Nouriched: Eat, Move and Rest Your way to Wellness

If you’re in your 30s or 40s, staring at your reflection wondering why you’re breaking out like a teenager or why your cycles have gone rogue, you’re not alone. You may be asking: Is it PCOS, or is it perimenopause?

Or maybe you’ve battled PCOS for years, and your symptoms have only worsened with age. Or, perhaps you had your PCOS under control—only for old symptoms to resurface during a stressful season. You’ve tightened up your eating, started moving again, prioritized rest… but something still feels off. Could it be perimenopause sneaking in?

I’m in that last category. I’ve reversed my PCOS symptoms before. But now? I’m not so sure what’s happening in my body. I wish I had a definitive answer. A part of me hopes it’s PCOS—because PCOS, I understand. Perimenopause? Not so much.

Here’s the truth: both PCOS (Polycystic Ovary Syndrome) and perimenopause can bring a whirlwind of hormonal chaos—and they often mimic each other. So let’s break it down.

PCOS at a Glance

PCOS is a hormonal condition that usually begins in adolescence or early adulthood. It’s characterized by high androgens (like testosterone), insulin resistance, and irregular ovulation. Symptoms often include:

• Irregular or absent periods
• Acne and oily skin
• Excess hair growth (especially on face/body)
• Weight gain, especially around the belly
• Thinning hair or hair loss
• Fertility challenges

PCOS is often driven by insulin resistance and can be managed—sometimes reversed—with lifestyle changes like diet, exercise, and stress management.

What is Perimenopause?

Perimenopause is the hormonal transition leading up to menopause, typically starting in your late 30s to 40s. As estrogen and progesterone begin to fluctuate wildly, symptoms can include:

• Irregular or changing periods
• Mood swings and increased anxiety
• Hot flashes and night sweats
• Sleep disturbances
• Vaginal dryness
• Brain fog
• Joint pain
• Changes in weight and metabolism

It’s a natural transition, but that doesn’t mean it’s always an easy one.

Where It Gets Tricky

Both PCOS and perimenopause involve shifting hormones, which can cause overlapping symptoms. So how can you tell them apart?

• Age matters: PCOS usually begins before age 30. If symptoms are showing up for the first time in your late 30s or 40s, perimenopause is a likely culprit.
• Cycle history: PCOS often brings lifelong irregular periods. Perimenopause causes changes in previously regular cycles.
• Hormones: PCOS typically features elevated androgens. Perimenopause is marked by declining estrogen and progesterone. But some women with PCOS can also be estrogen dominant, which complicates things.
• New symptoms: If you’re experiencing things like night sweats or joint pain for the first time, that’s a clue you may be entering perimenopause.

Oh—and here’s a twist: you can have both. Yep. PCOS doesn’t disappear at 40. And perimenopause doesn’t care if you already have hormonal chaos.

Women with PCOS tend to experience menopause later than average—by 3 to 4 years, according to research. That means the overlap window may be longer, and symptoms, more complicated.

What Should You Do?

If you’re unsure, talk to your doctor. PCOS is diagnosed based on the “Rotterdam” criteria:

1. Clinical or lab evidence of high androgens
2. Polycystic ovaries on ultrasound
3. Irregular periods

You need 2 of 3 to meet the diagnostic threshold. Perimenopause, on the other hand, is a clinical diagnosis—there’s no one test for it. That’s why tracking your symptoms, understanding your body, and developing hormonal literacy is so important.

Regardless of the cause, managing hormones through lifestyle changes can be incredibly helpful. A balanced diet, regular movement, stress management, and quality sleep can support your body through both conditions. Whether it’s PCOS, perimenopause, or the wild mix of both, your body deserves care, understanding, and a little patience.

I’m in the process of unraveling what’s happening in my body. Based on the above, I believe its resurfacing PCOS symptoms. My specific symptoms are longer ovulatory cycles, hormonal acne and PMS – all new symptoms for me since reversing my PCOS. But, I’m not worried. PCOS is like the alarm clock, alerting you of danger ahead. I’ll heed its warnings for a better shot at 2nd puberty that will come in the next few years. Wish me luck!