This drop in progesterone can create a lot of the issues that women experience in PMS and perimenopause.
Estrogen: In perimenopause, the estrogen drops slightly. But in PMS the estrogen does not drop. In fact, estrogen can be high (estrogen dominance) in PMS. But in perimenopause, the estrogen declines a slight amount.
Insulin and Cortisol: When there is estrogen-dominance or progesterone-insufficiency, insulin and cortisol have no buffer. Again, I don’t want to bore you with physiology. But when there is stress, it raises the cortisol. A rise in cortisol will cause an immediate surge in glucose. An increase in glucose will cause the pancreas to secrete insulin. Insulin is important for glucose to be facilitated into the cell.
But insulin is the only fat storing hormone. Example: you are sitting at your desk. You get some stressful news. This stressful news will cause your cortisol to rise. This sends a signal to cause a rise in glucose (even though you didn’t eat anything). The increase of glucose in the bloodstream will cause the pancreas to release insulin. But you are still sitting in your chair. You are not running from a bear or threatening situation. The result is the insulin allows the glucose to enter the cell and then get stored as fat. Yes, stress can make you fat. As mentioned above, when you are not in perimenopause, the hormones (estrogen and progesterone) help to buffer the effect of excess cortisol, insulin, and glucose.
That is why when you are 22 years old you can get 5 hours of sleep, work two stressful jobs, go to school and eat burgers and milkshakes without missing a beat or gaining weight. When you are 46 years old, and on Sunday eat a dinner of Mexican food, skipping the chips and salsa (maybe one glass of wine). Come Monday, you slept terribly and wake up 3-5 lbs heavier (and boy, do you feel it!).
Now, the difference between perimenopause and PMS is, in PMS this insulin issue happens during 3-14 days before your period. But in perimenopause, this is an issue the entire month.
Thyroid: Now we cannot forget the thyroid hormones when comparing perimenopause to PMS. The thyroid is a whole different animal in terms of hormones. Low thyroid can actually cause exaggerated PMS. So if your PMS is pretty bad, please have your thyroid levels checks. And if you have low thyroid or Hashimoto’s, your PMS can be intense, but that is another blog itself. But to keep it simple, in PMS the thyroid is not as much of an issue as it is in perimenopause. The thyroid function itself can decrease with time/age. In perimenopause when the progesterone has dived, and the estrogen is present but slightly decrease. This can cause a lot of pressure on the thyroid, causing the thyroid function to drop.
Androgens – Testosterone and DHEA: In PMS and perimenopause, there are complaints of feeling irritable, acne and hair loss. Now, this is not the complete answer, but it can be due to androgens. Testosterone and DHEA are both androgens. Men have quite a bit more androgens (testosterone and DHEA) than women. But if the other hormones are not balancing the androgen, you can have symptoms of high androgens. In PMS, anywhere from 3-14 days before a period, the low progesterone cannot buffer the androgens. In perimenopause, the lower hormones cannot buffer the androgen all month long. Hence, feeling testy, acne and hair loss can occur at this time.
Hormone Lab Testing:
After reading all of this, you might be wondering: How do I test if I have Perimenopause or PMS? While I cannot speak for most doctors, I will tell you how we test for PMS and perimenopause
Blood Test: We have been using blood testing for many years. But as mentioned above, in perimenopause and PMS the hormones are changing daily. I like to test the blood from day 19-25 of the cycle. If you test earlier in the cycle, the progesterone might not be accurate. I like to test, FSH, LH, Estradiol, Progesterone, DHEA-s, Testosterone, Pregnenolone. I will explain in another podcast, what the levels should be, and what the pregnenolone means:)
What happens if I’ve had a hysterectomy and cannot know what day of the cycle I am in? Then we just tell them to test any time of the month, and from experience, I know where they are in their cycle and where the levels are at.
Saliva Test: Saliva testing is common and extremely sensitive. So you can really get a measure of where the hormone levels are at using a saliva test. But the drawback is for me, the saliva tests are too sensitive. So when someone is on hormone therapy/BHRT, the saliva test is so sensitive the levels read extremely high. This makes it hard to dose a woman’s hormone prescription, supplements, glandulars on a saliva test as the levels can be hard to interpret.
DUTCH Test: The DUTCH test is very popular right now. And they are really amazing and can provide a lot of information. Unfortunately, a lot of doctors will order the test and do not know how to interpret the results or provide recommendations based on the results. DUTCH tests do not test progesterone. But they do test progesterone metabolites that can be an accurate reflection of progesterone levels. The one really great key value in a DUTCH test is the estrogen metabolites. There are no other tests out there that can give such an accurate measure of estrogen metabolites. DUTCH tests are not usually covered by insurance and can be a bit pricey out of pocket.
Unfortunately, there are not a lot of options to treat PMS or perimenopause conventionally. If you go to your PCP, general practitioner, gynecologist, the most common options are birth control pills, antidepressants and/or an IUD or perhaps anti-anxiety meds. But there are many healthy, natural options for both PMS and perimenopause. In the future, we will go into more depth and also options to help to alleviate the symptoms.
We hope this podcast shed some light on the differences between PMS and perimenopause. Any questions or concerns, please feel free to post a comment below or send an email to [email protected]
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Protecting your `heart health` is crucial, especially during `menopause`, when risks can increase. In this `women’s health` episode, Dr. Valorie Davidson and Dr. Robert Maki share essential `health tips` and insights into how `hormones` impact cardiovascular well-being. Learn about important lab tests and supplements to safeguard your heart. You’ll learn: ● Why heart disease in women is often a “silent” problem until it’s serious ● The difference between general “heart disease” and atherosclerosis ● Coronary calcium scores: what they are, what the numbers mean, and when to consider one ● Why total cholesterol alone is useless (and often scary for no reason) ● The key markers that matter more: ○ Triglycerides ○ HDL ○ Triglyceride HDL ratio (and why 1.5 is a powerful insulin-resistance clue) ○ ApoB ○ Lp(a) ○ hs-CRP (cardio CRP) ○ Blood pressure & insulin resistance ● How estrogen decline in perimenopause & menopause affects cholesterol, visceral fat, inflammation, and heart risk ● How rhythmic dosing and thoughtfully prescribed HRT can support metabolic and cardiovascular health ● Visceral fat vs “roly poly” fat: why where you store fat matters more than the scale ● Foundational supplements for heart protection (education only, not personal medical advice): ○ Omega3s (EPA/DHA) ○ Vitamin D 2 ○ CoQ10 ○ Curcumin/turmeric ○ Magnesium Red yeast rice, bergamot, berberine & more metabolic support ○ Nitric oxide support (beet root, citrulline, etc.) If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
Can You Do Rhythmic Dosing After a Hysterectomy? Short answer: Yes, but there are some other factors to take into consideration to make sure someone is a good candidate. In this episode, Dr. Valorie and Dr. Maki explain how rhythmic dosing works without a uterus, why it can be an excellent option after total hysterectomy (with oophorectomy) or surgical menopause, and when a simpler static approach might be better. We cover candidates, myths (like “no uterus = no progesterone”), brain and bone benefits, and how to personalize dosing for real-life outcomes—sleep, mood, cognition, libido, and long-term bone strength. What you’ll learn ● Rhythmic dosing 101 (mimicking a 26–28-day cycle) ● Hysterectomy types: uterus-only vs. total (with ovary removal) ● Why rhythmic dosing can still help—even without a period ● Customizing estrogen + progesterone to symptoms and goals ● Brain fog & sleep: why declining estradiol hits cognition ● Bone density protection in the first 5–7 years post-menopause ● Endometriosis & fibroids: nuance, not one-size-fits-all ● When rhythmic dosing may not be ideal (e.g., 60 and off HRT for many years) If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
Confused by your DEXA scan results? Not sure if your T-score is “normal,” “osteopenia,” or “osteoporosis”or what to actually do about it? In this episode, Dr. Valorie Davidson and Dr. Robert Maki walk through three real viewer examples to show You exactly how to interpret bone density scores in your 50s and beyond. You’ll learn: ● How to read your DEXA scan: T-score vs Z-score in plain English ● The cutoffs: ○ 0 to -0.9 → normal bone density ○ -1.0 to -2.4 → osteopenia ○ ≤ -2.5 → osteoporosis ● Why two women in their early 50s can have completely different bone density ● What a T-score of -3.7 or -3.8 really means—and whether it’s reversible ● How surgical menopause, long-term steroids, vitamin D deficiency, RA, and genetics impact bone health ● Why your 50s are really about protecting your 70s (fracture risk, independence, and longevity) ● How weight loss, GLP-1 meds, and low muscle mass affect bones ● Practical foundations to protect and improve bone density: ○ Smart movement: walking, weighted vests, strength & resistance training ○ Protein targets & why bone = “calcified protein” ○ Stress, cortisol & steroid impact on bone loss ○ Vitamin D + K2, food-based calcium & targeted bone support formulas ○ Where HRT—and rhythmic dosing—fit into a long-term bone strategy If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
Many women confuse cycling static HRT with rhythmic dosing, but they’re not the same thing. In this episode, Dr. Valorie Davidson and Dr. Robert Maki from Progress Your Health break down the difference between the two, why it matters for your safety, and how to do hormone therapy the right way. In this video, you’ll learn: ● What “rhythmic dosing” actually means ● Why cycling your static HRT is not rhythmic dosing ● How improper dosing can impact mood, energy, and breast tenderness ● The risks of trying to adjust hormones on your own ● Why rhythmic dosing must follow the body’s natural ovarian rhythm ● How men and women can use synchronized rhythmic dosing safely If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
In Part 2, we go symptom-by-symptom so you can sleep through the night again. Dr. Valorie and Dr. Maki cover night sweats, frequent urination, heart palpitations, muscle cramps, headaches, itchy skin, vivid dreams, and when to suspect sleep apnea (under-recognized in women). You’ll hear practical tactics—electrolytes, targeted magnesium types, phosphatidylserine timing, glycine, L-theanine, and smart melatonin use—plus when HRT helps and how to pair data (CGM, wearables) with your sleep plan. You’ll also discover practical, science-backed fixes like: 💧 Smart electrolyte balance & targeted magnesium types 🧠 Phosphatidylserine timing for cortisol control 😴 Glycine, L-theanine, and optimal melatonin use 💊 When HRT makes sense—and how to pair it with CGM or wearable sleep data What you’ll learn ● What nighttime urination signals (estrogen & ADH, electrolytes, cortisol) ● Palpitations in midlife: estrogen link, when to see cardiology, calming strategies ● Cramps/headaches/itchy skin—common causes & quick fixes ● How/when to test for sleep apnea at home (and why it’s missed in women) ● Fine-tuning supplements & dosing; when HRT is the lever Still not sure what’s really causing your sleepless nights? Find out if you’re in the In-Between stage of perimenopause and menopause. If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
Why midlife wrecks your sleep—and how to fix it naturally. In Part 1, Dr. Valorie and Dr. Maki unpack the hormone triad behind women’s insomnia: shifting estrogen/progesterone, cortisol dysregulation, and blood sugar/insulin resistance. You’ll learn the difference between trouble falling vs. staying asleep, how low progesterone affects GABA (hello 2–3 a.m. wake-ups), and the daily habits that reset your circadian rhythm. What you’ll learn ● The hormone triad driving midlife sleep loss ● “Vampire / Zombie / Ghoul” sleep patterns—what they mean ● Why blood sugar swings trigger nighttime cortisol spikes ● Morning fixes that help nights: protein breakfast, light exposure, movement, temperature ● Starter supplements & how to think about them: magnesium (glycinate, L-threonate), L-theanine, glycine, phosphatidylserine, melatonin If you have a question, please visit our website and click Ask the Doctor a question. Join the Progress Your Hormones Community Stay Connected Instagram: @drvalorie TikTok: @drvaloried Disclaimer: All content in this blog, including text, images, audio, video, or other formats, was created for informational purposes only. This video, website, and blog aim to promote consumer/public understanding and general knowledge of various health topics. This content is not a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider with any questions or concerns you may have regarding your condition before undertaking a new healthcare regimen. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If your healthcare provider is not interested in discussing your health concerns regarding this topic, then it is time to find a new doctor.
