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 to the world. In the words of Sally, age 52:
‘I think there are many things to love about being post-menopausal. PCOS is still there but I’m finding it’s easier to manage. There’s a light at the end of the tunnel of heavy bleeding, no bleeding, nightmare PMS and hot flushes. No more worry about pregnancy. Most women find their voice and have no qualms about raising it. This doesn’t happen overnight, of course, and for many women it takes time to stop feeling bad about speaking up – but they realize they’ve nothing to lose and a lot to gain!
‘Many women find another vocation of sorts for their “second act”. With children out of the house or getting older, they can spend time on themselves, go back to school and take a class in a subject they have always dreamt about. Some pick up a paint brush for the first time, try a musical instrument or write a best-seller. Others have relationships, get married for the first time or again, start a business or travel the world. Of course these aren’t snap decisions and take months if not years of meditation and consultation with family and friends. But the possibilities are endless.’
CHAPTER 4 WHAT AM I DEALING WITH?
Below you’ll find a list of the key short- and long-term symptoms that women with PCOS are likely to have. We stress likely, as your symptoms will be unique to you and different from those of another woman with the syndrome. There’s a wide menu of PCOS symptoms out there, and you can get any combination to any degree of severity, which is why it’s important to find the solutions that work for you.
The most important thing to note is that PCOS is a combination of day-to-day symptoms and longer-term health effects. Even if your day-to-day symptoms aren’t bothering you so much, don’t ignore the self-help plans that come later in the book – the long-term health risks of PCOS mean you need to take action now.
‘The thing that got me started on a self-help plan was worrying about diabetes, but actually I lost some weight and got less spotty just from eating better and getting fitter, and I feel great!’
Amy-Jay, 29
EARLY SIGNS
Many symptoms of polycystic ovary syndrome (PCOS) start gradually, and you may think they’re related to some other medical problem.
IRREGULAR PERIODS
Nine or fewer menstrual cycles per year, or no menstrual cycles at all, may be one of the most common signs of PCOS. When periods do occur, they may be heavier, longer and more painful than normal. These conditions are caused by a hormone imbalance. Almost 50 per cent of women with PCOS don’t ovulate every month.
EXCESS HAIR
Sometimes called ‘hirsutism’, this can be a difficult symptom if you have it. For most women with PCOS, hair in the moustache and beard areas becomes heavier and darker. Masculine hair on the arms and legs, and excess hair in the pubic region, abdomen, chest or back, or on your thumbs or toes, is also possible. This symptom is caused by high levels of male hormones
