Polycystic ovary syndrome (PCOS) affects approximately 1 in 10 women of reproductive age. In other words, it’s fairly common.
But here’s what many women with PCOS don’t realize: this condition does not disappear once menopause is reached.
In fact, PCOS creates unique challenges throughout a woman’s life—from her teenage years through menopause.
Understanding how PCOS impacts your hormones at various stages of life can help you to make informed decisions about treatment and healthy lifestyle choices.
What Is PCOS?
PCOS is a hormonal disorder characterized by a combination of symptoms that can include:
- Irregular or absent menstrual periods
- Elevated androgens (like testosterone)
- Multiple small cysts on the ovaries
- Insulin resistance
- Weight gain, particularly around the abdomen
- Acne and oily skin
- Excess facial and/or body hair
- Hair thinning on the scalp
- Difficulty getting pregnant
While the exact cause of PCOS isn’t fully understood, we do know that it involves complex interactions between insulin resistance, inflammation, and hormone imbalances.
The PCOS Hormone Picture
Women with PCOS typically have several hormone imbalances that occur simultaneously:
- Elevated Androgens : Higher-than-normal levels of testosterone and other androgens cause many of PCOS’s most visible symptoms, including excess hair growth on the face and body, hair loss on the scalp, and acne.
- Insulin Resistance : Most women with PCOS have some degree of insulin resistance, where the body’s cells don’t respond properly to insulin. This leads to elevated insulin levels, which can trigger the production of excess androgens—creating a vicious cycle.
- Disrupted Ovulation : High androgen and insulin levels interfere with normal ovulation, leading to irregular periods or no periods at all. Without regular ovulation, progesterone production drops dramatically.
- Low Progesterone : Because ovulation is irregular or absent, women with PCOS often have chronically low progesterone levels, leading to estrogen dominance and its associated symptoms.
PCOS Through the Decades
The Reproductive Years (Teens through 30s)
During the reproductive years, PCOS management typically focuses on:
- Regulating menstrual cycles
- Managing androgen-related symptoms (like acne and excess facial and body hair)
- Addressing insulin resistance and metabolic health
- Managing weight
- Supporting fertility if pregnancy is desired
Many women are prescribed birth control pills to regulate cycles. However, this approach only masks symptoms without addressing underlying hormone imbalances.
Perimenopause and Beyond (40s through Menopause)
Here’s where things often get interesting—and confusing for both patients and doctors.
Many women assume PCOS will improve or resolve as they approach menopause. After all, if the problem is related to ovulation and reproductive hormones, shouldn’t it get better when those systems shut down?
Unfortunately, that’s not how it works.
While some PCOS symptoms may improve (like irregular periods once periods stop entirely), other aspects of the condition persist and can even get worse:
- Insulin resistance often increases with age
- Metabolic syndrome and diabetes risk remains elevated
- Cardiovascular disease risk stays higher than average
- Weight management continues to be challenging
- Androgen-related symptoms may persist or change
Additionally, women with PCOS face unique challenges during the transition to menopause that women without PCOS don’t experience.
PCOS and Menopause: A Complex Transition
When women with PCOS reach menopause, they’re dealing with two sets of hormone changes:
Standard Menopausal Changes
Like all women, those with PCOS experience declining estrogen production and the complete cessation of progesterone production. This brings with it all of the typical symptoms of menopause: hot flashes, mood changes, vaginal dryness, and bone density concerns.
PCOS-Specific Considerations
But frequently women with PCOS also have:
- Persistently elevated androgens (though levels may decrease somewhat)
- Ongoing insulin resistance
- Higher risk for metabolic complications
- Different optimal hormone ratios than women without PCOS
This means that typical hormone replacement approaches may not work well for women with PCOS. Their hormone therapy needs to be customized to address the symptoms of menopausal, as well as their underlying PCOS-related imbalances.
Hormone Therapy Considerations for PCOS
Given that women with PCOS typically have chronically low progesterone throughout their reproductive years, progesterone replacement often provides significant benefits at any age.
Bioidentical progesterone can:
- Help regulate cycles during reproductive years
- Improve sleep and reduce anxiety
- Balance estrogen’s effects
- Support metabolic health
Testosterone Needs Careful Management
This is where PCOS hormone therapy gets tricky. While many women benefit from testosterone replacement during menopause, women with PCOS often have higher-than-optimal androgen levels already.
An experienced provider will:
- Test androgen levels carefully
- Consider symptoms alongside lab values
- Use lower doses if testosterone replacement is appropriate
- Monitor for signs of excess androgens
Some women with PCOS may not need testosterone replacement at all, or they may need it only in very small amounts.
Addressing Insulin Resistance
For women with PCOS, addressing insulin resistance should be a priority at any age. This often involves:
- Metformin or other insulin-sensitizing medications
- A low-carbohydrate or Mediterranean-style approach to diet
- Regular exercise, particularly strength training
- Supplements like inositol, berberine, and alpha-lipoic acid
- Maintaining healthy body composition
Improving insulin sensitivity not only helps with weight management and metabolic health but also supports better hormone balance overall.
The Importance of Specialized Care
Managing PCOS and hormone replacement together requires expertise, and not all hormone therapy providers will understand the unique needs of women with PCOS.
Look for a provider who:
- Has specific experience treating PCOS across all life stages
- Understands the metabolic aspects of PCOS, not just reproductive symptoms
- Uses comprehensive hormone testing
- Individualizes treatment rather than using one-size-fits-all protocols
- Monitors both hormone levels and metabolic markers not less than every 6 months
- Adjusts treatment based upon your response
Comprehensive PCOS Management Beyond Hormones
While hormone therapy is important, effective PCOS management at any age requires a comprehensive approach:
- Nutrition A diet that supports insulin sensitivity—lower in refined carbohydrates, rich in protein, healthy fats, and fiber—is crucial for managing PCOS long-term.
- Exercise Regular physical activity improves insulin sensitivity, supports healthy weight management, and reduces cardiovascular risk. Strength training is particularly beneficial for women with PCOS.
- Stress Management Chronic stress worsens insulin resistance and hormone imbalances. Prioritizing stress reduction is an important aspect of PCOS management.
- Sleep Quality sleep is essential for hormone balance and metabolic health. Many women with PCOS struggle with sleep issues, which should be addressed as part of comprehensive treatment.
Living Well with PCOS at Every Age
PCOS is a lifelong condition, but it does not have to control your life or limit your health.
With proper hormone management tailored to your unique needs, including attention to metabolic health and comprehensive lifestyle support, women with PCOS can thrive at any age.
The key is finding a provider who understand that PCOS is not just a reproductive disorder—it’s a metabolic and hormonal condition that requires ongoing, individualized care throughout life.
Are you ready to optimize your hormone health with PCOS-informed care? Renew Youth specializes in personalized hormone therapy that addresses your unique needs at every life stage. Call us at (800) 8598-7511 or use our easy contact form to schedule your complimentary 30-minute consultation.