What Happens to Women with PCOS as they Age?
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.
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.
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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.