Guide authored by PCOS supplement provider, Fertility Family.
Despite affecting around 1 in 10 women in the UK[1] (making it the most common female hormone condition), polycystic ovary syndrome (PCOS) is still often misunderstood by many.
The condition is most broadly associated with problems getting pregnant, and so is often seen as running ‘in parallel’ with the years when a woman might expect to be fertile. However, with the right treatments in place, PCOS does not need to be a barrier to conception. Many women with PCOS go on to have healthy, successful pregnancies.
That said, the various other symptoms PCOS causes mean that it does not simply ‘go away’ when a woman stops being able to conceive. The onset of menopause is not a ‘cure’ for PCOS – other factors remain and can continue to affect a woman’s health and quality of life, way beyond the productive years.
What is PCOS?
PCOS is actually a ‘mixed bag’ of signs and symptoms. Many women who have PCOS will look very different from each other. There is no ‘typical’ as the condition is so variable. This means diagnosing PCOS is not easy, because the patients are often so different from each other (for example, some may be overweight, others lean).
PCOS is a syndrome characterised by having at least two of the following three signs:
- Menstrual cycle disturbances (irregular or absent periods) – this tends to indicate unreliable or absent ovulation (anovulation).
- Raised testosterone levels or signs indicating raised androgen levels, such as hirsutism (unwanted hair growth), hair loss, acne/overactive sebaceous glands in the skin.
- The presence, as seen on an ultrasound scan, of small multiple follicles in the ovaries (these are not cysts, and PCOS has nothing to do with ovarian cysts)
The condition often runs in families and can affect different women in different ways, with some experiencing symptoms more severely than others. If left undiagnosed or untreated, PCOS can lead to a range of complications in later life, which, as mentioned, may overlap with symptoms of the menopause and worsen health in this phase of women’s lives.
What are the symptoms of PCOS?
Because of the different aspects of the syndrome, PCOS can have any or all of the following symptoms:
- Unwanted hair, i.e., on the face
- Hair loss or thinning
- Acne
- Greasy skin
- Weight management challenges
- Over 20 immature follicles or swollen ovaries, visible on an ultrasound scan
- Infrequent or absent periods indicate a lack of ovulation, which can lead to infertility
Having said this, women with PCOS can be lean and not have any obvious skin or hair distribution issues, so the presentation of the condition varies considerably. PCOS symptoms often mimic symptoms of other health conditions, so it is important that a diagnosis is made correctly.
What happens during menopause if I have PCOS?
Perimenopause can start around age 40 or earlier, and is caused by the normal drop in the production of female hormones oestrogen and progesterone. It eventually ends in postmenopause, which is when very little oestrogen or progesterone is produced (technically, a full year without a period signals the start of the menopause).
The drop in oestrogens and progesterone during the perimenopause is known to trigger weight gain and can increase insulin resistance as well as the cholesterol levels in the blood.
Women with PCOS tend to reach the menopause an average of two years later than women without PCOS.
PCOS alone can often be linked to insulin resistance and weight gain. Treating PCOS well before perimenopause will reduce the chances of suffering from perimenopausal symptoms, such as hot flashes and poor sleep, and from serious health problems, like heart disease and endometrial cancer.
Is there a crossover in symptoms between PCOS and menopause?
Some symptoms of PCOS are similar to those experienced during the perimenopause (the period leading up to the menopause, often characterised by hot flushes, increasing PMS (pre-menstrual syndrome) symptoms and irregular periods). This can make a new diagnosis of PCOS during the perimenopause difficult, and symptoms are sometimes dismissed. However, it is important to diagnose and treat PCOS even after the age at which conception can occur.
“The most common cause of irregular periods is PCOS. In this case, ovulation trackers, such as LH surge detection kits, may not be helpful, as women with PCOS often have raised LH levels throughout their menstrual cycle. Many women entering the peri-menopause years may notice their periods become heavier and closer together. This can be true for PCOS women too and may result in pain, ‘flooding’ and anaemia.
If this is something you’re currently experiencing, I’d recommend speaking with a healthcare professional.”
Both untreated PCOS and the perimenopause can cause the following symptoms:
- Irregular or missed periods
- Difficulty conceiving
- Mood swings
- Low sex drive
- Sleep difficulties
- Thinning hair or unexpected hair growth
- Weight gain
Because PCOS is a lifelong condition and many of its implications can impact your long-term health, it is important to consistently manage the symptoms and address any concerns with your GP.
How can you manage PCOS during the menopause?
The crossover in symptoms means that there are a number of steps you can take that will help make PCOS, the menopause, and the perimenopause, in particular, more manageable:
Achieving good quality sleep
Both PCOS and the menopause can cause disruption to your regular sleep patterns. In order to sleep longer and better, you can:
- Try to go to bed and get up at the same time every night and every morning
- Avoid screens for up to two hours before bed, including ensuring you do not bring smartphones into the bedroom
- Get darker blinds in order to make sleeping easier during the lighter months
- Use wax earplugs to ensure background noise does not keep you awake, especially if you feel your sleep is lighter.
- Invest in comfortable bedding and get rid of worn-out mattresses and pillows
- Don’t drink any caffeine after midday or eat heavy meals late at night
- Don’t exercise too close to going to bed, and try to do something that relaxes you each evening, such as reading (opt for books, not blue-light emitting screens, which have been shown to interfere with sleep patterns
- Light exercise or walking every day can improve your sleep
- Exposure to early morning light, simply by going outside for a short while, helps to establish a good sleep rhythm
- Limit alcohol: You might feel alcohol ‘helps you get to sleep’, but it can, in fact, lead to poor quality sleep and too-early waking. Alcohol can also be very high in calories when it contains lots of sugar.
Exercise and nutrition
The weight gain often associated with the hormonal imbalances of PCOS can be worsened by the menopause, and will often lead to health problems later in life. These can be serious and include a greater risk of heart attack and type 2 diabetes. The steps you can take to manage your weight include:
- Eating a balanced diet rich in whole foods, healthy fats, lean proteins, and essential vitamins can help to support hormone regulation.
- Limiting sugary snacks and sweet drinks, and instead opting for complex carbohydrates such as those found in whole grains, rice and barley, to avoid sugar cravings.
- Drinking plenty of water during the day and, ideally, a large glass before every meal or snack. It activates the ‘stretch receptors’ in the stomach and makes you ‘feel fuller’.
- Eating every four hours to avoid cravings and manage portion sizes, using smaller plates in order to achieve this more easily
- Engaging in movement every day. This is much easier if you are able to find a form of light exercise you can enjoy consistently, so try out a number of different options to see what works for you. Women typically lose 2-5% of their muscle mass each year, and this can lead to fatigue and falls. Exercise involving light weights, resistance bands, or even skipping can help to maintain vital muscles.
- Speak to your GP if you are concerned about your weight or nutrition, as they will be able to make recommendations specific to your needs
Can PCOS cause hot flushes and night sweats?
Hot flushes and night sweats are common symptoms of the perimenopause and may be increased if you have PCOS. To prevent getting too hot:
- Keep your weight stable by walking every day and enriching your diet
- Always dress in layers, whatever the time of year, so you can easily cool yourself down by removing just one layer
- Wear lightweight fabrics both during the day and in bed
- Try not to consume alcohol, caffeine, or spicy food
- Don’t use heavy duvets that leave you with nothing if you get too hot – layering blankets may work better
- Ensure you have a fan in your bedroom during the hotter months
How can PCOS change during the Menopause?
During reproductive years, many women with PCOS might be focused on fertility and having a family. However, as one matures and moves into the perimenopause, an increased tendency to put on weight, together with the drop in oestrogens and progesterone, can lead to more serious health issues.
There is an increased risk for women with PCOS of developing Metabolic Syndrome. This is a combination of abnormal changes that can put a woman at risk of cardiovascular disease in later life.
What is Metabolic Syndrome?
Women with PCOS have a 1.9-fold increased risk of developing Metabolic Syndrome, according to guidelines from the European Society of Human Reproduction and Embryology (ESHRE).[2]
Metabolic Syndrome is the name given to a collection of risk factors defined as when a man or woman has at least three of the following five factors:
- Obesity – excess abdominal weight or a Body mass index of >30
- A low hip to waist ratio (‘apple shaped rather than ‘pear shaped) is characteristic of PCOS and may be a better marker than BMI alone.
- Raised blood triglyceride levels (a type of fat found in your blood)
- Reduced HDL cholesterol (the ‘good’ cholesterol)
- Raised blood pressure
- Raised fasting blood glucose levels (a test to determine how much glucose (sugar) is in a blood sample after an overnight fast)
These factors are seen more frequently in PCOS women and can also predispose them to cardiovascular disease (heart problems and/or possibly strokes) as well as the onset of type 2 diabetes.
Mental Health well-being, PCOS, and the Menopause
Recent studies have shown that women with PCOS are 3-8 times more likely to be diagnosed with anxiety and/or depression [3], and many report a lower quality of life due to the physical and psychological impact of the condition.
During the peri-menopause and menopausal years, all women may find life particularly stressful and difficult, as children become adolescents and elderly parents may need support. More than half of all women are also in full-time employment during this period.
Women with PCOS passing through this phase of life are therefore doubly disadvantaged, especially if they have endured difficulty conceiving and have had problems managing their symptoms.
The Royal College of Obstetricians and Gynaecologists specifically recommends screening women with significant symptoms of PCOS for both anxiety and depression, too. It is sensible to minimise the exposure to the risk factors of anxiety and depression by making lifestyle changes, including an improved diet, weight management, and increased exercise. Try to also reduce your intake of refined sugars and alcohol.
How can Inofolic Alpha and Alpha Plus help during the menopause?
The evidence shows that not only does Inofolic Alpha have numerous benefits for women with PCOS, such as improved insulin resistance and hormone balance, but it also helps with weight loss. Studies even indicate that women lost about 6% of their body weight on Inofolic Alpha. However, unlike other medications, when observed at the recommended dose, Inofolic Alpha has virtually little to no side effects.
Research has also found that one of the benefits of inositol for women is that it lowers the risk of metabolic syndrome [4] and helps the body regulate and process insulin. In a year-long clinical study [5], 20% of the women taking myo-inositol supplements no longer met the criteria for metabolic syndrome by the end of the study.
Inositol supplements also help to lower cholesterol [6] by reducing the overall amount of fat in your body. It does this in part by combining with choline to produce lecithin. You need lecithin to break down fats in your body and prevent fat from building up in the cell walls of your heart, arteries, and brain.Inofolic AlphaPlus offers a unique solution with its patented formula of myo-inositol and D-chiro-inositol in the scientifically proven 40:1 ratio. This powerful combination has been shown to significantly improve metabolism and insulin resistance, especially for women with PCOS and a BMI over 25, delivering faster, more noticeable results.
[1] https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/
[2] https://www.monash.edu/__data/assets/pdf_file/0003/3379521/Evidence-Based-Guidelines-2023.pdf
[4] Role of Inositols and Inositol Phosphates in Energy Metabolism
