Women with <scp>PCOS</scp> have a later menopausal transition and a lower prevalence of menopausal symptoms at age 46: A population‐based birth cohort study

INTRODUCTION: Women with polycystic ovary syndrome (PCOS) have been suggested to experience later menopause, yet population-based studies are lacking. The present study aimed to assess, in a population-based birth cohort, whether women with PCOS are more likely to experience late peri-/postmenopause or to have menopausal symptoms in their mid-40s than women without the syndrome. MATERIAL AND METHODS: The present study is a long-term, population-based prospective cohort study from the Northern Finland Birth Cohort 1966 (NFBC1966). The PCOS group (n = 380) was identified based on the Rotterdam criteria (oligomenorrhea, hyperandrogenism, or polycystic ovarian morphology according to anti-Müllerian hormone levels). Women who did not meet the Rotterdam criteria for PCOS were considered as controls (n = 1469). Late peri-/postmenopause was defined as at least 60 days of amenorrhea accompanied by elevated follicle-stimulating hormone levels (>25 IU/L) or the use of menopausal hormone therapy. In women who had undergone hysterectomy or were using progestins, menopausal status was defined as elevated follicle-stimulating hormone levels (>25 IU/L). Menopausal symptoms were self-reported via questionnaire during a follow-up visit at age 46. RESULTS: Women with PCOS had a significantly lower likelihood of being late peri-/postmenopausal in their mid-40s compared with controls (PCOS: 3.1% vs. Controls: 18.4%; adjusted odds ratio 0.15, 95% confidence interval 0.07-0.32). To support this result, women with PCOS more often reported having regular menstrual cycles and had a lower risk of menopausal symptoms at age 46, even after adjusting for body mass index, education, and smoking status (adjusted odds ratio 0.68, 95% confidence interval 0.51-0.92). Hot flashes and sleep disturbances were less frequent among women with PCOS, but there were no differences in other menopause-related symptoms, such as vaginal dryness, affective symptoms, memory disturbances, or sexual dysfunction between the study groups. CONCLUSIONS: From the nonselective population data, it was shown that late peri-/postmenopausal status and symptoms were less frequent in women with PCOS at age 46, supporting the idea of prolonged ovarian function in affected women. This should be considered in patient counseling and future studies of fertility, contraception, and menopausal hormone therapy.