We focus on PCOS a bit too much during the childbearing years because the syndrome is viewed primarily as a reproductive disorder which affects fertility.
But, PCOS does not go away as a woman ages. Perhaps naturally, we don’t ever hear anyone talking about what happens when women with PCOS age? Does the syndrome get better or does it get worse and if so how worse, especially in a post-menopausal women?
Recent research is trying to answer some of these concerns. And the news for older women with PCOS is mixed.
There is however, some spicy, feel-good and unexpected news where PCOS and ageing is considered.
The good news is that ageing increases fertility in women with PCOS.
There are a couple of solid hidden benefits of PCOS for older women, after all.
A woman with PCOS has to go through a lot when she’s younger due to infertility issues but a seminal study from Miriam Hudecova and colleagues at Uppsala University in Sweden [Hudecova, M., J. Holte, M. Olovsson, and I. Sundström Poromaa. “Long-term Follow-up of Patients with Polycystic Ovary Syndrome: Reproductive Outcome and Ovarian Reserve.” Human Reproduction. Oxford University Press, 24 Jan. 2009. Web] has shown that women with PCOS can have children till later in life than normal women.
And, this happens because women with PCOS begin life with more eggs, also called an ovarian reserve, than women without PCOS.
This means that as women with PCOS age, they have more eggs left over than women without PCOS.
And it’s mainly this increased ovarian reserve which allows older women with PCOS to have a better shot at conception than their non-PCOS counterparts of the same age.
What happens when an ovary ages is that there is a drop in the number of follicles and what’s significant is that women with PCOS are born with more follicles as compared to non-PCOS women and this delays menopause in women with PCOS by at least two years.
PCOS women also ovulate less frequently because these extra follicles interfere with their hormonal activity and allow just a few healthy follicles from maturing.
With age when the number of follicles naturally reduce, the hormonal problems due to PCOS in older women also recede, if not disappear.
And this age-dependent reduction in the number of resting follicles causes more menstruation cycles to become ovulatory, allowing older PCOS women to conceive naturally.
So, at an age when non-PCOS women have almost no eggs and follicles left in their ovaries, PCOS women have enough eggs remaining and have an optimal number of follicles as compared to what they did in their youth.
But as far as the good news goes, this is about it!
The fertility bonanza in older women with PCOS also only applies if they are able to control their insulin response.
The other not-so-good news for older women with PCOS is that the syndrome does not disappear after menopause.
It’s just that PCOS becomes impossible to diagnose in post-menopausal women with PCOS because the salient features of the syndrome disappear-Menses cease and testosterone levels may no longer be higher than in non-PCOS women. But despite this, PCOS does not disappear and the ovary continues to have multiple cysts on it.
Other symptoms of PCOS like insulin resistance and obesity also don’t sort themselves out. What’s worrying for post-menopausal women with PCOS is that they are more prone to cascading insulin resistance and abdominal fat deposition along with chronic inflammation and an increase in LDL or bad cholesterol which has deep linkages with heart problems.
Let’s cast an eye towards the effect of age on 3 main hormones that kind of go out of whack in PCOS- leutinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone.
These reproductive hormones improve with age. Testosterone kind of levels off to the same level as in non-PCOS women at the age of 61, but levels of FSH persist even after menopause.
Hirsutism and male-pattern baldness are also the two symptoms that persist in post-menopausal women.
Post-menopausal women with PCOS also have a higher waist circumference which means more abdominal fat and higher BMIs as well as higher levels of insulin than women without PCOS, independent of weight, and more inflammation.
What does this mean if you are an older woman with PCOS? You can have a natural pregnancy later on in life as compared to a non-PCOS woman and go into menopause later, but you still are at an increased risk for type 2 diabetes, cardiovascular disease and metabolic syndrome much, much, more than non-PCOS post-menopausal women.
So, scientific data only reinforces what we already know that you have to work on your weight and improve your insulin sensitivity by eating a well-balanced, nourishing diet as well as exercise regularly to keep your insulin on an even keel.