If you are a woman with PCOS and have faced challenges since adolescence with irregular periods, body image issues and fertility, it is only natural to have gnawing questions regarding menopause in your midlife. All the hormonal havoc you have dealt with can make you wonder how menopausal hormone changes will interfere with your unique pattern or the lack of it. This article aims to help you make informed choices and navigate this transition with awareness.
A woman's body is an orchestra of hormones, each rising and falling at different times; the interplay of their levels plays a vital role throughout her life cycle. For women with polycystic ovarian syndrome (PCOS), this delicate balance is disrupted, resulting in a myriad of problems ranging from irregular periods, excess androgen levels, and polycystic ovaries to unwanted hair growth, persistent acne, infertility and insulin resistance.Â
To complicate things further, menopause brings on another hormonal shift, adding an extra layer of complexity to this imbalance. And often, menopause exacerbates PCOS symptoms, rather than providing relief. As the body adjusts to declining estrogen levels, women with PCOS may experience intensified symptoms along with additional problems, such as hot flashes, night sweats, mood swings, and weight gain, which are typical of menopausal transition.
This makes it imperative for us to understand the interplay of PCOS and menopause, and how navigating this hormonal roller coaster is the key to optimal physical and emotional health.Â
What is PCOS?Â
It is a complex condition involving an imbalance in the hypothalamic-pituitary-ovarian (HPO) axis, leading to increased androgen production and irregular ovulation. The exact causes remain unclear, but genetic, environmental, and lifestyle factors play a role. There is no direct, confirmatory test to diagnose this condition; it is usually diagnosed based on a combination of factors, such as the prevalence of symptoms, hormone tests, irregularity of menstrual cycles and ultrasound of the ovaries. While there is no cure, lifestyle changes and treatments for symptomatic relief can help.Â
How does PCOS impact health during menopause?
Research studies on the impact of this combination on health are conflicting, with some suggesting no significant correlation with health risks and others showing a noteworthy link.Â
Therefore, presented here, is data from a more recent study, a systematic review and meta-analysis from 2023, in which a comparison of controls with peri- and postmenopausal patients with PCOS showed that the women with PCOS had:
Increased circulating total testosterone, free androgen index and androstenedione (male hormones) due to changes in hormone turnover and the feedback mechanism
Increased BMI, waist circumference and waist-to-hip ratio together with increased insulin resistance and odds ratios for diabetesÂ
Decreased HDL and increased triglycerides, even though total cholesterol and LDL values were similarÂ
Increased risk of hypertension, myocardial infarction and stroke
Another study from 2021, specifically looking at women above age 40, showed that women with PCOS:
Reached menopause 4 years later than their age-matched controls
Had reduced HDL levels and increased triglycerides in middle-age
Cardiovascular risk normalised with age, except in a subgroup of PCOS women with high androgen levels even after menopause for whom the cardiovascular risk increased
Had less frequent hot flushes and sweating but vaginal dryness occurred more often
Presented less prevalence of hypothyroidism (hypothyroidism in postmenopausal women can amplify the symptoms of menopause and increase the risk of developing other health conditions)
Inflammatory and metabolic parameters worsened with age
How can I manage these combined challenges?
Given that PCOS does not disappear with menopause, it is best dealt with through a multifactorial approach that includes some or all of the strategies mentioned below:
Lifestyle modifications:Â In addition to diet and physical activity to maintain
optimal weight, growing research points to the significance of adequate, restful sleep and effective stress management in improving insulin sensitivity and CVD risk, thus also alleviating symptoms of both conditions. Practical tips are provided in the next section.
Medications:Â These usually target specific symptoms and underlying etiology rather than catering to the umbrella condition itself. Commonly used medications include hormonal therapies, insulin sensitisers, androgen blockers, pain relief or medications to address cardiovascular risk factors.
Hormone replacement therapy: HRT may help alleviate menopausal symptoms in general but there isn’t enough research to indicate additional benefits of HRT in women with PCOS.
Alternative treatment modalities: The use of natural herbs and supplements like inositol/myo-inositol, evening primrose oil, liquorice root, massage, and facial hair treatments are indicated but one needs to proceed with caution and do a risk-benefit analysis before trying these. It is best to check with your healthcare provider.Â
Regular symptom monitoring:Â Regular tracking of symptoms and check-ups with a healthcare professional are essential to monitor progression and keep symptoms in check.
What are some of the lifestyle modifications that can help?
A diet low in processed foods:Â The more processed food, the higher the likelihood that it is devoid of essential nutrients and facilitates insulin resistance. Swap out packaged snacks, processed meats, sugary treats for a Mediterranean-style diet rich in fruits, vegetables, whole grains, lean protein and healthy fats.
Regular exercise:Â Regularity in physical activity is the key to optimal health. While weight-bearing exercises are most helpful, you can even participate in activities that you may enjoy such as yoga, dance, swimming, walking, cycling, etc.
Stress relief and adequate sleep:Â Techniques like meditation, guided relaxation and deep breathing can alleviate stress and improve the quality of sleep.
Stay strong and disciplined
Understanding the complex relationship between PCOS and menopause has only recently gained scientific ground. What is clear is that the coexistence of these two conditions tends to increase the risk of various health conditions in women. But, with awareness and knowledge of management strategies and with adequate lifestyle modifications, there can be a significant improvement in quality of life.
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About the author
Kanchana is a Lifestyle Consultant & Weight Management Specialist. After a Masters degree in Molecular Biology from the USA, she ventured into the field of Nutrition and is certified in General Nutrition, Sports Nutrition, and Weight Management. Her own successful weight loss journey inspired her to help people of all age groups and health conditions via Calorie Culture, which she founded in 2012. She is also an avid dancer, mini marathoner, and sports enthusiast. She strongly advocates sustainable lifestyle changes as a means to long-term health benefits and optimal weight.
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