The Impact of PCOS on Menopause: How it Can Affect Your Health

February 7, 2024
Pink cutouts of body organs affected by PCOS

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting 1 in 10 women during their reproductive years. While the underlying cause of PCOS is unclear, ultimately, symptoms develop from increased insulin production, causing increased androgens (often referred to as male sex hormones, though everyone has these hormones).

While PCOS can impact fertility, it doesn’t end when menopause begins. Many women experience symptoms of PCOS as they transition into menopause, though these symptoms may change.

Understanding PCOS

PCOS is characterized by a hormonal imbalance primarily involving an overproduction of androgens, such as testosterone. This imbalance can lead to a variety of symptoms, including:1

  • Irregular or missed periods
  • Unexplained weight gain
  • Anovulation causing fertility issues
  • Fluid-filled ovarian cysts
  • Excess hair growth, particularly on the face, chest, and upper thighs
  • Skin issues such as severe acne and oily skin
  • Thinning hair or hair loss on the scalp
  • Thickened, velvety patches on the neck
  • Impaired carbohydrate and lipid metabolism

Insulin resistance occurs when the pancreas produces insulin, but body cells do not respond to it correctly. In response, the pancreas produces more and more insulin until it burns out. High insulin and insulin-like growth factor 1 (IGF-1) levels increase the effect of luteinizing hormone (LH).

LH stimulates the ovaries to produce androstenedione and testosterone (androgens). When these androgens increase, they contribute to PCOS symptoms. Increased androgens and insulin stimulate fat cell production. Ultimately, these metabolic changes increase the risk of obesity and type 2 diabetes.

Sign says "Menopause, leave me alone." PCOS and menopause can both cause symptoms

PCOS and Hormonal Changes During Perimenopause

As women with or without PCOS approach perimenopause, estrogen levels begin to fluctuate more widely and eventually drop. The ovary decreases estrogen and progesterone production. A decrease in the number of viable follicles and oocytes (eggs) left in the ovary causes ovulation and fertility to end.2

During the menopause transition, androgen levels remain stable and may even increase. As the ratio of androgens to estrogens increases, women with PCOS may experience more insulin resistance, inflammation, and abnormal lipid metabolism, leading to increased abdominal (belly) fat.1

At the same time, the excessive androgen levels associated with PCOS can begin to decrease as the ovaries’ overall hormone production declines. This shift can alleviate some symptoms of PCOS related to high androgen levels. However, even during perimenopause, women with PCOS typically still have higher androgen levels compared to those without the condition.

PCOS and Menopause Onset

Contrary to the belief that PCOS might induce early menopause, research indicates that women with PCOS tend to reach menopause about two years later than their peers without PCOS. This delayed onset is likely due to the larger number of follicles remaining in the ovaries of women with PCOS.1

PCOS Symptoms During Menopause

While the symptoms of PCOS can change with menopause, the condition itself does not disappear. Some PCOS-related symptoms, such as irregular periods and fertility issues, improve and then resolve as a woman reaches menopause.3 The ovaries decrease androgen production. However, people with PCOS still have higher androgen levels than people without the condition.  

Furthermore, new symptoms associated with menopause, such as hot flashes, night sweats, and vaginal dryness, can also emerge. Overlapping symptoms between PCOS and menopause can make the transition challenging for many women.

Two older women exercising

Long-Term Health Risks Associated with PCOS and Menopause

PCOS doesn’t just impact reproductive health; it also carries long-term health risks that persist well beyond menopause. These include:1,3,4

  • Increased risk of type 2 diabetes and obesity
  • Higher likelihood of developing cardiovascular disease
  • Greater prevalence of metabolic syndrome
  • Enhanced risk of endometrial hyperplasia and neoplasia
  • Potential for elevated blood pressure
  • Increased likelihood of experiencing sleep apnea
  • Higher risk of experiencing anxiety and depression
  • Increased risk of fatty liver disease

When researchers followed women with PCOS over time, they found that waist circumference, cholesterol, and triglyceride levels increased in women with PCOS as they reached 40 to 50 years of age. Body mass index (a measurement of weight for height) increased in some women and remained stable in others.

Researchers found that the prevalence of type 2 diabetes was much higher in women with PCOS (39%) when compared with the general population (5.9%). This increased risk was linked to having a higher body mass index.1

Insulin resistance and other metabolic changes associated with PCOS increase in women without PCOS as they enter perimenopause. People with PCOS are exposed to these metabolic risk factors longer, which may increase disease risk. However, one longitudinal study did not show an increase in mortality and cardiovascular disease risk in women with PCOS compared to women without PCOS post-menopause.5

Managing PCOS and Menopause

There is no cure for PCOS, but the condition can be effectively managed.

Lifestyle changes, such as maintaining a healthy diet, engaging in regular physical activity, and getting enough quality sleep, can significantly improve PCOS symptoms. It is important to prioritize self-care when you are living with PCOS.

Medications, including diabetes drugs like metformin and hormone therapy, can also help manage PCOS symptoms and reduce health risks.

For menopausal symptoms, hormone therapy may be an option for some women. This treatment involves taking medications containing the hormones estrogen and progestin to balance out the hormonal changes that occur during menopause. Additionally, vaginal estrogen creams or tablets can help alleviate symptoms of vaginal dryness.

The Importance of Regular Health Checkups

Given the increased health risks associated with PCOS, regular health checkups are crucial. These checkups can help monitor blood pressure, cholesterol levels, blood sugar levels, and other critical health indicators. Routine screenings can also help detect any potential complications early, allowing for prompt treatment and management.


PCOS is a lifelong condition that doesn’t end with menopause. Maintaining a healthy weight through perimenopause and beyond can be challenging for people with and without PCOS. However, PCOS can make weight loss even more difficult because of insulin resistance.

If you are finding weight management difficult, talk with a dietician who is knowledgeable about PCOS and menopause.

If lifestyle measures are not enough to help you attain a healthy weight, talk to a treatment specialist at Invigor Medical about the many weight-loss plans available.

Get started today with a subscription for Lipo B12.

Frequently Asked Questions

What happens at menopause if you have PCOS?

Menopause in individuals with PCOS can vary, but it typically occurs around the same age as menopause in women without PCOS, which is usually between the ages of 45 and 55. However, PCOS may complicate the transition to menopause, potentially causing irregular periods and hormonal fluctuations.

What are the 4 stages of PCOS?

PCOS does not have distinct stages like some medical conditions. Instead, it is diagnosed based on specific criteria involving hormonal imbalances, ovarian cysts, and clinical symptoms. PCOS can manifest differently in individuals, and its severity may vary.

What is the average age of menopause with PCOS?

The average age of menopause for individuals with PCOS is generally within the typical range of 45 to 55 years, similar to women without PCOS.

What is the life expectancy of a person with PCOS?

PCOS itself does not significantly affect life expectancy. However, it is associated with various health risks, such as insulin resistance, obesity, and cardiovascular issues. Managing these comorbidities through lifestyle changes and medical interventions can help improve overall health and potentially impact life expectancy positively.

Author: Leann Poston, M.D.
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  • Sharma S, Mahajan N. Polycystic Ovarian Syndrome and Menopause in Forty Plus Women. J Midlife Health. 2021 Jan-Mar;12(1):3-7. doi: 10.4103/jmh.jmh_8_21. Epub 2021 Apr 17. PMID: 34188419; PMCID: PMC8189332.
  • Hall JE. Endocrinology of the Menopause. Endocrinol Metab Clin North Am. 2015 Sep;44(3):485-96. doi: 10.1016/j.ecl.2015.05.010. PMID: 26316238; PMCID: PMC6983294.
  • Shah D, Rasool S. Polycystic Ovary Syndrome (PCOS) Transition at Menopause. J Midlife Health. 2021 Jan-Mar;12(1):30-32. doi: 10.4103/jmh.jmh_37_21. Epub 2021 Apr 17. PMID: 34188423; PMCID: PMC8189337
  • Palomba S, Santagni S, Falbo A, La Sala GB. Complications and challenges associated with polycystic ovary syndrome: current perspectives. Int J Womens Health. 2015 Jul 31;7:745-63. doi: 10.2147/IJWH.S70314. PMID: 26261426; PMCID: PMC4527566.
  • Welt CK, Carmina E. Lifecycle of Polycystic Ovary Syndrome (PCOS): From In Utero to Menopause, The Journal of Clinical Endocrinology & Metabolism, Volume 98, Issue 12, 1 December 2013, Pages 4629–4638,
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