PCOS Beyond Fertility: Perimenopause
PCOS Beyond Fertility: Why Symptoms Can Worsen in Perimenopause – and What You Can Do.
When most people think of Polycystic Ovary Syndrome (PCOS), they picture irregular cycles, excess androgens, and difficulty conceiving. But PCOS is a lifelong condition with effects that extend well beyond fertility.
In fact, for many women, symptoms can change – and in some cases worsen – during perimenopause, the years leading up to menopause when hormones fluctuate and gradually decline.
Why PCOS Can Worsen in Perimenopause
Perimenopause is a period of hormonal turbulence. Oestrogen and progesterone levels fluctuate and then decline, while androgens may remain relatively higher. This shifting hormonal environment can exacerbate the metabolic and cardiovascular risks already associated with PCOS.
Three main factors contribute to this:
Loss of muscle mass
Age-related muscle loss (sarcopenia) reduces insulin sensitivity, making blood sugar harder to regulate and weight easier to gain (Wilkinson et al., 2018).Increased insulin resistance
PCOS is strongly associated with insulin resistance (Purwar & Nagpure., 2022), and declining oestrogen during perimenopause can make this worse (Carr, 2003).Higher cardiovascular risk
Women with PCOS have an elevated lifetime risk of high blood pressure, dyslipidaemia, and cardiovascular disease (Cooney & Dokras, 2018). These risks increase with age and hormonal changes.
Blood Sugar and Perimenopause Symptoms
Poor blood sugar control doesn’t just affect long-term health – it’s linked to more severe perimenopause symptoms, including:
Hot flushes
Mood swings
Sleep disturbances
Research shows that glucose dysregulation is associated with greater symptom frequency and intensity (Thurston et al., 2012).
6 Practical Tips to Support PCOS During Perimenopause
1. Balance Blood Sugar at Every Meal
Pair every carbohydrate source with protein and healthy fats to slow glucose release and prevent spikes. Prioritising protein at each meal also helps protect muscle mass, which is crucial for maintaining metabolic health as we age.
Opt for high-fibre, low-GI carbohydrates such as:
Lentils, chickpeas, and other legumes
Quinoa, buckwheat, and pearl barley
Berries, apples, and pears
Sweet potatoes and non-starchy vegetables
These foods help stabilise energy, support hormone balance, and reduce cravings (Kazemi et al., 2021).
2. Strength Train to Preserve Muscle
Aim for at least two to three resistance training sessions per week. Strength training slows muscle loss, boosts insulin sensitivity, and supports a healthy metabolism (Westcott, 2012). Home-based workouts using bodyweight, resistance bands, or dumbbells can be just as effective as gym sessions.
3. Support Your Body with Tailored Supplements
Supplements can be a helpful part of a PCOS strategy, particularly during perimenopause. Options to discuss with your practitioner or GP include:
Inositol – particularly myo-inositol or a myo- and d-chiro combination – to support insulin sensitivity and ovulatory function
Vitamin D – for hormone regulation, immune health, and metabolic support
Magnesium – to aid sleep, stress resilience, and insulin sensitivity
Omega-3 fatty acids – for cardiovascular health and reducing inflammation
Always seek professional guidance and, where possible, test levels first so doses can be tailored to your needs.
4. Reduce Stress Load
Chronic stress raises cortisol, which can worsen abdominal fat gain and insulin resistance (Hackney, 2006). Build regular stress-relieving activities into your week, such as gentle walks, breathing exercises, journalling, or mindfulness practices.
5. Protect Your Sleep
Poor sleep disrupts appetite-regulating hormones, increases insulin resistance, and worsens mood regulation. Aim for 7–9 hours per night and establish a consistent bedtime routine. Reduce screen use in the evening and keep your bedroom cool, dark, and quiet (Taheri et al., 2004).
6. Nurture Your Social Connections
Spending time with friends, family, or community groups supports mental health, reduces stress, and improves resilience (Holt-Lunstad et al., 2010). Schedule regular social contact, even if it’s a short phone call or a walk with a friend.
The Bottom Line
PCOS is not just a fertility condition — it’s a metabolic and hormonal disorder that needs attention throughout life. During perimenopause, shifting hormones and muscle loss can magnify its impact, but the right nutrition, movement, lifestyle strategies, and personalised supplements can make a real difference.
By taking a proactive approach now, you can protect your metabolic health, ease symptoms, and improve your quality of life well into menopause and beyond.
References
Kazemi M, Hadi A, Pierson RA, Lujan ME, Zello GA, Chilibeck PD. Effects of Dietary Glycemic Index and Glycemic Load on Cardiometabolic and Reproductive Profiles in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Adv Nutr. 2021;12(1):161-178. doi:10.1093/advances/nmaa092
Carr MC. The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab. 2003;88(6):2404-2411. doi:10.1210/jc.2003-030242
Wilkinson DJ, Piasecki M, Atherton PJ. The age-related loss of skeletal muscle mass and function: Measurement and physiology of muscle fibre atrophy and muscle fibre loss in humans. Ageing Res Rev. 2018;47:123-132. doi:10.1016/j.arr.2018.07.005.
Hackney AC. Stress and the neuroendocrine system: the role of exercise as a stressor and modifier of stress. Expert Rev Endocrinol Metab. 2006;1(6):783-792. doi:10.1586/17446651.1.6.783
Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7(7):e1000316. Published 2010 Jul 27. doi:10.1371/journal.pmed.1000316
Purwar A, Nagpure S. Insulin Resistance in Polycystic Ovarian Syndrome. Cureus. 2022;14(10):e30351. Published 2022 Oct 16. doi:10.7759/cureus.30351
Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1(3):e62. doi:10.1371/journal.pmed.0010062
Thurston RC, El Khoudary SR, Sutton-Tyrrell K, et al. Vasomotor symptoms and insulin resistance in the study of women's health across the nation. J Clin Endocrinol Metab. 2012;97(10):3487-3494. doi:10.1210/jc.2012-1410
Westcott WL. Resistance training is medicine: effects of strength training on health. Curr Sports Med Rep. 2012;11(4):209-216. doi:10.1249/JSR.0b013e31825dabb8
Cooney LG, Dokras A. Beyond fertility: polycystic ovary syndrome and long-term health. Fertil Steril. 2018;110(5):794-809. doi:10.1016/j.fertnstert.2018.08.021