Blog written by Dr Nitu Bajekal, Senior Consultant ObGyn and Co-Author of ‘Living PCOS Free‘.

I wrote Living PCOS Free with my daughter Rohini, a nutritionist, as I am extremely passionate about empowering those with PCOS to live long, healthy and happy lives. This practical guide will show you how to successfully manage your condition using proven lifestyle approaches alongside western medicine. Raising awareness of what to look out for allows those with PCOS who are going through perimenopause and menopause to access early help, support and advice. This may be through campaigns such as this month’s Menopause Awareness Month, workshops and education in workplaces or even by opening up the conversation between friends, family and colleagues. It’s never too early – or too late – to start.

What is PCOS?

PCOS is a complex condition that affects the way the ovaries function, resulting in a wide range of reproductive, metabolic and psychological symptoms. The exact cause of PCOS is unknown, although insulin resistance, when insulin levels rise as tissues become resistant to the action of insulin, is considered to be a main driver of the condition and many of the common symptoms.

Despite PCOS being the most common endocrine condition to affect women and those AFAB (assigned female at birth), with at least 1 in 10 affected, most people have never heard of it. Depending on how hard one looks for the condition, up to 3 in 4 of those with PCOS remain undiagnosed.

What are the common symptoms of PCOS?

Infrequent periods or missed periods are the most common sign of PCOS (oligomenorrhoea/amenorrhoea). It’s important to note that pain is not a feature of PCOS and other coincidental causes such as endometriosis should be considered.

• Excess facial/body hair (hirsutism)
• Acne (often adult and/or cystic)
• Scalp hair loss (alopecia)
• Excess weight gain
• Insulin resistance
• Fertility problems (PCOS is the leading cause of anovulatory infertility)

There are several less well-known symptoms including:

Eating disorders, especially binge eating disorders without purging, unlike bulimia. This may be missed, especially in those from different ethnic groups, LGBTQ+ or those with excess weight.

• Excessive daytime sleepiness
• Breathing problems (sleep apnoea, snoring)
• Acanthosis nigricans (darkened skin: behind the neck, underarms, groin).
• Psychological issues such as depression, anxiety and OCD

How does the condition change as a woman approaches menopause?

In my new book, Living PCOS Free, I dedicate an entire chapter to the topic of menopause in PCOS as this condition does affect how women and AFAB people experience this crucial phase of life.

There has been little scientific research on how PCOS affects the menopause or the lead up to it and more studies are urgently needed. The criteria to diagnose PCOS (Rotterdam criteria) change in the menopause as periods stop, so irregular periods cannot be used as a criterion.

How can women distinguish between PCOS and perimenopause symptoms?

The perimenopause can last from 2 to 8 years (the average is 4 years) and is the lead up to menopause. The perimenopause is a time, often in one’s early 40s, when women and those AFAB may notice hormonal fluctuations, period irregularities and mood changes. As a result, there can be a lot of overlap with symptoms of PCOS and perimenopause, such as female-pattern hair loss and anxiety.

If you have never been diagnosed with PCOS, a long history of irregular cycles or anovulatory subfertility may help give your doctor a clue.

Do PCOS symptoms change after menopause?

A common symptom in PCOS, acne, is actually reported by 15% of all women over the age of 50 so it is difficult to work out how exactly PCOS symptoms change after menopause. Even without PCOS, women going through menopause experience issues such as anxiety, female-pattern hair loss and excess hair growth – all common symptoms in PCOS.

Are androgen levels still high through the transition?

Androgen excess symptoms seem to persist in menopause for those with PCOS. In particular, increased hair growth (hirsutism) and risks of hypertension (high blood pressure), high blood sugars and blood lipids are higher than in those without PCOS. This indicates that it is especially important to make lifestyle changes early, which I discuss in detail in Living PCOS Free.

Is there anything different that a woman should expect as she goes through menopause if she had PCOS in the past? Any symptoms that may be more or less severe?

Menopause appears to be delayed by two years in women with PCOS, and periods seem to become more regular after the age of 40. Women with PCOS also appear to have fewer hot flushes than those without PCOS. Other PCOS symptoms, such as excess hair growth or scalp hair loss, may continue to persist.

Are there any treatments or lifestyle changes a woman should be aware of as she goes through menopause with PCOS?

It is important to be mindful of the long-term risks of PCOS and bring in lifestyle changes as early as possible. Women now often live 30 years after their menopause and this period of their lives is extremely important. The average life expectancy in the UK is around 81 years.

Information is key, as myths and misinformation can prevent women from accessing both lifestyle and nutritional support. For example, strength training can reduce osteoporosis, and eating soya foods such as tofu is safe and particularly healthy for menopausal women as they are a rich source of healthy plant oestrogens. Life-improving formal hormone replacement therapy (HRT) may also help. Women can be safely advised to use HRT after discussion of the very small risks rather than relying on expensive supplements that have unproven and sometimes serious unwanted side effects. Always rely on reliable and credible evidenced based health resources (NHS, RCOG, Verity, www.nitubajekal.com).

PCOS is a chronic condition so, while there is no ‘cure’, making positive lifestyle changes can go a long way in managing it and its symptoms in the menopause and beyond, including insulin resistance, both in the short  and longer term. Lifestyle modifications can tackle the underlying insulin resistance. In fact, national and international guidelines recommend lifestyle and behavioural changes as the first line of management for PCOS, even before medications. This is important given the higher risk of other health conditions if you have PCOS (type 2 diabetes, womb cancer, cardiovascular disease etc).

Here are some lifestyle changes that are helpful for those going through menopause with PCOS:

Adopt a plant-predominant dietary pattern
People with PCOS should be advised to focus on predominantly whole plant foods, including whole grains, beans, fruit, vegetables, nuts and seeds, herbs and spices. These foods are full of fibre and micronutrients that are nourishing and absorbed slowly, helping to normalise blood sugars. We know this works very well in people with type 2 diabetes and metabolic syndrome as well as reducing excess weight gain reported as one gets older. Crowd out trans fats, oils, junk and ultra-processed foods, sugar-sweetened drinks, fruit juices and sugary foods such as cakes and biscuits which promote oxidative stress and inflammation. Limit barbecued and fried foods and ultra-processed foods that are high in tissue-damaging advanced glycation end products (AGEs) which are linked to ageing, heart disease and infertility. Vitamin D deficiency is common in women and those AFAB with PCOS, and there is some evidence that vitamin D supplementation after an initial blood test to measure levels may improve insulin sensitivity.

Move your body regularly
Regular movement in a form that you enjoy is key. Aerobic exercise and resistance training (including high intensity interval training (HIIT) in short bursts) are all recommended to help improve insulin sensitivity in women with PCOS. Aim for 300 minutes of exercise per week (approximately one hour a day) and try to exercise outdoors in natural light to boost your mood. Physical movement and exercise are also immensely helpful in improving tissue sensitivity to insulin, especially when undertaken after meals to dampen blood sugar swings.

Prioritise sleep
Ensure a regular sleep routine with seven to nine hours of restorative sleep.

Find a way to de-stress and relax
Consider exercise, spending time in nature, meditation, mindfulness, community work, psychotherapy or yoga to help manage stress and lower cortisol levels which make insulin resistance worse.

Foster positive social connections
Build or join a community, whether online or offline; ensure you have a support network or a friend you can trust and confide in. Loneliness, which is more common as we get older, is a source of chronic stress and is associated with an increased risk of heart disease, high blood pressure, Alzheimer’s disease and type 2 diabetes.

Avoid or limit risky substances
Eliminate risky substances such as drugs and tobacco and limit alcohol (people with PCOS are at higher risk of non-alcoholic fatty liver disease), as these offer no health benefits.

 

Visit https://nitubajekal.com/menopause/ for more information as well as nutrition advice https://nitubajekal.com/menopause-nutrition-advice/