Beyond the Biological Clock: Eight Conversations About Fertility, Aging, and Longevity
Week 3 of 8 | Sunday, November 8, 2026
What if a diagnosis affecting your fertility could also offer important clues about your long-term health?
For decades, conditions such as polycystic ovary syndrome (PCOS) and endometriosis have been viewed primarily through the lens of reproduction.
Women are often diagnosed when they experience irregular menstrual cycles, painful periods, or difficulty conceiving.
But what happens after they have completed their families?
Too often, these conditions receive less attention, even though their implications may extend far beyond the reproductive years.
After more than 35 years practicing obstetrics and gynecology, I believe we need to rethink how we approach reproductive disorders.
A reproductive diagnosis should not mark the beginning and end of a fertility conversation. It may be an opportunity to understand a woman’s lifelong health.
PCOS: Is It Time for a New Name?
Polycystic ovary syndrome affects approximately 10–13% of reproductive-aged women, depending on the diagnostic criteria used.¹
Yet its name can be misleading.
Despite the term polycystic, the condition is not primarily a disease of ovarian cysts. The ultrasound appearance reflects an increased number of small follicles, and polycystic ovarian morphology is not required for every diagnosis.
PCOS is a complex endocrine and metabolic condition that may involve insulin resistance, hyperandrogenism, ovulatory dysfunction, and metabolic disturbances.
This has prompted discussion about whether a different name would better represent the condition.
One proposed term is polycystic metabolic-ovarian syndrome (PMOS).
I find this terminology useful because it draws attention to the metabolic aspects of the condition rather than focusing exclusively on the ovaries.
However, PMOS is not currently the universally accepted diagnostic name. PCOS remains the terminology used in international clinical guidelines.
Whatever name we use, the important point is that PCOS affects much more than fertility.
The Metabolic Connection: Why PCOS Matters Beyond Pregnancy
One of the most significant features of PCOS is its association with insulin resistance.
Insulin resistance can occur even in women who are not overweight, although obesity may amplify metabolic disturbances.
Women with PCOS have an increased risk of impaired glucose tolerance and type 2 diabetes.
The 2023 International Evidence-Based Guideline for the Assessment and Management of PCOS emphasizes that women with PCOS should receive appropriate metabolic screening, including assessment of glycemic status and cardiovascular risk factors.¹
The guideline recommends reassessing glycemic status every one to three years, depending on individual risk factors.
This is important because metabolic abnormalities may develop long before symptoms become obvious.
A woman diagnosed with PCOS at age 22 may still benefit from metabolic monitoring at age 42, even if she is no longer concerned about fertility.
PCOS is not simply a condition to manage until pregnancy occurs. It deserves attention throughout life.
Does PCOS Affect Longevity?
This is a question that researchers are increasingly exploring.
We know that PCOS is associated with several conditions that can influence long-term health, including type 2 diabetes, hypertension, dyslipidemia, and obstructive sleep apnea.
A systematic review and meta-analysis published in Human Reproduction Update found that women with PCOS had higher risks of cardiovascular disease and cerebrovascular disease than women without PCOS.²
However, the available studies vary considerably in their methods, populations, and adjustment for confounding factors.
Importantly, an increased risk of cardiovascular disease does not automatically mean that women with PCOS have a shorter lifespan.
The evidence regarding overall mortality and exceptional longevity remains less certain.
PCOS is also a heterogeneous condition. Not every woman has the same metabolic profile or long-term risk.
Some women have significant insulin resistance, while others have relatively normal metabolic markers.
This is why individualized assessment matters.
Rather than asking whether PCOS inevitably shortens life, I believe the more useful question is:
How can identifying PCOS earlier help us reduce preventable health risks?
That is a much more empowering approach.
Endometriosis: More Than a Cause of Pelvic Pain and Infertility
Endometriosis is another condition traditionally associated with reproductive health.
It affects approximately 10% of reproductive-aged women and is characterized by endometrial-like tissue growing outside the uterus.
It may cause severe menstrual pain, chronic pelvic pain, painful intercourse, and infertility.
But endometriosis is not simply a mechanical problem involving tissue in the wrong location.
It is a complex inflammatory condition involving altered immune responses, hormonal signaling, and changes in the local tissue environment.
Increasingly, researchers are investigating whether these biological processes may also have implications for long-term health.
Endometriosis and Cardiovascular Disease
One of the most intriguing areas of research concerns cardiovascular health.
A prospective study published in Circulation: Cardiovascular Quality and Outcomes followed more than 116,000 women in the Nurses’ Health Study II.
Researchers found that women with laparoscopically confirmed endometriosis had a higher risk of coronary heart disease than women without endometriosis.³
The association was particularly pronounced among younger women.
Interestingly, part of the relationship appeared to be explained by hysterectomy and oophorectomy, procedures that some women undergo as part of endometriosis treatment.
This illustrates an important challenge in interpreting reproductive health research.
Are the increased risks related to the underlying disease, its treatments, shared biological mechanisms, or a combination of these factors?
The answer is not yet fully understood.
Nevertheless, the findings suggest that women with endometriosis may benefit from greater attention to their cardiovascular risk factors.
Endometriosis, Inflammation, and Biological Aging
Chronic inflammation is increasingly recognized as one of the biological processes associated with aging.
Scientists sometimes use the term inflammaging to describe the chronic, low-grade inflammation that can develop with advancing age and contribute to age-related disease.
Endometriosis involves inflammatory and immune processes, making it an interesting condition to study in the context of reproductive aging.
But we need to distinguish between two different ideas.
The first is that endometriosis involves inflammation.
The second is that endometriosis accelerates biological aging or shortens lifespan.
The first is well established. The second remains an active area of investigation.
We cannot currently conclude that women with endometriosis are biologically older than their chronological age simply because they have the condition.
Nor do we have evidence that treating endometriosis necessarily slows systemic biological aging.
However, research into inflammation, immune dysfunction, and cellular aging may eventually help us understand why some reproductive conditions are associated with health problems beyond the reproductive system.
What About Endometriosis and Overall Mortality?
A large prospective study published in the BMJ in 2024 examined endometriosis, uterine fibroids, and premature mortality among women in the Nurses’ Health Study II.⁴
The researchers found that women with laparoscopically confirmed endometriosis had a modestly higher risk of premature death than women without endometriosis.
The study also reported associations with certain causes of death.
These findings deserve attention, but they should not be interpreted as a prediction for an individual woman.
Observational research cannot establish that endometriosis itself caused the increased mortality.
Factors such as disease severity, treatment history, shared risk factors, and other health conditions may influence the results.
The clinical implication is not that women with endometriosis should fear a shorter life.
It is that endometriosis deserves recognition as a condition with potentially broader health implications.
Fertility as a Window into Preventive Medicine
Consider two women.
One is diagnosed with PCOS in her early twenties because she has irregular periods.
The other is diagnosed with endometriosis in her thirties after years of painful menstruation.
Both may eventually seek fertility treatment.
But imagine if their diagnoses also prompted a broader conversation about lifelong health.
For the woman with PCOS, this might include monitoring blood glucose, blood pressure, cholesterol, sleep, and metabolic health.
For the woman with endometriosis, it might include reviewing cardiovascular risk factors, managing chronic pain, considering the implications of hormonal or surgical treatments, and assessing overall well-being.
Neither diagnosis means that future disease is inevitable.
Instead, each creates an opportunity for individualized prevention.
This is the kind of thinking I believe should become central to modern reproductive medicine.
Can Lifestyle Make a Difference?
Lifestyle interventions are important components of long-term health, particularly for women with PCOS.
The international PCOS guideline recommends healthy lifestyle behaviours for all women with the condition, recognizing benefits for metabolic health and general well-being even when weight loss is not the primary goal.¹
Nutrition, regular physical activity, adequate sleep, and management of cardiometabolic risk factors can all play important roles.
For endometriosis, the evidence is more complicated.
Although dietary patterns, exercise, and other lifestyle approaches are being investigated, there is not yet sufficient high-quality evidence to recommend a particular diet or supplement as a proven treatment for endometriosis or as a way to prevent its long-term complications.
Lifestyle strategies may support overall health, but they should complement—not replace—appropriate medical and surgical care.
As a physician who advocates for optimizing health naturally whenever possible, I believe it is especially important to distinguish between promising interventions and those supported by strong clinical evidence.
Looking Beyond the Diagnosis
For too long, women’s reproductive health has often been compartmentalized.
Menstrual problems are treated as menstrual problems.
Infertility is treated as infertility.
Menopause is treated as menopause.
Yet the reproductive system is connected to the cardiovascular, metabolic, endocrine, and immune systems throughout life.
PCOS and endometriosis provide compelling examples of why we need a more integrated approach.
As we prepare for the next era of longevity medicine, I believe reproductive health must become part of the conversation.
This is one of the central themes of my book, Optimize Your Fertility Naturally: A Holistic Guide to Achieving a Healthy Pregnancy, and a message I will be bringing to LongevityFest 2026 in Las Vegas this December.
My goal is not simply to help people conceive.
It is to help them understand how reproductive health fits into their broader health journey.
A diagnosis of PCOS or endometriosis should not define a woman’s future. But it may help us understand how to protect it.
Coming Next Sunday
The Reproductive Clock: Can Science Tell Us How Fast It’s Ticking?
We hear increasingly about biological age tests, epigenetic clocks, ovarian reserve markers, and even the possibility of slowing reproductive aging.
But how much can these tests really tell us?
Next week, we’ll explore the emerging science of measuring reproductive aging—and separate established clinical tools from exciting but still experimental technologies.
Join me each Sunday for Beyond the Biological Clock: Eight Conversations About Fertility, Aging, and Longevity, leading up to my presentation at LongevityFest 2026.
Dr Marina OBGYN
References
- Helena J. Teede et al., “Recommendations from the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome,” Human Reproduction 38, no. 9 (2023): 1655–79. https://doi.org/10.1093/humrep/dead156.
- Maureen C. J. de Groot et al., “PCOS, Coronary Heart Disease, Stroke and the Influence of Obesity: A Systematic Review and Meta-Analysis,” Human Reproduction Update 17, no. 4 (2011): 495–500. https://doi.org/10.1093/humupd/dmr001.
- Fan Mu et al., “Endometriosis and Risk of Coronary Heart Disease,” Circulation: Cardiovascular Quality and Outcomes 9, no. 3 (2016): 257–64. https://doi.org/10.1161/CIRCOUTCOMES.115.002224.
- Yi-Xin Wang et al., “Endometriosis, Uterine Fibroids, and Risk of Premature Mortality in Women: Prospective Cohort Study,” BMJ 387 (2024): e078797. https://doi.org/10.1136/bmj-2023-078797.
