In the context of longevity medicine, menopause is not a finish line for metabolic health but rather a shift in how we need to monitor it.

That’s the philosophy of Angela Mazza, DO, ABAARM, FAMMFM, ECNU, a triple board-certified endocrinologist, anti-aging and regenerative medicine specialist, and thyroid expert known for her integrative, functional approach to metabolic and hormonal health. Menopause may mark the end of the reproductive years, Dr. Mazza maintains, but it’s also a time of metabolic changes that call for a new approach to monitoring health.

Metabolic Consequences

A hormonal condition that affects approximately 6-13% of women of reproductive age, Polycystic Ovary Syndrome (PCOS) is one of the leading causes of infertility and can lead to various long-term health issues, including type 2 diabetes and cardiovascular disease. The proposed updated name, Polyendocrine Metabolic Ovarian Syndrome (PMOS), emphasizes the syndrome’s broader effects, including insulin resistance, androgen excess, metabolic risks, and mental health impacts. PCOS/PMOS is gaining attention because of its ongoing role in the aging process. At the onset of menopause, the condition does not necessarily disappear; it changes its clinical expression in ways that longevity experts are just beginning to take seriously.

“The evolving concept of Polyendocrine Metabolic Ovarian Syndrome (PMOS) reflects a growing recognition that this condition extends beyond reproductive dysfunction and ovarian morphology to encompass complex interactions among metabolic, endocrine, inflammatory, and cardiometabolic pathways,” says Dr. Mazza. “While PMOS is most commonly diagnosed during the reproductive years, increasing numbers of affected women are now entering perimenopause and menopause, highlighting important limitations of current diagnostic paradigms.”

Advancing age and menopause render traditional reproductive markers less informative, yet many women with a history of PCOS/PMOS continue to exhibit persistent metabolic and endocrine abnormalities – insulin resistance, excess visceral fat, dyslipidemia, metabolic dysfunction-associated steatotic liver disease, chronic low-grade inflammation, and elevated cardiovascular risk – as they age.

Dr. Mazza reports that, according to emerging evidence, “these metabolic consequences may persist across the lifespan and contribute to trajectories of accelerated cardiometabolic aging.”

A Lifespan Model

In her review, Dr. Mazza examines the challenges of applying reproductive-age diagnostic frameworks to midlife and older women, proposing a lifespan model in which PCOS/PMOS evolves from a predominantly ovarian and reproductive syndrome into a broader metabolic-endocrine phenotype.

“We explore the clinical implications of this transition for risk assessment, long-term surveillance, and therapeutic decision-making during perimenopause and beyond,” she says.

Elena HogenEsch, MD, MSC, an obstetrician-gynecologist and clinical fellow specializing in reproductive endocrinology and infertility at UCSF Health, and Heather G. Huddleston, MD, a board-certified obstetrician-gynecologist, reproductive endocrinologist, and director of the PCOS Clinic at the UCSF Center for Reproductive Health, concur, stating that “Recognition of PMOS as a lifelong endocrine disorder has important implications for risk assessment, preventive care, and multidisciplinary management throughout the lifespan.”

The experts emphasize that PCOS/PMOS requires ongoing metabolic surveillance beyond the reproductive years, rather than a hard stop at menopause, when metabolic changes call for a new approach to monitoring health.

Treating PCOS/PMOS

Beyond the lifespan model proposed by Dr. Mazza, a separate narrative review in Frontiers in Endocrinology by Xinjiang Huang, Zhi Chen, Liyi Zhang, and Jie Li examined lifestyle and treatment strategies for PCOS/PMOS. The authors noted that available evidence supports physical activity and structured exercise as important components of management, particularly for improving insulin sensitivity, body composition, and cardiometabolic risk markers. In some studies, exercise also improved menstrual cyclicity and ovulatory function, although findings varied according to baseline BMI, hyperandrogenic phenotype, intervention type, intensity, duration, adherence, and co-interventions such as diet or pharmacotherapy.

They also noted that individualized, patient-centered intervention strategies, combined lifestyle-pharmacological approaches, and precision medicine frameworks are recommended for women with PCOS/PMOS.

Other medications used to treat PCOS/PMOS include insulin-sensitizing agents, which help improve insulin sensitivity and regulate menstrual cycles, and anti-androgens, which can help reduce hirsutism and acne by blocking the effects of androgens.

Concluding Thoughts

As Menopause Awareness Month comes to an end, research on menopause and its role in the aging process continues. As understanding of PCOS/PMOS evolves, researchers like Dr. Mazza emphasize that menopause may represent not the end of the syndrome, but rather a shift in its clinical expression. Reframing PCOS/PMOS as a dynamic lifespan condition may provide a more comprehensive approach to women’s care as they age and support the development of age-appropriate diagnostic and management strategies.

Sources:

When Does Polyendocrine Metabolic Ovarian Syndrome (PMOS) Change Definition? A Lifespan Perspective on Menopause and Metabolic Health 

Polyendocrine Metabolic Ovarian Syndrome Beyond the Reproductive Years: Menopause and Long-Term Health Outcomes - PubMed

Physical Activity, Sedentary Behavior, and Metabolic-Reproductive Health in Women with PMOS (PCOS): A Narrative Review of Mechanisms, Clinical Evidence, and Individualized Intervention Strategies