Polycystic Ovarian Syndrome (PCOS) is well-known for disrupting hormonal balance and fertility, but surprisingly, its effects often shift as women age past 40. Research suggests that as these women age, their ovaries may naturally reshape. This change can lead to more regular menstruation, a delay in perimenopause, and even better fertility prospects.

According to Tehi Piltonen, a researcher at Oulu University Hospital in Finland, “Many women with PCOS had initially believed they would need assisted reproductive technology (ART) to conceive. They were shocked to discover they could conceive naturally in their 40s. We refer to these unexpected pregnancies as ‘evening stars.’”

As part of the Northern Finland Birth Cohort Study, Piltonen and her team examined how PCOS impacts the menopausal transition by analyzing data from 1,849 women born in Finland in 1966, all of whom have regularly participated in health check-ups.

At the age of 31, 380 women met the criteria for PCOS, defined by exhibiting at least two of three characteristics: irregular periods or amenorrhea, elevated testosterone levels, and increased anti-Müllerian hormone levels, a marker produced by ovarian follicles.

Remarkably, only 3% of women with PCOS reached late menopause or menopause by age 46, in contrast to 18% of women without the condition. This delayed transition aligns with findings from a smaller study conducted in Sweden, where women with PCOS tend to experience menopause four years later on average.

Piltonen theorizes that this delayed menopausal transition is linked to women with PCOS having a greater initial reserve of eggs, thus prolonging their fertile years.

During their younger years, having an excess of eggs may pose challenges. “It causes the ovaries to become ‘crowded,’” Piltonen explains. Often, multiple eggs attempt to mature simultaneously but stall midway due to this crowding, leading to the misnomer “polycystic ovary syndrome.” This misdiagnosis arises because these poorly developed eggs manifest as dark spots on an ultrasound, resembling cysts. Consequently, ovulation becomes infrequent or non-existent, resulting in irregular menstruation and diminished chances of conception.

Additionally, the hormonal imbalances associated with PCOS can lead to weight gain, metabolic issues, acne, and excessive body hair.

However, as the natural decline of egg count occurs with age, the ovaries of women with PCOS may become less congested. This change can facilitate proper egg maturation and release. “This is why women with PCOS often enjoy more regular menstrual cycles as they age,” Piltonen states. It may also elucidate why women who previously struggled with fertility find it easier to conceive later in life.

Piltonen posits that the delayed onset of menopause due to PCOS might carry health benefits. The estrogen drop during menopause has been tied to weaker bones, thinner skin, and heightened risks of heart disease and other complications. Research indicates that women who experience menopause after age 55 tend to live two years longer on average compared to those who undergo menopause before 40.

Piltonen also mentions that PCOS may have conferred evolutionary advantages in our ancestors. When food resources were scarce and childbirth posed risks, the ability to retain extra energy by carrying weight and effectively extending the time between births could have been beneficial. “Given how common PCOS is, I believe it must have provided some form of advantage,” she concludes.