What Happens When People With PCOS Go Through Menopause?

PCOS affects people assigned female at birth who are of reproductive age. It is usually characterized by elevated androgen levels (androgens are male hormones), irregular menstruation, fertility difficulties, and multiple small cysts on the ovaries.

Menopause usually occurs between the ages of 45 and 55 when your hormone levels change and your periods stop. If you have PCOS, you might be wondering how menopause will affect you.

This article explains how PCOS affects menopause, including symptoms and complications.

What is PCOS, and how does it affect people who have it?

PCOS is an endocrine condition that impacts the entire body, especially the reproductive system. Endocrine refers to the glands and organs that make hormones, which are then released into your bloodstream.

The exact mechanism that underlies PCOS is unknown, but it is thought to be related to the ovaries and the balance of various hormones, including insulin, luteinizing hormone (LH), androgens, and follicle-stimulating hormone (FSH).

90% of people with PCOS have abnormal ovarian androgen function. 50% of these people also have obesity, excess LH, and insulin resistance with compensatory hyperinsulinemia. In insulin resistance, your body doesn’t respond to insulin normally. This affects how your cells use the glucose in your blood as energy.¹

PCOS symptoms and signs differ from person to person, and range from mild to severe. Common symptoms include the following:

• An irregular menstrual cycle

• Unexplained weight gain

• Fertility problems

• Cysts on the ovaries

• Excess hair growth (hirsutism)

• Hair loss

• Oily skin and acne

Periods in PCOS may occur on a longer or shorter cycle. They can also be absent altogether. Improperly developed eggs may not be released. In other words, ovulation might not occur, causing these retained “eggs” to form small cysts.

In PCOS, the ovaries produce too much androgen hormone. Having excess androgen hormone in your body is called hyperandrogenism.

Most PCOS symptoms that women find bothering, such as excessive hair growth (hirsutism), hair loss, and oily skin, are caused by hyperandrogenism.

PCOS and menopause: Hormonal changes

Women with PCOS tend to experience improved and more regular menstruation as they age closer to menopause. This tends to be a function of age-related androgen decline.²

However, research has found that androgen levels in women with PCOS remain higher than in people without the condition even after menopause (even though they may be in the normal range).

A study published in 2015 looked at androgen levels in women with PCOS of different ages before menopause. It found that the highest androgen levels were seen in the 18–39 age group and that levels decreased with age. Researchers noted that women experienced a more regular menstrual cycle as they aged, attributing this to ovarian aging and declining androgen levels.³

Researchers in this study also noticed that while androgen levels gradually declined in the lead-up to menopause, they increased thereafter (this varied greatly from person to person). However, the difference in androgen levels seen between those with PCOS and those without disappeared after adjustment for BMI, suggesting that there’s a strong link between obesity and hyperandrogenism.

A follow-up study of older women with PCOS aged 72–91 years found that mean androgen levels in the women studied did not differ from the control group (women of the same age without PCOS). This further indicates that androgen levels in women with PCOS normalize with age.⁴

Despite this, researchers also found that hirsutism, a clinical sign of hyperandrogenism, continued to be more prevalent in the women with PCOS than those without. This suggests that while androgen levels may normalize with age, the effects of hyperandrogenism may continue after menopause.

Do people with PCOS reach menopause at the same time as others?

Less is known about the age of menopause in PCOS. Although there is no consensus, some researchers have demonstrated that people with PCOS reach menopause slightly later than normal, ranging from 2–4 years later based on the calculation method used.⁵ ⁶

People with PCOS who have irregular periods may miss the early signs of perimenopause (the transition period around menopause). Infrequent periods are normal during perimenopause, and you will not have gone through menopause until you haven’t had a period for 12 months.

How PCOS affects menopause symptoms

Women with PCOS may continue to experience androgen-related symptoms during menopause, as their androgen levels are still higher than people unaffected by the condition. However, these symptoms will decline in line with falling androgen levels.

During menopause, women with PCOS tend to experience more severe vaginal dryness, which can cause pain during intercourse. This effect is thought to be androgen-related. One theory is that people with PCOS may have a higher libido during menopause compared to controls, meaning they are more likely to notice vaginal dryness.⁷ ⁸

Vaginal dryness can be treated by using an internal and/or external vaginal moisturizer. Internal moisturizers are inserted into the vagina, while external ones are for your vulva. You can also use a water-based lubricant when sexually active to ease discomfort.

Another treatment option is an estrogen cream or tablet inserted into the vagina or an estrogen-releasing vaginal ring. This does not carry the same risk as systemic hormone therapy.

Is it possible to diagnose PCOS during menopause?

PCOS may not be diagnosed in people who have already reached menopause for several reasons.

Diagnosis depends on different criteria. The most commonly accepted criteria are the Rotterdam Criteria. Using these criteria, your doctor will diagnose PCOS based on the presence of at least oligo ovulation (irregular or infrequent periods) and hyperandrogenism.

However, when you reach menopause, your androgen levels may normalize. This rules out hyperandrogenism as a criterion. Little to no noticeable increase in androgen can make diagnosis impossible.

Furthermore, as menopause is defined by ceased ovulation, you won’t have the oligo ovulation characteristic either.

PCOS complications and menopause

PCOS is known to increase the risk of long-term health complications, including cardiovascular disease, type 2 diabetes, obesity, endometrial cancers, and mental health conditions. However, more research is needed to understand whether this increased risk carries over to the timeframe after menopause.⁹

A 2011 study demonstrated that postmenopausal women with PCOS have higher levels of insulin resistance than those without PCOS. Insulin resistance can lead to type 2 diabetes, cardiovascular disease, and many other health complications.¹⁰

Higher C-reactive protein concentrations have also been noted in women with PCOS after menopause, correlating with the risk of cardiovascular disease, stroke, and heart attack.

A controlled follow-up study also identified a high prevalence of high blood pressure (hypertension) and high triglyceride levels (hypertriglyceridemia) in postmenopausal women with PCOS.¹¹

Of note, the study did not find increased risk of heart attack, stroke, diabetes, cancer, or excess mortality when controlled for BMI.

Looking after your health after menopause with PCOS

Research indicates that women with PCOS are at increased risk for health complications post-menopause, including type 2 diabetes and cardiovascular disease.¹²

Risk assessments for cardiovascular disease are recommended for people with PCOS at any age, involving assessment for blood pressure, waist circumference, BMI, cholesterol, blood glucose, cigarette smoking, family history of cardiovascular disease, depression, anxiety, and quality of life.

To reduce your risk of serious complications, be sure to attend all appointments with your doctor so that they can assess your health.

Your doctor will recommend steps to take to reduce your risk of developing these health problems. These may involve taking medications or making lifestyle changes.

The American Heart Association (AHA) recommends making healthy choices throughout life, not just when you reach menopause. The healthy choices they recommend include the following:¹³

• Consuming a healthy diet. Focus on your intake of fruits, vegetables, nuts, whole grains, lean vegetables, animal protein, and fish. You should minimize your intake of trans fats, red meat, processed red meats, sweetened drinks, and refined carbohydrates.

• Do enough exercise. For adults, AHA advises doing at least 150 minutes per week of moderate-intensity physical activity (accumulated; not all at once). You can also do 75 minutes per week of vigorous-intensity physical activity.

• Quit smoking cigarettes. Ask your doctor for help and guidance if quitting is difficult for you. There’s help available, including smoking cessation programs.

• Reduce your alcohol consumption. Moderate your alcohol consumption by sticking to one drink or less per day for women and two drinks per day or less for men on days when alcohol is consumed.

The lowdown

PCOS does not go away at menopause. It may also impact the symptoms experienced during perimenopause, with some (such as hot flashes) being less common and others (vaginal dryness) more so.

As people with PCOS already have increased androgen levels, their hormones do not change in quite the same way at menopause. Research indicates that androgen levels in people with PCOS normalize with age, but they still tend to be higher than in people without the condition.

Having PCOS increases your risk of serious health complications. Researchers have found that postmenopausal women with PCOS have higher levels of insulin resistance than control groups, increasing the risk of developing cardiovascular disease and type 2 diabetes.

Attend all your regular screening appointments and follow guidance on exercise and healthy eating to lower your risk of poor health later in life.