Question: "Hi, I enjoy reading your newsletter about PCOS, but haven't read anything about how things change or not, during menopause. Can you look at this topic in an upcoming newsletter, please? Thank you." -- Mary S.
Answer: Good question, Mary!
Does polycystic ovary syndrome just fade away as you get older? Well, I think it depends to a great extent what you do between now and when you reach menopause.
It depends on your health practices, such as healthy diet, plentiful exercise and physical activity, restful sleep, management of stress, minimization of exposure to chemical pollution and toxic metals, and abstinence from recreational intoxicants.
These health practices are the key to helping you to keep your hormones in balance, reduce inflammation and maintain optimal function of your cells.
Assuming your health practices are the excellent over time, you could reasonably expect PCOS (as you know it today) to fade away by menopause -- but not entirely disappear. You'll no longer be concerned about fertility or monthly cycles. Acne should diminish or disappear. Hirsutism (unwanted hair growth) may diminish but some may still be present. Hair thinning is likely to continue but hopefully the rate of loss will be less. Hard to say about weight. It might stay about the same. All this is just my guess, based on what I've seen of the very skimpy amount of information about polycystic ovarian syndrome and menopause. Of course, there's a lot of individual variation with PCOS. So no one can say how it will turn out specifically for you.
But let's suppose you're undisciplined about your diet over the years. You get heavier every year, so you become more and more sedentary. You're not careful about chemicals in your environment. You can't get a decent night's sleep because you develop sleep apnea or another sleeping disorder. And so on.
This is when deep-seated trouble begins to bubble to the surface.
For example, Leicester General Hospital in the UK reported that the prevalence of chest pain and heart attack among women over 65 years old with polycystic ovary syndrome is 2.6 times that of other women.
In a study from Cedars-Sinai Medical Center in Los Angeles, postmenopausal women with a history of PCOS and higher levels of chronic inflammation had a 12.2-fold higher risk of cardiovascular death or nonfatal heart attack than women without this disease and lower levels of inflammation. This suggests that chronic inflammation is a major contributor to the problems you may experience later in life. Poor health practices and added weight accelerate the inflammatory process.
And what about diabetes? The Alma Mater Studiorum University of Bologna in Italy followed 225 women with polycystic ovarian syndrome from youth to middle age. The age-adjusted prevalence of diabetes at the end of follow-up was 39.3% for the PCOS women, which is significantly higher than the general Italian female population of a similar age (5.8%). I don't have any information on menopause at the moment, but if you have PCOS, the risk of diabetes is high.
Also worthy of mention is metabolic syndrome. Many women with polycystic ovary syndrome develop metabolic syndrome. Overweight PCOS women aged 36-45 are four times more likely to have metabolic syndrome than PCOS women aged 26-35, so it can get worse as you get older. Metabolic syndrome is a cluster of conditions (increased blood pressure, a high blood sugar level, excess abdominal fat and abnormal cholesterol levels) that occur together. In general, a person who has metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as someone who doesn't have metabolic syndrome.
If you don't follow good health practices, is there anything else to be aware of? What about cognitive impairment, dementia or Alzheimer's? Rush University Medical Center recently reported that Alzheimer?s disease may be one of the leading causes of death in the United States. There's some evidence to suggest that the hormonal and metabolic features of polycystic ovarian syndrome have some commonality with brain aging and diseases. For example, women with polycystic ovarian syndrome are known to typically have low levels of a hormone called adiponectin. Studies have shown that adiponectin is protective of the brain in a number of ways. So if you're low in this vital hormone, your brain is less protected.
Here's the bottom line: PCOS changes its presenting features as you get older. But many of the underlying factors are still at play. (Note that polycystic ovary syndrome, heart disease, diabetes, metabolic syndrome, and Alzheimer's have elements in common, such as inflammation.) Your main concern will become the risk of degenerative diseases.
You can completely avoid or at least minimize any and all of these diseases when you reach menopause. But the time to start is now. Dump the refined carbs and fast foods. More veggies and essential oils. Adequate protein. Plenty of sleep. Loads and loads of physical activity. Minimize chronic stress. And stay with it!
Disease avoidance in later life is mostly a result of the lifestyle choices you make every day. It's almost that simple! You can take these fire-breathing disease dragons and put them back into their cave where they belong!
(PS: The Natural Diet Solution for PCOS ebook has quite a number of tips for better diet, exercise and stress management that will head you in the right direction. Selected nutritional supplements can also be helpful).
Mani H et al, Diabetes and cardiovascular events in women with polycystic ovary syndrome: a 20-year retrospective cohort study. Clin Endocrinol (Oxf). 2013 Jun;78(6):926-34.
Shaw LJ et al, Postmenopausal women with a history of irregular menses and elevated androgen measurements at high risk for worsening cardiovascular event-free survival: results from the National Institutes of Health--National Heart, Lung, and Blood Institute sponsored Women's Ischemia Syndrome Evaluation. J Clin Endocrinol Metab. 2008 Apr;93(4):1276-84.
Gambineri A et al, Polycystic Ovary Syndrome Is a Risk Factor for Type 2 Diabetes: Results From a Long-Term Prospective Study. Diabetes. 2012 Sep;61(9):2369-74.
Johnstone EB et al, Age-related differences in the reproductive and metabolic implications of polycystic ovarian syndrome: findings in an obese, United States population. Gynecol Endocrinol. 2012 Oct;28(10):819-22
Song J et al, Adiponectin as a new paradigm for approaching Alzheimer's disease. Anat Cell Biol. 2013 Dec;46(4):229-34.
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