What Happens to Women with PCOS as they Age?

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Until recently, the focus on PCOS has been during the childbearing years as PCOS has been primarily viewed as a reproductive disorder. Questions about what happens when women with PCOS age have remained elusive. For example, does the syndrome get worse and if so, how worse? Or, does PCOS get better after menopause? Could PCOS simply disappear altogether? We now have the answers to some of these questions as researchers are now exploring what happens when women with PCOS transition through menopause. The news is good and not so good. Let’s first start with the reproductive hormones.

The Effect Of Age On Reproductive Hormones

So what happens to leutinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone and all those other reproductive hormones that have made PCOS so difficult to live with thus far? Well, it looks as though the sex hormones improve with age but remain different in women with PCOS than those without the syndrome.

In a prospective study, Schmidt and colleagues reexamined women with PCOS whom they first examined 21 years prior and matched them with non-PCOS women. They found that total testosterone does gradually decrease to “normal” age-related levels by age 61 and that DHEAS declines with age but doesn’t reach “normal” levels until 20 years after menopause. Older women with PCOS still had lower levels of sex-hormone binding globulin (SHBG), a hormone that binds to testosterone, and higher free androgen index (FAI) than controls. Lower levels of FSH persisted after menopause. This evidence led the researchers to conclude that women with PCOS reach menopause later than women without the syndrome and differ in reproductive hormones.

What else did they find? Good news: overall, women with PCOS experienced more regular periods as they aged due to androgen decreases. Improvement in menstrual regularity may occur earlier than you think: women in their early 30’s started to see regular periods, suggesting that women with PCOS may have a better chance of conceiving as they get older. Older women with PCOS reported less hot flashes and sweating than non-PCOS women but reported significantly more hirsutism (64%) compared with controls (9%). So it looks as if some sex hormones and menstrual cycles eventually get better for women with PCOS as they age. However, the effects of high androgen levels such as hirsutism, persist past menopause.

Weight And Height Changes In PCOS Women With Age

When Schmidt and colleagues measured the height and weight of the women with PCOS they first examined 21 years prior, they found that women with PCOS, like women without the syndrome, got shorter and had greater BMIs and waist-hip-ratios. Unlike the women without PCOS, women with the syndrome maintained their weight over the 21 year period. Body fat redistribution along with height loss explains why women with PCOS had larger waist circumference measurements and increased BMI values as they got older.

Metabolic Changes With Age

You may be wondering what happens with insulin and cardiovascular parameters as women with PCOS age. It has been established that women with PCOS have higher levels of insulin than women without PCOS, independent of weight. We also know that women with the syndrome have more inflammation as shown by higher C-reactive protein (CRP) levels and have more dyslipidemia (high triglycerides and low HDL the “good” cholesterol). Well, this is where the news is not good: insulin and other metabolic and inflammatory markers persist and worsen after menopause, but mostly if you are overweight.

In a cross-sectional study, Puurunen and colleagues examined pre-menopausal and post-menopausal women with PCOS and compared them to healthy controls. They found that post-menopausal women with PCOS had greater CRP levels, impaired glucose metabolism and insulin resistance than women without PCOS; levels worsened with age. This shows that women with PCOS are at risk for life-long health conditions such as type 2 diabetes, cardiovascular disease and metabolic syndrome.

There is some hopeful news: Evidence from 1345 women with PCOS found that aging increases insulin resistance in obese women but not in lean and overweight women with PCOS. In fact, women in the study who were not overweight or did not gain weight in menopause did not develop type 2 diabetes. Lean women actually improved their insulin levels as they got older.  Authors from the study suggested “if women with PCOS do not become obese they may exhibit a better metabolic profile during their reproductive years.”

Bottom line: PCOS does not disappear as women get older. Women with PCOS differ in reproductive hormones past menopause. Hirsutism symptoms such as unwanted hair growth and balding worsen with age. The most important findings are that metabolic parameters worsen in overweight women with PCOS, increasing their risk for life-long health issues beyond menopause. This supports the need for effective weight management treatment with diet and lifestyle along with early detection and treatment of PCOS.

If you’re interested in learing more about the changes of PCOS with age, PCOS: The Dietitian’s Guide has a whole chapter devoted to this topic.PCOS-Dietitian-Guide-3D

Livadas S, Kollias A, Panidis D, Diamanti-Kandarakis E2.Diverse impacts of aging on insulin resistance in lean and obese women with polycystic ovary syndrome: evidence from 1345 women with the syndrome.Eur J Endocrinol. 2014 Sep;171(3):301-9. doi: 10.1530/EJE-13-1007.

Panidis D, Tziomalos K, Papadakis E, Chatzis P, Kandaraki EA, Tsourdi EA, Macut D, Bjekic-Macut J, Marthopoulos A, Katsikis I. Associations of menstrual cycle irregularities with age, obesity and phenotype in patients with polycystic ovary syndrome. Hormones (Athens). 2015 Jul-Sep;14(3):431-7.

Brown ZA et al. The phenotype of polycystic ovary syndrome ameliorates with aging. Feril Steril 2001. 96(5):1259-65.

Schmidt J et al. Reproductive hormone levels and anthropometry in postmenopausal women with PCOS: A 21 year follow up study. J Clin Endocrinol Metabl. 2011;96(7).

Puurunen J et al. Unfavorable Hormonal, Metabolic, and Inflammatory Alterations Persist after Menopause in Women with PCOS. J Clin Endocrinol Metabl. 2011. 96(6):1827-1834.

Winters SJ et al. Serum testosterone levels decrease in middle age in women with the polycystic ovary syndrome. Feril Steril. 2000;73(4):724-9.

 

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Comments (24)
  • Karla

    May 16, 2012 at 11:00 am

    Just wanted to say THANK YOU for letting us know about PCOS in aging women!! A recent blood lab showed my CRP Ultraquant readings much higher than they should be :(. This information propels me forward to healthier eating and living!

  • Aneta

    February 10, 2015 at 11:01 am

    Thank you for this article. I have to say, I am finding (now in my 30’s) that my periods are finally regular, and had my first pregnancy (naturally) a couple of months ago. After living with this my entire ‘reproductive’ life, I have to say I am somewhat rather relieved with the results of this study. Of course with age, there is a long road ahead.

  • Jennifer

    July 5, 2015 at 11:01 am

    I don’t see any good news in this article at all except for women who are interested in birth which is not the case regarding my person. Even more hirsutism, even more weight gain, even more balding, even more being endangered by diabetes. The only message this article seems to convey is this one: at one point the only reasonable thing you should do as a PCOS-patient is to tie a rope around your neck! Thanks for cheering me up PCOS nutrition center!

  • Angela Grassi

    July 7, 2015 at 11:01 am

    Jennifer, There is good news for women with PCOS who are getting older who may have an easier time conceiving thanks to the lowering of tesosterone with age. While it’s not good news that symptoms of PCOS such as the hirsutism may not improve or could worsen, the good news is that knowing that risk for metabolic conditions like diabetes is increased. By being informed with this information, it is our hope that women with PCOS will be proactive and make choices to improve their health and prevent conditions like diabetes from developing. Posted by: Angela Grassi, MS, RDN

  • SusieQ

    September 8, 2015 at 11:01 am

    I’m curious, for those of us with hormonal acne from PCOS, does the acne improve/lessen/disappear as we near/enter menopause? I’m 45, close to menopause, and I’ve had moderate to heavy acne every day of my life since I was 11/12 yrs old. Blemishes heal slowly/I scar easily (I think from the insulin resistence). I’m so over it! lol

  • Cat

    September 23, 2015 at 11:01 am

    I agree with Jennifer that this information is discouraging. Angela, I am a 40 year old PCOS sufferer, diagnosed at age 18. I have attempted to follow the lifestyle recommended by doctors and have managed with some minor success to stabilize my hormonal levels. A year ago I was referred to my doctor to an endocrinologist to discuss my worsening hair loss and hirsutism, and was told that I may have been misdiagnosed originally because my blood work did not reveal significant abnormalities. After a lifetime of suffering from the symptoms of this illness and following a difficult to maintain dietary and exercise regimen, to then have my diagnosis denied altogether was infuriating. My lesson here was that if you manage to make small improvements through the recommended lifestyle, you will then be told you have imagined the whole thing and receive no support from the medical community when you need it most, particularly when aging. Angela, your very clinical response to Jennifer fails to address the grief, humiliation, and isolation women like us endure.

  • Kimberly

    September 23, 2015 at 11:02 am

    I have suffered the effects of pcos since I was in my 20’s. I am now 49. I am gaining more weight with age. Taking metformin and watching diet. I went to see a reproductive endocrinologist today. She wanted to do a fortune in lab work and put in a IUD. In order to balance hormones. She told me my pros would go away with menopause. Your website don’t speak of this. I am not sure where to find the correct information to help gain control of this disorder and menopause. Thanks! Kim

  • Gabby

    October 23, 2015 at 11:02 am

    Thank you for this. I’ve been curious as to know how PCOS will effect me later on in life. And I do want to have at least one child one day, hopefully. I’m 20 and was diagnosed with PCOS at about 16 and this is quite disheartening to hear, but it is good that we’re becoming more informed… Wish this disease was easier to deal with, and that doctors can understand it even more. My diet is really quite unhealthy, and I’m barely exercising, so my lifestyle and diet really needs to improve as soon as possible. I was on birth control and spironolactone a few years ago, but hated all the side effects (my asthma inhaler was interacting with the spiro and I was getting quite dizzy, with heart palpitations too). After a while of stopping the pills, my periods were not regulated and skipping for about a year. But, for about 11 months now I’m getting my periods every month and on time, (which, since puberty I’ve practically always had my period out of wack and skipping when not on BC) and yet with the regulated periods as of this past year, the facial and excess body hair has increased quite ridiculously. Now I’m starting to lose my hair a lot too 🙁 so I’m really going to fix my diet and exercise regime. Hoping to see improvements, wish I would’ve done this sooner honestly. I definitely do not want to go back to taking pills with a bunch of side effects and not actually fixing and improving my health. I’m so happy to be able to research and find sites like this one with such useful info. Thank you

  • Gina Oliveras

    November 6, 2015 at 11:02 am

    I’m thankful for the information in this article. I was just wondering how PCOS changes in menopause and I found out in this article. I wish they knew more about it too but the fact remains that they just don’t know. And while it can be frustrating, stressful and embarrassing, at times, I’ve accepted it. None of our bodies will function as they once did as time goes on and that’s ok. We just have to learn how to enjoy life even through the ups and downs of our bodies.

  • SH

    October 6, 2016 at 1:27 pm

    I agree with Jennifer and Cat. An increased risk for diabetes in menopausal PCOS women is NOT good news. To try to spin it as such is condescending.

    Being unnaturally hairy as a woman sucks. Losing hair, especially as a woman (it’s much more accepted in men), sucks. Unnatural weight gain sucks. You know what else sucks? Taking the time and trouble to go to a female endocrinologist for help, having one basic test done, and then receiving a condescending voicemail from her telling me I just need to keep on losing weight without medical help. She said oh, she understands how very frustrating it is to exercise (constantly) and to diet (starve yourself), but I’ll just need to keep at it. Oh, and I guess I just need to just get used to be unnaturally hairy and stop complaining about it.. Sure, you really understand there, lady.

    I wonder if doctors tell men whose hormones are out of whack that oh, they really understand how very distressing it is for him to be growing breasts, but hey, he’ll just have to live with it. And diet more.

    The only good news here may be that hot flashes seem to be diminished with PCOS menopausal women, and that menopause starts later. That’s it. Let’s not exaggerate the truth, people.

    There’s a lack of concern in the medical field for women in general, and for women with PCOS in particular.

  • Ali Browning

    October 6, 2016 at 4:33 pm

    I can vouch for it that PCOS still affects women after the menopause, I had my womb, ovaries and tubes removed due to cancer ( having never been been pregnant as well as having done IVF ( it failed) is a risk for womb cancer) Now I have still got the excess hair to deal with, the waxing,plucking and shaving, the beard, the tache, the breast and belly hair and legs and arms hairier than many men. I also have apple shaped weight gain and now Diabetes type 2. I always was apple shaped with age my legs have got even thinner and my belly bigger so I have that typical barrel shaped middle aged woman figure with funny, sad little thin legs. PCOS has caused three major problems for me besides the horrible body shape, hairy face and body and skin tags, it has made me infertile, had a brush with cancer and now Diabetes type 2, the affects of this illness will be with me for life. Ever since I got a downy dark moustache and hairy arms at age 11 I knew life was not going to be easy.

  • Jacqueline Beere

    November 3, 2016 at 5:43 pm

    I am almost 47 and since age 31 have been on Cyproterone acetate and Dianette to control PCOS symptoms, My doctor is increasingly concerned that I should come off the hormone meds soon. I have been peri menopausal since around age 43.
    In the past I tried to come off these meds a few times and when I did, all the symptoms returned with a vengeance, hair loss was the worst thing, I know that if I come off these meds again I will have horrendous hair loss and I am terrified, I have no one to talk to about this as I don’t know anyone else going through or who has gone through this.
    I don’t know how I will cope with losing so much hair again. Is there anything at all that I could take as an alternative to slow down or stop my hair falling out? I haven’t found any empathetic consultants in the past, no one really seems to know how to treat this very complicated and distressing condition, it is, as Teresa Chung once described, the most neglected horomone problem. If trans women can get their hormone meds no problem, why can’t we?
    Many thanks
    Jacqui

  • Deb

    January 5, 2017 at 8:34 pm

    I am 63 years old & was not diagnosed with PCOS until my surgeon removed my cervix, ovaries, fallopian tubes & uterus at 48 years old due to endometrial cancer, endocervical cancer & uterine cancer. I was a chubby child with an apple body shape, my menstruation started at 12 1/2 years old, I never had another period for 1 year, then maybe 2 periods a year until I was 23 & became pregnant. My doctor treated me with a cocktail of 2 hormones to being on my periods when I was 18 through 22 years old. 3 years after my 1st child I delivered another & my periods began to come more regular, although I did not use birth control I never became pregnant again. I had a lot of hair on my chin since & was 13 & plucked everyday of my life, still do but it has lessened. I did manage to lose weight, however my body structure is more manly, fat upper back, broad shoulders, large waist & thin legs, no hips & flat butt. I always say I look like an upside down bowling ball. I have always dreamed of a more womanly body like other girls. My saving grace is my face. I do have high cholesterol & triglicerides & high blood pressure, take bp meds & I take Crestor, also have a somewhat fatty liver & teter on type 2 diabetes. I don’t drink. A CT scan taken 6 years ago showed 2 adrenal adenomas. I do suffer from anxiety & depression at times but I am able to control this , I try to always be upbeat & happy & laugh a lot. I am 1 of the lucky ones, I have 2 daughters & I thank God for that. Why does my doctor not treat me for this. Is there any treatment that would help me. I read a study on resveratrol which looks very promising. I have ordered resveratrol & will begin soon. I hope it works. I agree with many regarding the down side. Wish I could just be normal….Any suggestions

  • Angela Grassi

    January 6, 2017 at 9:29 am

    Hi Deb,
    Thanks for sharing your struggles. You are not alone! Lifestyle modifications (diet, exercise, sleep, stress management) are the primary treatment approaches for PCOS, however, as women get older, they do become more insulin resistant or in your case, pre-diabetes. In that case, treatments to help reduce insulin resistance are important. This includes medications and supplements such as NAC and Ovasitol http://www.pcosnutrition.com/product-category/supplements/. Both fatty liver and pre-diabetes can be reversed. Here’s an article on fatty liver:http://www.pcosnutrition.com/fattyliver/

    If you aren’t happy with your current care or want a more aggressive approach to managing your PCOS, we advise you to talk with your doctor or to get a second (or third!) opinion with a different doctor.

    If you need help managing your food and nutrition, email us at info@PCOSnutrition.com.

  • Trisha

    January 26, 2017 at 8:33 am

    I am 26. I was diagnosed with PCOS when i was 18. Since then i have undergone treatment such as metmorfin or so. I have 6 to 7 periods a year. I find very difficult ti loose weight especially in the waist areas. The main problem i am facing is that i have tremendous hair fall and no growth. My scalp is totally visible now. I have seen dermatologists but no use. Its worsening day by day. What can I do ?

  • Angela Grassi

    January 26, 2017 at 9:22 am

    Hi Trisha, Hair growth and weight gain are 2 of the biggest struggles women with PCOS face. You may want to look into Ovasitol to help reduce testosterone which will help to regulate your menstrual cycle even more and possibly help with hair and weight. It also helps to reduce insulin. Here is a link to it: http://www.pcosnutrition.com/product/ovasitol/

    We also provide individual nutrition coaching for PCOS to help you take control over it. Email us at info@PCOSnutrition.com if you are interested in this.

    There is also a medication called spironolactone (aldactone) which works very well to regrow hair and prevent more loss. Ask your doctor about it.

  • Lisa

    March 20, 2017 at 6:31 pm

    Hi ,I am 47 I was diagnosed with PCOS via ultrasound at 27 years old I had the typical strand of pearls (pcos) ovaries and I was not having cycles at all, But I started having regular cycles on my own at 38 and now at 47 I am having perfect 28 day cycles like clockwork, I am trying to conceive and I read about MYO increasing egg quality so I started taking it but I am worried that the MYO inositol might lower my DHEA which is working for me at this age so I started low dose DHEA just 25 mg this cycle and I am not sure if I even ovulated because I am not having the typical progesterone symptoms ( sore BBs etc.) that I normally get in the 2ww. Should I stop the DHEA and MYO since I was ovulating fine on my own anyway?.. I am also on vitamin D , CoQ10 pqq and folate.

  • Angela Grassi

    March 20, 2017 at 7:20 pm

    Myo can not only reduce the risk of metabolic complications, but can improve egg quality. We can’t give you a yes or no answer because we don’t know more about you or your labs. Feel free to contact us at info@pcosnutrition.com if you would like to schedule a PCOS nutrition supplement check up.

  • Lisa

    March 23, 2017 at 12:21 pm

    Thanks, I stopped taking DHEA for now, I am going to get in for a AMH test and see where to go from there. My last CD3 FSH was 6 but the doctor did not test AMH or androgens.

  • Tori

    March 29, 2017 at 8:50 am

    I am trying to figure out what is the best route for me… I am 42, I’ve had my kids, had a Mirena IUD placed after I had a miscarriage (didn’t even know I was pregnant)!! Husband finally agreed to a vasectomy (1 year later)… in June 2014, diagnosed with Hashimoto’s thyroiditis, then in August 2014, I was diagnosed with Relapsing Remittal Multiple Sclerosis… PCOS diagnosed in 2004…
    so now it’s a what do I do with all this!?!?! My mom had uterine cancer at 48 & had hysterectomy, 6 years later- she died of lung cancer- I am convinced my mom had undiagnosed PCOS… so… do I continue with a hormonal IUD or do a hysterectomy?? So many things to consider…it’s overwhelming at times…

  • Lucia Alexander

    March 29, 2017 at 4:13 pm

    A very interesting and informative article, many thanks. I was diagnosed with PCOS at the age of 42 . I am now 69 years of age and have incredible difficulty with weight. Thank you for your article.

    Kind regards Lucia

  • Liz

    April 24, 2017 at 6:46 am

    Thank you to all the Dr’s and nurses and other healthcare workers who are doing this important research. Those of us with PCOS are very grateful that we have more knowledge and info. I was diagnised with PCOS in my late twenties after many years of infrequent periods and in my thirties several years of infertility issues. It took over 3 years of trying but Thankfully studying my fertile times with the old school “rhythm method” and metformin for two and a half years and then a round of Clomid took care of it. We have two healthy kids now 12 and 11. My second pregnancy happened without any medical help at all. Obviously with my kids being exactly a year apart, it happened very quickly after my first was born. I know learning about my cycle and my fertile time each month with natural fsmiky planning was a huge factor in me finally getting pregnant too. I am on the thin side mostly because I was an athlete growing up and into my twenties, and I continue to eat healthy and exercise regularly too. I believe this helps tremendously too.

  • Mamie

    July 1, 2017 at 11:30 am

    I am 69 years old and have excessive facial hair sinceI was about 15 years old. It is worse than ever now and want to know if it’s too late to do something to get rid of it. I was always told when younger that I was “shedding cysts” when I noticed clotting during my very heavy periods. I’ve asked every doctor I’ve ever met with, and was aways told there was no treatment that it was genetic and that I could try electrolysis, waxing, etc. Laser treatments seem out of my budget, but I’ve never actually contacted an expert. Any hope for getting rid of this beard? Have to shave day. Please!

  • Angela Grassi

    July 1, 2017 at 6:35 pm

    Hi Mamie, you are not alone! Many women find success with the medication spironolactone in reducing hair growth. We suggest talking to your doctor about it.

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