Polycystic ovarian syndrome, or PCOS, is a chronic condition that affects a person’s reproductive hormones. In the United States, it is the most common endocrine disorder in reproductive-aged people with uteruses. People with PCOS typically have elevated levels of androgens, or male sex hormones. As a result, they experience symptoms like irregular periods, painful ovarian cysts, weight gain, and difficulty conceiving. In fact, many patients discover they have PCOS when they seek treatment for infertility.
According to the World Health Organization, PCOS affects anywhere from 8 to 13 percent of reproductive-aged women globally. Since it is a lifelong condition, those estimates include many women in their late 30s, 40s, and even 50s.
Although much has been said about the diagnostic delays associated with PCOS, there’s often a lack of information about what it’s like to enter perimenopause or menopause while living with this condition. It’s no surprise given the historical lack of funding for medical research on related topics like menstrual pain, and the cultural taboos that still surround menopause.
Many women are under the impression that menopause will “cure” their PCOS. That’s not totally accurate, explains gynecologist Dr. Ruth O. Arumala. “‘Cure’ is a strong word in medicine,” she tells Flow. During menopause, “a person’s PCOS symptoms may resolve, which is the language we like to use. But that’s really not a cure because the underlying issues are still there and may actually be exacerbated.”
One study from 2021 found that postmenopausal PCOS patients still have clear hormonal and metabolic markers of the condition.
This popular misconception illustrates a need for further education on PCOS and menopause. In honor of PCOS Awareness Month, Flow spoke with multiple reproductive health experts to better understand what people with PCOS can expect as they age. Here are their observations and advice for patients in this demographic.
PCOS patients might not realize they’re in perimenopause.
Menopause marks the end of regular menstrual cycles. It’s a natural biological process preceded by a transitional phase called perimenopause, during which a person’s periods become sporadic or irregular. This is usually when people begin experiencing disruptive physical and emotional symptoms, like hot flashes, vaginal dryness, or mood changes.
People who menstruate regularly won’t have a problem discerning if they’re in perimenopause. But if you have PCOS and don’t get your period every month, “you might not know that you’re not having a period because you’re going into menopause,” says Dr. Arumala. “And if they don’t have periods, they might not know that the symptoms that they’re having — such as night sweats, hot flashes, brain fogginess, lack of concentration, or weight gain — are due to perimenopause or menopause.”
If you’re experiencing any of the above symptoms, it’s worth talking to your doctor to determine what’s going on internally and what your options are in terms of treatment. Menopausal hormone therapy is generally not recommended for people with a history of cardiovascular disease, which is more common in PCOS patients. Again, it all depends on your personal history, so consult with your doctor about what’s right for you.
Your periods may actually become more regular as you age.
Dr. Heather Huddleston, director of the PCOS Clinic at UCSF, has observed that many people with PCOS actually menstruate more regularly in their 40s. “There is a natural decline in testosterone and ovarian reserve with age, so this leads to more normalized PCOS symptoms,” she tells Flow. For these patients, “if their cycles change again to become irregular with aging, then that may be a good indicator of menopause.”
To that end, PCOS patients should be mindful of potential pregnancies at midlife. When Dr. Arumala encounters pregnant patients in their 50s who didn’t know they were expecting, they usually have PCOS, she says. “They’ll come to the hospital complaining of abdominal pain” when they’re in fact pregnant. But since they’re PCOS patients, “they’re used to not having a period. So if they didn’t get their period for months, that didn’t bother them.”
So keep in mind if you’re having unprotected sex at midlife, don’t assume that your age or PCOS diagnosis will prevent you from getting pregnant.
Will having PCOS make menopause worse?
Again, menopause won’t automatically “cure” your PCOS — but it may alleviate certain symptoms, says Dr. Huddleston. Irregular periods won’t be an issue anymore, and hormonal symptoms like acne and excess body hair often get better as patients age.
But how does having PCOS affect the transition into menopause? While the condition isn’t associated with increased hot flashes during perimenopause, some research suggests that people with PCOS reach menopause approximately two years later than their peers who don’t have the condition.
This might not be the case for everyone, but it’s helpful to be aware of in case you end up experiencing perimenopause on a different timeline than other people your age.
Cardiovascular disease and type 2 diabetes are concerns for aging PCOS patients.
Since most PCOS patients initially seek treatment to address infertility, some stop consulting regularly with their OB-GYN once they’ve reached menopause. But this isn’t recommended, Dr. Arumala explains. Regardless of your age, “you want to make sure that you still are regularly seeing your physician to ensure that any long-term complications are treated and prevented as much as possible.”
For instance, having a history of PCOS increases your risk of developing serious conditions like cardiovascular disease and type 2 diabetes. The latter is because PCOS is strongly associated with insulin resistance. According to Dr. Huddleston, this metabolic vulnerability “[does] not necessarily get better and may get worse” with age. Recent research on the topic supports her observation.
Dr. Huddleston generally recommends that her postmenopausal PCOS patients check their blood glucose “once a year,” ideally with a fasting glucose and two-hour glucose challenge test. “Some people may find that continuous glucose monitoring is helpful and motivating,” she adds.
Dr. Arumala also suggests regular cardiovascular fitness screenings. If a patient has a high BMI, which is common among people with PCOS, dietary or lifestyle changes that promote weight loss can be helpful, too. As always, consult with your doctor to figure out which tests or preventative measures are best for you.
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