Menopause results from a gradual fall in female hormone levels, but polycystic ovary syndrome (PCOS) can stem from high levels of so-called male hormones. Symptoms of PCOS may continue into menopause.
PCOS leads to the development of ovarian cysts and other symptoms. One of the criteria for diagnosis is high levels of androgens, such as testosterone. PCOS can affect menstruation and fertility.
Though people often call androgens male hormones, they are also essential for females.
Menopause occurs when menstruation stops due to a reduction in the levels of the hormones progesterone and estrogen. After menopause, a person cannot become pregnant with their own eggs.
Both PCOS and menopause involve changes in sex hormones, but the processes are different.
Doctors can no longer diagnose PCOS after menopause, as the key features usually disappear. However, some research suggests that underlying changes persist into the later years. People with PCOS may have a higher risk of metabolic syndrome after menopause than those without, and some people continue to have symptoms.
This article explores the links between the two conditions, the key differences, and the treatments available.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
Is There A Link Between Menopause And PCOS?
A person enters menopause 12 months after their last period. In the United States, this happens at an average age of 52 years. Perimenopause, the time leading up to menopause, usually starts when a person is in their mid to late 40s and lasts around 4 years.
PCOS appears during the reproductive years, but there is evidence that some features are present before puberty, such as a higher number of follicles and metabolic changes. PCOS continues throughout a person’s life. In a person with PCOS, menopause may occur an average of 2–4 years later than in those without PCOS.
Research suggests that, even after menopause, people with PCOS continue to have different measures of sex hormones than those without.
During menopause, a person may experience symptoms of both PCOS and menopause. Some of these symptoms also overlap.
Role Of Hormones
Hormones play different roles in menopause and PCOS.
Hormones in PCOS
The symptoms of PCOS result partly from an imbalance in sex hormones. Experts do not know precisely why this happens, but it seems that genetic factors make some people more susceptible. Other health issues that may increase this risk are obesity and insulin resistance.
People with PCOS may produce a higher level of androgen hormones — such as testosterone — than usual.
Hormones In Menopause
Menopause results from a change in the balance of progesterone and estrogen over time. The changes start around 4 years before menopause happens. This duration between the start of these changes and menopause is called perimenopause.
In time, ovulation and menstruation stop, and a person can no longer become pregnant without medical assistance.
Does PCOS Change With Menopause?
As menopause approaches, periods become more regular for many people with PCOS. However, the hormonal changes that happen around menopause may not balance out the hormone factors responsible for PCOS. This is because not all cases of PCOS involve high androgens.
As such, menopause does not cure PCOS, but the experience and treatment of PCOS may change.
When PCOS first appears, often in adolescence, it mainly affects the reproductive organs and is primarily a reproductive disease. However, many people who develop PCOS during adolescence also have metabolic diseases, such as obesity and high blood pressure.
However, it also increases the risk of comorbidities, such as cardiovascular disease and type 2 diabetes — features of metabolic syndrome. After menopause, the inflammatory aspect of PCOS persists, and the risk of metabolic disease increases as people get older.
Symptoms And Diagnosis
Menopause and PCOS have some overlapping symptoms.
Menopause
Menopause usually occurs around the age of 52 years. Doctors define menopause as starting 12 months after a person’s last period.
Around menopause, a person may experience:
- hot flashes
- irregular menstruation, which eventually stops completely
- mood changes
- vaginal dryness and a fall in libido or sex drive
PCOS
PCOS begins during the reproductive years. Symptoms can appear at any age, but tests may detect PCOS from adolescence. Symptoms can appear 2–3 years after menstruation begins.
A doctor will diagnose PCOS according to the Rotterdam criteria. This means they will diagnose PCOS if a person has at least two of the following symptoms:
- irregular periods or no menstruation
- higher testosterone levels than usual, which may lead to acne, excess facial and body hair, and thinning scalp hair
- ovarian cysts
The doctor will also need to rule out other conditions that cause similar symptoms and resemble PCOS, such as hypothyroidism and steroid use.
A doctor can no longer diagnose PCOS after menopause because the key features disappear.
Similarities
The following may occur with both PCOS and menopause:
- irregular or missed periods
- difficulty becoming pregnant
- mood changes
- difficulty sleeping
- thinning hair on the head
- excess hair growth on the face or body
- weight gain
- depression
Differences
Symptoms of PCOS and menopause often overlap, but some symptoms are more typical of one than the other.
Symptoms more likely to occur with PCOS include acne and darkening of the skin.
Symptoms that are more typical of menopause are hot flashes and night sweats. Some researchers have noted that PCOS does not seem to increase the risk or severity of hot flashes during menopause.
Symptoms of PCOS can begin during the teenage years and continue throughout a person’s life, although they may change. The symptoms of menopause usually begin around the mid-40s and often fade away within a few years.
Treatment
Anyone who thinks they may have PCOS should seek medical advice. Currently, treatment cannot cure PCOS, but it can help manage symptoms.
A doctor may prescribe drugs to help balance hormones, such as hormonal birth control or medications to reduce androgen levels. Metformin, which helps manage glucose levels, may also have some benefits.
As a person with PCOS approaches menopause, they should speak with their doctor about what to expect and whether they recommend any changes to treatment.
People should also ask for medical advice if they have concerns about the effects of menopause. A range of hormonal and other treatments can help manage symptoms.
Lifestyle Remedies
Lifestyle remedies can also help manage some aspects of both PCOS and menopause.
Managing Weight
Weight gain can occur with both PCOS and menopause, increasing the risk of obesity, type 2 diabetes, and other conditions.
Ways of managing weight include:
- eating a varied and balanced diet that focuses on fresh fruits and vegetables
- avoiding fried foods and foods with added sugars
- exercising regularly
- speaking with a doctor or nutritionist about a weight management plan, if appropriate
Getting Enough Sleep
Both PCOS and perimenopause can affect sleep.
To improve sleep, a person can try:
- going to bed and getting up at regular times
- keeping electronic devices outside the bedroom
- having the room as quiet and dark as possible, with a comfortable temperature
- avoiding eating and drinking soon before bed
- being active during the day
Managing Unwanted Hair
Hormonal therapy can help reduce hirsutism, which is when a person has a lot of unwanted hair. A doctor can also prescribe a topical cream to slow facial hair growth.
For milder cases, people can try home methods, such as waxing, plucking, or hair removal cream. However, it is best to check first with a dermatologist, as some creams can have adverse effects.
Laser hair removal and electrolysis can have longer-term effects than waxing or cream, but they can be expensive. Always see a qualified and experienced practitioner for these treatments. There may be risks, and they can affect people in different ways.
Frequently Asked Questions
Here are some answers to questions people often ask about PCOS and menopause.
What happens to PCOS during menopause?
The hormonal imbalance that causes PCOS does not change over time, and PCOS does not go away with menopause.
Does PCOS make menopause worse?
PCOS and menopause share a range of symptoms, such as a risk of weight gain and an increase in facial and body hair. However, research suggests that a common feature of menopause — hot flashes — is not worse in people with PCOS than those without.
Does PCOS get worse with age?
The risk of metabolic syndrome, including cardiovascular disease and type 2 diabetes, may worsen with age in people with PCOS. However, menstruation often becomes more regular as a person approaches menopause.
Summary
PCOS is a hormonal condition that begins during the reproductive years. Menopause marks the end of the reproductive years.
PCOS and menopause share some features, but they are not the same, and menopause does not balance out the hormones that cause PCOS.
When a person has PCOS, their periods may become more regular toward menopause, and they may continue to have a higher risk of complications such as metabolic syndrome. However, some evidence suggests that lean people with PCOS have a lower risk of metabolic disease than other groups with PCOS.
People with PCOS often need medical treatment throughout their life to manage symptoms and reduce the risk of complications. During menopause, people can seek treatment to help manage symptoms, such as hot flashes.
Sources:
- Davis, S. R., et al. (2015). Testosterone in women — the clinical significance.
https://pubmed.ncbi.nlm.nih.gov/26358173/ - Do you get enough sleep? (2021).
https://www.cdc.gov/chronicdisease/resources/infographic/sleep.htm - Excessive hair growth. (2022).
https://www.nhs.uk/conditions/hirsutism/ - Fu, L., et al. (2022). The association between polycystic ovary syndrome and metabolic syndrome in adolescents: A systematic review and Meta-analysis.
https://link.springer.com/article/10.1007/s43032-022-00864-8 - Goyal, M., et al. (2017). Debates regarding lean patients with polycystic ovary syndrome: A narrative review.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5672719/ - Healthy weight, nutrition, and physical activity. (2022).
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https://www.womenshealth.gov/menopause - PCOS (polycystic ovary syndrome) and diabetes. (2020).
https://www.cdc.gov/diabetes/basics/pcos.html - Puurunen, J., et al. (2011). Unfavorable hormonal, metabolic, and inflammatory alterations persist after menopause in women with PCOS.
https://academic.oup.com/jcem/article/96/6/1827/2834493 - Rasquin Leon, L. I., et al. (2022). Polycystic ovary syndrome.
https://www.ncbi.nlm.nih.gov/books/NBK459251/ - Sharma, S., et al. (2021). Polycystic ovarian syndrome and menopause in forty plus women.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189332/ - Welt, C. K., et al. (2013). Lifecycle of polycystic ovary syndrome (PCOS): From in utero to menopause.
https://academic.oup.com/jcem/article/98/12/4629/2834024 - Williams, T., et al. (2016). Diagnosis and treatment of polycystic ovary syndrome.
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Important Notice: This article was originally published at www.medicalnewstoday.com by Lana Burgess where all credits are due. Medically reviewed by Amanda Kallen, MD
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