In midlife women with PCOS, which features are commonly present?

• A. Ovarian cancer symptoms
• B. Irregular menses, metabolic syndrome, and cardiovascular risk factors
• C. Regular cycles and hypotension
• D. Hypertension without metabolic changes

Answer: (B)

In midlife, PCOS often presents with a blend of ongoing ovulatory dysfunction and metabolic changes. The irregular or oligo/anovulatory menses comes from continued disruption of the normal ovarian cycle, which is a hallmark of PCOS. At the same time, insulin resistance commonly drives metabolic syndrome features—central obesity, high triglycerides, low HDL cholesterol, elevated blood glucose, and hypertension. These metabolic shifts increase cardiovascular risk, and that risk tends to become more evident with age as hormonal and metabolic factors accumulate.

That combination—irregular menses together with metabolic syndrome components and cardiovascular risk factors—best matches what clinicians commonly see in midlife women with PCOS. Ovarian cancer symptoms aren’t characteristic of PCOS, regular cycles don’t align with the ovulatory disruption seen, and hypertension without metabolic changes ignores the frequent metabolic profile that accompanies PCOS.