Do you feel tired all the time? Struggle with weight that won’t budge, even when you’re eating clean? Do you deal with facial hair, thinning scalp hair, irregular cycles—or had those issues in the past—and now you’re going through menopause?
You may be dealing with something many women have but don’t know about:
Polycystic Ovary Syndrome (PCOS).
Even more surprising? PCOS doesn’t just affect young women. It can continue to impact your health well into menopause, even after your periods stop.
If you’ve been dismissed, misdiagnosed, or confused about your symptoms, this guide is here to change that.
What Is PCOS?
Polycystic Ovary Syndrome (PCOS) is a hormonal and metabolic disorder that affects how a woman’s ovaries function. It’s one of the most common but underdiagnosed conditions in women. Experts estimate that up to 1 in 10 women has PCOS—but the real number could be higher because many women don’t get diagnosed until much later, if ever.
What Causes PCOS?
The exact cause of PCOS is not fully understood, but research points to a combination of genetic, hormonal, and environmental factors. Here’s how it breaks down:
🔹 1. Insulin Resistance
(a key driver)
- Insulin is the hormone that helps your body use sugar (glucose) for energy.
- In many women with PCOS, the body becomes resistant to insulin, so the pancreas makes extra insulin to compensate.
- High insulin levels stimulate the ovaries to produce more testosterone, disrupting ovulation and hormone balance.
📌 Note: Even women with a “normal” body weight can have insulin resistance with PCOS. You don’t have to be overweight to be affected.
🔹 2. Excess Androgens (Male Hormones)
- Women naturally produce some androgens (like testosterone), but in PCOS these levels are often too high.
- This leads to symptoms like:
- Facial hair growth
- Scalp hair thinning
- Acne
- Irregular periods due to disrupted ovulation
🔹 3. Irregular Ovulation
- The hormonal imbalance prevents the ovaries from releasing eggs properly, leading to:
- Missed or irregular periods
- Enlarged ovaries with immature follicles (“cysts”) that never fully develop or release
🔹 4. Low-Grade Inflammation
- Many women with PCOS have chronic low-grade inflammation in the body.
- This inflammation can worsen insulin resistance and contribute to heart disease over time.
🔹 5. Genetics
- PCOS often runs in families.
- If your mother, aunt, or sister has it—or had trouble with irregular periods, infertility, or excess facial hair—you may carry the same genetic risk.
The Diagnostic Criteria (Rotterdam Criteria)
To be diagnosed with PCOS, doctors typically look for at least two of these three signs:
- Irregular or absent ovulation (leading to irregular or absent periods)
- High levels of androgens (testosterone or other male-type hormones, measured by blood tests or physical symptoms like hair growth)
- Polycystic ovaries seen on ultrasound (not required for diagnosis)
What Does PCOS Do?
PCOS affects your:
✅ Ovaries — often preventing them from releasing eggs regularly (irregular or missed periods)
✅ Hormones — increasing androgens (male-type hormones like testosterone)
✅ Insulin sensitivity — making it harder for your body to use insulin properly, which raises blood sugar
✅ Metabolism — slowing it down, leading to weight gain and difficulty losing weight
✅ Skin and hair — causing acne, hair thinning on the scalp, or excessive facial/body hair
Common Symptoms of PCOS
- Irregular or missed periods (or very heavy bleeding)
- Facial hair or chin hair
- Hair thinning or balding at the crown of the head
- Oily skin or adult acne (especially around the jawline)
- Weight gain or difficulty losing weight—especially around the belly
- Dark patches of skin (often on the neck or underarms)
- Fatigue, mood swings, and trouble sleeping
- Anxiety or depression
- Cravings for sugar or carbs
- Brain fog and forgetfulness
- Difficulty getting pregnant in earlier years
You don’t need to have all these symptoms to have PCOS. Some women only have a few, and it can still severely impact their health.
So What Happens to PCOS at Menopause?
Many people assume PCOS “goes away” after menopause—but that’s a myth.
In truth, the hormonal imbalance and insulin resistance behind PCOS often persist into menopause. While you might stop having periods, the underlying issues—like high testosterone and poor blood sugar control—can keep causing symptoms and health risks.
Here’s How PCOS and Menopause Intersect
1. Hormone Levels Shift Differently
In menopause, estrogen and progesterone drop. But in women with PCOS, testosterone and insulin resistance often remain elevated. This means:
- Fatigue stays or worsens
- Facial hair continues (or increases)
- Scalp hair thinning progresses
- Weight gain (especially belly fat) accelerates
- Mood swings and brain fog worsen
You may be postmenopausal but still feel like your hormones are out of control—and they are.
2. Higher Risk of Metabolic Conditions
Women with PCOS have an increased risk of:
- Type 2 diabetes
- High blood pressure
- High cholesterol
- Heart disease
- Stroke
- Sleep apnea
- Endometrial cancer (due to years of unopposed estrogen)
During menopause, your body loses the protective effect of estrogen—which means these risks become even more serious if you’ve had PCOS.
3. Weight Becomes Harder to Manage
Both menopause and PCOS slow metabolism and promote insulin resistance—which means your body stores fat more easily, especially around the middle. Even with a healthy diet, women with PCOS may gain weight rapidly in menopause.
Worse, this type of weight gain—called visceral fat—surrounds your organs and increases your risk for:
- Heart disease
- Diabetes
- Inflammation
- Cognitive decline
It’s not about vanity—it’s about your health.
4. PCOS Is Often Missed or Misdiagnosed
Many women reach menopause never knowing they had PCOS. If you’ve struggled for years with irregular periods, fertility issues, unexplained weight gain, or facial hair, it could have been PCOS all along.
Unfortunately, even in menopause, women are often told their symptoms are “just aging” or “just hormonal.” But you deserve real answers—not dismissal.
Signs You May Still Be Dealing With PCOS After Menopause
- You still have unwanted facial or body hair
- You experience hair thinning on your scalp
- You have skin tags or dark patches on your neck or underarms
- You gain weight easily—especially in your belly
- You’ve been told you have insulin resistance or prediabetes
- You have trouble concentrating, remembering, or sleeping
- You’ve had irregular cycles most of your life, even if they’ve stopped now
If this sounds familiar, it’s time to bring it up with your doctor—and this blog post can help you explain what’s going on.
How to Manage PCOS in Menopause
There’s no cure for PCOS, but it’s very manageable—especially once you understand how menopause impacts it. Here’s how to take back control:
1. Balance Your Blood Sugar
PCOS is closely tied to insulin resistance, which becomes more dangerous with age. Managing blood sugar is the most important step you can take.
- Eat high-fiber foods (vegetables, legumes, whole grains)
- Cut back on sugar and processed carbs
- Eat protein with every meal
- Consider intermittent fasting if medically appropriate
- Ask your doctor about metformin or GLP-1 medications if needed
2. Exercise Regularly
Exercise helps:
- Improve insulin sensitivity
- Lower testosterone
- Reduce belly fat
- Boost your mood and energy
Walking, strength training, yoga, and resistance bands are all excellent. You don’t need to go to the gym—just move your body daily.
3. Treat Hair and Skin Concerns
Excess facial hair and hair thinning are more than cosmetic—they’re signs of hormonal imbalance.
Options include:
- Spironolactone (a medication that blocks testosterone)
- Laser hair removal or electrolysis
- Minoxidil (Rogaine) for scalp thinning
- Androgen-blocking supplements (with medical advice)
4. Monitor Your Heart Health
Have your doctor check:
- Blood pressure
- Cholesterol
- A1C (blood sugar levels over time)
- Weight and waist circumference
- Inflammatory markers like CRP
If you’re on HRT (Hormone Replacement Therapy), ask if it’s appropriate for someone with PCOS and insulin resistance.
Take This to Your Doctor
Many women feel dismissed or unheard. If you suspect PCOS is still affecting you after menopause, take this article with you to your doctor and say:
“I’ve been dealing with these symptoms—weight gain, facial hair, brain fog, hair loss—and I think it may be connected to PCOS. I’d like to get my hormone and insulin levels tested and talk about what I can do.”
Ask about:
- Fasting insulin
- Free and total testosterone
- DHEA-S
- A1C
- Lipid panel (cholesterol)
- Pelvic ultrasound (if appropriate)
Final Thoughts: Know Your Body, Own Your Health
You are not crazy. You are not just “getting old.”
You may be experiencing the long-term effects of PCOS—and with knowledge, you can get help.
Menopause is already a massive shift. Add in a hidden or unrecognized condition like PCOS, and it can feel overwhelming. But once you know what’s going on inside your body, you can take informed, empowered action.
You deserve answers. You deserve relief. You deserve care.
Menopause Matter is here to help you understand your body, advocate for your health, and live fully—at every stage of life