PCOS and Menopause

We know that PCOS care is often not all-inclusive, and this includes age. If you feel that once you’ve left the child-bearing years your PCOS diagnosis doesn’t seem to be considered much, or at all, when it comes to discussions with healthcare providers, you’re not alone. Those in peri-menopause or menopause (and beyond) don’t always receive proper screening or health care specific to having PCOS, even though it is well-established that PCOS increases certain health risks during these life stages. Even in the research, this population is lacking in study and support!

We’re passionate about making PCOS care and resources accessible and inclusive across age, gender, size, and more. This post was researched and written by Rachel Hilts, RD (she/her) to help bring more awareness, information and support to our PCOS community.

Polycystic Ovary Syndrome (PCOS) often gets attention when it comes to trying to conceive and start a family, but the truth is that PCOS is a complex disorder that impacts those with it at all life ages and stages. 

Unfortunately, when it comes to transitioning to menopause, PCOS has been largely ignored in research and health care.  PCOS is a chronic condition, meaning it doesn’t go away as we age, and it continues to need to be managed throughout life. 

Recent research has highlighted the impact that PCOS can have on increasing risks for some health conditions (like Type 2 Diabetes and Cardiovascular Disease), and this has helped to shed a light on the importance of PCOS care at all ages, including supporting PCOS beyond reproduction. 

Understanding Menopause

Menopause is when a menstruating human has had 12 months since they last had a period (without being caused by other medications or health conditions), and we call the years leading up to that point perimenopause – when hormonal changes result in hot flashes, menstrual changes, difficulty sleeping, mood changes, and other symptoms. During perimenopause, estrogen and progesterone hormone levels gradually decrease, which will result in ovulation decreasing and eventually stopping, ending menstruation. Typically, perimenopause begins around age 45-55, and can last anywhere from a few years up to 14 (1).

Is it PCOS or is it Menopause?

The tricky part is, as you may have noticed, PCOS and perimenopause can share some symptoms, which can sometimes make it difficult to be sure when you’ve entered perimenopause or if its PCOS causing these symptoms. Some of these similar symptoms of both PCOS and perimenopause include:

  • Irregular or missed periods
  • Infertility
  • Changes in mood
  • Difficulty sleeping
  • Thinning hair or hair growth changes

So how can you be sure to tell the two apart? If you notice a change in symptoms, or worsening of symptoms that may be related to perimenopause, notice increased symptoms of hirsutism (hair growth on your face or body), or find a change to the regularity or heaviness of your periods, it could be menopause. 

Surprisingly, those with PCOS actually tend to have a longer reproductive life span, and periods may become more regular with aging, due to natural age-related declines in androgen hormones (like testosterone) that typically tend to be higher in PCOS (2,3). We also see that those with PCOS tend to start perimenopause 2 years later, on average, and those struggling with infertility related to PCOS may actually see some improvements and a higher likelihood of pregnancy as they get older, prior to menopause (4,5). 

Does Menopause ‘cure’ PCOS?

In short, no. 

While sex hormone levels tend to improve with age, they do still remain different in those with PCOS and those without. High androgen hormones (testosterone, androstenedione, DHEA) are a hallmark symptom in many with PCOS – these elevated androgen levels do decline with age, but still remain elevated in postmenopausal women with PCOS (5).

Many symptoms of PCOS do get better with age because of the decrease in androgens, such as improved menstrual regularity and fertility, prior to menopause. However, other symptoms seem to get worse in some with PCOS with perimenopause and menopause, including increased hair growth symptoms on face and body (hirsutism), and increased hair loss and even balding with the hair on our head (5). This can, understandably have a huge impact on body image and self-esteem. 

Metabolic Changes with PCOS and Menopause

Aside from the impact of the changes in reproductive hormones with aging, there are also some potential increased health risks that it’s important to be aware of. 

PCOS often (though not always) causes higher levels of insulin, inflammation, and cholesterol, and these can worsen with age (6). This can result in a higher risk of developing conditions including Type 2 Diabetes and Cardiovascular Disease (7,8). Because of this higher risk, it’s recommended by the Androgen Excess and PCOS Society to screen for impaired glucose tolerance and diabetes with a 2 hour oral glucose tolerance test every 2 years in those with PCOS (or annually if there are elevated glucose levels) (9). Early detection and treatment with diet, lifestyle changes, and medications can be crucial for preventing further health complications (10). 

Managing PCOS when Peri- or Post-Menopausal 

It’s important to be aware of changes that can occur with aging so that we can take the necessary steps to screen for and manage any potential concerns. It’s also important to recognize that if you have PCOS, you’re not alone in your experiences. 

Supporting your mental health through counselling, self-care, or group support from others with PCOS can be an important step as you go through this transition. 

There are also some nutrition changes that can help to improve health outcomes (10):

  • Choose lower glycemic index carbs and balance the overall glycemic load of a meal to help minimize increases in blood sugar and insulin from meals. 
    • For example, pair your carbs with a source of protein, fat, and fibre, and choose lower GI options like sourdough instead of white bread when it’s accessible and affordable for you. 
  • Include a bit more protein with your meals and snacks to improve satiety and help to keep blood sugars balanced. 
  • Emphasise anti-inflammatory foods, including foods higher in fibre, omega 3 fats, and fruits and vegetables. 
  • Some supplements may also be beneficial, including inositol, magnesium, or omega 3 – talk to your health care provider to see if this is right for you before making any changes to supplements or medications. 
A woman with light brown skin, dark brown hair, wearing a purple shirt is stands in a kitchen, chopping vegetables at the counter.

The Bottom Line

We know now that PCOS doesn’t go away with age, and it’s not something that we can simply ignore. While there are some increased life-long health concerns, we can help to lower the risk of health concerns with regular screening and nutrition and lifestyle management.  

There are also some potential benefits that come with aging when you have PCOS! Including the potential for more regular periods and increased fertility chances prior to menopause, as well as a delay in the start of perimenopause and lower rates of hot flashes and night sweats during this transition. 

References:

1. U.S. Department of Health and Human Services. (n.d.). What is menopause? National Institute on Aging. Retrieved March 23, 2022, from https://www.nia.nih.gov/health/what-menopause#:~:text=Menopause%20is%20a%20point%20in,between%20ages%2045%20and%2055 

2. Winters SJ, Talbott E, Guzick DS, Zborowski J, McHugh KP. Serum testosterone levels decrease in middle age in women with the polycystic ovary syndrome. Fertil Steril. 2000;73(4):724-729.

3. Elting MW, Korsen TJ, Rekers-Mombarg LT, Schoemaker J. Women with polycystic ovary syndrome gain regular menstrual cycles when ageing. Hum Reprod. 2000;15(1):24-28.

4. Corrine K. Welt, Enrico Carmina, Lifecycle of Polycystic Ovary Syndrome (PCOS): From In Utero to Menopause, The Journal of Clinical Endocrinology & Metabolism, Volume 98, Issue 12, 1 December 2013, Pages 4629–4638, https://doi.org/10.1210/jc.2013-2375

5. Schmidt J, Brännström M, Landin-Wilhelmsen K, Dahlgren E. Reproductive hormone levels and anthropometry in postmenopausal women with polycystic ovary syndrome (PCOS): a 21-year follow-up study of women diagnosed with PCOS around 50 years ago and their age-matched controls. J Clin Endocrinol Metab. 2011;96(7):2178-2185.

6. Puurunen J, Piltonen T, Morin-Papunen L, et al. Unfavorable hormonal, metabolic, and inflammatory alterations persist after menopause in women with PCOS. J Clin Endocrinol Metab. 2011;96(6):1827-1834.

7. Gambineri A, Patton L, Altieri P, et al. Polycystic ovary syndrome is a risk factor for type 2 diabetes: results from a long-term prospective study. Diabetes. 2012;61(9):2369-2374.

8. Krentz AJ, von Mühlen D, Barrett-Connor E. Searching for polycystic ovary syndrome in postmenopausal women: evidence of a dose-effect association with prevalent cardiovascular disease. Menopause. 2007;14(2):284-292.

9. Salley KE, Wickham EP, Cheang KI, Essah PA, Karjane NW, Nestler JE. Glucose intolerance in polycystic ovary syndrome–a position statement of the Androgen Excess Society. J Clin Endocrinol Metab. 2007;92(12):4546-4556.

10. Grassi, A. (2014, February). PCOS in aging women – beyond hormones and hot flashes. Today’s Dietitian. Retrieved March 23, 2022, from https://www.todaysdietitian.com/newarchives/020314p40.shtml 

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