PCOS and menopause

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women1, affecting an estimated 8-13% of reproductive-aged women2. It impacts hormone levels and can cause a range of symptoms. It is also associated with a variety of long-term health problems which can affect someone’s quality of life.

Menopause is a life stage that all women encounter. Due to declining oestrogen and progesterone, it can also produce a broad array of symptoms that may have a significant effect on an individual's physical and mental well-being. So, what happens when a woman with PCOS enters menopause?

In this guide, we explore polycystic ovary syndrome and menopause so that you can understand how they impact one another, what to expect during and after menopause and how to manage menopause with PCOS.

What is PCOS?

PCOS is a common condition that affects how the ovaries function. The exact cause of it is unknown, but it is related to abnormal hormone levels in the body, including high insulin which contributes to the increased production and activity of hormones like testosterone3.

The three main features of PCOS are:

Irregular periods or no periods - indicate that you do not regularly ovulate.
Excess androgen - elevated levels of ‘male’ hormones.
Polycystic ovaries – the ovaries become enlarged and contain many fluid-filled sacs (follicles) that surround the eggs3.

Other symptoms of PCOS include:

Difficulty getting pregnant
Excessive hair growth, usually on the face, chest, back or buttocks
Weight gain
Oily skin
Acne
Thinning hair and hair loss from the head3

Further, PCOS is associated with an increased risk of high cholesterol, diabetes and high blood pressure, which can put you at greater risk of developing cardiovascular disease or a stroke.3,4.

There is no cure for PCOS but there are lifestyle changes and medications that can help manage the symptoms.

How PCOS affects menopause

PCOS can influence the timing, symptoms, and overall experience of menopause. Women with PCOS often have irregular or infrequent ovulation during their reproductive years, which may lead to a delayed onset of menopause compared to those without the condition.

Perimenopause typically starts in your 40s or 50s, with the average age of menopause being 515. However, women with PCOS typically reach menopause about two years later than women without PCOS6.

During perimenopause, the levels of the hormones oestrogen and progesterone produced by the ovaries begin to decline, whether you have PCOS or not. As women with PCOS may already have lower levels of oestrogen and progesterone anyway, this reduction may make existing symptoms worse.

In women with PCOS, their excess androgen levels (testosterone) can also lower which may resolve some of the PCOS symptoms associated with high androgen levels6 but can also produce symptoms of testosterone deficiency including memory problems, brain fog and low libido.

Women with PCOS may experience the same menopause symptoms as women without PCOS. Some research suggests that people with PCOS are less likely to experience hot flushes and sweating during menopause but more likely to suffer from vaginal dryness1.

As some PCOS and menopause symptoms can overlap, it can be more difficult for women to be diagnosed with PCOS once they enter perimenopause6.

What to expect during and after menopause with PCOS

Menopause brings significant hormonal changes, which can affect how PCOS presents. While some symptoms may improve, others may persist or evolve, requiring ongoing management. Key changes and considerations to be aware of during and after menopause with PCOS include:

Changes to periods: In perimenopause, periods can become more regular for women with PCOS7. In comparison, women without PCOS may encounter changes to their period including increased irregularity.
Androgen-related symptoms: Excess hair growth or acne may lessen, but thinning hair can persist due to hormonal changes.
Weight and metabolism: Slower metabolism can increase the risk of weight gain.
Insulin resistance: PCOS-related insulin resistance may continue, raising the risk of type 2 diabetes.
Bone and heart health: Lower oestrogen levels can lead to reduced bone density and an increased risk of fractures. It can also affect cardiovascular health.

Does menopause cure PCOS?

Menopause doesn’t cure PCOS, but hormonal changes during this stage can alter how the condition presents. While ovulation stops, and some symptoms like irregular periods naturally resolve, other aspects of PCOS may persist.

Can you take HRT with PCOS?

Hormone replacement therapy (HRT) is generally safe for people with PCOS and can effectively manage menopause and PCOS symptoms as both are the result of hormonal imbalances. In addition, HRT reduces the risk of type 2 diabetes8 and cardiovascular disease9, which are higher in people with PCOS.

Learn more about what HRT is and how it can help in our guide.

Advice for coping with PCOS and menopause

Navigating PCOS and menopause can be challenging, but lifestyle changes and effective management strategies can help you feel more in control and improve your quality of life.

Diet

A balanced diet is essential for managing PCOS and menopause symptoms. Focus on whole foods, including plenty of fruits, vegetables, lean proteins, and healthy fats. Limit refined sugars and processed foods to help stabilise blood sugar levels and reduce inflammation10. Including foods rich in fibre, such as whole grains and legumes, can improve gut health and support hormone balance.

Adopting a Mediterranean diet combined with a low carbohydrate approach is shown to be beneficial for women with PCOS, particularly if they are overweight11. A Mediterranean diet can also improve well-being for menopausal women as it can reduce weight, blood pressure, and cholesterol levels12.

Exercise

Regular physical activity is crucial for both physical and mental well-being. Strength training helps maintain muscle mass, while aerobic exercises like walking or cycling improve cardiovascular health and insulin sensitivity which is why exercise is considered a first-line strategy in the management of PCOS13.

Regular exercise is also associated with a reduction in menopausal symptoms14 as well as improved mobility, a reduction in breast cancer risks and better heart health15, which are all important for women as they age.

Aim for at least 150 minutes of moderate exercise per week16, incorporating flexibility and relaxation practices like yoga to reduce stress and support joint health.

Sleep

Hormonal changes can disrupt sleep, making it important to establish good sleep hygiene. Studies indicate that sleep disturbances and disorders occur more frequently in women with PCOS17 and are reported by 40-60% of menopausal women18.

Create a calming bedtime routine, avoid screens before bed, and keep your sleep environment dark and cool. Managing stress through mindfulness or relaxation techniques can also promote better sleep quality.

Find out more about how menopause impacts sleep.

Medications

In addition to lifestyle changes, medications may help manage specific symptoms of PCOS and/or menopause. For example:

Metformin is often used off-label to improve insulin sensitivity and regulate blood sugar levels in women with PCOS19.
The combined oral contraceptive pill can be used to regulate periods, improve acne and slow down the growth of unwanted facial hair19.
Eflornithine cream can also be used to slow down the growth of unwanted facial hair19.
Anti-androgens are sometimes offered by specialists for excessive hair growth. A blood pressure medication called clonidine, and an epilepsy medication called gabapentin can help with menopausal hot flushes and night sweats20.
Veozah is a new and approved prescription for the treatment of moderate to severe menopause vasomotor symptoms21.
Selective Serotonin re-uptake inhibitors (SSRI) such as fluoxetine and citalopram are used in the treatment of anxiety and depression but can also be used to treat hot flushes22.
Oxybutinin, which is typically used to treat overactive bladder, has been shown to reduce hot flushes22.
Beta-blockers may help with anxiety, palpitations and vasomotor symptoms.

At Menopause Care, our team of specialists are experienced in helping women navigate menopause when they have coinciding health conditions, such as PCOS. If you’d like support in managing symptoms, reducing the risk of long-term health conditions and improving the quality of your life, book a consultation with a menopause doctor.

DisclaimerAt Menopause Care, we ensure that everything you read in our blog is medically reviewed and approved. However, the information provided is not meant to replace professional medical advice, diagnosis, or treatment. It should not be relied upon for specific medical advice.

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