PCOS and HRT: What to Know Before Menopause Hormone Therapy

Table of Contents

Polycystic ovary syndrome, now called polyendocrine metabolic ovarian syndrome (PMOS), is a common hormone and metabolic condition that can affect menstrual cycles, androgen levels, insulin function, skin, weight, and fertility. Hormone replacement therapy (HRT) is a treatment used to relieve certain menopause symptoms and to reduce the risk of bone loss after menopause. Determining if HRT is appropriate for people with PMOS at menopause depends on individual health history and risks, and may require additional screenings, assessments, and follow-up care. This article explains how menopause may affect people with PMOS and how a PMOS history may impact HRT.

Disclaimer: This page is educational and is not a substitute for personalized medical advice. A history of PCOS can change how HRT is screened and monitored; discuss your symptoms, history, and options with a licensed clinician.

At A Glance

A history of PMOS, formerly called PCOS, does not automatically rule out menopause hormone therapy, but HRT should be considered through individualized clinician review.

HRT may help relieve menopause symptoms such as hot flashes, night sweats, and vaginal dryness. It is not a treatment for PMOS.

PMOS can remain relevant during perimenopause and after menopause. Some androgen-related symptoms and cardiometabolic risks, including insulin resistance, blood pressure, cholesterol, and diabetes risk, may persist.

People with a PMOS history may need additional screening before and during HRT, including assessment of blood pressure, glucose or insulin markers, cardiovascular risk, and uterine or bleeding concerns.

Hormonal birth control and menopause HRT are not interchangeable. They may contain similar types of hormone, but they are used for different life stages, symptoms, doses, and treatment goals.

People with PMOS should seek specialist review if they have unexplained bleeding, severe new or worsening acne or facial hair growth, complex metabolic risks, or uncertainty about whether HRT is appropriate.

Can You Take HRT If You Have PMOS?

A history of PMOS, formerly polycystic ovary syndrome, does not rule out hormone replacement therapy; it may be used for menopause symptoms in some people with PMOS, based on individualized clinician review. Hormone replacement therapy, also called menopausal hormone therapy, is commonly prescribed to relieve menopause symptoms, such as hot flashes and night sweats.¹HRT may be prescribed for people with PMOS for menopause symptoms; it is not a recognized treatment for PMOS.²

HRT is generally considered safe and may be prescribed for people with PMOS, depending on their individual health history and risk factors.¹ A PMOS history is associated with specific cardiometabolic risks in women at perimenopause and menopause, such as higher BMI and insulin resistance and increased risk of hypertension and diabetes.³ Cardiometabolic risks are risks that affect the cardiovascular system, comprising the heart and blood vessels, and the metabolic system, which processes energy in the body.

Due to higher cardiometabolic risks, people with a PMOS history may need additional screening and assessments to determine if HRT is right for them, as well as extra follow-up to monitor their cardiovascular and metabolic health during HRT.^{2, 3} This may include screening for blood pressure, glucose tolerance, insulin resistance, and general cardiovascular risk.

Is HRT Used to Treat PMOS?

No, menopause hormone replacement therapy is not a treatment for PMOS; it can relieve menopause symptoms, which is different from managing PMOS. Hormonal contraceptives for PMOS symptom management during reproductive years are distinct from menopausal hormone therapy. Studies on different types of hormone therapies are not interchangeable.

There is no cure for PMOS, but treatments may help manage symptoms and reduce long-term health risks, such as diabetes and cardiovascular disease.⁴ PMOS is a lifelong diagnosis, and symptoms and treatment strategies may evolve with age and the approach of menopause.^{2, 7}

Many people with PMOS experience high levels of androgens, a group of sex hormones that includes testosterone and androstenedione. Increased androgen levels can impact fertility and cause acne and excessive hair growth on the face, abdomen, or back in people with PMOS.⁵ According to the International Menopause Society, high androgen levels may persist in people with PMOS in the years around menopause.³

HRT does not balance hormones in people with PMOS. The treatment replaces estrogen (and sometimes progesterone) that the body produces less of around menopause. Some symptoms of perimenopause, the transitional period leading to menopause, may overlap with characteristics of PMOS, such as irregular periods.^{5, 6} HRT is not indicated to relieve PMOS symptoms, including weight gain, excessive hair growth, or acne and other skin issues.²

PMOS, Perimenopause, and Menopause: What Changes?

PMOS does not disappear at menopause; some features of the condition change, and others can persist. Some people with PMOS may experience an alleviation of symptoms as they age.⁷ Changes in hormone levels during perimenopause can impact the menstrual cycle, causing periods that are significantly longer, shorter, or more unpredictable.⁶Menopause marks the permanent end of menstrual periods as the ovaries produce less of the hormones estrogen and progesterone.⁸

According to the International Menopause Society, high levels of androgen hormones, including testosterone, can persist after menopause in people with PMOS.³ High androgen levels post menopause are associated with symptoms such as excessive hair growth and acne.

Menopause does not cure PMOS. It is a lifelong condition that may still require monitoring and management during and after menopause.² Some symptoms of PMOS, such as irregular periods, may overlap with perimenopause symptoms, which may impact diagnosis and treatment options.^{5, 6}

Birth Control vs HRT for PMOS

Hormonal birth control is commonly used to manage PMOS in people of reproductive age, while HRT is the most effective treatment to relieve certain symptoms of menopause, such as hot flashes.⁹ The therapies are not interchangeable. Deciding which hormonal treatment is right depends on life stage, symptoms, health history, and individual risk factors.

Both hormonal contraceptives and HRT use estrogen, but in different doses. Progestogens are hormones that regulate the menstrual cycle and the thickness of the uterine lining (endometrium). Progesterone is a naturally occurring progestogen that is frequently used in combination with estrogen in HRT, whereas hormonal contraception for PMOS uses progestin, a synthetic form of progesterone. HRT may also use progestin in combination with estrogen, but the treatments are distinct.

Combined oral contraceptives for PMOS

Combined oral contraceptives are a combination of estrogen and progestin prescribed to people with PMOS of reproductive age.
Purpose: Manage PMOS symptoms, such as irregular bleeding, excessive hair growth, and acne
Dose: Contains a higher dose of estrogen than HRT¹⁰
How it works: Combined oral contraceptives can reduce androgen levels, prevent the endometrium from growing too thick, and may reduce the risk of endometrial cancer, which affects the lining of the uterus.⁵

HRT for menopause with PMOS

HRT is a treatment containing estrogen (and progesterone or progestin if a uterus is present) prescribed for menopause symptoms.
Purpose: Relieves menopause symptoms, such as hot flashes, night sweats, and vaginal dryness
Dose: Contains a lower dose of estrogen than combined oral contraceptives. The exact dose is determined by a clinician based on the patient’s symptoms, medical history, and individual needs.^{9, 11}
How it works: HRT replaces the hormones estrogen and progesterone, which the body produces at lower levels during menopause.

What Risks Should Be Screened Before HRT?

A PMOS history may require cardiometabolic screening and monitoring before and during HRT. The Menopause Society recommends personalized care and shared decision-making between the patient and provider to develop an appropriate HRT treatment plan specific to the patient’s needs.⁹

People with PMOS have higher cardiometabolic risk than the general population, which can impact how a provider approaches HRT for menopause. PMOS symptoms related to elevated androgen levels and endometrial health are also taken into consideration when determining if HRT is appropriate. The 2023 International PCOS Guideline recommends that providers consider people with PMOS, formerly PCOS, to have increased cardiovascular risks and metabolic risks and assess risks accordingly.²

According to the International Menopause Society, compared to controls, women with PMOS in peri- or post-menopause have:³

Higher levels of androgens (testosterone and androstenedione)
Increased BMI
Increased insulin resistance
Lower HDL cholesterol (a form of cholesterol that helps remove harmful cholesterol from the body)
Higher triglycerides (fat in blood that can accumulate in blood vessels and damage the pancreas)
Elevated blood pressure
Higher risk for hypertension, diabetes, heart attack, and stroke

PMOS-related cardiometabolic risks are also closely associated with weight. Cholesterol levels were the only cardiometabolic factor that differed between women with PMOS and controls with similar BMIs during per- and post-menopause.³

Estrogen, Progesterone, and PMOS

In HRT, estrogen relieves menopause symptoms like hot flashes and night sweats, while progestogens, like progesterone and progestin, protect the uterine lining. Progesterone or progestin are typically prescribed in combination with estrogen for menopausal hormone therapy when a uterus is present.⁹ Combined oral contraceptives containing estrogen and progestin are used to manage PMOS symptoms in people of reproductive age who have a uterus.²

People with PMOS who have not had a hysterectomy and have a uterus may need progesterone with HRT, based on clinician review of their individual symptoms, risk factors, and health history.

Estrogen is generally considered safe and is routinely prescribed for some people with PMOS, although additional assessments and monitoring may be necessary due to cardiometabolic risks related to the condition.^{4, 2} Some people with PMOS experience abnormal thickness of the uterine lining, which may also be taken into consideration by a clinician as part of an individualized HRT treatment plan.

Questions to Ask an HRT Provider If You Have PMOS

The following questions may help guide a conversation with an HRT provider to address concerns about starting treatment with a PMOS history.

What types of cardiometabolic screening and assessments do I need before or during HRT?
What outcomes should I expect from HRT with my history of PMOS?
What is the plan for monitoring my health during HRT, given my PMOS history?
Do you separate PMOS management from menopause care?
Can I use an online HRT provider if I have PMOS?
Will I need to see a specialist before I can begin HRT?

Note that some complex cases, such as those with additional risk factors, may warrant specialist review. Find an online HRT provider.

When to See an OB-GYN or Menopause Specialist

Specialist review is recommended for people with PMOS if they have new or worsening androgen-related symptoms, unexplained bleeding, or complex risk factors. PMOS can increase cardiometabolic risk, so it is important to speak with a provider about individual risk factors and changes in PMOS symptoms, particularly severe new or worsening symptoms.^{2, 3}

HRT treatment plans are not one-size-fits-all; they are highly individualized to the patient’s needs and risks.^{1, 9} Decisions to start, modify, or end an HRT treatment plan should be made only through clinical assessment by a healthcare provider.

People with PMOS who experience severe new or worsening androgen-related symptoms during HRT, such as rapidly growing facial hair or sudden and severe acne, should seek individualized evaluation by a clinician. A clinician can assess symptoms, in the context of a patient’s health history and risk factors, to determine what, if any, HRT treatment plan is appropriate.

Frequently Asked Questions

No difference in age of natural menopause is seen in women with PMOS compared to women without PMOS, according to an International Menopause Society summary of evidence.³ Some research suggests that people with PMOS may enter menopause slightly later, including a 2018 cohort study and a 2024 population-based study, but research on the topic is limited.^{12, 13, 14}

Yes, lifestyle changes can help manage PMOS symptoms during menopause. The 2023 International PCOS Guideline recommends lifestyle interventions, including staying active and following a healthy diet, to improve cardiometabolic health factors, such as insulin and cholesterol levels in people with PCOS, now called PMOS.² Weight management can significantly relieve PMOS symptoms like irregular periods, acne, and excess hair growth, while reducing your risk for hypertension and diabetes during the peri- and post-menopause.^{2, 5, 3}

Metformin may be an appropriate treatment for managing certain metabolic PMOS risks, such as elevated insulin and triglyceride levels, that may persist at menopause, as directed by a clinician. The 2023 International PCOS Guideline recommends that providers consider the treatment for adults with PMOS who have a BMI of 25 or higher to improve body weight and composition as well as metabolic outcomes.² The guidelines recommend metformin over combined oral contraceptives for metabolic indications and combined oral contraceptives over metformin for managing irregular periods and excessive hair growth.²

Compounded hormones, including those containing estriol, are not FDA-approved, and the FDA does not have evidence that they are safer or more effective than FDA-approved hormone therapies.⁸Bioidentical hormones are similar to hormones produced by the body and are made from plant sources. While some bioidentical hormones, such as progesterone, are regulated by the FDA, compounded hormones are not and may vary in purity and dose, posing safety risks.¹⁵According to the FDA, drugs containing estriol are compounded hormones and are not FDA-approved; the FDA does not have evidence that these drugs are safer than other forms of estrogen.⁸

References

American College of Obstetricians and Gynecologists. Hormone therapy for menopause [Internet]. www.acog.org; 2024 [cited 2026 Jul 1]. Available from: https://www.acog.org/womens-health/faqs/hormone-therapy-for-menopause
Teede HJ, Tay CT, Laven JJE, Dokras A, Moran LJ, Piltonen TT, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Eur J Endocrinol. 2023;189(2):G43-G64. Available from: https://academic.oup.com/ejendo/article/189/2/G43/7242362
International Menopause Society. Vincent, A. Polycystic ovary syndrome in peri- and postmenopausal women – what is the evidence? [Internet]. www.imsociety.org; 2023 [cited 2026 Jul 1]. Available from: https://www.imsociety.org/2023/12/22/polycystic-ovary-syndrome-in-peri-and-postmenopausal-women-what-is-the-evidence/
Mayo Clinic. Polyendocrine metabolic ovarian syndrome (PMOS) – Diagnosis and treatment. [Internet]. www.mayoclinic.com; 2026 [cited 2026 Jul 1]. Available from: https://www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443
American College of Obstetricians and Gynecologists. Polycystic Ovary Syndrome (PCOS). [Internet]. www.acog.org; 2025 [cited 2026 Jul 1]. Available from: https://www.acog.org/womens-health/faqs/polycystic-ovary-syndrome-pcos
Mayo Clinic. Perimenopause – Symptoms and causes. [Internet]. www.mayoclinic.com; 2025 [cited 2026 Jul 1]. Available from: https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666
Owens LA, Franks S. Polycystic ovary syndrome: origins and implications: The impact of polycystic ovary syndrome on reproductive health: a narrative review. Reproduction. 2025;169(5). Available from: https://academic.oup.com/reproduction/article/169/5/e240485/8373310
U.S. Food and Drug Administration. Menopause. [Internet]. www.fda.gov; 2023 [cited 2026 Jul 1]. Available from: https://www.fda.gov/consumers/womns-health-topics/menopause
The 2022 hormone therapy position statement of The Menopause Society. Menopause. 2022;29(7):767–94. Available from: https://menopause.org/wp-content/uploads/professional/nams-2022-hormone-therapy-position-statement.pdf
Allen, RH. Combined estrogen-progestin oral contraceptives: Patient selection, counseling, and use [Internet]. www.uptodate.com. 2026. [cited 2026 Jul 2]. Available from: https://www.uptodate.com/contents/combined-estrogen-progestin-oral-contraceptives-patient-selection-counseling-and-use
Harper-Harrison G, Carlson K, Shanahan M. Hormone Replacement Therapy. [Internet]. StatPearls; [updated 2024 Oct 6]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493191/
Forslund M, Landin‐Wilhelmsen K, Schmidt J, Brännström M, Trimpou P, Dahlgren E. Higher menopausal age but no differences in parity in women with polycystic ovary syndrome compared with controls. Acta Obstet Gynecol Scand. 2019;98:320–326. Available from: https://obgyn.onlinelibrary.wiley.com/doi/10.1111/aogs.13489
Amiri M, Rahmati M, Firouzi F, Azizi F, Ramezani Tehran F. A prospective study on the relationship between polycystic ovary syndrome and age at natural menopause. Menopause. 2024;31(2):130-137. Available from: https://journals.lww.com/menopausejournal/abstract/2024/02000/a_prospective_study_on_the_relationship_between.8.aspx
Millán-de-Meer M, Luque-Ramírez M, Nattero-Chávez L, Escobar-Morreale HF. PCOS during the menopausal transition and after menopause: a systematic review and meta-analysis. Hum Reprod Update. 2023;29(6):741-772. Available from: https://academic.oup.com/humupd/article/29/6/741/7206372
American College of Obstetricians and Gynecologists. Compounded bioidentical menopausal hormone therapy. Clinical Consensus No. 6. [Internet] ACOG; 2023;142(6):1358–66. Available from: https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2023/11/compounded-bioidentical-menopausal-hormone-therapy