Polycystic ovary syndrome (PCOS) and menopause are both influenced by hormonal changes, but they affect the body in different ways. PCOS is a common endocrine disorder that begins during the reproductive years, often causing irregular periods, insulin resistance, and high androgen levels. In contrast, menopause marks the end of menstruation and is usually associated with symptoms like hot flashes.(1)
PCOS can have lasting effects beyond the reproductive years. Some women with PCOS may face a higher risk of conditions such as cardiovascular disease, type 2 diabetes, and osteoporosis during menopause. However, proper management, including lifestyle changes, medications, and regular health screenings, can help lower these risks. Consulting a healthcare provider can help determine the right treatment options and detect potential health risks early.
This article explores the connection between PCOS and menopause, highlighting shared symptoms, potential health risks, and effective management strategies to help women approach this phase with awareness and confidence.
Is there a connection between PCOS and menopause?
PCOS and menopause are conditions driven by hormonal changes, but they are distinct from each other. PCOS results from elevated androgen levels, which can cause symptoms like irregular periods, excess hair growth, and insulin resistance. In contrast, menopause occurs when estrogen and progesterone levels decline, marking the end of menstruation.(1)
These two conditions share several symptoms, including mood swings, sleep disturbances, thinning hair on the scalp, excess facial or body hair, and weight gain. These overlapping symptoms occur due to shifts in hormone levels, particularly in androgens and insulin, making it difficult to distinguish between the two.(1)(2)
How does PCOS affect menopause?
As menopause approaches, women with PCOS may notice shifts in their metabolism, heart health, hormones, and bone strength.(1)(2)
Metabolic Changes
As estrogen levels decline during menopause, the body tends to store more fat around the abdomen. In women with PCOS, this effect can be even more pronounced due to consistently higher androgen levels, which the adrenal glands continue to produce. Elevated androgen levels contribute to insulin resistance, a condition where the body struggles to use insulin effectively, leading to persistently high insulin levels.
This cycle further promotes fat accumulation in the abdominal area, increasing the risk of metabolic issues. Women with PCOS often have elevated HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) scores, indicating impaired insulin function. As a result, they face a higher risk of developing type 2 diabetes, especially those with a higher body weight.
Cardiovascular Health
Research shows that women with PCOS may have a higher risk of elevated blood pressure, lower HDL (good) cholesterol, and increased triglycerides during the menopausal transition — factors that impact heart health. These changes are often associated with long-standing insulin resistance and low-grade inflammation, both common in PCOS.
Although not all women with PCOS will develop heart problems, studies indicate that some may experience arterial stiffness or calcium buildup over time, which can increase the risk of heart disease or stroke.
Hormonal and Skin Changes
Although ovarian androgen production slows down with age, adrenal androgens often remain elevated in women with PCOS. This can prolong symptoms like facial hair growth (hirsutism) and thinning scalp hair. On the other hand, some women report fewer hot flashes, which may be linked to androgens influencing the body’s temperature regulation.
Bone and Joint Health
Bone density naturally declines after menopause, and women with PCOS may be at even greater risk. Years of irregular menstrual cycles, which reduce exposure to protective estrogen, can weaken bones. As estrogen levels drop further during menopause, the risk of osteoporosis and fractures increases, especially in those with long-term anovulation.
Emotional Well-Being
Hormonal fluctuations during menopause can cause mood swings, but for women with PCOS, the risk of emotional distress may be even greater. Insulin resistance and chronic low-grade inflammation, both common in PCOS, can contribute to increased anxiety, depression, and irritability during this stage of life.
Cancer Risk
Irregular periods in PCOS lead to prolonged exposure to unopposed estrogen — estrogen without the balancing effect of progesterone — which increases the risk of endometrial cancer. However, research has not established a clear connection between PCOS and breast or ovarian cancer.
Age at Menopause
Menopause occurs when the ovarian reserve (the supply of eggs) declines to a critical level. Women with PCOS often have a larger ovarian reserve, which may delay the natural decline of ovarian function.
Research suggests that women with PCOS reach menopause approximately two to four years later than average, likely due to higher levels of anti-Müllerian hormone (AMH), a marker of ovarian reserve.
Managing Symptoms of PCOS During Menopause
Managing PCOS during menopause requires a comprehensive approach, with a strong focus on lifestyle changes, particularly diet and physical activity. Both PCOS and menopause can contribute to weight gain and make weight loss more challenging due to hormonal changes, insulin resistance, and a slower metabolism. However, the right diet and consistent exercise can help manage symptoms and promote better health during this transition.
Dietary Changes
Diet plays a central role in managing both PCOS and menopause. Since insulin resistance is a common concern, adopting a diet that helps regulate blood sugar levels and reduces inflammation is essential.(3)
Low-Glycemic Foods: Choosing foods with a low glycemic index (GI), such as whole grains, legumes, vegetables, and fruits, can help manage blood sugar and improve insulin sensitivity.
Fiber: High-fiber foods, including leafy greens, nuts, and seeds, slow digestion and help prevent blood sugar spikes, making them especially beneficial for managing insulin resistance.
Healthy Fats: Incorporating foods rich in omega-3 fatty acids, such as fatty fish, chia seeds, and walnuts, can help reduce inflammation and support heart health.
Antioxidant-Rich Foods: A diet rich in antioxidants from berries, citrus fruits, and colorful vegetables helps combat oxidative stress, which is known to worsen insulin resistance and inflammation.
Exercise
Regular exercise is essential for improving insulin sensitivity, supporting weight management, and enhancing cardiovascular health. It also helps reduce oxidative stress and inflammation.(3)
Aerobic Exercise: Activities like walking, swimming, and cycling improve heart health and burn calories.
Resistance Training: Strength training builds muscle, boosts metabolism, and reduces insulin resistance.
Mind-Body Practices: Yoga and meditation reduce stress, improve mood, and support hormonal balance.
Medications
Metformin is an oral medication classified as a biguanide, a type of drug that helps manage blood sugar levels. While primarily used to treat type 2 diabetes, it’s also prescribed for managing PCOS, especially in women with insulin resistance.(4)
Research shows that women who use metformin alongside lifestyle changes, such as a healthy diet and regular exercise, often experience better outcomes than those who rely on lifestyle changes alone.
Although metformin can help manage PCOS symptoms during and after menopause, it’s not a standalone solution. It works best when paired with a balanced diet, regular physical activity, and other healthy lifestyle habits.
Spironolactone, a diuretic and aldosterone antagonist, is also used to help manage unwanted hair growth and acne related to PCOS. Additionally, glucagon-like peptide-1(GLP-1) medications can serve as helpful adjuncts to treat insulin resistance, manage or prevent weight gain associated with PCOS, and reduce the risk of progression to diabetes. GLP-1 is a naturally occurring hormone in the body that plays a key role in blood sugar regulation, appetite control, and metabolism.(4)
Can HRT help manage menopausal symptoms in women with PCOS?
Women going through menopause, whether they have PCOS or not, often experience similar symptoms, such as hot flashes, night sweats, mood changes, and sleep disturbances. Hormone replacement therapy (HRT) is a common treatment option that helps manage these symptoms by replenishing declining hormone levels during menopause. However, it’s important to note that while HRT can address menopausal symptoms, it’s not a treatment for PCOS and is not prescribed solely for managing PCOS-related concerns.(5)
The decision to use HRT depends on an individual’s health history, symptoms, and risk factors. The type and combination of hormones vary based on a woman’s specific needs. Women with PCOS considering HRT should consult their healthcare provider to ensure the treatment is tailored to their unique health profile and goals. Below are the key hormones commonly used in HRT and their roles:
Estrogen is the primary hormone used in HRT to relieve symptoms such as hot flashes, vaginal dryness, and bone loss.
Progesterone is recommended alongside estrogen for women with an intact uterus. It protects the uterine lining from overgrowth, which can occur with estrogen use alone and increase the risk of endometrial cancer.
DHEA (dehydroepiandrosterone), an androgen precursor, may be included in some cases to support energy levels, mood, and libido. However, it’s not routinely prescribed for women with PCOS. This is because PCOS already increases the risk of masculinizing physical changes (e.g., excessive hair growth, deepened voice, and male-pattern baldness), and additional androgenic substances may further exacerbate these effects.
Managing PCOS Through Menopause
PCOS may continue to affect women beyond menopause, but with the right management strategies, many symptoms can be effectively controlled. Lifestyle changes, medications, and HRT can help address both PCOS and menopausal symptoms. It’s essential for women to seek support from healthcare providers to receive a personalized management plan that fits their unique needs. With the right care and guidance, women with PCOS can maintain their health during menopause and beyond.
