There are a lot of misunderstandings and questions out there about polycystic ovarian syndrome (PCOS). Many women spend years getting a diagnosis and learning to manage symptoms. So it’s no wonder that, as you age, you may be asking the question: does PCOS go away after menopause?
I don’t have a PCOS diagnosis yet. Do I really need to get one?
Unfortunately, for a lot of women, a frustrating aspect of PCOS can be trying to get a diagnosis. As of 2019, as many as 1 in 10 women in their reproductive years deal with PCOS, and that number probably is even higher due to cases that go chronically undiagnosed. Other times, long waits to diagnosis can be a result of not having access to quality care or being told that symptoms don’t indicate PCOS (even when they do). Even if you’ve made it to menopause without an official PCOS diagnosis, it’s still important to find a physician who will investigate it.
PCOS often gets labeled simply as a hormone issue. Some women have even been told by their healthcare provider that PCOS is “just high testosterone” or “elevated androgen hormones.” That view is inaccurate and not in line with PCOS research. PCOS is a multi-system and multifaceted disorder. And there’s not just one type of PCOS. (You can read about the different types here.) In fact, even though PCOS may be behind about 70% of infertility cases, its effects are much more far-reaching than fertility or even just one part, or system, of the body.
Are there labs that can help with diagnosing my PCOS?
Unfortunately, no single lab test can diagnose or rule out PCOS. But there are labs that are helpful and that a provider may want to check if you or they suspect PCOS? Thyroid function, cortisol levels, a pelvic ultrasound, or other tests can help exclude certain conditions that may be causing your symptoms. Some other labs that can help provide clues in patients with suspected PCOS include:
- Testosterone, free and bound: usually elevated for your age
- Anti-Müllerian hormone (AMH): may be elevated
- Sex hormone binding globulin (SHBG): often low
- Luteinizing hormone (LH): may be normal or elevated*
- Follicle-stimulating hormone (FSH): may be normal or low*
- DHEA (a precursor to testosterone): may be normal or high
- Progesterone: may be low due to anovulation
- Estrogen: may be elevated, though not always
While your provider is evaluating you for PCOS, you’ll want to also evaluate your provider. He or she should take a full medical history and understand the symptoms you’re having. But you should also expect interpretation of your labs beyond whether or not they fit within limits, or reference ranges. For example, LH and FSH can return normal values with PCOS. It can be helpful for a provider to know to calculate the LH to FSH ratio. In women with PCOS, it’s often higher than 1:1. These types of things can help your provider keep an eye on you and if your symptoms are being managed.
What exactly do I need to be diagnosed with PCOS?
Even though labs can be helpful clues in ruling out other conditions and honing in on PCOS, two of the three following need to be present for an official diagnosis: hyperandrogenism (high levels of androgen hormones), ovulatory dysfunction, and polycystic ovaries.
What these criteria mean is that, despite the name polycystic ovarian syndrome, you don’t need polycystic ovaries for a diagnosis if you have ovulatory dysfunction and high androgens. It’s also possible to have polycystic ovaries and not have PCOS.
So, does PCOS go away after menopause?
Unfortunately, there’s no cure for PCOS right now, and it’s a lifelong condition. With PCOS, you may experience a slight delay in when you reach menopause. (Research shows many women with PCOS go through menopause about two years later than women who do not have the condition.) But it’s likely you’ll continue to have and need to manage symptoms in perimenopause, menopause, and after.
It’s really common for women to think that the hormonal changes we see in menopause will relieve their PCOS symptoms. But here’s the thing: in general, most women, regardless of type of PCOS, experience high androgen hormones and lower-than-ideal progesterone. Leading up to menopause, women experience declines in estrogen and progesterone. Testosterone, however, does not usually decline. In fact, testosterone is often a female’s dominant hormone postmenopause. This can exacerbate the already-high androgens women with PCOS already have and lead to a continuation of symptoms.
How important is it to continue to manage PCOS in perimenopause, menopause, and postmenopause?
If you have a PCOS diagnosis, you’ll want to make sure you manage the condition throughout your life. And it’s not just to minimize symptoms (although that’s important too!). Even though many women get told PCOS is only associated with high testosterone and infertility, the disorder carries other long-term risks that need to be monitored and managed—including in and beyond menopause. PCOS raises your risk for cardiovascular issues, sleep apnea, and endometrial cancer.
Something else to consider: insulin resistance is a common component in PCOS. More than one half of women with PCOS will go on to develop type 2 diabetes by 40 years old. In the U.S., diabetes is currently the 4th top cause of death for women. Among other hormones, the sex hormones estrogen and progesterone play a valuable role in managing blood sugar levels and how you respond to insulin. With those hormones on the decline in perimenopause, you may notice more variations in your blood sugar. Women in menopause, even without PCOS, are at greater risk for diabetes. Menopausal women with PCOS need even more careful monitoring and to take diligent steps to lower their risk. Diabetes raises your chance of stroke, blindness, neuropathy, kidney disease, and heart disease.
Is there any hope for managing my PCOS symptoms in menopause?
Even though you may deal with it throughout your life, there’s so much hope PCOS. Whatever stage of life you’re in, there are options to manage your PCOS symptoms. Sometimes, medications are prescribed—from fertility medications to anti-estrogens to insulin and more.
But many women find lifestyle modifications manage their PCOS more than anything else. Movement, stress reduction, and including an integrative physician and dietitian on your PCOS healthcare professional team can all be really helpful. An integrative physician can evaluate what type of PCOS you have, so you can better understand your condition and make the right changes. Dietitians deeply familiar with PCOS create tailored nutrition advice and plans, along with support and guidance as your symptoms, inflammation, and other factors change and improve.