Polycystic Ovary Syndrome (PCOS) and the menopause
This article is to provide information for women who already have a diagnosis of PCOS, and focuses on menopause related questions. It does NOT go into full detail of the symptoms, complications and treatment of PCOS. If you are wondering if you have PCOS you should discuss your symptoms with a doctor.
Does having PCOS make it harder to identify the menopause?
Polycystic ovary syndrome is a fairly common endocrine (hormone) problem in women. Many women with PCOS have irregular periods, and some women may have long gaps with no periods (amenorrhoea).So changes in your periods are less reliable as a symptom of perimenopause if you have PCOS. However hot flushes and night sweats are highly suggestive of menopause rather than PCOS.
Mood and sleep disturbances can be common to both conditions. Acne and hair loss or increased facial hair can also occur with both conditions. But PCOS symptoms are more likely to have been present for many years, as PCOS usually develops in your teens or 20’s. PCOS symptoms including irregular periods can be intermittent, and may fluctuate if your body weight changes. Symptoms tend to be worse if you are overweight.
If you are aged 45 years or more NEW changes in periods, mood, skin or hair are more likely to be due to the perimenopause, especially if associated with hot flushes or night sweats.
However if you are not sure what is going on it is worth talking to your doctor about your symptoms, and occasionally a blood test looking at hormone levels might be helpful.
Some women with PCOS may be treated with the combined oral contraceptive pill (COCP) to give them regular periods and protect them from overgrowth of the lining of the womb (endometrium). In women with PCOS who have less than 4 periods a year long term this is a slight increased risk of endometrial cancer, and the COCP or intermittent progesterone treatment to cause a bleed can protect against this .If you are on the COCP it will provide the hormone estrogen and mask symptoms of the menopause, so you will probably need to discuss with your doctor when to stop the COCP, and once off it whether you are in the perimenopause and want HRT.
Can you take HRT if you have PCOS?
Yes, you can take HRT if you have PCOS, providing that you have no other medical reasons not to take HRT. You will get all the usual benefits from the HRT. The non-hormonal healthy lifestyle changes recommended for menopause should also help PCOS, especially weight loss if you are overweight.
Does PCOS affect the type of HRT recommended?
Transdermal estrogen (patches or gel) would be the safest estrogen to use. The Intra Uterine System (IUS Mirena), otherwise known as the Mirena hormonal coil, would be a good first choice of progesterone since it works locally to thin the endometrium (lining of the womb) and reduces the risk of endometrial (womb) cancer. However micronised progesterone tablets such as Utrogestan are also safe. It is important to take other risk factors into consideration and get individual advice on HRT.