A Guide to PCOS and Menopause

Polycystic ovary syndrome (PCOS) typically affects people of child-bearing age. Because of this, some people wonder if it stops once a person reaches menopause. The short answer is no, menopause does not cure PCOS. However, PCOS does manifest differently in perimenopause and beyond.

Read on to learn how PCOS and menopause are connected, including symptoms and management.

PCOS Hormone Levels During Perimenopause

Both PCOS and perimenopause (time leading up to menopause) cause hormonal changes and imbalances. People with PCOS have higher-than-average levels of androgens (hormones such as testosterone that typically are more abundant in people with testes, but also present in people with ovaries). This imbalance occurs with the onset of PCOS, regardless of age.

During perimenopause, everyone's ovaries, whether they have PCOS or not, start producing fewer hormones, particularly estrogen and progesterone (hormones that are more abundant in people with ovaries than people with testes).

When people with PCOS reach perimenopause, their excess androgen levels can also begin to lower as their ovaries produce fewer hormones overall. This can resolve some of the symptoms associated with high androgen levels.

Perimenopausal people with PCOS still tend to have higher androgen levels than perimenopausal people without PCOS.

Facts About PCOS and Menopause

While irregular menstrual periods are common in younger people with PCOS, as people with PCOS near perimenopause, their periods may become more regular.

People with PCOS may also have a longer reproductive period, reaching menopause about two years after their peers without PCOS.

Some research suggests people with PCOS who experience difficulties with fertility may have increased chances of conceiving as they get older.

PCOS Continues After Menopause

PCOS is considered a lifelong condition and needs to be managed even after fertility ends.

People without PCOS go through similar changes when they reach perimenopause and menopause as people with PCOS. Factors associated with PCOS commonly appear during perimenopause for people who don't have PCOS. These include:

• Increasing insulin resistance (body does not respond fully to the blood sugar–regulating hormone insulin)
• Fat gain around the middle abdomen
• Increased cholesterol levels
• Higher blood pressure
• Irregular or absent periods
• Symptoms such as facial hair growth

However, people with PCOS tend to experience these changes earlier, often before perimenopause and, therefore, are exposed to these risk factors for a longer amount of time.

PCOS May Increase Your Risk of CVD and Diabetes

People with PCOS have an increased risk of cardiovascular disease (CVD) and type 2 diabetes. It's unclear whether PCOS directly causes these conditions or if they are due to common risk factors such as obesity.

Most of the research on these increased risks have focused on premenopausal and perimenopausal people. It generally supports the existence of an increased risk for metabolic and cardiovascular disease in people with PCOS, particularly those with extra body fat.

Research on menopausal and postmenopausal people indicate that these risk factors continue (and often increase) past menopause, but the extent to which people with PCOS are at a higher risk than their non-PCOS peers has not been well-established.

This effect is not because the risks go down for people with PCOS, but rather because those without PCOS "catch up" as they age.

There may be some cases in which the risks do decline. One longitudinal study found that people with PCOS whose periods became more regular as they aged had a decrease in their LDL cholesterol (low-density lipoprotein, consider "bad" cholesterol) and had an improvement in their cardiovascular risk.

The same study found that people with PCOS who remained anovulatory (not ovulating) had increases in total cholesterol, LDL cholesterol, and non-high-density lipoprotein (non-HDL) cholesterol levels (a total of different "bad" cholesterol levels). Their cardiovascular risk remained significantly higher than in the general population.

Overlapping Symptoms

PCOS is a condition, while menopause is a developmentally normal life change like puberty. But just as puberty and PCOS can have overlapping symptoms, so can PCOS and menopause.

Some symptoms that can occur with PCOS and/or perimenopause and menopause include:

• Irregular or missed periods
• Infertility
• Weight gain, especially around the abdomen
• Mood changes
• Sleep difficulties
• Hair growth in areas such as the face and chest
• Thinning hair on the head

PCOS and Menopause Effects on Sex Drive

Sex drive and function aren't typically included in profiles of PCOS, but a small study suggests it should be. This study of 130 married people with PCOS who were experiencing infertility reported sexual dysfunction about 58% of the time. Sexual desire and arousal were listed as the main concerns.

It's theorized this is largely due to hormonal imbalance, body image, and the increased risk of depression, along with side effects of the medications that treat PCOS. These factors can also affect menopausal people.

Menopausal people can also experience changes in the vagina such as dryness that can make intercourse uncomfortable or painful.

Managing PCOS and Menopause

Both PCOS and perimenopause/menopause are managed in these two main ways:

• Lifestyle practices
• Medication (if necessary)

Lifestyle

Because both PCOS and menopause come with an increased risk of type 2 diabetes, CVD, and other health concerns, adopting healthy lifestyle habits is important. Ideally, don't wait for perimenopause to begin—the earlier these habits are adopted, the better:

• Eat a healthy diet: There is no single best diet for PCOS or menopause. For those with insulin resistance, a diet with a low glycemic index and glycemic load may help (these are measures of how a food or meal affects blood sugar levels). The DASH diet (Dietary Approaches to Stop Hypertension) is great for heart health. Some people with PCOS benefit from an inflammation-fighting diet. Stock up on non-starchy vegetables, lean proteins, whole grains, and healthy fats.
• Exercise: Cardiovascular exercise (such as running, brisk walking, and cycling) and strength-training exercises are beneficial for many conditions associated with both PCOS and menopause.
• Reduce body fat, if necessary: If you carry extra fat around your midsection, speak with your healthcare provider about healthy ways you can lose weight. Even a reduction of 5%–10% of body weight can improve PCOS symptoms.
• Sleep well: Get enough quality sleep. It may also be worth getting assessed for obstructive sleep apnea (in which breathing stops and starts repeatedly during sleep), which is common in people who are medically overweight.

Non-Medicinal Treatment for Specific Symptoms

These treatments can address symptoms:

• Hot flashes/night sweats: Try dressing in layers, sleeping in a cool room, using breathable bedding and clothing, avoiding foods and drinks that trigger your hot flashes, drinking cold water or fruit juice when a hot flash starts, or keeping an ice pack or ice water by your bed at night.
• Facial and body hair: Cosmetic procedures such as plucking, waxing, and shaving can remove hair temporarily. Electrolysis or laser treatment can help remove hair permanently.
• Vaginal dryness: Over-the-counter (OTC) lubricants can help make sex more comfortable.

Medication

If symptoms of PCOS and/or menopause can't be managed through lifestyle alone, medication may be an option.

PCOS

Medications include:

• Hormonal birth control: Most commonly, the combination birth control pill is prescribed. This is typically used to treat high androgen levels. It can pose higher risks in people over age 35, so your healthcare provider may not recommend it during menopause.
• Diabetes medications: Metformin is most prescribed. It helps the body process insulin.

Menopause

If medication is used for menopause, it is typically hormone therapy.

Hormone therapy:

• Usually involves estrogen and/or progestin
• May involve vaginal estrogen for dryness, inserted in cream, tablet, or flexible plastic ring form
• Should be started before the age of 60 years
• Is typically given for up to five years
• Is not recommended for people with a history of/high risk for some medical problems, including breast cancer, heart disease, and stroke
  

Reasons to Work With a Dietitian 

Maintaining a weight that is healthy for you is important both for people with PCOS and for people who are menopausal.

PCOS can make weight loss difficult, largely because of the associated insulin resistance. Menopausal people may also find losing weight more difficult than it used to be. This can be discouraging.

PCOS can cause strong cravings, particularly for sugar. Older people with PCOS who have struggled with food management over their lifetime may also have disordered eating practices to face.

A dietitian who is knowledgeable about PCOS, menopause, and how they interact can be beneficial to breaking down these barriers to weight management and healthy eating.

Summary

PCOS changes its manifestation but does not go away after menopause. People with PCOS continue to have an increased risk of conditions such as type 2 diabetes and cardiovascular disease. Some of the symptoms of perimenopause and menopause overlap with PCOS.

Both PCOS and menopause can often be managed with lifestyle habits. If lifestyle alone isn't enough to offer relief, medications are available.

A Word From Verywell

While PCOS isn't cured by menopause, it can be managed at any life stage. If you are experiencing PCOS symptoms, or if you find your PCOS symptoms have changed with the onset of menopause, talk to your healthcare provider about a treatment plan.