PMS Linked to More Severe Vasomotor Symptoms During Menopause

Women who’ve had a premenstrual disorder like PMS (premenstrual syndrome) are more likely than others to experience moderate to severe vasomotor symptoms like hot flashes and night sweats when they go through menopause, a new study finds.

For this research, investigators examined data on 1,220 women who reported symptoms consistent with premenstrual disorders and 2,415 women who did not. Women with a history of premenstrual disorders were more than twice as likely to go through menopause early, before age 45, and 68 percent more likely to experience moderate to severe vasomotor symptoms in study results published September 19 in JAMA Network Open.

“Although premenstrual disorders (PMDs) end at menopause, the biological vulnerability to hormonal fluctuations underlying PMDs may predispose affected individuals to adverse outcomes during the menopause transition, which are also characterized by dramatic fluctuations in sex hormones,” says the study’s lead author, Yihui Yang, MPH, of the Karolinska Institute in Stockholm.

PMS is a combination of symptoms that women may experience about a week or two before their periods and that may include bloating, headaches, and moodiness.

Typically, women go through menopause between their midforties and their midfifties, when they stop menstruating. Reduced production of the hormones estrogen and progesterone in the years leading up to menopause and afterward can lead to a wide range of symptoms, including mood swings, joint pain, vaginal dryness, insomnia, memory problems, and hot flashes and night sweats.

Researchers Asked Women to Recall Symptoms Related to Menstrual Cycles and Menopause

Researchers looked at data collected through questionnaires for the Nurses’ Health Study II, which asked participants to recall and report on a wide range of health issues including symptoms associated with menstrual cycles and menopause.

The study classified women as going through early menopause if they went through this transition before age 45; this occurred for 17 women with a history of PMDs and 12 women without this experience.

Most women with PMDs reported milder symptoms consistent with PMS. More rarely, participants reported severe symptoms that are seen with premenstrual dysphoric disorder (PMDD).

The study didn’t find any connection between PMDs and mild vasomotor symptoms like hot flashes and night sweats during menopause.

One limitation of the study is that researchers relied on women to accurately recall and report on symptoms over several decades, the study authors noted. Another drawback is that the perception of symptoms as mild or severe is somewhat subjective, and severity was assessed only on the basis of what participants reported.

It’s possible some women may have a heightened sensitivity to what happens with their body and be more aware of changes like breast tenderness or fluid retention during their monthly cycles and more attuned to hot flashes during menopause, says Susan Davis, MBBS, PhD, a professor and the director of the women’s health research program at the school of public health and preventive medicine at Monash University in Melbourne, Australia.

“So in part, the link may simply be a body awareness or self-vigilance thing,” says Dr. Davis, who wasn’t involved in the new study.

Are Some Women More Sensitive to Hormonal Changes Throughout Their Lives?

Hormonal fluctuations, such as a drop in estrogen, that occur before the onset of menstruation and during menopause, may influence the symptoms women experience, says Asima Ahmad, MD, MPH, a reproductive endocrinologist in Chicago and the chief medical officer and cofounder of Carrot Fertility.

“The question of whether someone who is more sensitive to these hormone changes during the menstrual cycle will also be more sensitive in the perimenopause/menopause transition is very interesting,” says Dr. Ahmad, who wasn’t involved in the new study. “More research is still needed to determine whether this is true in different populations, and if so, why this may be the case, and what makes one person more sensitive to these hormone fluctuations compared to others.”