Perimenopause vs. PCOS: Why Hormonal Shifts Don’t Look the Same for Everyone

This post kicks off a little mini-series on hormones — something so many of us are curious (and sometimes confused) about. Over the next few weeks, I’ll be sharing simple, supportive ways to understand and work with your body through seasons like PCOS, perimenopause, and even the stress-driven ups and downs we often call “adrenal fatigue.”

Even simple rituals can reset your hormones.

My Story: Living With PCOS in My 40s

I was diagnosed with polycystic ovarian syndrome (PCOS) many years ago, and it became the turning point that pushed me to start making lifestyle changes. At the time, my cycles were irregular, I was dealing with symptoms that didn’t make sense, and I felt like my body was working against me.

Fast forward to now: I just turned 44. My cycles are regular, I don’t have ovarian cysts showing up anymore, and even my gynecologist has said she might not diagnose me with PCOS today. That’s the power of consistent, sustainable shifts — not perfection, but steady support.

That said, I’ve started to notice new changes: shifts in my cycle, energy fluctuations, and how my body holds onto fat differently. It’s made me wonder: is this my PCOS showing up in new ways? Or am I stepping into perimenopause? The truth is, for many women, these seasons overlap and can feel confusing.

What’s Happening in Perimenopause

Perimenopause is the transition phase before menopause, often beginning anytime in our 30s or 40s and lasting several years. Hormones like estrogen and progesterone start to rise and fall unpredictably, which can look like:

Irregular, heavier, or skipped cycles

• Hot flashes or night sweats

• Sleep disturbances

• Mood swings or brain fog

• A shift toward storing more visceral fat (the deeper fat around your midsection)

It’s your body learning how to find a new rhythm after decades of cycling — and it can feel unsettling, especially if you’re not sure what’s “normal.”

What’s Happening in PCOS

PCOS is a chronic hormonal condition that often starts much earlier, sometimes in your teens or 20s. It usually involves irregular ovulation and an imbalance of hormones, especially higher androgens (like testosterone) and insulin resistance. Symptoms can include:

• Irregular or missing periods

• Acne or oily skin

• Excess facial or body hair

• Fertility struggles

• Weight gain or difficulty losing weight

Because PCOS affects how your body uses insulin, it often plays a big role in how fat is stored — with more tendency toward abdominal fat, which is metabolically active and more tied to inflammation.

Why the Symptoms Overlap

Here’s where it gets tricky: both PCOS and perimenopause can cause:

• Irregular cycles

• Mood shifts or anxiety

• Sleep struggles

• Changes in fat distribution (especially around the belly, thanks to visceral fat and shifting cortisol levels)

But the why is different:

• Perimenopause = natural hormone fluctuations as your ovaries transition.

• PCOS = ongoing hormonal miscommunication, often tied to insulin and stress hormones.

Supporting Your Body in Either Season

No matter which label you’re navigating, the foundation of support often looks surprisingly similar:

• Balance blood sugar → Aim for protein, healthy fat, and fiber at each meal. (Think eggs with veggies and avocado, not just coffee and toast.)

• Support your adrenals → Minerals like magnesium, potassium, and sodium help with energy and resilience.

• Move with intention → Strength training, Pilates, and walking help improve insulin sensitivity and support hormone balance — without overstressing your system.

• Prioritize rest → Protect your sleep rituals and weave in small resets throughout the day (a walk outside, breathwork, or even a few minutes of quiet).

• Practice self-compassion → It’s not about doing everything perfectly. It’s about supporting your body with love and consistency.

The Gentle Takeaway

Whether you’re living with PCOS, moving into perimenopause, or just feeling the effects of stress and life shifts, remember this: your body is not broken. It’s speaking to you. Symptoms are signals, not failures. And while the labels can help guide testing and treatment, it’s the everyday resets — how you nourish yourself, how you move, how you rest — that create real change over time.

This post is part one of my new Hormone Reset Series on Consciously Free. In the coming weeks, I’ll be sharing more about subcutaneous vs. visceral fat (and what it means for hormones), plus a gentle look at adrenal fatigue and burnout. Stay tuned.