Here’s How PMS Can Change in Your 20s, 30s, and 40s

Bloating, cramps, food cravings, brain fog, mood swings—at this point in your life, you’re well acquainted with these and other symptoms of PMS, or premenstrual syndrome. Up to 85% of women experience at least one PMS symptom during the week before their period, while others deal with several, including acne breakouts, fatigue, headaches, breast tenderness, and depression.

While the severity of these symptoms normally varies month to month, they tend to change more noticeably as you get older. Why isn’t PMS consistent throughout your reproductive years? Like everything else related to your cycle, it’s a hormone thing. As levels of estrogen and progesterone naturally fluctuate with age, the symptoms you’re used to fluctuate as well.

To get the lowdown on what PMS in your 20s, 30s, and 40s can be like, we talked to Suzanne Fenske, MD, assistant professor of obstetrics, gynecology and reproductive science at Icahn School of Medicine at Mount Sinai in New York City.

In your 20s, PMS can be rough

In this decade, PMS can feel like a rollercoaster. “PMS tends to be worse early and late in a woman’s reproductive years because there’s just much more fluctuation in hormones during those times,” says Dr. Fenske. It’s unclear why some women experience more aggressive symptoms than others—or why an estimated 3%-8% of women develop premenstrual dysphoric disorder (PMDD), a more serious form of PMS that makes regular symptoms severe and even debilitating.

Certain lifestyle habits that women in their 20s are more likely to have—not prioritizing sleep, an all-over-the-place meal schedule, smoking, and avoiding the gym—can amplify PMS symptoms. So your skin issues, fatigue, and irritability, for example, can hit harder and be more difficult to manage.

If you’re in your 20s and your PMS isn’t so bad, it could be because of your birth control. Twentysomething women tend to be more focused on work or education, and they’re not necessarily thinking about having kids. For this reason, many rely on hormonal methods such as the Pill or implant. The artificial hormones in these methods prevent ovulation and put your natural cycle is on hold—which eases or eliminates PMS as well, says Fenske.

By your 30s, symptoms tend to ease

In this decade, PMS tends to even out and not feel so extreme. Women in their 30s are likely to have fewer symptoms—or the ones they do have may not be as severe.

One reason why: For many women, their 30s are the decade when they become moms, and pregnancy and breastfeeding can provide a reprieve from PMS symptoms, says Dr. Fenske. Getting pregnant puts a halt to ovulation and regular periods, and without a period, there’s no PMS. 

Still, sometimes the 30s are the worst decade for PMS. That can be the case if you’ve been on hormonal birth control all through your 20s and then go off the Pill in your 30s to have kids. The time between going off birth control and before conception can be a wild hormonal ride, as your natural hormones kick in and start the week-by-week fluctuations that lead to PMS.

After 40, PMS can return with a vengeance

While PMS in your early 40s can be similar to what it feels like in your 30s, symptoms will likely get worse when you reach perimenopause, the five- to 10-year stretch before menopause actually hits. (The average age when women enter menopause is 51.) Generally speaking, whatever symptoms you’ve already been having will likely be ramped up.

But what makes PMS in this decade a little trickier is that your period may start to become irregular thanks to decreasing hormone levels. You won’t necessarily know exactly when to expect the mood swings, fatigue, or other PMS issues. The other thing is, what you think might be PMS could just be hormonal weirdness caused by perimenopause.

“If a woman did not have a history of PMS and has a sudden onset of PMS-like symptoms in her 40s, it’s more likely perimenopausal changes rather than sudden onset of PMS,” says Dr. Fenske. 

How to deal with PMS in any decade

Whatever decade you’re in, one of the keys to managing PMS is to adhere to a healthy lifestyle—eating right, working out regularly, and keeping stress and anxiety at bay. “You can also treat psychological symptoms with antidepressant and antianxiety medications, either daily or only during the two weeks prior to your period,” says Dr. Fenske. Hormonal birth control can provide relief as well.