PCOS and Menopause: What to Know About Symptoms, Risks, and Treatment

Polycystic ovary syndrome (PCOS) doesn’t just disappear when your periods do. Even after menopause, PCOS can influence your hormonal balance, long-term health, and vaginal well-being (can we catch a break?). While classic symptoms like irregular or missed periods fade, people with a history of PCOS often continue to face metabolic and cardiovascular risks well past their reproductive years. 

Understanding how PCOS evolves during the menopausal transition is key to managing symptoms, supporting hormone health, and protecting your heart, bones, and overall wellness. Keep reading to learn more about PCOS and menopause, and explore how PCOS changes with age, its long-term effects, and strategies for healthy living in postmenopausal years.

What is PCOS and how does it change at menopause?

Polycystic ovary syndrome, sometimes called polycystic ovarian syndrome, is a common endocrine disorder that affects people with ovaries. It often causes irregular menstrual periods, higher levels of “male” hormones (androgens), and changes in the appearance of the ovaries characterized by the presence of cysts. 

As you approach menopause, your hormone levels start to fluctuate quite a bit. Estrogen and progesterone levels drop, marking the end of menstrual cycles. For women with PCOS, this transition can often have a “calming” effect on some reproductive features. Menstrual cycles may become more regular, and those frustrating hyperandrogenic symptoms like acne or unwanted facial hair growth may start to fade away, though you might still have higher male hormones compared to women of the same age. After menopause, the importance of having polycystic ovaries decreases. This happens because the ovaries get smaller, making it harder to use the usual criteria for diagnosis.

Even though the classic signs of PCOS might lessen over time, it’s important to remember that the condition is something that stays with you for life. As women enter menopause, they may find that their reproductive symptoms aren't as pronounced, but they can still encounter some challenges like insulin resistance, changes in weight, and an increased risk of heart-related issues. 

Does PCOS affect you after menopause?

Yes, PCOS continues to influence health even after menopause. After menopause, some issues from PCOS may remain, even though reproductive symptoms go away. Many postmenopausal women with a history of PCOS experience insulin resistance, which happens when your body doesn’t process insulin as efficiently as it should, making it harder to regulate blood sugar levels and increasing the risk of type 2 diabetes, cardiovascular disease, and other metabolic issues. They may also have higher body fat around the waist and unhealthy cholesterol levels, including lower HDL (“good”) cholesterol and higher triglycerides, which can increase the risk of heart disease. 

Another way PCOS can affect your health after menopause is by increasing your risk of certain cancers. Women with PCOS are two to five times more likely to develop endometrial (uterine) cancer, mostly because of years with irregular periods and extra estrogen exposure. There’s also evidence that PCOS increases the risk of ovarian cancer in menopausal women, including pre-cancerous growths. Some studies even suggest a slightly higher risk of breast cancer, especially after menopause. These risks don’t mean cancer is inevitable if you have a PCOS diagnosis — in fact, the overall risk is still very low — but they do make regular check-ups and open conversations with your healthcare provider really important for staying on top of your health.

Does PCOS cause early menopause?

Contrary to some misconceptions, PCOS doesn’t cause early menopause. In fact, most studies suggest a modest delay in the onset of natural menopause due to a larger ovarian reserve and higher anti-Müllerian hormone (AMH) levels, which can prolong reproductive years. Data shows that women diagnosed with PCOS reach menopause two to four years later than those without PCOS, averaging around 51–53 years compared to 49–50 years.

However, irregular periods during reproductive years can make it tricky to determine exactly when menopause begins. It’s also worth noting that while menopause may occur slightly later, the hormonal changes still bring classic menopausal symptoms like hot flashes, sleep problems, and vaginal dryness. Monitoring these changes is crucial for long-term health and symptom management.

PCOS and menopause symptoms

The menopausal transition is a time of big changes regardless of whether or not you have a pre-existing condition, but for those with a history of PCOS, the experience can feel even more complex. Some symptoms from reproductive years may fade, while others — particularly metabolic or hormonal — can persist or even become more noticeable. Understanding these changes helps with symptom management and long-term health planning.

Hormonal fluctuations and irregular cycles

Even though your period stops after menopause, hormone levels don’t completely flatten. Women with PCOS tend to have persistently higher androgens, such as testosterone and androstenedione, compared to women of the same age. 

This hormonal imbalance can contribute to lingering features like facial or body hair, thinning hair on the scalp, and acne flare-ups. Additionally, the relative drop in estrogen can make these androgenic symptoms more noticeable. While cycles are no longer present, changes in hormone levels can influence mood swings, sleep quality, and even libido.

Weight gain and metabolic changes

Weight gain around the belly is common in postmenopausal women with PCOS. Insulin resistance, which often begins earlier in life, makes it hard to maintain a healthy weight and raises the risk of type 2 diabetes. Even small amounts of weight gain can impact blood pressure, cholesterol, and energy levels. Making lifestyle changes, such as strength training and mindful eating, is very important. The drop in estrogen levels, combined with past metabolic issues, can increase heart-related risks.

Cardiovascular and bone health risks

After menopause, estrogen levels drop, which weakens heart protection. Research shows that women with PCOS may not have the same increased heart risk after menopause as they do in their reproductive years. However, those with obesity, insulin resistance, or bad cholesterol still have higher risks compared to others. It’s important for postmenopausal women with PCOS to regularly check their blood pressure, cholesterol, and blood sugar.

Bone health is also important. Studies suggest that PCOS does not directly increase the risk of osteoporosis. However, lower estrogen levels, chronic inflammation, and age-related bone loss can lead to fragile bones if women ignore healthy habits like resistance exercise, calcium, and vitamin D intake.

In general, managing PCOS and menopause symptoms requires a complete approach. This includes balancing hormones, improving metabolism, and making lifestyle changes. Regular check-ups, a healthy diet, exercise, and stress management can help make this transition easier and support long-term health.

PCOS and menopause diet

Even after menopause, women who have a history of PCOS may still face some ongoing health challenges related to their metabolism and hormones. Conditions like insulin resistance, obesity, type 2 diabetes, and an increased risk of developing cardiovascular disease can linger, often due to changes in how the body processes sugar, manages fat, and distributes body weight over time. Some women might also continue to experience symptoms like excess facial hair growth or thinning hair due to lingering excess androgen levels. Since these risks don’t just disappear with menopause, focusing on a healthy diet becomes really important for long-term well-being.

No single "magic" diet exists for PCOS or menopause; the focus should be on balanced, nutrient-rich, and anti-inflammatory foods with a sustainable approach that is tailored to personal preferences, cultural context, and metabolic goals.

Certain diets can help with insulin sensitivity, weight management, heart health, and mood. The Mediterranean diet, which includes plenty of fruits, vegetables, whole grains, lean proteins, olive oil, and omega-3 fatty acids, can lower cardiovascular disease risk and reduce inflammation. Diets that are low in glycemic index can help control blood sugar, making them helpful for women dealing with insulin resistance. 

Practical dietary strategies include:

• Prioritize high-fiber foods such as vegetables, fruits, legumes, and whole grains to support blood sugar regulation and gut health.
• Include lean protein from fish, poultry, tofu, or legumes to maintain muscle mass and satiety.
• Incorporate omega-3 fats from fatty fish, chia seeds, flaxseeds, and walnuts for heart and metabolic support.
• Limit excessive refined carbs and sugars. This will help you control blood sugar spikes after meals and manage your body weight.
• Avoid excessive calorie restriction; under-eating can worsen metabolic stress and make it harder to stick to a healthy diet. 

How to treat PCOS after menopause

You can't really treat or cure PCOS, but you can manage it. The focus should be on supporting your overall health and well-being.

Incorporating healthy lifestyle habits can make a big difference. Eating a balanced diet, staying active, getting enough quality sleep, and finding ways to manage stress can help with symptoms and lower the risk for issues like diabetes and cardiovascular disease. It’s all about finding realistic and sustainable approaches that work for you.

Sometimes, medications can help address specific concerns. For example, Metformin can help your body process insulin, which is often a concern for women with PCOS. If excess body hair is an issue, antiandrogen medications like spironolactone might be an option, along with treatments like laser therapy that can boost your body image.

Women who have dealt with PCOS might find they experience anxiety or depression more often, so it’s a good idea to talk to someone if those feelings come up. Therapy and counseling can be really helpful for addressing body image or eating challenges.

Regular check-ups are also important for keeping an eye on things like weight, blood pressure, blood sugar, and cholesterol levels. For those with a history of ovulation issues, checking on uterine health is a good idea as well.

Things to know about PCOS and menopause

• PCOS doesn’t disappear after menopause; hormonal and metabolic effects can persist.
• PCOS may delay the onset of menopause.
• Monitoring for cardiovascular disease and type 2 diabetes is important post menopause.
• Weight management and metabolic health remain key to long-term wellness.
• Classic PCOS symptoms, like irregular periods, become less useful diagnostically after menopause.

Supporting your long-term health with Evvy

Hormone imbalances, such as those seen in PCOS, can increase the risk of vaginal microbiome imbalance, or dysbiosis, which may make women more susceptible to infections like bacterial vaginosis (BV). While research in this area is still limited, there is growing evidence suggesting a connection between PCOS and vaginal health.

During menopause, natural shifts in hormones can further alter the vaginal microbiome, increasing the risk of infections, inflammation, and discomfort. These changes can impact overall comfort, urinary and sexual health, and long-term well-being.

Evvy’s Vaginal Health Test allows you to monitor your vaginal microbiome over time, helping you identify changes that may affect your health. By tracking these shifts (especially if you have a history of PCOS), you can make informed lifestyle, dietary, and medical decisions to support vaginal health, reduce inflammation, and maintain overall wellness during menopause. 

Personalized insights from Evvy give you the tools to take control of your postmenopausal health journey with confidence.

FAQs about PCOS and menopause

What is the average age of menopause for women with PCOS?

Women with PCOS typically reach menopause slightly later than those without the condition. Large cohort and genetic studies show an average onset between 51 and 53 years, compared to 49 to 50 years in women without PCOS. This delay is linked to a larger ovarian follicle pool and persistently higher AMH levels, which indicate slower ovarian aging.

Can PCOS symptoms improve after menopause?

Yes, many PCOS symptoms get better after menopause. Irregular periods and cysts on the ovaries are no longer a concern once periods stop. Symptoms like acne and extra hair growth often improve, too. However, hormone levels can still be higher than in other women the same age, and issues like insulin resistance, weight gain, and high cholesterol may continue. Some women might notice more signs of higher male hormones because estrogen drops, so ongoing care is important.

Is PCOS considered a risk factor for osteoporosis or heart disease in menopause?

The good news is that PCOS doesn’t seem to raise your risk of osteoporosis, though it’s still important to look after your bones after menopause. When it comes to heart health, the risk is a bit more complicated. While the extra risk from PCOS during your younger years may not last, metabolic risk factors like weight gain, insulin resistance, and high cholesterol can still affect your heart.

Are there long-term cancer risks associated with PCOS after menopause?

Yes, women who’ve had PCOS do have a slightly higher risk of certain cancers, mainly due to years of irregular cycles and extra estrogen exposure. While the overall risk is still relatively low, it’s important to understand that PCOS can continue to affect your health even after your periods end, influencing metabolism, hormone balance, and long-term risks beyond just irregular cycles.

How can I manage lingering PCOS symptoms post-menopause?

Managing PCOS after menopause is all about keeping your hormones in balance, supporting your metabolism, and easing any lingering symptoms. Simple healthy lifestyle habits — like eating a balanced diet, staying active, maintaining a healthy weight, and managing stress — form the foundation of care. Hormone replacement therapy (HRT) can help with bothersome symptoms such as hot flashes, sleep issues, and vaginal dryness. It’s also a good idea to keep up with regular check-ups to monitor blood sugar, heart health, and uterine health.