PCOS after menopause: an ongoing metabolic condition

Polycystic ovary syndrome, or PCOS, is the most common hormonal condition in women of reproductive age, affecting between five and 10 per cent of women.

PCOS is the most frequent cause of irregular periods, but it’s more than a reproductive condition. It’s a metabolic condition that is linked to health issues such as insulin resistance, diabetes and sleep apnea.

“Insulin resistance is what underlies PCOS,” says endocrinologist Dr. Sheila Laredo, chief of staff at Women’s College Hospital. “Women with PCOS have a four to five times increased risk of developing diabetes. They have an increased risk of high blood pressure, abnormal cholesterol, fatty liver, sleep apnea, and probably increased risk of cardiovascular disease.”

An ongoing condition

Unlike some other gynecological conditions, PCOS does not end with menopause.

“Women sometimes lose track of the fact that they have PCOS after menopause because they’re not dealing with periods, but they forget about the other things they need to deal with, including things related to insulin resistance,” Dr. Laredo says.

Women with PCOS continue to have a higher risk of diabetes after menopause. It’s recommended that they have their blood sugar checked more regularly than guidelines suggests for people without this condition.

“They should think of themselves as higher risk, and their physicians should think of them at higher risk,” Dr. Laredo says.

Managing risks

PCOS treatment often means addressing the underlying metabolic condition.

“The best treatment we have for insulin resistance continues to be lifestyle: diet and exercise,” Dr. Laredo says. “Some of the drugs that we use in PCOS and in diabetes and insulin sensitivity are still not as good as lifestyle in terms of the outcome. So we always talk about lifestyle.”

Lifestyle changes may sound challenging for the many women with PCOS who struggle with weight issues. But Dr. Laredo stresses that the goals for treatment are achievable: losing five to 10 per cent of body weight.

“Five to 10 per cent weight loss in women with PCOS is often enough to improve regularity of periods,” she says, adding that diabetes research has shown that losing six to seven per cent of body weight can prevent diabetes in those prone to it.

“Medically, we’re not looking for the amount of weight loss that women think they need to be successful. Women think they need to lose 30, 50 or even 100 pounds. We’re looking for five to 10 per cent, so in a woman who weighs 200 or 250 pounds, we’re talking about 10, 12, 15 pounds. If you can do it and sustain it, can have a big impact.”

Although the metabolic issues underlying PCOS affect women’s health risks through their whole lives, those risks – and the symptoms of PCOS – are manageable.

“The predisposition to PCOS is always there, but for most women we can find a way of managing the different issues at different times,” Dr. Laredo says. “You can’t cure the underlying disposition but you can address a lot of the symptoms very, very well.”