PCOS & Menopause: Navigating the Shift

If you have PCOS, you might be wondering about how it affects menopause, and maybe aren’t quite sure whether to look forward to it or to dread it. Well, you definitely aren’t alone in having these doubts. While awareness about both conditions has been increasing in recent years, there are still many misconceptions that persist. For those living with PCOS, dealing with the changes can be more complicated, making open and honest conversations even more important. So here we are to help guide you through the journey.

Can you still have PCOS after menopause?

Since PCOS is primarily regarded as a condition that affects women in the reproductive-age group, many assume that it will resolve completely with menopause. Unfortunately, this is not the case. Although women with PCOS may experience relief from some symptoms with menopause, others persist and may even worsen as they are also linked with menopause.

A defining feature of PCOS is the hormonal imbalance in which women have higher than normal levels of male hormones like testosterone, causing a range of symptoms. During the onset of menopause (perimenopause), the production of hormones slows down. While this primarily involves a reduction in oestrogen and progesterone, levels of androgen can also fall, reducing some PCOS symptoms. However, this isn’t always the case, as studies indicate that levels still remain higher than normal for decades after menopause, posing a continued risk of certain chronic health conditions.

Does PCOS delay or cause early menopause?

Contrary to popular belief, there is no connection between PCOS and premature menopause. Instead, menopause onset is often delayed by a few years, and women with PCOS first tend to notice a normalisation of irregular periods during perimenopause. Although there’s still more to learn about the link between PCOS and late menopause, research has already shed some light on the subject.

Evidence suggests that the delay in menopause may be connected to higher levels of anti-Müllerian hormone (AMH) and antral follicles in women with PCOS. This means that there is a larger ovarian reserve in PCOS. Since menopause sets in as the ovarian reserve declines, its onset is delayed in women with PCOS.

PCOS symptoms that persist after menopause

With all of the hormonal changes ushered in by menopause, some imbalances may be resolved. In cases where androgen levels decline significantly, PCOS symptoms associated with hyperandrogenism will resolve. However, some studies indicate that despite the decline in hormone production, hyperandrogenism can persist after menopause. Moreover, not all PCOS symptoms are linked to high androgen levels, as there are other metabolic factors involved. 

PCOS symptoms and comorbidities that may persist or worsen with menopause include:

• Weight gain

• Anxiety and depression

• Insulin resistance

• Decline in memory and cognitive function

• Hypertension

PCOS & menopause diet: What to eat

Following a menopause diet after being affected by PCOS is not very different from a diet that you would follow to manage PCOS because menopause amplifies the risk of the same comorbidities, including cardiovascular disease and type 2 diabetes. A heart-healthy and low-glycaemic diet can help to lower these risks, while also protecting against age-related conditions such as cognitive decline that pose a higher risk when you have both PCOS and menopause. 

Such a diet should therefore comprise primarily of fresh fruits and veggies, especially those with high fibre content, including plenty of leafy greens, whole grains, and legumes. At the same time, ultra-processed, sugary, and salty foods should be eliminated from your diet as much as possible. To get adequate protein and fat, make sure to consume healthy sources such as fish, lean meats, eggs, nuts, and seeds.

Managing PCOS in menopausal years

Managing PCOS in menopause does not change much, as you will still need to follow the same dietary and lifestyle recommendations as you did when managing PCOS. In addition to the dietary recommendations, it’s important to get adequate sleep, lower stress levels, and exercise regularly with a combination of both cardio and weight training. This will mitigate many of the risks associated with PCOS and menopause, including heart disease, stroke, cognitive decline, insulin resistance, and diabetes. 

There are, however, a few added precautions that you should adopt for a healthy PCOS and post-menopause lifestyle. This includes getting more frequent health checks and screenings as recommended by your doctors to monitor various health parameters such as blood glucose and cholesterol levels. This will ensure that warning signs are detected early so that you can receive prompt treatment to prevent or delay the onset of complications.

Frequently Asked Questions

1. Does PCOS go away after menopause?

Unfortunately, PCOS does not go away after menopause, but some symptoms may become less severe. 

2. Does obesity affect PCOS in menopause?

Yes, obesity increases the risk of both PCOS and menopause-related symptoms, making it harder to manage. Entering menopause with excess weight is also associated with a higher risk of chronic disease.

3. Will menopause increase the risk of PCOS complications?

Both conditions can increase the risk of complications such as heart disease, stroke, and diabetes, but these risks can be mitigated with dietary and lifestyle changes, along with proper medical care.