Q&A: Understanding the unique health care needs of midlife women with PCOS
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Key takeaways:
- There is a lack of published research on managing polycystic ovary syndrome during midlife and the menopause transition.
- Comprehensive care could help women cope with symptom burden.
Hormonal dysregulation seen in polycystic ovary syndrome can cause a cascade of issues for women, from hirsutism and weight gain to subfertility and type 2 diabetes. Yet beyond the reproductive years, the condition is often ignored.
Emerging data show that peri- and postmenopausal women with PCOS have a higher prevalence of visceral obesity, insulin resistance and elevated triglycerides compared with age-matched women without PCOS. Hyperandrogenism, a hallmark of PCOS, persists over the lifespan and drives undesirable signs such as hirsutism and alopecia in midlife, according to Pamela J. Wright, PhD, MS, MEd, RN, CEN, assistant professor in the department of biobehavioral health and nursing science at University of South Carolina College of Nursing. These women also remain at cardiometabolic risk or have an established comorbidity like type 2 diabetes while continuing to manage persistent PCOS signs and symptoms.
In a recent cross-sectional survey of 72 midlife women with PCOS, Wright and colleagues found respondents reported concern over the lack of information on managing the dual burden of PCOS and menopausal symptoms, as well as a high incidence of anxiety and depressive symptom burden.
Healio spoke with Wright about the unique health care needs among peri- and postmenopausal women with PCOS, how the menopause transition can compound the complications of PCOS and how tailored multidisciplinary solutions could help. Wright’s analysis was recently published in the International Journal of Women’s Health.
Healio: What led you and your colleagues to conduct this review with midlife women specifically?
Wright: Most PCOS studies are emphasize the reproductive years. Adolescent research is just now emerging, and literature on PCOS in general only started building in the last 10 to 15 years. PCOS is still considered an issue of infertility, which I prefer to call subfertility. PCOS is much more than that, which we clearly see as more women are diagnosed and these women are getting older.
Our team recognized that this is a chronic health condition, which means it transcends the reproductive years. So, what are the issues and concerns when you have PCOS and you are entering midlife? What about their health, now and in the future? That is what we want to learn more about.
Healio: What are some of the unique health care needs among peri- and postmenopausal women with PCOS compared with similarly aged women without a PCOS diagnosis?
Wright: There is not a lot of information out there about how to manage menopause for women with PCOS, and these women have a prolonged menopausal transition. The menopause transition can last on average 2 to 4 years longer than that of women without PCOS. These women are dealing with vaginal dryness, vasomotor symptoms — all the things we experience with menopause plus the symptoms of PCOS, which have not improved.
Women with PCOS are at much higher risk for type 2 diabetes, cardiovascular disease and dyslipidemia, if they do not already have these conditions. Older women with PCOS also tend to have more visceral obesity, which puts them at higher risk for fatty liver disease. They are also at risk for certain reproductive cancers because of the hormone status. There is a whole host of comorbidities, and that risk does not decrease with time — it increases with time.
The name “PCOS” is misleading. PCOS is not just about the ovaries, and this goes well beyond the reproductive years. The diagnostic criteria have been a huge source of debate. Thankfully, the updated guidelines now give us uniform diagnostic criteria.
Healio: how should these women be followed as they enter this peri- and postmenopausal phase of their life?
Wright: That we are still researching. I recently interviewed 30 women with PCOS who are in the peri- and postmenopausal age range. We are just now analyzing that data to get more insight from their perspective. We do know there must be more preventive screenings earlier. We should be looking for things like insulin resistance before the problem of diabetes emerges.
Many times, older women do have type 2 diabetes and hypertension. We must manage that better with prevention, and not with just medications. Lifestyle is a big part of managing PCOS. That means exercise, nutrition and stress management, coping strategies, and restorative sleep. Resistance exercises for women with PCOS can be beneficial.
Healio: Data suggest a bidirectional relationship between mental health conditions and PCOS. What are midlife women with PCOS reporting about psychosocial/body image/sexual function concerns at this stage of life?
Wright: I started with the PCOS-specific health-related quality of life questionnaire. That is another reason I am researching the older years, because I received — rightfully so — negative feedback on the questions. The questionnaire has a heavy emphasis on fertility. It was designed for women aged 18 to 42 years. Now, I want to redesign that questionnaire for older women with PCOS.
Psychosocial symptoms are worse. Many women are concerned about excess weight and obesity. There is much to be learned about dysregulation of fat cells in women with PCOS. It is probably more complex than hyperandrogenism. Hirsutism is mentioned in almost every interview and survey I have conducted. That does not improve with menopause. Their self-image continues to suffer because there is a lack of effective treatments.
One study revealed that midlife women reported better psychosocial adaptation. On the health-related quality of life scale, it indicated that older women cope better; that they develop coping skills. However, when depressive screenings are administered, the depressive scores are as high if not higher than younger groups of women with PCOS. There becomes a mindset of almost resignation — this is what I have to deal with. There may be better acceptance that comes with age, but that does not mean they are happy dealing with these symptoms.
Healio: What further research would you like to see about midlife women with PCOS?
Wright: What I would love to see or work toward is a program that resembles cardiac rehab, but for PCOS. A comprehensive program with access to a dietitian, a lifestyle expert, a counselor, a stress management program. All of that is needed. How do we create access to such a program and make it practical and affordable?
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For more information:
Pamela J. Wright, PhD, MS, Med, RC, CEN, can be reached at wrightpamelaj@sc.edu.