PCOS and Perimenopause: What Every Woman Needs to Know

Many women are told that PCOS only affects them in their teens and twenties. These are the years when irregular cycles, acne, sugar cravings, and stubborn weight tend to feel the most intense. But as I remind my clients all the time, PCOS doesn’t suddenly disappear once you reach your late thirties or forties. It continues to influence your hormones, metabolic health, and overall wellbeing throughout your reproductive years, including the transition into perimenopause.

If you’re noticing new symptoms such as cycle changes, weight fluctuations, sleep issues, or shifts in mood and energy, it’s natural to wonder whether it’s perimenopause… PCOS… or a mix of both.

Many women I see feel confused about their symptoms, especially if they were never formally diagnosed with PCOS in the first place and only recognised the pattern later in life.

This guide helps you understand how PCOS and perimenopause overlap, what’s normal during this phase, and how nutrition and lifestyle can support your hormones as your body changes.

How PCOS Shows Up During Perimenopause

Perimenopause is the transition towards menopause, often starting in the early to mid-40s. Hormones begin to fluctuate more widely, cycles can shorten or lengthen, and symptoms can feel unpredictable. For women with PCOS, these changes can feel amplified or different from what their friends are experiencing.

Here’s what I commonly see in practice:

Irregular or changing cycles

Women with PCOS are used to irregularities, but perimenopause adds another variable. You may experience shorter cycles, longer gaps between periods, or periods that suddenly become heavier or lighter. PCOS can make it harder to recognise when the transition is starting.

Increased sensitivity to blood sugar changes

As oestrogen naturally declines, the body can become less insulin-sensitive. If you already have underlying insulin resistance from PCOS, this change can feel more noticeable. Many women report stronger hunger cues, more intense cravings, or weight that feels harder to shift despite doing “the right things”.

Worsening or resurfacing symptoms

Even if your PCOS has felt manageable for years, perimenopause can wake up symptoms you thought you’d left behind like breakouts, fatigue, mood swings, or midsection weight gain. These aren’t signs that you’re “doing something wrong”. They reflect the hormonal shifts of this new life stage interacting with a metabolic system that’s always been a little more sensitive.

More significant impact from stress and poor sleep

During perimenopause, stress physiology becomes more dominant. Cortisol changes can affect ovulation, appetite, and alcohol tolerance. Women with PCOS are often more sensitive to this shift because stress, sleep, and blood sugar are closely interconnected.

Why PCOS Behaves Differently During Perimenopause

PCOS and perimenopause share several underlying pathways:

• metabolic health

• insulin sensitivity

• inflammation

• stress physiology

• ovarian hormone feedback

This means your experience of perimenopause might feel different from that of your sister, mother, or best friend, even if you grew up thinking your symptoms were “just normal”.

Women with PCOS often move through perimenopause with:

• more fluctuating cycles

• stronger metabolic symptoms

• greater sensitivity to carbohydrate load

• a noticeably slower shift in weight

• increased fatigue or brain fog

• changes in how they tolerate exercise

None of this means you’re heading for a difficult menopause. It simply means you benefit from a more targeted, root-cause approach to support your symptoms.

What You Can Do to Support PCOS Symptoms During Perimenopause

A functional, whole-person approach makes the biggest difference during this phase. You don’t need intense diets, strict plans, or rapid overhauls. You need a structured way to support your hormones as they naturally shift.

Here are the key areas I focus on with clients:

1. Prioritise blood sugar balance

This becomes even more important in your forties. Balanced meals with protein, fibre, healthy fats, and slow-release carbohydrates help stabilise energy, reduce cravings, and support weight management.Small changes, such as adding protein at breakfast or spacing carbohydrates throughout the day, often create the biggest improvements.

2. Support stress physiology

This is not about meditation or bubble baths. It’s about supporting the body’s actual stress pathways through nutrition (B vitamins, magnesium-rich foods, stable blood sugar), restorative movement, and consistent sleep.Women with PCOS often see cycle improvements simply by stabilising this foundation.

3. Focus on inflammation-reducing habits

You don’t need a restrictive anti-inflammatory diet. Instead, prioritise whole foods, a colourful variety of vegetables, oily fish, good-quality protein, and gentle movement.Consistent habits matter more than perfection.

4. Adjust exercise to the season you’re in

During perimenopause, high-intensity exercise can trigger more fatigue, sleep issues, or cravings in women with PCOS. A combination of strength training, steady cardio, and restorative movement supports both metabolic and hormonal health without overloading the body.

5. Consider targeted functional testing

Some women benefit from understanding what’s driving their symptoms at this stage, whether it’s nutrient deficiencies, thyroid changes, stress hormones, or metabolic markers. Testing isn’t essential for everyone but can provide clarity when your symptoms don’t match the effort you’re putting in.

You Don’t Need to “Fix” Everything

Perimenopause is a normal transition, but when layered on top of PCOS, it can feel confusing and more unpredictable. With the right support, like evidence-based nutrition, lifestyle foundations, and a clear plan, this phase can become more manageable and far less overwhelming.

If you're noticing changes in your cycles, energy, cravings, or weight and want help understanding whether it's PCOS, perimenopause, or both, I’m here to help you navigate it with clarity and confidence.

Disclaimer: The information provided is for educational and informational purposes only and should not be considered medical advice. While I provide guidance based on my expertise as a BANT registered nutritionist and health coach, all health-related decisions should be made in consultation with your GP, specialist, or healthcare provider. Any changes to medication, supplements, or treatment plans should only be made under the supervision of a qualified medical professional. The suggestions outlined are intended to support general well-being and do not replace medical treatment or diagnosis. Always consult a healthcare professional before making significant lifestyle or dietary changes.