09/30/2025
Call me a troublemaker…
**Today, on the last day of PCOS Awareness Month, I’m issuing a demand. Yes, I said it, demand.**
**STOP describing PCOS as a “disorder of reproductive age”!!!**
That phrasing is scientifically outdated, misleading, and damaging.
🔹 Emerging evidence and expert opinion increasingly recognize that PCOS can begin in the peripubertal years. But no matter when it develops, it persists throughout life — it does *not* magically vanish at menopause.
🔹 Current adolescent diagnostic guidelines require **irregular menstrual cycles** (appropriately defined relative to years post-menarche) **plus clinical or biochemical hyperandrogenism**, after excluding other mimicking conditions. ([PubMed][3])
🔹 The use of pelvic ultrasound or AMH levels for diagnosis is *not* recommended in adolescents, reinforcing that the condition cannot be shoehorned into adult “reproductive age” definitions alone. ([BioMed Central][2])
OVERLOOKED RISKS WHEN CARE STOPS AT MENOPAUSE:
🔹Cardiovascular Disease: PCOS confers a higher risk of hypertension, coronary artery disease, and stroke. These risks increase after menopause as estrogen’s protective effects wane. Ignoring PCOS at this stage overlooks an important predictor of cardiovascular morbidity.
🔹Type 2 Diabetes & Metabolic Syndrome: Insulin resistance remains a cornerstone feature of PCOS. After menopause, weight gain and loss of estrogen further compound this. Failure to screen and intervene means missed opportunities to prevent diabetes, fatty liver disease, and systemic inflammation.
🔹Endometrial Cancer: Lifelong anovulation and unopposed estrogen can increase endometrial cancer risk, and this risk doesn’t vanish at menopause. Some studies suggest women with PCOS may carry a higher lifetime risk.
🔹Mental Health & Cognitive Outcomes: PCOS is associated with higher lifetime prevalence of depression and anxiety. These mental health burdens may persist or worsen post-menopause, especially if medical follow-up is withdrawn. Emerging evidence links insulin resistance and inflammation to cognitive decline and dementia risk, another overlooked consequence.
🔹Bone Health: The relationship is complex: higher androgens may have protective effects on bone density, but insulin resistance and chronic inflammation may offset these. Without ongoing attention, osteoporosis risk may be underestimated.
🔹Quality of Life & Symptom Burden: Hirsutism, hair loss, and weight struggles do not necessarily resolve at menopause. Dismissing PCOS as “done” can leave women unsupported in managing symptoms that affect self-image and daily life.
Framing PCOS solely as a “reproductive disorder” erases the lived reality and risk profile of millions:
→ Girls who show early signs before puberty
→ Women whose metabolic, cardiovascular, and hormonal burdens endure long after menopause
It’s time for medical schools, professional societies, journals, CME programs, and clinical guidelines to evolve.
**Change the language. Change the framing. Change the care.**
Doctors. Researchers. Journal editors. Educators.
Will you step into the future — or cling to an outdated paradigm that ignores much of the story?
Christine Updegraff (nee Gray-DeZarn)
Founder and Chairman
Polycystic Ovarian Syndrome Association, Inc.
[1]: https://journals.lww.com/co-pediatrics/Fulltext/2019/08000/The_diagnosis_and_treatment_of_PCOS_in.21.aspx?generateEpub=Article%7Cco-pediatrics%3A2019%3A08000%3A00021%7C10.1097%2Fmop.0000000000000778%7C&utm_source=chatgpt.com "The diagnosis and treatment of PCOS in adolescents"
[2]: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-025-03901-w?utm_source=chatgpt.com "International evidence-based recommendations for polycystic ..."
[3]: https://pubmed.ncbi.nlm.nih.gov/40945763/?utm_source=chatgpt.com "Update on diagnosis of polycystic o***y syndrome during ..."
