How PMOS (once called PCOS) affects women after menopause

The end of monthly periods ushers in a sense of relief for virtually every woman who reaches menopause. Women with polyendocrine metabolic ovarian syndrome (PMOS; formerly known as polycystic ovary syndrome, or PCOS) — which is characterized by irregular periods and heavy bleeding — might also expect that the menopause transition represents the end of their PMOS symptoms.

The reality is starkly different, however. A hormonal and metabolic syndrome that can lead to many small, cystlike follicles on the ovaries (see “PCOS has a new name”), PMOS doesn’t vanish with a woman’s reproductive years. Women with this syndrome continue to face some of the same symptoms they had before menopause, as well as ongoing threats of serious health problems for the rest of their lives.

That leaves the 10 million women with PMOS in the United States with questions when they reach menopause, says Dr. Margaret Lippincott, director of the Multidisciplinary Care Center for Polycystic Ovary Syndrome at Harvard-affiliated Massachusetts General Hospital. “They no longer get their period, but they continue to have all the other metabolic and endocrine features of PMOS, which can be made worse by the menopausal transition.”

PMOS stages and changes

During the reproductive years, PMOS shows up in a variety of disruptive ways, including

• obesity
• irregular or painful periods
• heavy bleeding
• fertility problems
• treatment-resistant acne
• hair loss on the scalp (known as androgenic alopecia)
• hair growth on the face, chest, and back.

For all women, menopause brings the end of ovulation and a dramatic drop in estrogen and other hormones, including androgens — male hormones such as testosterone that are normally present in small amounts in women. But for those with PMOS, androgen levels may decline only slightly.

“Androgen levels remain higher in postmenopausal women with PMOS than estrogen levels do, so they may still have hair loss on the scalp or notice a mild worsening of hair growth where they don’t want it,” Dr. Lippincott explains. “They may still notice some acne. Those symptoms, hormonally, tend to stay.”

Health risks of PMOS after menopause

Other downstream effects of PMOS after menopause are more sinister. While reproductive symptoms abate, obesity and insulin resistance — when the pancreas makes insulin but body cells don’t use it effectively — usually stick around, Dr. Lippincott says. On top of that, the risks of high blood pressure, high cholesterol, and cardiovascular disease rise significantly.

“You could consider it a double hit: for women with PCOS who struggle with weight, or have insulin resistance independent of their weight, menopause itself is associated with a loss of lean mass and an increase in weight distribution around the middle — both of which are metabolically unfavorable,” Dr. Lippincott says.

Additionally, endometrial cancer occurs more often in women with PMOS both before and after menopause because of their history of irregular ovulation and buildup of uterine lining tissue. The average woman has a one-in-33 risk of endometrial cancer; for women with PMOS, it’s about one in 11.

Doctors and patients need to be ever mindful of all these elevated health threats, Dr. Lippincott says. “It’s incredibly important that a PMOS diagnosis never falls off the chart for these women.”

Managing PMOS later in life

Postmenopausal PMOS patients can take important steps to protect their health. Dr. Lippincott suggests these measures:

Lifestyle approaches. Healthy eating and regular exercise — particularly resistance training, which improves the body’s insulin use — can lower the risks of high blood pressure, high cholesterol, and diabetes. Losing weight may also improve PMOS-related health problems, but women with the condition are genetically prone to excess weight. “It’s within your control to live a healthy lifestyle, independent of any weight loss,” Dr. Lippincott says.

Aggressive monitoring. Regular checks of blood sugar, cholesterol, and blood pressure are paramount. “The first thing women with PMOS can do is know their numbers — their cholesterol, body mass index, and hemoglobin A1c,” she says. (The latter is a measure of average blood sugar levels over a three-month period.)

Medications (if appropriate). These might include cholesterol-lowering statins, blood pressure drugs, and metformin for blood sugar control. “Use modern medicine to help optimize your health,” she says. “You don’t have to power through this on your own.”

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