Ask any woman over 40 about perimenopause, and they’ll likely recall several uncomfortable symptoms and bodily changes.
Many women with polycystic ovarian syndrome (PCOS) may wonder if their experiences will differ.
Here’s an overview of PCOS and perimenopause and a few things you can expect.
A brief overview of PCOS
PCOS is a hormonal disorder that affects 7%-10% of females of reproductive age worldwide. Although little is known about the condition and its causes, excess male hormones — androgens and testosterone — are prevalent.
Endocrinologists and gynaecologists often diagnose PCOS based on whether you have two or more of the following symptoms:
Irregular periods or anovulation, in which the ovaries do not release eggs
Excess male hormones, which could cause unwanted hair, male-patterned balding and weight changes
Polycystic ovaries — tiny fluid-filled sacs on enlarged ovaries
It’s noteworthy that, despite the name, not all women with PCOS have polycystic ovaries, which is why ultrasounds aren’t enough for a diagnosis.
Perimenopause typically begins between 45 and 55 years old and lasts until you haven’t had your period for at least 12 months. At that point, you’re considered postmenopausal.
Generally, there are similarities between PCOS and perimenopause or menopause, such as the following symptoms:
Irregular or infrequent periods
Mood changes and depression
Hirsutism on the face, stomach or other parts of the body
Hair thinning or male-patterned balding
While you may experience night sweats with PCOS, traditional hot flushes are more common during perimenopause and menopause. A 2018 study suggested that PCOS did not impact the frequency of hot flushes in ageing women.
We have produced a symptom list to help you identify and track your own symptoms against the common list of symptoms.
Research has long shown that women with PCOS are at an increased risk of developing obesity, diabetes, cardiovascular disease, reproductive cancers and infertility due to hormones.
Yet, hormonal changes are unavoidable as the body naturally transitions into perimenopause.
The changes aren’t necessarily bad, though, as you may notice some of your PCOS symptoms subside or ease as you age. However, a diagnosis of both can prove challenging at times.
Here are eight things to know about going through perimenopause with PCOS.
1. PCOS doesn’t go away
After enduring PCOS during your reproductive years, you may look forward to not having it anymore. Unfortunately, PCOS doesn’t disappear once you’ve reached perimenopause and menopause.
Consider that normal follicle-stimulating hormone (FSH) levels are 10 international units per litre of blood (iu/I) or less. Women with PCOS tend to have higher FSH levels over 30 (iu/I) — those increased levels signal that the ovaries aren’t functioning correctly and may lead to anovulation and infertility.
In a follow-up study of PCOS patients between the ages of 72 and 81, researchers determined that FSH decreased since perimenopause, but women remained clinically hyperandrogenic. Hyperandrogenism is another term that refers to the body’s production of excess male hormones, resulting in unwanted body hair and weight gain, among other symptoms.
2. PCOS can delay or hurry menopause
Interestingly enough, you may experience delayed menopause with PCOS. Research is limited, but one study found that menopause sometimes occurs four years later in PCOS patients.
The reason for this was unclear, but experts ruled out smoking habits, which could have similar effects. Additionally, they found that ovarian function improved in some women with age. That leads some to wonder about the possibility of newly balanced cycles and hormones protecting the ovaries and delaying perimenopause.
This outcome is not the same for all perimenopausal women with PCOS, as some may reach it on time or transition earlier — called premature ovarian insufficiency (POI).
POI can be traumatic for many women who haven’t yet reached menopause age. If you are experiencing POI, listening to and reading about other women’s accounts of their body’s natural changes will help you feel less alone.
3. Lifestyle changes can help
Much can be said about lifestyle changes and the positive effects on PCOS and perimenopause. Current treatments for PCOS already lean into dietary changes and exercise, and women should continue managing their condition this way during hormonal fluctuations.
Weight gain is typical during perimenopause due to low estrogen levels and the loss of functioning ovaries. An uptick in stress levels during changes may also lead to emotional eating.
You could have higher cholesterol levels and a predisposition to metabolic conditions and cardiovascular disease as you reach perimenopausal age. Losing just 5%-10% of your body weight is significant for your overall health, especially with PCOS.
Reducing your body mass index (BMI) may also decrease your risk of developing osteoporosis, joint pain, degenerative bone disorders, and endometrial and uterine cancers. These conditions are common in perimenopausal women who are obese or overweight.
Women who reach menopause at 46 years old are 25% more likely to develop Type 2 diabetes. Meanwhile, those who reach menopause at 55 have a 12% higher risk.
In a broader view, 39% of women with PCOS have Type 2 diabetes compared to a 5.8% prevalence among the entire population — an occurrence that medical experts blame on obesity and high BMI.
PCOS already puts you at an increased risk of diabetes due to insulin levels — 65%-80% of PCOS patients have insulin resistance. Naturally, this could also result in heart disease later on. Women undergoing perimenopause should regularly check their blood glucose levels and sugar intake.
If you ever experienced night sweats during your reproductive years with PCOS, hot flushes may feel somewhat familiar, just slightly more uncomfortable. Nearly 80% of women have hot flushes during perimenopause, which could last between one and five minutes and occur several times a day.
A hot flush is a spontaneous episode of heat, sweating, and chills, sometimes accompanied by anxiety and a flushing sensation. Some women describe hot flushes as an “internal oven” that begins at the face, chest or neck.
Hot flushes are a direct response to hormonal fluctuations. The brain fails to understand why the ovaries aren’t creating enough estrogen, causing the blood to rush to the surface. You can speak to your doctor about hormonal therapy and other treatments to ease your discomfort if hot flushes are too intense and frequent.
Hormonal changes during perimenopause raise the risk of breast, uterine and endometrial cancers. There’s also evidence that PCOS can lead to cancer, particularly endometrial.
Women with PCOS have a 2.7 to four times higher risk of endometrial cancer — obesity, insulin resistance and age are the most significant risk factors for those in perimenopause. There’s also a threefold increase in breast cancer cases in PCOS patients during perimenopause.
You must speak with your doctor and monitor your body’s changes. Going for annual checkups, feeling for lumps in your breasts, and following up on medical exams and tests will ensure you catch potential cancers early and receive proper care.
Mood disorders are much more prevalent in women with PCOS. One study suggests patients have 3.78 higher odds of depression and 5.62 higher odds of anxiety.
There aren’t any clear answers as to why women with PCOS struggle with mood disorders, although some have pointed toward obesity, insulin resistance, infertility and hyperandrogenism as possible factors.
Of course, the transition toward menopause bears an increased risk for depression and anxiety, too. Negative moods and feeling frustrated are also common.
However, the previously mentioned study suggests there is a chance that PCOS and perimenopausal-related mood disorders may subside once women reach postmenopause. More research is needed to confirm this.
Hirsutism — hair growth on the chin and jawline, chest, stomach or elsewhere on the body — is a PCOS symptom that plagues many diagnosed women. Perimenopause may also cause different hair growth patterns.
Conversely, PCOS and perimenopause could induce hair thinning, too. According to research, hair loss affects 50% of women by the time they turn 50, while 80% of women experience hair loss by age 60.
Hair loss can be distressing for many women, often leading to low self-esteem, anxiety, depression, anger and isolation. Improving your diet may help if you experience thinning during perimenopause. You can also ask your doctor about potential treatment options to strengthen your strands and promote hair growth.
Learn more about how menopause affects your long-term health, including your susceptibility to cardiovascular disease, osteoporosis and pelvic floor dysfunction.
Change is inevitable with PCOS and perimenopause
Entering perimenopause is a rite of passage for women who’ve reached their mid-40s and 50s. Hormonal changes can prove even more frustrating when you have PCOS.
However, many women find some relief once they’ve hit postmenopause.
Self-care and healthy lifestyle changes can make your transition much more manageable.
Mia Barnes is a freelance writer and researcher who specializes in women’s health and wellness. Mia is also the Editor-in-Chief of Body+Mind magazine and a staff writer for sites like the SMSNA and the MedShadow Foundation.
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