PCOS and Perimenopause – What Every Woman Needs to Know

PCOS affects up to 13% of women of reproductive age, according to the World Health Organization, with an estimated 70% of affected women remaining undiagnosed.¹ 

So, what exactly is PCOS, does perimenopause affect the condition, and if so, how? 

Bonafide Chief Medical Officer, Dr. Alyssa Dweck, helps break down the acronym, its associated symptoms, and what it means for those approaching their menopausal years.

What Is PCOS in Women?

Polycystic ovary syndrome (PCOS) occurs when small sacs of fluid (cysts) develop along the outer edge of the ovaries.² There is no one definitive cause of the condition, however, a complex combination of variables including genetics and hormonal imbalances can play a role;³ PCOS may also run in families and commonly starts in adolescence.⁴ 

Common PCOS symptoms may include:⁵

• Irregular periods, including absent, heavy, long, or unpredictable cycles
• Infertility
• Acne
• Excessive facial hair
• Hair thinning or baldness
• Weight gain
• Darkening of the skin
• Skin tags
• High levels of androgens—male hormones 
• High levels of inflammation

PCOS and Perimenopause

Many women with PCOS may wonder how PCOS will affect their menopause experience, and vice versa.

According to Dr. Dweck, there are a few important takeaways women with PCOS should be aware of as they approach this midlife, transitional period.

Can PCOS Cause Early Perimenopause?

The average age of menopause in the United States is 52, though perimenopause symptoms may begin eight to 10 years prior.⁶ For women with PCOS approaching perimenopause, however, timing may be different—and symptoms may overlap. 

“Limited research shows that PCOS seems to be associated with a later onset of menopause, on average,” says Dr. Dweck.⁷ “PCOS is marked by several signs and symptoms, which can be similar to those experienced during perimenopause, thus the recognition of perimenopause might be blurred.”

According to Dr. Dweck, those symptoms can include irregular menses and elevated androgens, resulting in acne, facial hair, and pattern baldness. 

While it may be challenging to decipher which culprit—menopause or PCOS—is responsible for the abovementioned symptoms, limited research suggests women with PCOS may reach menopause around two years later than women without PCOS.⁸

Will PCOS Symptoms Change During Menopause?

According to Dr. Dweck, how women with PCOS experience symptoms throughout menopause varies. While menopause is certainly no cure for PCOS, some research suggests certain symptoms may improve slightly as menopause nears. 

“In general, symptoms related to elevated testosterone levels, like acne and facial hair growth tend to improve during perimenopause,” says Dr. Dweck. “Despite testosterone/estrogen ratios changing, overall testosterone levels decrease with age. On the other hand, insulin resistance and metabolic syndrome may persist.”

While high androgen levels may begin to come down during perimenopause, perimenopausal women with PCOS still tend to have higher than average levels of these hormones compared to those without PCOS.⁹ However, periods may become more regular in midlife compared to younger women with PCOS—potentially boosting and prolonging fertility.¹⁰

How to Treat PCOS

Unfortunately, there’s no cure for PCOS, but with close monitoring, under the guidance of a healthcare professional you can potentially determine what lifestyle changes, medications, or therapies may help manage your specific symptoms.¹¹ 

Which of these therapies is right for each person often comes down to contraceptive needs, adds Dr. Dweck. 

“A lower androgenic or antiandrogenic activity progestin-containing combination oral contraceptive—including newer generation pills containing desogestrel or drospirenone—might be helpful for those sexually active and wanting to avoid pregnancy or maintain menstrual cycle control,” she advises. “Menopausal hormone therapy (MHT) could be considered for usual indications like vasomotor symptoms or bone protection. Oftentimes, an antiandrogen regimen containing spironolactone, which lowers free testosterone, can be helpful with symptom control.”

Other PCOS treatments may include: ^11,12,13

• Lifestyle changes that emphasize weight management, an anti-inflammatory diet, and consistent exercise regime
• Medications like birth control pills, progestin therapy, diabetes medications, or hormone medications
• Other treatments for symptom management like topical acne medication, and hair removal therapies, like creams or laser treatments

A Healthcare Provider Can Help

If you have been diagnosed with or suspect you have PCOS and have questions about its connection to perimenopause, a trusted healthcare provider can answer questions and provide guidance on the treatment options that may be right for you. 

Resources

1. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
2. https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC9705998/
4. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
5. https://my.clevelandclinic.org/health/diseases/8316-polycystic-ovary-syndrome-pcos
6. https://my.clevelandclinic.org/health/diseases/21841-menopause
7. https://pubmed.ncbi.nlm.nih.gov/40238089/
8. https://www.healthline.com/health/menopause/pcos-and-menopause#symptoms
9. https://www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443
10. https://www.verywellhealth.com/pcos-and-menopause-5211322
11. https://www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443
12. https://www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443
13.  https://www.hopkinsmedicine.org/health/wellness-and-prevention/pcos-diet
14. https://www.healthline.com/health/womens-health/exercise-for-pcos