Persistent insulin resistance

Insulin resistance is common among women struggling with PCOS during their reproductive years (in general from the onset of menstruation until five to ten years before menopause), but can also last at menopause. It’s what happens when cells in your muscles, fat, and liver don’t respond as they should to insulin (a hormone produced by the pancreas that regulates blood sugar, or blood sugar). When your cells become resistant to insulin, your blood sugar levels can rise. Over time, this phenomenon leads to weight gaintype 2 diabetes and metabolic syndrome (an accumulation of several disorders related to weight gain that can lead to heart problems and diabetes).

According to one recent study in Gynecological and Reproductive Endocrinology and Metabolism journal that examined how insulin resistance affects menopausal women, women with PCOS typically have too much estrogen without enough progesterone. Combine this with the rise in cortisol that comes with aging, and you have a recipe for worsening insulin resistance as you go through menopause.

What to do: Get it A1C (a blood test that measures your average blood sugar level over three months) and your current glucose levels checked. Mary Jane Minkin, MDclinical professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine, says women with PCOS should do the same as people with diabetes: monitor blood sugar, eat a good diet (she recommends — surprise! — the Mediterranean diet) and doing as much aerobic and strength training as possible. If your glucose levels are high, an endocrinologist can help you explore possible treatment options, such as metformin, a commonly used diabetes drug that lowers insulin levels, or weight-loss drugs such as Wegovy and Ozempic. Also of note: Study researchers found that perimenopausal women who used transdermal hormone replacement therapy appeared to be protected from weight fluctuations.

Greater risk of cognitive decline

While menopause is notorious for messing with your memory, women with PCOS may be taking an extra hit: a recent longitudinal study published in Neurology revealed a link between PCOS and cognitive dysfunction later in life. Kaitlin Casaletto, PhD, associate professor at the University of California, San Francisco’s Weill Institute for Neuroscience, who helped conduct the study, says women who met criteria for PCOS showed poorer cognitive performance in midlife (between the ages of 48 and 60 years) than women who did not. ‘t. “This suggests that endocrine, cardiovascular, metabolic and other differences associated with PCOS are risk factors for brain health,” she explains. “Our data may also suggest that PCOS influences brain vascular function, which is known to change with age and is associated with age-related cognitive changes.”

What to do: Casaletto says a diet high in vegetables, whole grains and legumes is associated with a 30 percent reduced risk of stroke and cognitive decline. Referring to the brain as “elastic,” she recommends staying active and social, getting enough sleep, and staying curious, like learning a new hobby or a new language or talking to someone new. “If you find it hard, you’re probably getting somewhere,” she says, adding that older adults who are more open to new experiences generally do better. Treating any ticker and blood vessel problems will also help. “What’s good for the heart is good for the brain,” she says. “Think of the vascular system as our brain’s plumbing system.”

Potential for depression

Anyone who has experienced the monthly roller coaster that a period can bring knows how much hormonal fluctuations can affect our day-to-day mood. The same goes for the rocking hormones in PCOS. Numerous studies have linked PCOS with an increased likelihood of depression. Although researchers are still working to determine exactly why, it’s likely a vicious cycle related to insulin resistance—impaired insulin signaling can affect your mood, and your mood can also cause behaviors that lead to resistance. That Casaletto’s study notesall those fluctuating hormones that can cause depression in PCOS women get worse at menopause.

What to do: If you notice a drop in your mood or just feel inexplicably down, tell your doctor and consider seeing a therapist or psychiatrist for further evaluation.

Increased risk of heart disease

Women with PCOS may have a 30 to 40 percent higher risk of developing cardiovascular disease during pregnancy or later in life. Erin Michos, MDprofessor of medicine in the division of cardiology at Johns Hopkins School of Medicine, worked at more studies examining the link between PCOS and cardiovascular disease. Excess male hormones and ovulatory dysfunction are linked to the greatest risks to heart health, she explains, noting a tendency for women with PCOS to develop elevated blood pressure, LDL cholesterol and triglycerides.

What to do: Most adults with PCOS, especially those who are pregnant, should “have a comprehensive cardiovascular screening; have their blood pressure, glucose and lipids checked; make sure they know their A1C; and try to maintain a healthy weight to offset some of these risks,” says Michos. She also recommends a low-dose CT scan called a coronary artery calcium test which can identify calcified plaque in the arteries of the heart. Your cardiologist may order it, but be sure to check and make sure your insurance covers it.