The truth about PCOS and menopause

Understanding PCOS as a long-term condition

Polycystic ovary syndrome (PCOS) is a hormonal disorder that’s often thought of as just a reproductive condition. While it does affect people with ovaries - mainly by disrupting ovulation and causing irregular periods - it’s actually a complex endocrine condition that can influence many aspects of your health, from metabolism to mood.

Dr Daniel Atkinson, Clinical Lead at Treated, in Greater Manchester, UK, explains that PCOS is characterised by complex hormonal imbalances, including high testosterone levels and insulin resistance.

“While these issues affect fertility, they can also affect life in other ways,” he says. “For example, many people with PCOS have a higher chance of developing cardiovascular diseases and type 2 diabetes. So saying it’s only a ‘reproductive condition’ is a bit of an understatement.”

Atkinson also points out that people with PCOS often go through menopause a few years later than average. That’s likely because they tend to have a higher ovarian reserve, as irregular ovulation means fewer eggs are released over time.

Some symptoms of perimenopause - particularly weight gain and mood changes - can be more severe in people with PCOS due to underlying insulin resistance and hormonal imbalances. In some cases, the condition can even worsen after menopause, potentially contributing to long-term inflammation, additional weight gain, and higher cholesterol levels.

Atkinson explains that this is largely due to persistently high testosterone levels, which are linked to these conditions, combined with falling oestrogen levels that reduce some of your body’s natural cardioprotective effects. As a result, people with PCOS may have a higher chance of cardiovascular disease, endometrial cancer, and other health issues.

During perimenopause, oestrogen levels decline significantly, while androgen levels usually decrease gradually. But in people with PCOS, androgen levels can still be disproportionately high after menopause. So while reduced oestrogen worsens insulin sensitivity and increases fat accumulation, at the same time, higher androgen levels in people with PCOS can contribute to insulin resistance by disrupting insulin signalling and increasing inflammation.

“Insulin resistance is a common feature of PCOS and often worsens with age and weight gain,” says Atkinson. “This creates a vicious cycle, where excess fat further worsens insulin resistance. This raises the likelihood of developing type 2 diabetes, overweight, and obesity in midlife.”

He notes that people with PCOS also have a higher chance of developing cardiovascular diseases even after menopause.

“Insulin resistance contributes to high blood pressure, elevated cholesterol levels, and long-term inflammation,” explains Atkinson. “Paired with the loss of oestrogen's cardioprotective effects during menopause, the chance of heart attacks, stroke, and diabetes increases.”

He adds that menopause can make some people more prone to mood changes, with depression and anxiety being particularly common. These effects can be amplified in those with PCOS, as the hormonal imbalances associated with the condition increase your vulnerability to mental health challenges.

People with PCOS should always talk to their doctor for guidance on how to navigate menopause with PCOS - particularly when it comes to diet, lifestyle changes, and medicines. Routine monitoring should include blood pressure checks, cholesterol levels, and blood sugar testing to assess your probability of cardiovascular disease and type 2 diabetes.

“It’s also important to regularly monitor your weight and focus on maintaining a healthy BMI,” Atkinson adds. “Living well with PCOS can look different for everyone. If you maintain a healthy weight and have normal blood pressure, cholesterol, and blood sugar levels, it can help reduce your chance of developing serious illnesses.

“Achieving this is easier said than done, but with the right diet, an active lifestyle, and appropriate medicine, it’s possible.”

Atkinson concludes by emphasising that PCOS doesn’t simply disappear once your periods stop. It’s a lifelong condition that requires ongoing monitoring and care to support a healthy, good-quality life.