What to know about menopause and PCOS

PCOS is often associated with fertility and menstrual health. But did you know it can persist into postmenopause?

One common misconception about polycystic ovary syndrome (PCOS) is that it only impacts people that are of a reproductive age and disappears with menopause. 

And this belief makes sense to an extent: part of the Rotterdam criteria, which is used to diagnose PCOS, asks whether a person is experiencing irregular or absent ovulation, which does not apply to postmenopausal people since they have reached a stage of life in which they no longer have a menstrual cycle. Also, many people do find that their day-to-day symptoms improve once they reach menopause. 

However, PCOS is not just a hormonal disorder: for a majority of cases, it is also a metabolic condition, and these metabolic imbalances persist beyond one’s reproductive years (1).

In other words, PCOS can impact people who have reached menopause!

We will be diving into the relationship between PCOS and menopause in this article. Read on to learn:

  • What is perimenopause? What is menopause? What is “normal” for these stages of life? 
  • Does PCOS continue after menopause?
  • Can PCOS be diagnosed during perimenopause or postmenopause? 
  • If PCOS and metabolic issues are making your perimenopause or menopause symptoms worse, what are more effective reatment options to improve health and quality of life?

Perimenopause & menopause basics

In case you are not yet experiencing perimenopause or menopause, let’s take a moment to review what changes occur during these phases of life.

Menopause is defined as the ceasing of menstruation, which usually occurs by the time we hit our late 40s or early 50s. By the time someone has  reached menopause, many of the bothersome symptoms you may have heard about (more on those below!) have likely decreased or gone away entirely, because hormones have stabilized to their new-normal.

Perimenopause is known as the transitional period before menopause. During this time period, which usually lasts for several years, our estrogen levels drop, our ovaries stop releasing eggs consistently each month, and our cycles become irregular. We may experience symptoms like:

  • Shorter cycles
  • Missed periods 
  • Lighter periods 
  • Hot flashes 
  • Insomnia and night sweats 
  • Vaginal dryness 
  • Urinary problems (e.g. leakage, UTIs)
  • Vaginal infections
  • Lower bone density 

Once a full 12 months have gone by with no period, menopause has officially ocurred. The time after this milestone is referred to as postmenopause. 

Perimenopause, menopause, and postmenopause are normal parts of aging. This can be an uncomfortable time due to shifting hormones and entering a new life stage, but it is important to know what is “normal” versus what is indicative of an underlying issue.  

What to know about PCOS and menopause 

It is only recently that the medical community has looked beyond the reproductive system to analyze what PCOS means for a person’s overall health over a much broader timeline. While there has been very little research into how PCOS manifests in a  person’s later years, we do know a bit about how PCOS impacts people leading into menopause and beyond.

Below are several things to keep in mind when it comes to PCOS and menopause.

1. You cannot be diagnosed with PCOS if you are postmenopausal, and it is unlikely that you will be diagnosed during perimenopause. 

Polycystic ovarian syndrome (PCOS) is a hormone imbalance that impacts at least 10% of menstruating people. This makes it the most common endocrine disorder in females, yet it is often ignored, dismissed, or missed entirely as many of its symptoms such as irregular periods, weight gain and blood sugar issues, acne, hair loss, hirsutism, and mental health struggles can all be mistakenly deemed as “normal” (2). 

To be diagnosed with PCOS, you must fulfill 2 of the 3 Rotterdam Criteria:

  • Anovulation (absent or irregular ovulation, determined with menstrual cycles)
  • Hyperandrogensim (high levels of male hormones, determined with blood work)
  • Polycystic ovaries (determined with an transvaginal ultrasound)

It is not possible to diagnose PCOS if you have reached menopause because the cardinal feature of this hormone imbalance (e.g., menstruation) disappears (1). Many doctors will also hesitate to diagnose someone with PCOS if they are experiencing symptoms like irregular periods during perimenopause, as irregular periods in the years leading up to menopause are a “normal,” expected symptom of aging.

However, it is important to understand that PCOS is not a disease but rather a spectrum disorder. Many experts believe our diagnostic frameworks to be outdated, and just because you were not not diagnosed with a hormone imbalance like PCOS earlier in life does not mean you did not have it (3). 

This PCOS diagnostic issue can be particularly difficult for people going through perimenopause or menopause are often told that the bothersome symptoms they are experiencing is “just a part of getting older,” which is undoubtedly a frustrating thing to hear if you are seeking help for your health and wellbeing. This frustration can be enhanced if there is undiagnosed PCOS occurring because symptoms will often be more intense. 

If it is an option for you, it may be helpful to find a physician who is familiar with how PCOS manifests in postmenopausal people, particuarly if you had not beeing diagnosed during your reproductive years. 

2. There are several menopause-related symptoms to watch out for if you also have PCOS.

The confusion around PCOS and menopause makes sense to an extent when you consider that there is somewhat of an overlap between PCOS symptoms and “normal” symptoms someone experiences with the shifting hormones that occur with menopause. The below are examples of symptoms that are commonly seen with both “normal” menopause and PCOS:

  • Irregular or missed periods 
  • Mood swings
  • Insomnia and difficulty sleeping 
  • Weight gain 
  • Hirsutism (irregular hair growth)
  • Hair loss

On the other hand, there are several symptoms to watch out for that may imply an underlying hormone imbalance like PCOS (5, 6):

  • Delayed menopause compared to what is average for others (studies show people with PCOS go through menopause 2 years later than the average person)
  • Metabolic symptoms such as insulin resistance, weight gain, and blood sugar imbalance that is more extreme than what is considered for perimenopause and menopause
  • Acne and other skin changes 
  • Headaches 
  • Pelvic pain

3. For some people with PCOS, symptoms do disappear in menopause, but if you are insulin resistant, it is more likley your symptoms will stick around.

Menopausal transition, along with aging, is associated with several hormonal and metabolic changes. As we age, we can experience increasing insulin resistance, belly fat, an increase in inflammation, and elevated cholesterol while transitioning to our next life stage (5). As explained earlier, this is largely what makes it challenging to distinguish what is “normal” for aging and experiencing menopause versus what is indicative that PCOS may be present. 

However, metabolic changes can be intensified for aging people with PCOS. Studies have shown that people with PCOS experience an increase in waist circumference, cholesterol, and triglyceride levels as they reach their 40s and 50s (6). 

One element that is fairly consistent across postmenopausal people who are still experiencing PCOS symptoms is that they are insulin resistant. There is a large overlap between insulin resistance and PCOS, which is the basis for PCOS being a condition that sits at the intersection of hormonal and metabolic health. 

During our reproductive years, insulin resistance can be a root cause of PCOS symptoms. Being insulin resistant can lead to hyperandrogenism and increase inflammation throughout our bodies, making it more difficult for consistent ovulation to occur and leading to the infamous PCOS symptoms such as irregular cycles, weight gain, acne, hair loss, and more. 

But unlike our periods, insulin and blood sugar regulation issues are not things that just disappear with menopause. In fact, insulin resistance can often worsen, thus increasing symptom severity during this phase of life. 

4. There are various health risks to be aware of if you have PCOS that has persisted into menopause. 

If you look at the metabolic dysfunctions that may appear with aging – insulin resistance, prediabetes, hypertension, insulin resistance, and gut problems, to name a few –  you will see that many of these patterns are the same dysfunctions that people with PCOS also have.

We talk about the health risks of PCOS in other Hormone Zone articles, and it is important to understand that these risks are intensified if you are someone with PCOS who is still experiencing symptoms like uncontrolled insulin resistance. 

But attitude is important: with lifestyle changes and targeted treatment, many of these risks can be mitigated. 

Managing PCOS and menopause 

Just like having PCOS in your reproductive years, there is much you can do to improve your health and quality of life if you are experiencing this hormone imbalance during perimenopause or postmenopause. 

Much of this centers on improving insulin sensitivity and blood sugar control. If you are insulin resistant or experiencing more advanced symptoms of metabolic syndrome like prediabetes or diabetes, focusing on blood sugar stabilizing is a must. Some general tips include:

Diet

  • Focus on complex carbohydrates (e.g., whole grains, sweet potatoes, legumes) over simple carbohydrates (e.g., refined sugars, processed foods, white flours, white rice)
  • Be sure you are eating protein and fat along with carbohydrates so that your body can more efficiently process the energy in food and your energy remains stable
  • There has been research that suggests that intermittent fasting or a keto diet is more beneficial for people in menopause than it is for reproductive-aged ffemales (7,8).

Exercise

  • Exercise has been shown to ease both menopause-related and PCOS symptoms. 
  • Aging people should be aware of their greater risk for bone fractures due to lower estrogen levels. For this reason, low-impact exercises like brisk walking, yoga, pilates, cycling, and swimming are all recommended.
  • Strength training has also been shown to benefit insulin resistance and general metabolic health and bone density. As we age, it is also important to add stretching and mobility exercises into our routines. 

Stress management

  • Hormonal changes and their symptoms (e.g., disrupted sleep) can lead to increased levels of stress. Over time, this can further disrupt our hormones! 
  • For this reason, finding ways to stop or reduce this viscous stress cycle is important. Meditation, journaling, exercising, taking intentional time for self care, breathwork, and connecting with those around you can all help reduce stress. 

Supplements

Medication 

  • Hormone replacement therapy is a popular treatment for people going through menopause.
  • There are two main types of hormone replacement therapy: systemic hormone replacement therapy (e.g., taking medication with synthetic estrogen) that can help with general menopause treatment, and more localized, lower-dose treatment (e.g., estrogen cream that is applied to treat vaginal and urinary symptoms). 

Take note that the above is intended for educational purposes only, and you should be sure to talk with your doctor before starting any new lifestyle habits or medications. 

Conclusion

While menopause does not cure PCOS for everyone like you may have hoped, being aware of how to most effectively manage symptoms is key. 

If you were not diagnosed with PCOS before perimenopause or menopause, you may find yourself having a more difficult time during this transition than others. For this reason, it is important to be aware of symptoms that signal PCOS may also be at play. 

Just like hormone imbalances during our reproductive years, there is much that can be done to improve your health and reduce or reverse your symptoms. While Pollie does not currently focus on postmenopausal PCOS, our team would be happy to point you in the direction of other helpful resources. Feel free to reach out to us at hello@pollie.co if you would like to chat. 


Carla Moss

FMCHC, NBC-HWC

Carla Moss is a Functional Medicine Certified Health Coach and a National Board Certified Health and Wellness Coach who has been health coaching since 2012.