PCOS and Perimenopause: Understanding the Overlap

Polycystic ovary syndrome (PCOS) is a complex hormonal condition that can affect a woman’s body inside and out. Thanks to imbalanced hormones, they can cause frustrating symptoms of PCOS like weight gain, fatigue, hair loss, irregular periods, acne, mood swings, and more. 

If you’ve ever looked into perimenopause and menopause, you may have noticed some of these symptoms sound very familiar. While hot flashes and vaginal dryness are more menopausal symptoms, the overlap is real and it leads many women to wonder: is there a link between PCOS and perimenopause?

In today’s blog post, I’m breaking down the connection between PCOS and perimenopause, what causes the overlap in symptoms, and most importantly, how you can naturally manage and ease those symptoms as your body moves through this next phase. Let’s dive in! 

PCOS and Perimenopause: Understanding the Overlap

Most women are diagnosed with polycystic ovarian syndrome (PCOS) in their teens or early 20s, but for some, the diagnosis doesn’t happen until they reach perimenopause. Because PCOS can be difficult to identify, especially during hormonal transitions, it’s hard to know exactly how many women are affected at this stage. According to Yale Medicine, an estimated 5–10% of women between the ages of 18 and 44 have PCOS, though the actual number may be higher due to underdiagnosis and misdiagnosis.

What makes it more confusing? The symptoms of PCOS and perimenopause overlap a lot. So some women might develop PCOS later in life and not even realize it. On the flip side, if you’ve had PCOS for years, your symptoms may actually improve during this menopausal transition thanks to shifting hormone levels. 

I know, it sounds a little contradictory, but don’t worry. In this post, I’m breaking down how PCOS shows up during perimenopause, what makes the two different, and how you can support your body naturally through both. 

How Does PCOS Affect Perimenopause?

Some research shows that women with PCOS might enter perimenopause a bit later, sometimes 2 to 4 years later, compared to women without PCOS. But here’s the thing: while PCOS and perimenopause both involve shifting hormone levels, they aren’t directly linked. They’re two different hormonal experiences that happen at different stages of life, and they impact your body in their own unique ways, even if they share symptoms. 

In PCOS, it’s common to see elevated androgen levels (like testosterone), higher estrogen, and often increased cortisol (the stress hormone), while progesterone typically runs low. 

Perimenopause, on the other hand, usually comes with increased follicle-stimulating hormone (FSH) and a gradual decline in progesterone, estrogen, and testosterone. 

And yes, if you’ve already been dealing with irregular periods due to PCOS, things might shift even more as you approach perimenopause. You might notice your menstrual cycle getting shorter in your 30s, that’s one of the signs your hormones are beginning to change. 

What is the Difference Between Perimenopause and PCOS?

Difference 1: Primary Cause

One of the biggest differences between PCOS and perimenopause comes down to what is actually causing the hormonal changes. 

Perimenopause is a completely natural transition that happens as we get older (typically in our 40s) when our ovaries gradually slow down egg production. It’s just your body’s way of preparing for menopause. 

PCOS, on the other hand, is driven by hormonal imbalances likely caused by anovulation when your ovaries don’t regularly release eggs. This disrupts your hormone levels and can lead to deeper root issues like insulin resistance and chronic inflammation. Those imbalances don’t just create frustrating symptoms; they can also increase the risk of long-term health problems if left unmanaged. 

Difference 2: Starting Age

Perimenopause usually kicks in a little later in life most women start noticing changes in their 40s as their bodies naturally transition toward menopause. 

PCOS often shows up much earlier. Most women begin experiencing symptoms and get diagnosed in their late teens or early to mid-20s, right around the time they enter their reproductive years. Here are some early signs of PCOS!

Difference 3: Hormone Levels

While both perimenopause and PCOS throw our hormones out of balance, they do it in completely different ways. 

During perimenopause, hormone levels shift naturally. FSH rises, while progesterone, estrogen, AMH, and testosterone all decline. 

With PCOS, it’s a different story. Hormones like LH, testosterone, AMH, and estrogen tend to be elevated, while FSH and progesterone run low. 

One common thread? Low progesterone. 

However, there is a silver lining when women with PCOS start perimenopause. Since perimenopause often brings down estrogen and testosterone levels, it could actually help ease some of the more frustrating PCOS symptoms tied to those high hormone levels. 

How to Manage PCOS in Perimenopause

Focus on balancing blood sugar levels through diet. 

I recommend trying a gluten- and dairy-free anti-inflammatory diet for 30 days if you’re a Cyster looking to balance blood sugar and boost insulin sensitivity. Many women with PCOS trigger their symptoms because of inflammatory foods like gluten and dairy that can make insulin resistance worse (and more than 80% of us struggle with insulin resistance). If left unaddressed, it can raise your risk of type 2 diabetes and cardiovascular disease. Trying it for 30 days and reintroducing it back is a good way to figure out if these ingredients do impact your hormone imbalances.

The key to managing it? A whole-food, balanced approach focused on lean protein, healthy fats, fiber, and complex carbs. But here’s the thing: not all carbs are the enemy! That’s why I recommend finding your Carb Tolerance Range, the amount of carbs your body can comfortably handle without triggering your symptoms (like cravings and fatigue). When you eat in a way that supports your hormones and metabolism, you’ll notice fewer crashes, better energy, and more stable moods.

And, here’s the thing: If you’re entering perimenopause, keeping your insulin levels in check becomes more important than ever. Even if insulin resistance hasn’t been an issue for you before, the natural drop in estrogen during perimenopause can make you more susceptible to it. 

So, getting ahead of your metabolic health now is one of the best ways to support your body through this next stage of life. If you’re looking for a starting point, check out my PCOS meal plan and grocery list for inspiration, or dive into The Cysterhood app, where you’ll find hundreds of PCOS-friendly recipes designed to support your hormones and help you feel your best. 

And, to give your body that extra boost to fight insulin resistance, consider adding Berberine Advanced to your daily routine. This natural GLP-1 booster helps stabilize blood sugar, lower androgens, reduce inflammation, and promote weight loss. 

Prioritize good quality sleep. 

Getting a solid 7-10 hours of quality sleep each night is one of the best things you can do for your PCOS body, especially during perimenopause. Sleep is when your body resets and recharges, and it plays a huge role in lowering cortisol, balancing estrogen, boosting your mood, and even helping regulate your cycle. 

If you’re struggling to wind down, try taking magnesium glycinate before bed. It’s my go-to for relaxing the body, calming the mind, and gently supporting sleep and ovulation. I also recommend putting down your phone/tablet screens at least an hour before bedtime to avoid disrupting melatonin production. Instead, cozy up with a hot cup of tea (herbal, of course! like Testosterone Relief Tea), a calming book, or a peaceful activity like journaling or puzzles. Your hormones will thank you in the morning! 

Embrace stress-reducing habits. 

Women with PCOS are already working with higher cortisol levels, which can keep our bodies stuck in fight-or-flight mode. This not only makes it hard to fully relax, but it can also trigger inflammation, anxiety, insulin resistance, and mood swings. Add perimenopause to the mix, when estrogen and progesterone start to decline, and you’ve got even more changes happening in your brain chemicals like serotonin and GABA that can impact how you feel day to day. 

However, there are so many natural ways to support your mood and manage stress! Try adding calming rituals to your daily routine, like yoga, walking outside, breathing exercises, meditation, journaling, or doing a hobby that soothes you (even if that’s baking or putting together puzzles).  And, if you need a little extra support, supplements like Ovasitol and Testosterone Relief Tea have ingredients that support your energy and mood naturally.

Build muscle with low-impact, slow-weighted exercises. 

Exercise is one of the best things you can do for your body, especially if you’re navigating both PCOS and perimenopause. Starting in your 30s and 40s, it naturally becomes harder to build and maintain muscle due to shifting hormone levels. At the same time, PCOS often comes with metabolic dysfunction and insulin resistance, making intentional movement even more important.

That’s why I highly recommend slow weighted strength training. These workouts are low-impact but powerful. They help build lean muscle, which boosts your metabolism and improves the way your body uses glucose (a big win for insulin resistance). Unlike high-intensity workouts that spike cortisol and leave you feeling drained, slow weighted workouts are gentle on your adrenals and better for long-term hormone balance.

Other great PCOS- and perimenopause-friendly workouts include pilates, weight lifting, and yoga—anything that supports strength without overstressing your system. Consistent movement not only helps regulate blood sugar and maintain a healthy weight but also supports mood, sleep, and resilience during this transitional time in your life.

You can find all my PCOS-friendly workout routines and videos on The Cysterhood app! 

Sip on hormone-balancing teas. 

Living a healthy, balanced lifestyle through diet, movement, and stress management is key for managing PCOS, but if you’re ready to take your healing to the next level, sipping on hormone-balancing herbal teas is the ultimate glow-up move. 

Here are a few of my go-to blends to support your hormones naturally:

• Testosterone Relief Tea – My custom herbal blend that targets high testosterone levels and helps ease symptoms like acne, hair loss, mood regulation, belly fat, and irregular cycles. It combines all the teas above and more, including spearmint, lemon balm, orange peel, chamomile, rosehip, peppermint, cinnamon, nettle, lavender, and calendula. 
  • Spearmint – Helps reduce inflammation and lower cortisol.
  • Chamomile Mint – A calming combo that supports insulin sensitivity, lowers androgens, and soothes inflammation.
  • Cinnamon Clove – A cozy powerhouse that improves insulin sensitivity, reduces inflammation, and supports a healthy menstrual cycle.
  • Nettle Leaf – Packed with minerals and amazing for lowering androgens and cortisol.

Whether you’re brewing a single cup or making a whole pot, adding these teas to your daily routine (I drink Testosterone Relief Tea 2-3 times a day) can make a big difference in your PCOS journey as you enter perimenopause. Sip slow, breathe deep, you got this! 

Add strategic supplements to your routine. 

Adding herbal teas to your routine is a great start, but pairing them with the right supplements? This is where you’ll see big progress! Whether you’re navigating the ups and downs of PCOS or heading into perimenopause, your body might need a little extra support to feel balanced, energized, and like you again. 

At Ovafit, we’ve created the only NSF-certified supplement line specifically for women with PCOS (yes, the only one), designed to fill those nutritional gaps and give your hormones the boost they need. 

• MetaMulti Vitamin – Your daily dose of essential vitamins and minerals to support hormone health, energy, and nutrient deficiencies that come with PCOS, all in one easy-to-take supplement.
• Berberine Advanced – The ultimate support for insulin resistance. It also helps with weight management, gut health, and inflammation perfect for tackling those stubborn PCOS symptoms head-on. 
• Ovasitol – My ride-or-die supplement. This clinical-grade 40:1 ratio blend of myo- and di-chiro-inositol is incredible for improving insulin sensitivity, regulating ovulation, and balancing hormones across the board. 

The bottom line? You don’t have to do this alone, and your healing doesn’t have to feel overwhelming. With the right tools, your PCOS journey (and your perimenopause transition!) can feel lighter, more manageable, and actually empowering. 

Support your PCOS in all stages of life with Ovafit and The Cysterhood. 

While many women are diagnosed with PCOS early, it can sneak up during perimenopause, or at the very least, bring on symptoms that feel way too familiar. The truth is, our hormones shift and change throughout our lives, and understanding why they do is the first step toward healing in a way that actually works with your body not against it. 

Want to stay in the loop with the latest natural remedies, lifestyle tips, and hormone-balancing strategies for every stage of your PCOS journey? Be sure to:

• Download The Cysterhood app
• Tune into The Cyster and Her Mister Podcast
• Keep reading the Ovafit Blog

There’s so much to learn, and you don’t have to do it alone!