PCOS is often associated with fertility and menstrual health. But did you know it can persist into postmenopause?
We will be diving into the relationship between PCOS and menopause in this article. Read on to learn:
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:
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.
Below are several things to keep in mind when it comes to PCOS and menopause.
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:
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 Many experts believe our diagnostic frameworks to be outdated, and just because you were not not diagnosed with a hormone imbalance like PCOS earlier in life does not mean you did not have it (3).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.
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:
On the other hand, there are several symptoms to watch out for that may imply an underlying hormone imbalance like PCOS (5, 6):
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.
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.
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:
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.
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 email@example.com if you would like to chat.