PCOS and Menopause: What Really Happens and How to Support Your Body Through It

For years, PCOS has been framed as something that only affects women of “childbearing age.” But here’s the thing: PCOS doesn’t clock out once your periods stop.

As you move through perimenopause and into menopause, your hormones shift dramatically - and if you have PCOS, those shifts can look and feel a little different. Understanding what’s going on beneath the surface can make this stage of life far easier to navigate.

So, let’s break down what the research says about how PCOS interacts with menopause, what symptoms you might notice, and how to support your body for a smoother transition.

Does PCOS go away after menopause?

Ah, if only! When menopause hits, periods stop, ovulation ends, and the ovaries slow down oestrogen and progesterone production. But studies show that the hormonal and metabolic features of PCOS persist long after menopause (Puurunen et al., 2011).

That means insulin resistance, inflammation, and higher androgen levels can still be part of the picture - even without monthly cycles. Essentially, menopause doesn’t erase PCOS; it just changes the playing field.

Does PCOS delay menopause?

Now here’s one of the few silver linings of PCOS. Research suggests that women with PCOS tend to reach menopause two to four years later than those without it (Amiri et al., 2024).

Why? Because women with PCOS often have more ovarian follicles and higher anti-Müllerian hormone (AMH) levels - meaning the ovaries take longer to run out of eggs.

So while your friends might be waving goodbye to their cycles, you could still be getting a few extra years of hormone protection before menopause fully sets in.

The gut–hormone connection

This is where things get fascinating (and often overlooked).

Emerging research shows that menopause alters the gut microbiome - the community of microbes that help regulate hormones, metabolism, and inflammation (Baker et al., 2022).

As oestrogen and progesterone decline, there’s typically a drop in microbial diversity and a reduction in the estrobolome - the bacteria responsible for recycling oestrogens.

Women with PCOS already tend to have gut imbalances, so menopause can compound the problem. A less diverse gut can mean more inflammation, poorer blood sugar control, and even a greater risk of bone loss (Torres et al., 2022).

But the good news? You can nourish your gut - and by extension, your hormones - through food and lifestyle changes that help restore balance. Supporting your body through the transition

Below are research-backed strategies to help you manage the most common PCOS–menopause challenges - grouped by symptom or underlying cause.

Supporting your body through the transition

Below are research-backed strategies to help you manage the most common PCOS–menopause challenges - grouped by symptom or underlying cause.

To improve insulin resistance

• Build muscle. Strength training 2–3 times per week is a game changer. Muscle acts like a sponge for glucose, pulling sugar out of your bloodstream and keeping insulin levels steady.

• Prioritise protein. Aim for a protein source at every meal - Greek yoghurt, eggs, lentils, fish, tofu. Protein slows glucose release and helps you feel fuller for longer.

• Balance your plate. Pair carbs with fibre, protein, and healthy fats to prevent blood sugar spikes.

  
  

To protect heart and metabolic health

• Move regularly. Combine cardio (walking, swimming, cycling) with resistance work. Both improve blood pressure and cholesterol.

• Choose heart-healthy fats. Think salmon, chia seeds, flax, and walnuts - rich in omega-3s and anti-inflammatory compounds.

• Keep an eye on key markers. Ask your GP to monitor blood pressure, glucose, and lipids - risks rise post-menopause, especially with PCOS.

To support a healthy gut microbiome

• Eat the rainbow. Aim for at least 30 different plant foods each week - fruits, veg, herbs, nuts, seeds, legumes, and whole grains. Variety = microbial diversity.

• Include plant proteins. Chickpeas, lentils, and tofu feed beneficial gut bacteria and support hormone balance.

• Try fermented foods. Yoghurt, kefir, kimchi, and sauerkraut add natural probiotics.

• Tame stress. The gut–brain axis is real. Stress alters gut bacteria - meditation, journaling, or gentle movement can help rebalance things.

  
  

To protect bone and muscle strength

• Load your bones. Weight-bearing exercise like walking or resistance training keeps bones strong.

• Prioritise calcium and vitamin D. Include dairy or fortified plant alternatives, leafy greens, and consider a supplement if needed.

• Don’t forget magnesium. Found in nuts, seeds, and legumes - crucial for bone metabolism and recovery.

To support mood, sleep, and energy

• Create a calming evening routine. Limit caffeine after lunch, keep your room cool and dark, and wind down with reading or breathing exercises.

• Move daily. Exercise boosts mood-regulating neurotransmitters and improves sleep quality.

• Stay connected. Hormonal transitions can feel isolating. Talking - whether with friends, peers, or professionals - makes a huge difference.

Thinking about HRT?

Hormone Replacement Therapy (HRT) can be transformative for some women - improving hot flushes, mood, and sleep, while supporting bone and heart health.

There’s no evidence that having PCOS prevents safe HRT use, but it’s vital to discuss it with your GP, especially if you have cardiovascular risk factors.

Research shows that HRT can improve cholesterol and insulin sensitivity in menopausal women (Li et al., 2021). So, if menopause symptoms are affecting your quality of life, it’s a conversation worth having.

The bottom line

Menopause doesn’t “cure” PCOS - but it does mark a shift. Periods stop, fertility declines, but your body’s hormonal story continues.

The silver lining? You already know your body better than most. You’ve learned to manage symptoms, fuel yourself well, and adapt through change.

This next phase isn’t about restriction -

it’s about refinement. Supporting your metabolism, gut, and mental wellbeing through simple, sustainable habits can make menopause not just manageable, but empowering.

References (Harvard Style)

Amiri, M., Ramezani Tehrani, F., Behboudi-Gandevani, S. and Azizi, F. (2024) ‘A prospective study on the relationship between polycystic ovary syndrome and age at natural menopause’, Menopause, 31(2), pp. 130–137.

Baker, J.M., Al-Nakkash, L. and Herbst-Kralovetz, M.M. (2022) ‘Estrogen–gut microbiome axis: Physiological and clinical implications’, Frontiers in Cellular and Infection Microbiology, 12, 837860.

Li, S., Chen, C., Zhang, W. et al. (2021) ‘Effects of hormone replacement therapy on glucose and lipid metabolism in peri- and postmenopausal women with a history of menstrual disorders’, BMC Endocrine Disorders, 21, 121.

Puurunen, J., Piltonen, T., Morin-Papunen, L. et al. (2011) ‘Unfavorable hormonal, metabolic, and inflammatory alterations persist after menopause in women with PCOS’, The Journal of Clinical Endocrinology & Metabolism, 96(6), pp. 1827–1834.

Sharma, S. and Mahajan, N. (2021) ‘Polycystic ovarian syndrome and menopause in forty plus women’, Journal of Mid-life Health, 12(1), pp. 3–7.

Torres, P.J., Bittinger, K., Patel, S. et al. (2022) ‘Menopause is associated with changes in the gut microbiome and cardiometabolic risk factors’, Menopause, 29(8), pp. 982–991.

Welt, C.K., Carmina, E., & Azziz, R. (2013) ‘Lifecycle of Polycystic Ovary Syndrome (PCOS): From in utero to menopause’, The Journal of Clinical Endocrinology & Metabolism, 98(12), pp. 4629–4638.