Transitioning to Menopause with PCOS

Guest post by Dr. Felice Gersh

For many years, Polycystic Ovary Syndrome, known as PCOS, was viewed as a reproductive condition. It’s primary symptoms were seen exclusively as irregular or absent menstrual cycles and infertility, which were accompanied by the aesthetic issues of acne, hirsutism (dark body hair on the face and other typically male areas with hair), and androgenic alopecia (loss of scalp hair). All of these textbook PCOS symptoms stem from androgen excess, or simply too much testosterone, which is the dominate male sex hormone. For decades, androgen excess has been considered the hallmark identifier of PCOS and the root cause of all reproductive and aesthetic symptoms. Menopause ends reproductive cycles and causes a drop in all sex hormones, including testosterone. Consequently, menopause came to be viewed as the ultimate “cure” for PCOS.

Viewing PCOS and menopause as a cure for PCOS is inaccurate and does a disservice to all women. Menopause may be a great equalizer, but it is not a cure for anything.

What causes PCOS and Menopause?

To understand the relationship between PCOS and menopause, we first need a modern, holistic view of PCOS. Although high testosterone levels are the key diagnostic symptom, they are not the root cause of PCOS. The female body produces testosterone as a precursor to the dominant estrogen, called estradiol. Women with PCOS have low, improperly cycling levels of estradiol, and their bodies produce high levels of testosterone in order to increase levels of estradiol. The true root cause of PCOS is low estradiol caused by a defect in aromatase, the enzyme that converts testosterone to estradiol in the female ovaries.

Estradiol is the master hormone in the female body and plays a key role in the health of every major organ and system in the body. There are receptors for estradiol in the brain, throughout the digestive tract, the cardiovascular system, skin, muscles, bones, and in the immune system. Due to chronic low estradiol, women with PCOS have higher rates of obesity, cardiovascular disease, diabetes, autoimmune disease and mood disorders such as depression and anxiety. Categorizing PCOS as a reproductive disorder is a gross simplification that deeply harms the health of women.

Understanding Menopause

Menopause is marked by the end of ovarian hormone production, which includes estradiol. Without estradiol, women in menopause experience a dramatic increase in rates of obesity, cardiovascular disease, diabetes, autoimmune disease, and mood disorders such as depression and anxiety — the exact same list of symptoms connected to PCOS. Menopausal women also develop osteoporosis and Alzheimer’s disease at rates much higher than men. Loss of estradiol is a primary cause of the accelerated aging that women experience after menopause.

Does menopause “cure” PCOS? No.

Menopause is not a disease, but it is a natural condition marked by hormone deficiency that causes a systemic decline in whole body health. Consequently, menopause cannot be considered a cure for anything. I see menopause as a great equalizer. It is a transition that causes non-PCOS women to begin to rapidly acquire the same health dysfunctions that PCOS women have already been experiencing. After menopause, PCOS women do look a lot more like non-PCOS women because non-PCOS women get sicker. There are no great studies on how PCOS women, specifically, fair after menopause, but the little research that exists suggests that the premenopausal years spent in estradiol deficiency make PCOS women more susceptible to postmenopausal health conditions.

What Can We Do?

With that cheery prognosis, what should PCOS women, menopausal women, and especially PCOS menopausal women do? First of all, don’t panic or despair. Both PCOS and menopause can be treated, and with treatment, the prognosis improves dramatically! It is possible to have PCOS and be healthy. It is possible to go through menopause and stay healthy.

The secret is to live the healthiest life you can. I know, this is very boring advice. But the truth is that PCOS doesn’t have to be a disease. It’s been around for tens of thousands of years and it became a disease state in modern society due to modern unhealthy behaviors. The best way to reverse PCOS is through lifestyle:

• Eat a mostly plant-based diet high in beans, fruits, and veggies with just a little animal protein to support muscle health.
• Sleep 7-8 hours every night.
• Fast from 6PM to 7AM (13 hours total) every night.
• Exercise daily.
• Get sunshine every morning and afternoon.
• Lower stress.
• Avoid harmful chemicals in your food and environment.

Women in perimenopause and menopause should consider bioidentical hormone replacement. For women in their reproductive years, estradiol is the hormone of health and fertility. It is literally the giver of life. After menopause, your body no longer makes it, but it still needs it.

As a practicing medical doctor, I have helped hundreds of women successfully navigate PCOS and menopause. By choosing the best lifestyle approaches and appropriately using bio-identical hormones, women with PCOS can transition through the menopausal journey and come out strong, vital, and glowing! Not only do I see it with my patients, but as a menopausal PCOS woman myself, I have walked this path, and I stand proudly as a living testament that the PCOS menopausal years can be some of the most fulfilling, vibrant, and creative years of your life.

Felice Gersh, M.D. is a multi-award winning physician with dual board certifications in OB-GYN and Integrative Medicine. She is the founder and director of the Integrative Medical Group of Irvine, a practice that provides comprehensive health care for women by combining the best evidence-based therapies from conventional, naturopathic, and holistic medicine. She taught obstetrics and gynecology at Keck USC School of Medicine for 12 years as an Assistant Clinical Professor, where she received the highly coveted Outstanding Volunteer Clinical Faculty Award. She now serves as an Affiliate Faculty Member at the Fellowship in Integrative Medicine, through the University of Arizona School of Medicine, where she lectures and regularly grades the case presentations written by the Fellowship students for their final exams. Felice Gersh, M.D. is the bestselling author of PCOS SOS and the PCOS SOS Fertility Fast Track. She is a prolific lecturer and has been featured in several films and documentary series, including The Real Skinny on Fat with Montel Williams and Fasting with Valter Longo, Ph.D.

 

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References:

1. Schmidt J, Landin-WilhelmsenK, Brannstrom M, Dahlgren E. Cardiovascular disease and risk factors in PCOS women of postmenopausal age: a 21-year controlled follow-up study. J Clin Endocrinol Metab. 2011;96(12): 3794-3803
2. Welt CK Carmina E. Lifecycle of Polycystic Ovary Syndrome (PCOS): From In Utero to Menopause, J Clin Endo Metab. 2013;98(12):4629-4638.