Guide authored by PCOS supplement provider, Fertility Family.
Despite affecting around 1 in 10 women in the UK[1], which makes it the most common female hormone condition, polycystic ovary syndrome (PCOS) is still often misunderstood by many. It is most broadly associated with problems getting pregnant (although in many cases it does not need to be a barrier to successful conception with the right treatments in place) and so is often seen as running ‘in parallel’ with the years where a woman might expect to be fertile. However, the various other symptoms that PCOS causes aside from this 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.
What is PCOS?
PCOS is actually a ‘mixed bag’ of signs and symptoms. Many women that have PCOS will look very different from each other. There is no ‘typical’ as it is so variable. Consequently, diagnosing PCOS is not easy because the patients are often so different from each other (some may be overweight, others lean).
PCOS is as 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, 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 may often run in families and affects different women in different ways, with some experiencing symptoms much more severely than others. If left undiagnosed or untreated, PCOS can lead to a range of complications in later life which, as mentioned above, may overlap with symptoms of the menopause and worsen health in this phase of women’s lives.
What are the symptoms of PCOS?
As described above, because of the different aspects of the syndrome, PCOS can have any or all of the following:
- Unwanted hair, for example on the face
- Hair loss or thinning
- Acne
- Greasy skin
- Being overweight/obese
- Over 20 immature follicles or swollen ovaries visible on ultrasound scan
- Infrequent or absent periods indicating a lack of ovulation, which can lead to infertility
Having said this, PCOS women can be lean, not have any obvious skin or hair distribution issues, so the presentation of the condition varies considerably. PCOS symptoms often copy symptoms of other health conditions, so it is important that diagnosis is made correctly.
What happens during menopause if I have PCOS?
Perimenopause can start around age 38 or earlier, and is caused by the normal drop in the production of female hormones estrogen and progesterone, which eventually ends in postmenopause which is when no estrogens or progesterone at all will be produced any longer (technically a full year without a period signals the start of the menopause).
The drop in estrogens and progesterone during the perimenopause is known to trigger weight gain and can increase insulin resistance and increase the cholesterol levels in our 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 such as 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 that is often characterised by hot flushes, increasing PMS 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 where conception can naturally take place.
“The most common cause of irregular periods is PCOS. In this case, ovulation trackers, such as LH surge detection kits, may not work, as PCOS women often have raised LH levels that can give false positive results in relation to the LH surge.
If this is something you’re currently experiencing, I’d recommend speaking with a healthcare professional.”
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 that is often characterised by hot flushes 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 where conception can naturally take place.
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 never stops being important to 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
PCOS and the menopause can both 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 ear plugs 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
- Light exercise or walking every day can improve your sleep
Maintain a healthy weight
The weight gain caused by the hormonal imbalances of PCOS, which can be worsened by the menopause, 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 and cancer of the womb lining (endometrium). The steps that you can take to keep your weight managed easily include:
- Limiting unhealthy snacks and sweet drinks, instead opting for complex carbohydrates such as those found in whole grains, rice and barley to avoid sugar cravings.
- Eat lots of fresh fruits and vegetables
- Eat every four hours to avoid cravings and reduce portion sizes, using smaller plates in order to achieve this more easily
- Engage in physical exercise every day. This is much easier if you are able to find a form of light exercise that you enjoy, so try out a number of different options to see what works for you
- Speak to your GP if you are concerned about your weight 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 a common symptom of the perimenopause and may be increased if you have PCOS. In order to prevent getting too hot:
- Keep your weight stable and in the healthy range by walking every day and enriching your diet
- Always dress in layers, whatever the time of year, so that you can easily cool yourself down by removing just one
- 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 are focused on fertility and having a family, or they might be interested in managing the various symptoms. However, as one matures and you move into the perimenopause, an increased tendency to put on weight together with the drop in estrogens and progesterone can lead to more serious health issues. There is an increased risk for PCOS women of developing the Metabolic Syndrome. This is a combination of abnormal changes that can put a woman at risk of cardiovascular disease in later life.
What is the Metabolic Syndrome?
Women with PCOS have a higher chance of developing a Metabolic Syndrome.
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 – characterised by a large waist measurement (or a Body mass index of >30, (especially around the midriff)
- 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 blood sample after an overnight fast)
The increased risk of developing the above factors has been published by the Royal College of Obstetricians and Gynaecologists in Green Top Guide No 33[2]. These factors are seen more frequently in PCOS women and can predispose to cardiovascular disease (heart problems and/or possibly strokes) and the onset of type 2 diabetes.
It is sensible to minimise the exposure to these risk factors by lifestyle changes including: an improved diet, weight loss, increased exercise. Try to reduce refined sugars and alcohol.
How Inofolic Alpha can help during the menopause?
The evidence shows that not only does Inofolic Alpha have numerous benefits for women with PCOS. In addition to improved insulin resistance and hormone balance, Inofolic Alpha helps with weight loss. Studies indicate that women lost about 6% of their body weight on Inofolic Alpha, but unlike the medications, when observed at the recommended dose, has virtually little to no side-effects.
[1] https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/
