From the Guidelines
Polycystic ovary syndrome (PCOS) can have lasting implications on a woman's health after menopause, particularly in terms of metabolic and cardiovascular health, emphasizing the need for continued lifestyle management and monitoring 1. The manifestations of PCOS often change after menopause, with symptoms like insulin resistance and metabolic syndrome persisting, while hirsutism may improve as ovarian hormone production decreases. Key aspects of management after menopause include:
- Lifestyle modifications, such as regular exercise (aiming for at least 150 minutes weekly of moderate activity) and a balanced diet rich in whole foods, to address cardiovascular and metabolic health 1.
- Medications like metformin for insulin resistance, statins for cholesterol management if indicated, and continued blood pressure monitoring and treatment.
- For persistent hirsutism, treatments like spironolactone may be continued, though doses might be reduced.
- Regular screening for diabetes, cardiovascular disease, and endometrial cancer, as women with PCOS have higher lifetime risks for these conditions. The importance of early lifestyle intervention at the time of PCOS diagnosis is highlighted to prevent or minimize longitudinal weight gain and associated health complications 1. Provider recommendations should target meeting daily energy intake requirements and adequate consumption of select nutrients and core foods to achieve and maintain optimal health and healthy body weight 1. Hormone replacement therapy can be considered for menopausal symptoms using standard protocols, as PCOS doesn't typically alter these recommendations. Overall, the management of PCOS after menopause focuses on addressing the persistent metabolic concerns and preventing long-term health complications, with an emphasis on lifestyle modifications and regular monitoring 1.
From the Research
Implications of PCOS after Menopause
The implications of Polycystic Ovary Syndrome (PCOS) after menopause are significant and can have a substantial impact on a woman's health. Some of the key implications include:
- Increased risk of cardiovascular disease (CVD) and cardiovascular events, such as hypertension, coronary heart disease, and stroke 2, 3, 4, 5
- Higher prevalence of metabolic syndrome, insulin resistance, and type 2 diabetes 2, 4, 5, 6
- Increased risk of endometrial cancer and other cancers 2
- Potential for worsening cardiovascular event-free survival, especially in women with clinical features of PCOS 4
- Increased risk of overweight and obesity, which can further exacerbate cardiovascular and metabolic risks 2, 5, 6
Cardiovascular Risks
Women with PCOS are at a higher risk of cardiovascular disease and events, including:
- Hypertension: Women with PCOS are more likely to develop hypertension, which can increase the risk of cardiovascular disease 2, 4
- Hyperandrogenism: Hyperandrogenism is associated with elevated blood pressure, independent of age, insulin resistance, obesity, and dyslipidaemia 2
- Cardiovascular events: Women with PCOS are at a higher risk of cardiovascular events, such as coronary heart disease and stroke 3, 4, 5
Metabolic Risks
Women with PCOS are also at a higher risk of metabolic disorders, including:
- Insulin resistance: Women with PCOS are more likely to develop insulin resistance, which can increase the risk of type 2 diabetes and cardiovascular disease 2, 4, 5, 6
- Metabolic syndrome: Women with PCOS are more likely to develop metabolic syndrome, which can increase the risk of cardiovascular disease and type 2 diabetes 2, 4, 5
- Type 2 diabetes: Women with PCOS are at a higher risk of developing type 2 diabetes, especially during the menopausal transition 6