PCOS Doesn’t
PCOS Doesnt Pause At Menopause

PCOS is a complex “whole body” hormonal and metabolic condition often driven by insulin resistance. While irregular periods and fertility issues are hallmark signs in younger women, these criteria become less relevant once perimenopause and menopause occurs. However, other features - such as higher androgen levels, increased risk of insulin resistance, and cardiometabolic complications - can persist well into midlife. Recent research also shows an increased risk of dementia for women with PCOS.

Interestingly, research suggests cycles often become more regular after 40 for those with PCOS. Acne may improve, but symptoms such as scalp hair loss or excess hair growth on the face and body may remain.

Perimenopause, typically lasting four years but sometimes up to a decade, brings fluctuating oestrogen and progesterone levels that can cause mood changes, menstrual irregularities, and hair or skin changes. These symptoms can overlap with PCOS, making diagnosis and management even more complex.

For those never formally diagnosed - approximately 70% of those with the condition - a history of irregular periods or fertility challenges may provide important clues. Health professionals should therefore take a detailed menstrual and metabolic history when supporting women in their 40s, 50s and beyond.

PCOS is a lifelong condition with metabolic consequences that don’t stop when periods do. Women with a history of PCOS have an increased risk of insulin resistance, pre-diabetes and type 2 diabetes, high blood pressure, and dysregulated lipid profiles e.g. high cholesterol. The focus in midlife should shift towards long-term metabolic, cardiovascular, and bone health.

The good news? Women with PCOS may experience fewer vasomotor symptoms, such as hot flushes, than those without PCOS - though this is not universal and more research is needed.

Lifestyle and behavioural change are the foundation of PCOS management at every age. National and international guidelines recommend these approaches as first-line therapy. During perimenopause and menopause, these changes can help maintain hormone health, metabolic wellbeing, and overall quality of life.

1. Eat a plant-predominant diet
   Focus on whole plant foods as much as possible - whole grains, beans, fruits, vegetables, nuts, seeds, herbs, and spices. These foods are high in fibre and antioxidants, helping to regulate blood sugars and reduce inflammation. Soya foods such as tofu and edamame, rich in natural phytoestrogens, are particularly beneficial during perimenopause and menopause. Limit ultra-processed foods, processed and red meat, sugary snacks, and fried foods that promote oxidative stress and ageing.
2. Move your body regularly
   Aim for at least 300 minutes of activity per week - or an hour of daily movement. A combination of aerobic, strength, and even high-intensity interval training (HIIT) supports insulin sensitivity, bone strength, and cardiovascular health. Movement after meals e.g. a short 10-minute walk is especially helpful for regulating blood sugars.
3. Prioritise quality sleep
   Seven to nine hours of restorative sleep supports hormonal regulation, appetite control, and mood stability.
4. Manage stress
   Chronic stress can worsen insulin resistance and exacerbate symptoms. Practices such as mindfulness, yoga, or spending time in nature help lower cortisol levels and improve wellbeing.
5. Build social connections
   Meaningful, quality relationships protect against loneliness and its associated risks, including heart disease and cognitive decline.
6. Limit alcohol and avoid smoking
   Toxic substances increase the risk of liver and cardiovascular disease - both of which are already higher in PCOS.

Hormone Replacement Therapy (HRT) can safely be used in women with PCOS after informed discussion about benefits and risks. Alongside HRT, lifestyle medicine, encompassing nutrition, exercise, stress management, and connectedness, plays a central role in improving quality of life during this transition.

Healthcare professionals can help by providing evidence-based information and challenging myths. Trusted sources include the NHS, the Royal College of Obstetricians and Gynaecologists (RCOG), and Verity, the UK’s leading PCOS charity.

Remember, PCOS doesn’t pause at menopause - it shifts. With the right lifestyle foundations and professional support to encourage long-term behaviour change, women with PCOS can thrive through perimenopause, menopause, and beyond.

Rohini Bajekal (MA Oxon, MSc Nutrition and Food Sciences, Dip IBLM) is a Nutritionist and Board-Certified Lifestyle Medicine Professional based in London. She provides expert guidance to women with hormonal health issues - with a passion for PCOS, endometriosis, fertility challenges, perimenopause and menopause. She shares evidence-based wellbeing tips via her Instagram page @rohinibajekal Book a free 15-minute discovery call with her via rohinibajekal.com