Polycystic ovary syndrome (PCOS) and the menopause

How to manage your symptoms of this lifelong condition

• Symptoms of PCOS can be similar to those experienced during the perimenopause
• How a testosterone deficiency can affect you
• Why HRT can be beneficial

Polycystic ovary syndrome (PCOS) affects the way the ovaries work. There are three main diagnostic features of PCOS:

1. irregular or absent periods
2. excess androgen (characteristically ‘male’ hormones that women also produce), which can lead to excess facial hair, male pattern hair loss, and acne
3. polycystic ovaries – a scan may show that your ovaries are enlarged, and may contain fluid-filled sacs (cysts) that surround the eggs.

At least two of these three criteria are required to diagnose PCOS [1]. However, more than half of those affected by PCOS don’t have any symptoms.

Around 1 in 10 women are thought to have PCOS [1]. It is often associated with women of reproductive age, because those who do have symptoms are most likely to become aware of them during their late teens and early 20s.

However, PCOS doesn’t automatically resolve when your periods stop and you reach the menopause. In fact, it is a lifelong condition and some of its symptoms are similar to those experienced during the perimenopause. This overlap of symptoms can make PCOS harder to diagnose and manage during the perimenopause and menopause.

RELATED: how can I diagnose my own perimenopause?

What happens to PCOS during the menopause?

During the perimenopause, levels of the hormones oestrogen, testosterone and progesterone begin to fluctuate and then decline and stay low forever. If you have PCOS, you may already have lower levels of oestrogen and progesterone (which helps to regulate periods and maintain a pregnancy) so these changes can make your existing symptoms worse.

People with PCOS also tend to have higher levels of testosterone but levels of testosterone reduce during the perimenopause and menopause. Women with PCOS often have symptoms of testosterone deficiency more than those without PCOS – these include memory problems, brain fog, reduced stamina, fatigue and low libido.

Both PCOS and perimenopause or menopause can cause the following symptoms or changes. If you are over the age of 40, these changes are most likely associated with the perimenopause rather than PCOS:

• irregular or missed periods
• fertility problems
• mood swings
• difficulty sleeping
• hair loss (general thinning in menopause, male pattern hair loss in PCOS)
• unwanted hair growth (e.g. facial hair)
• weight gain.

Some studies show that people with PCOS are less likely to experience hot flushes and sweating during the perimenopause and menopause, however they are more likely to report problems with vaginal dryness [2].

RELATED: more than a little vaginal dryness: how vaginal hormones can transform lives

Women with PCOS tend to reach the menopause an average of two years later than those who are not affected [3].

How can I manage my PCOS?

There’s no cure for PCOS, but symptoms can sometimes be managed through lifestyle changes such as eating a healthy diet, taking regular exercise and taking steps to improve your sleep.

Eating a Mediterranean-style diet is one of the best ways to help PCOS [4]. This type of diet involves eating plenty of vegetables, legumes/pulses/beans, whole grains, extra virgin olive oil, nuts and seeds, fermented dairy foods, fish and seafood, fresh fruit and eating little meat. Eating 30g of milled flax seed each day, perhaps stirred into breakfast, may also help reduce the inflammatory and glycaemic effects of PCOS [4].

RELATED: changing minds about food and diets with Dr Robert Lustig

These types of dietary and lifestyle changes may also improve more general symptoms of the perimenopause and menopause.

Your doctor may also be able to prescribe medication to help with PCOS symptoms such as excessive hair growth, irregular periods and fertility problems.

Can I take HRT?

Most people with PCOS can safely take HRT. As well as managing symptoms of the perimenopause and menopause, HRT can help reduce your risk of type 2 diabetes and cardiovascular disease, which is particularly beneficial as PCOS increases your risk of developing these conditions.

Replacement oestrogen can be given through your skin as a patch, a spray or a gel, or as a tablet that you swallow. If you still have a uterus (womb), you’ll also need a progesterone alongside this. The safest type of replacement progesterone is called micronised progesterone, which is branded as Utrogestan in the UK, and comes in the form of a capsule that you swallow and can sometimes be used vaginally. Alternatively, you can have a Mirena coil inserted into your uterus that will last for five years.

If you have PCOS, you’re likely to be used to having higher levels of testosterone, so you’re more likely to experience symptoms when levels begin to decline sharply during the perimenopause and menopause and stay low thereafter. As a result, you may benefit from taking testosterone as part of your HRT. Although it’s not currently licensed for women in the UK, testosterone is prescribed by many menopause experts and some GPs as it has many benefits including:

• increased energy and stamina
• improved muscle mass and strength
• better concentration, clarity of thought and memory
• improved sleep
• increased libido and sexual arousal.

Testosterone is usually given as a cream or gel, which you rub into your outer thigh or buttocks. It can also sometimes be given as an implant that is inserted under the surface of your skin.

You don’t usually need to have a blood test before treatment is started, but your doctor is likely to want to measure the testosterone levels in your blood after a few months, to ensure your levels are within the normal ‘female’ range.

RELATED: testosterone the forgotten hormone with Professor Isaac Manyonda

References

[1]. NHS PCOS diagnosis

2, 3. Sharma S., Mahajan N. (2021), ‘Polycystic Ovarian Syndrome and Menopause in Forty Plus Women’, J Midlife Health. 12(1):3-7. doi: 10.4103/jmh.jmh_8_21

4. Barrea L, Arnone A, Annunziata G, Muscogiuri G, Laudisio D, Salzano C, Pugliese G, Colao A, Savastano S. (2019), ‘Adherence to the Mediterranean Diet, Dietary Patterns and Body Composition in Women with Polycystic Ovary Syndrome (PCOS). Nutrients. Sep 23;11(10):2278. doi: 10.3390/nu11102278

5. Haidari F, Banaei-Jahromi N, Zakerkish M, Ahmadi K. (2020), ‘The effects of flaxseed supplementation on metabolic status in women with polycystic ovary syndrome: a randomized open-labeled controlled clinical trial’, Nutr J. 24;19(1):8. doi: 10.1186/s12937-020-0524-5