Delayed menopausal transition in polycystic ovary syndrome: A call for research on age‐dependent phenotypes and different ethnic populations

Sir,

We read with great interest the insightful commentary by Dr. Danxi Lv ¹ regarding our original article ² We highly appreciate their merited contribution and the relevant aspects they raised concerning polycystic ovary syndrome (PCOS) and delayed menopausal transition.

Indeed, menopausal symptoms (such as hot flashes and sleep disturbances) in women with PCOS were less frequent in our cohort study at the age of 46. After excluding users of medications known to alleviate menopausal symptoms, including SSRIs and SNRIs, affective symptoms became less frequent in women with PCOS; however, sleep disturbances no longer differed between groups, which could reflect medication use rather than a reduction in menopause‐related sleep problems. However, in our estimation, women with PCOS would be expected to exhibit a higher symptom burden in their mid‐40s given their well‐known baseline symptom burden, provided they were at the same stage of the menopausal transition. Since they seem to experience fewer menopausal‐related symptoms, our interpretation is that this difference is specifically related to a delayed menopausal transition. As mentioned in the commentary, the potential link between AMH levels and menopausal symptoms is an interesting point that warrants further investigation.

We acknowledge certain limitations in our study. First, the Northern Finland Birth Cohort (NFBC) represents a homogeneous Western European population. Therefore, it is crucial to recognize that these findings should be validated in future studies involving different ethnic populations and larger, population‐based cohorts. For example, African American, South American, and Asian female populations seem to have lower AMH levels at fertile age compared to White women, but African American women experience less of a reduction in AMH levels with advancing age. ³ Furthermore, we recognize that PCOS presents with diverse phenotypes. Unfortunately, due to the limited sample size in the subgroups, our study design could not be powered to evaluate these phenotypes separately. This is relevant, as different phenotypes are known to exhibit varying anti‐Müllerian hormone (AMH) levels. ⁴

Nevertheless, we believe our study demonstrates a novel finding from population‐based data: a more concrete delayed menopausal transition among women with PCOS than previous studies that predicted delay based on AMH levels. Predictive models utilizing AMH are inherently challenging, as our understanding of longitudinal AMH decline across different clinical subgroups—particularly in women with PCOS—remains limited.

In conclusion, the points raised by Dr. Danxi LV offer valuable depth to this field. We agree that further research is warranted to better understand the late reproductive years, age‐dependent phenotypes, and menopausal transition in this patient population.

AUTHOR CONTRIBUTIONS

All authors participated in writing and approving its submission for publication.

DATA AVAILABILITY STATEMENT

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.