PCOS Doesn’t End at 30: What High-Functioning Women Need to Know in Midlife
Anna Harrelson • March 22, 2025
It’s not just about fertility. It’s about your metabolism, hormones, and long-term health—even in perimenopause and beyond.
"You can’t have PCOS anymore, you’re too old."
"You were just estrogen dominant."
"It was probably just your birth control messing with your cycle."
If you’ve heard any of these before, you’re not alone—but they’re not the full story. Polycystic Ovary Syndrome (PCOS)
is one of the most misunderstood and underdiagnosed hormonal conditions in women, especially as we move into midlife.
As a lifestyle medicine physician and menopause specialist, I see so many women in their 40s and 50s who were never properly diagnosed, or who were told their PCOS “resolved” after their twenties. But the truth is, PCOS is not just a reproductive disorder—it’s a lifelong metabolic and neuroendocrine condition that can shape how you experience perimenopause, menopause, and the decades beyond.
Let’s dive into what PCOS really looks like, why so many smart, high-functioning women have been missed or misdiagnosed, and how we can support your hormones, metabolism, and nervous system at midlife and beyond.
What Is PCOS, Really?
Polycystic Ovary Syndrome is a condition of hormonal imbalance, typically involving irregular or absent ovulation, higher levels of androgens (like testosterone or DHEA), and signs like acne, hirsutism, or hair thinning. It’s diagnosed using the Rotterdam criteria, which require two out of three of the following:
- Irregular cycles or lack of ovulation
- Elevated androgens (on labs or symptoms)
- Polycystic-appearing ovaries on ultrasound
But here’s the thing: you don’t need to look like a textbook case to have PCOS. And you don’t have to be overweight, either.
Many women I see had irregular periods in their teens or early 20s, were put on birth control to "regulate" them, and never thought about it again. But under the surface, they may still be dealing with insulin resistance, metabolic dysfunction, and the downstream effects of decades of low ovulatory progesterone.
PCOS in High-Functioning, Chronically Stressed Women
I want to name a pattern I see over and over again in my clinic: high-performing, deeply thoughtful, often anxious women with a history of:
- Childhood trauma or emotional neglect
- Chronic stress, perfectionism, or people-pleasing tendencies
- Neurodivergence or sensory sensitivity
- Head injuries or subtle brain trauma
- Long histories of surviving on willpower alone
These women may have had "normal" labs, been told their hormones were fine, and still feel awful—tired, inflamed, emotionally fragile, or completely burned out. Their PCOS may have never been diagnosed, or it may present now as midlife metabolic dysfunction, vasomotor instability, or nervous system dysregulation.
And because PCOS is so often framed as a fertility problem, it gets missed entirely after age 35.
PCOS Doesn’t Magically Go Away After Menopause
Yes, ovulation stops. But PCOS is not just about ovulation. Women with a history of PCOS:
- Often go through perimenopause with more erratic hormone fluctuations
- May retain higher levels of androgens than peers
- Often experience insulin resistance, stubborn weight gain, and mood swings
- Are at higher risk for type 2 diabetes, cardiovascular disease, fatty liver, and dementia
You may also experience a sudden onset of classic estrogen-deficiency symptoms after years of feeling "estrogen dominant": vaginal dryness, poor sleep, brain fog, hot flashes, or joint pain. This hormonal shift can feel disorienting—especially if you were previously told that you had too much estrogen or testosterone.
So Yes, You Might Still Need Hormones
One of the most common questions I get is:
"If I had PCOS or high estrogen before, why would I ever take hormones in menopause?"
Here’s why:
- PCOS doesn’t protect you from the effects of estrogen and progesterone deficiency
- You may still have low progesterone, especially if you had anovulatory cycles for years
- Testosterone levels decline sharply after menopause, even in women with a PCOS history
And importantly, many women who thrived on higher testosterone levels in their younger years may feel the effects of that decline even earlier—sometimes in late perimenopause rather than after menopause. This can look like a sudden drop in motivation, mental clarity, libido, or muscle tone. While your labs may still appear "in range," they may be low for you, based on where your body functioned best in your 20s or 30s. This is why a personalized approach matters—because it’s not just about numbers on a chart, but about how you feel in your body.
Hormone therapy can help with symptoms, muscle mass, cognition, and overall metabolic health
Of course, it has to be individualized. But fear of hormones due to your "PCOS past" should not be a reason to avoid evidence-based treatment that could dramatically improve your quality of life.
Where Do We Start?
I always begin with:
1. Lifestyle foundations:
- Balanced blood sugar (this is critical)
- Resistance training and muscle-building
- Nervous system regulation (because stress is metabolic)
- Sleep, circadian health, and gut support
2. Supportive supplements (individualized):
Inositol (myo + d-chiro), magnesium, omega-3s, sometimes berberine or NAC
3. Hormone support (when appropriate):
- Bioidentical progesterone for sleep, mood, and cycle regulation
- Estradiol and testosterone for quality of life and long-term disease prevention
- Vaginal estrogen for GSM, even in women with a PCOS history
Final Thoughts
If you have PCOS or suspect you might—even if no one ever told you that you did—you deserve midlife care that goes deeper. You deserve a plan that honors your past hormone story and supports the road ahead.
At Wondercreek Health, I don’t just treat numbers on a lab report. I listen to your lived experience, your history, your intuition. PCOS is real. Your symptoms are real. And there is help.
WonderCreek Health Blog
You’ve probably seen it popping up in wellness podcasts, health stores, or even your friend's supplement cabinet: bovine colostrum. Marketed for gut health, immune support, and recovery, this early-life nutrient source for calves is now showing up in adult wellness routines. But is it worth your time and money? As a lifestyle medicine physician focused on women’s midlife health and longevity, here’s what I want you to know before you jump on the colostrum bandwagon. Let’s Start With the Basics: What Is Colostrum? Colostrum is the first form of milk produced by mammals (including humans) in the first few days after giving birth. It’s loaded with antibodies, growth factors, and immune-modulating compounds designed to jumpstart a newborn’s immune system and line the gut. Bovine colostrum—from cows—is the form used in most supplements. It's freeze-dried and packaged into powders or capsules, and often promoted for: Gut barrier support ("leaky gut") Immune system priming Exercise recovery Anti-aging benefits But let’s be honest: just because something has growth factors doesn’t mean it belongs in your Amazon cart. Does the Science Support It? Evidence in humans is limited— but not nonexistent. Some small clinical studies have shown potential benefits: Gut health: In people with NSAID-induced intestinal permeability ("leaky gut"), bovine colostrum has been shown to reduce damage and symptoms. Immune function: Some data in athletes suggests reduced upper respiratory infections. Exercise recovery: A few studies report improvements in performance, gut comfort, or muscle soreness—especially in endurance athletes. But these benefits aren’t guaranteed. And the quality and dosage of colostrum varies widely, with no standardized formulation across brands. So Should You Take It? Here’s where my clinical voice kicks in: Before you reach for colostrum, ask yourself: Have you addressed the basics? Are you sleeping? Managing stress? Eating fiber and whole foods? Getting enough protein? Building muscle? Moving your body? Supporting your gut with real food (not just powders)? If the answer is no—then colostrum is not your next step. You’re throwing powdered fuel on an engine that’s missing spark plugs. Do you have dairy sensitivity? Colostrum is a dairy product. Even if it's low in lactose, it may not be tolerated by everyone. Are you already taking quality foundational supplements? Vitamin D, omega-3s, magnesium, creatine, iron (when needed), and probiotics have stronger bodies of evidence for many women in midlife. When Might It Be Worth Trying? Colostrum might be a reasonable add-on if you: Have mild gut symptoms (especially post-infectious or stress-related) Are recovering from illness or antibiotics Train hard and experience frequent upper respiratory issues Want to support your immune system during travel or stress Even then, I recommend: A 2–3 month trial only after dialing in basics Choosing a third-party tested brand Tracking symptoms and benefits Cost, Hype, and the Bigger Picture Many women I work with are overwhelmed by supplement costs. Colostrum can run $50–100/month —and that adds up. So here’s what I tell my patients: Just because something is trending doesn’t mean it’s essential. And just because it works for someone on TikTok doesn’t mean it’s the right tool for your body right now. Your body is an incredible machine. When you give it rest, movement, nourishment, and support—it can do amazing things. Colostrum is not magic. It’s just one tool in a very big toolbox. Bottom Line Colostrum may hality sources. You’re not broken. You might just need a reset—not another powder.
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