Postmenopausal Health Outcomes in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

Backgrounds: Polycystic ovary syndrome (PCOS) is one of the most common reproductive and endocrine disorders and may impact a woman’s health throughout her lifespan. Research has historically focused on adolescents and women of reproductive age. However, the health status of postmenopausal women with PCOS remains insufficiently characterized. Methods: We conducted this systematic review and meta-analysis to identify the association between the health status of postmenopausal women and PCOS. Embase, the Cochrane Library, Web of Science, and PubMed were searched through July 4, 2025. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Weighted mean differences (WMDs) and corresponding 95% confidence intervals (CIs) were calculated for relevant health parameters comparing postmenopausal women with PCOS and healthy controls. Pooled odds ratios (ORs) were used to evaluate the association between PCOS and specific health outcomes. Heterogeneity was evaluated using the Q-test and I2 statistic. A random-effects model meta-analysis was applied when I2 >50%, which indicated significant heterogeneity; otherwise, a fixed-effects model was applied. Results: Our study included 20 studies with 1042 postmenopausal women with PCOS and 5289 controls. Compared to the controls, postmenopausal women with PCOS exhibited significantly higher body mass index (BMI) (WMD = 2.75; 95% CI: 0.98 to 4.51; I2 = 96%, p = 0.002), waist circumference (WMD = 7.85; 95% CI: 4.12 to 11.57; I2 = 73%, p < 0.001), waist/hip ratio (WMD = 0.04; 95% CI: 0.01 to 0.06; I2 = 92%, p = 0.008), systolic blood pressure (WMD = 3.30; 95% CI: 1.27 to 5.32; I2 = 27%, p = 0.001), blood glucose (WMD = 7.44, 95% CI: 2.59 to 12.30; I2 = 75%, p = 0.003), insulin levels (WMD = 4.27; 95% CI: 3.17 to 5.37; I2 = 0%, p < 0.001), insulin resistance (WMD = 0.89; 95% CI: 0.15 to 1.63; I2 = 91%, p = 0.020), low-density lipoprotein (WMD = 5.14, 95% CI: 0.74 to 9.53; I2 = 49%, p = 0.020), triglycerides (WMD = 0.25; 95% CI: 0.11 to 0.40; I2 = 55%, p < 0.001), total testosterone (WMD = 0.40; 95% CI: 0.25 to 0.55; I2 = 81%, p < 0.001), and free androgen index (WMD = 1.86; 95% CI: 1.37 to 2.36; I2 = 83%, p < 0.001). In addition, postmenopausal women with PCOS were at increased risk of developing type 2 diabetes (OR = 3.08; 95% CI: 1.51 to 6.27; I2 = 78%, p = 0.002), hypertension (OR = 1.72; 95% CI: 1.04 to 2.85; I2 = 69%, p = 0.040), and metabolic syndrome (OR = 3.93; 95% CI: 1.17 to 13.22; I2 = 67%, p = 0.030). Conclusions: This study demonstrates that women with PCOS may have a higher risk of developing type 2 diabetes, hypertension, and metabolic syndrome after menopause. These findings highlight the need for early intervention and targeted health management strategies in postmenopausal women with PCOS. Registration: The study has been registered on https://www.crd.york.ac.uk/PROSPERO/ (registration number: CRD42022370637; registration link: https://www.crd.york.ac.uk/PROSPERO/view/CRD42022370637).