The Ultimate PCOS Handbook. Theresa Cheung

after all, you’ve ovulated – but unfortunately this isn’t the case. ‘Although some women with PCOS find that their post pregnancy cycles get more regular, there isn’t any evidence to suggest that pregnancy cures PCOS,’ says PCOS expert Adam Balen. ‘What we do know, though, is that research does seem to indicate that a PCOS pregnancy is at greater risk.’ While it may seem scary to read about the risks, knowing about them means you can deal with them in a proactive and positive way.

      Research⁶ suggests that women with PCOS are more likely to miscarry, possibly due to excess weight, which is itself associated with an increased risk of miscarriage. It could also be due to the higher LH concentrations in PCOS, which could damage egg quality.

      PCOS may also increase the risk of gestational diabetes⁷ (diabetes that occurs during pregnancy) due to weight issues and/or insulin resistance, and this ups the risk of hypertension and the need for a Caesarean section during labour.

      Pregnant women with PCOS who are insulin resistant are also at an increased risk of hypertension or high blood pressure.⁸ Pregnancy-induced hypertension carries with it the risk of growth retardation in the baby and damage to the nervous system and kidneys in the mother.

      We know this all sounds alarming, but do remember that every pregnancy carries risks, whether you have PCOS or not. And if your doctor is aware, and works with you to monitor your pregnancy closely, you should pick up any early warning signs.

      PERIMENOPAUSE AND THE MENOPAUSE

      In the same way as a car can’t go from 60 mph to standstill without slowing down, your ovaries also need time to slow down before they stop completely at the onset of the menopause. Perimenopause is the period of gradual physical and biochemical change that leads to the menopause, when your ovaries’ production of oestrogen slows down, causing irregular periods. Generally changes such as shorter or longer periods, heavier or lighter bleeding and varying lengths of time between periods may be an indication of perimenopause, which usually lasts around two to five years, before the menopause itself – your last period. The average age for the onset of perimenopause is 47, though this varies.

      Typical symptoms of perimenopause include fatigue, mood swings, hot flushes, vaginal dryness, loss of libido, memory loss, night sweats and irregular periods.

      The average age of the menopause for women in Western nations is 51, though some may experience it as early as their thirties or as late as their sixties due to hereditary influences or even illness. You’re classified as post-menopausal when you haven’t had a period for 12 months.

      PCOS AND THE PERIMENOPAUSE

      Perimenopause can often go unnoticed in women with PCOS, as they are used to having irregular periods. Some women with PCOS say that, instead of their cycles becoming more irregular, they actually become more regular. A possible explanation for this is that the hormonal swings and high oestrogen and androgen levels associated with PCOS may lessen as a woman nears the menopause, when oestrogen and androgen levels naturally lower.

      Many women with PCOS assume that because they’ve always had irregular periods they won’t go through the menopause. This isn’t the case. Whether you have PCOS or not, the menopause causes a significant decrease in oestrogen and this can increase the risk of heart disease, osteoporosis and cancer, so you do need to manage it.

      Many of the symptoms of the menopause are related to this drop in oestrogen, and you can still expect these changes if you’ve got PCOS.

      According to research, the high levels of androgen in PCOS may fall during the menopause, sometimes to normal levels, although they usually remain higher than for women who don’t have PCOS. But many androgen-related problems, such as increased hair growth (hirsutism) and acne, continue (although they rarely get worse).

      The risk of heart disease increases for all women after the menopause, but women with PCOS are at even higher risk due to raised androgen levels, unhealthy changes to blood fats and obesity. In addition, 40 per cent of women with PCOS develop Type 2 diabetes by the age of 40, which further increases the risk of heart disease.

      For this reason you should make sure your doctor regularly checks your blood fat levels and blood pressure.

      ‘I always thought menopause would be the end of it all. What a shocker to find out that this is a myth!’

       Linda, 49

      HRT OR NOT HRT?

      In the past, HRT (hormone replacement therapy) has been widely used to help women going through the menopause and post-menopause. Some doctors even prescribe it for perimenopause if hot flushes are a problem. What research there is suggests that taking HRT can bring about the same benefits for women with PCOS as it does for women without PCOS. But because of the increased risk of cancer of the endometrium (womb), women with PCOS should use a type of HRT that includes progesterone to induce periods. Androgenic progesterones, such as levonorgesterel, should be avoided.

      Also bear in mind that recent research on the effects of HRT (since 2003) has led doctors to question whether any possible long-term benefits are worth the risks associated with the treatment, such as an increased risk of breast cancer and heart disease if you take it for more than five years. You should be aware of these risks and how they might compare with the possible benefits when deciding what you want to do.

      If you’re considering hormone replacement therapy, do make sure your doctor is familiar with PCOS and can help you select a treatment plan that will take into consideration the specific problems associated with PCOS.

      You may of course decide not to go down the HRT route, and protect yourself with diet and lifestyle changes instead. If this is the case, it’s still important that you keep in close touch with your doctor to make sure you’re protected against the long-term health risks associated with PCOS.

      ‘My mother died of breast cancer at 56, so there was absolutely no way I was going to go on HRT.’

       Maureen, 57

      AFTER THE MENOPAUSE

      Because we now have longer life spans and often live well into our eighties, modern women are usually post-menopausal for a third of their lives.

      So does PCOS fade away after the menopause? ‘This is probably the most asked question by women over age 40 with PCOS,’ says PCOS expert Samuel Thatcher, ‘The answer to which is, No!’

      This was shown in a study⁹ from Kaplan Medical Centre in Israel, which evaluated 104 post-menopausal women by physical examination, detailed questionnaire and laboratory measurements of glucose, blood fats and sex-hormone levels. Seven (6.7 per cent) of the women were diagnosed with PCOS. As compared to women without PCOS, central obesity (fat around the stomach) was more common in the PCOS group, 4 out of 7 had Type 2 diabetes compared to 8 out of 97 in the non-PCOS group, and 6 out of 7 (versus 31 out of 97) had elevated blood fats (triglycerides, cholesterol) characteristic of the Metabolic Syndrome (Syndrome X). PCOS appears to be fairly common in post-menopausal women, and is a marker for a metabolic profile associated with a high risk of cardiovascular diseases.

      ‘I really noticed “middle-aged spread” as I put weight on my tummy. But then so did my friends without PCOS when they went through menopause.’

       Jan, 56

      To recap: We know that women with PCOS are already at an increased risk of developing diabetes, heart disease and endometrial cancer. Because such risks only increase with age, treating PCOS both during and after the menopause is essential.

      SAVING THE BEST TILL LAST

      From our many chats with women with PCOS it’s very clear that this post-menopause stage in life offers a wonderful and liberating opportunity to understand ourselves, our sexuality and what we have to contribute