Average age menopause onset: The request could not be satisfied
The Timing of the Age at Which Natural Menopause Occurs
Obstet Gynecol Clin North Am. Author manuscript; available in PMC 2012 Sep 1.
Published in final edited form as:
Department of Public Health Sciences and Division of Epidemiology, School of Medicine, University of California, Davis, One Shields Avenue, Med Sci 1C, Davis, CA 95616 USA
Keywords: Menopause, Smoking, Parity, Race/ethnicity, Socioeconomic status, Age, Genetics, Family history, Diet
See other articles in PMC that cite the published article.
The age at the final menstrual period holds intrinsic clinical and public health interest because the age at which natural menopause occurs may be a marker of aging and health.1–3 Later age at natural menopause has been associated with:
longer overall survival and greater life expectancy4 and reduced all-cause mortality5;
reduced risk of cardiovascular disease4,6–11 and mortality from cardiovascular12 and ischemic heart disease,13 stroke,14 angina after myocardial infarction,15 and atherosclerosis16;
less loss of bone density,17 and a reduced risk of osteoporosis18 and fracture19;
but an increased risk of breast,20,21 endometrial, and ovarian4,22–25 cancers.
In addition, women who have undergone bilateral oophorectomy under the age of 45 years have been observed to be at increased risk of mortality from cardiovascular disease, particularly if they were not treated with estrogen.26 However, women who underwent natural menopause before age 45 years had an increased risk of ischemic heart disease that was not attenuated by use of hormone therapy.27 Further, early menopause has been associated with earlier decline in cognitive function.28–30 Because 40 million women in the United States alone and several hundred million worldwide31 experienced the menopausal transition between 1990 and 2010 due to the aging of the baby boomer generation,32 millions of women are undergoing or have recently undergone the menopause transition, and the timing of their final natural menstrual periods could have important clinical and health implications, because one third of women’s lives is spent postmenopause.
Although menopause is a universal phenomenon among women, the timing of the onset and the duration of the menopausal transition and the timing of the final menstrual period are not.33 Most of our knowledge and perceptions of menopause have been based largely on studies of white women, and many have been studies of clinic-based, rather than population-based, samples of women. Thus, until recently, much of the knowledge about the timing of the natural final menstrual period has been affected by the nature of the samples of women studied and a number of other methodologic differences in the studies of this phenomenon, which must be considered in comparing and summarizing their results.
Most studies of the menopausal transition have been cross-sectional, rather than longitudinal, in design, providing an opportunity for distortion of the true picture of the timing of the final natural menstrual period, particularly for understanding factors that precede and may affect the timing of menopause. Further, definitions of menopause or the final menstrual period have varied from study to study in terms of the number of months of amenorrhea considered to represent in retrospect the final menstrual period. Studies have also varied with regard to which factors have been included in multivariable analyses that control simultaneously for the effects of multiple variables, which also makes the studies not directly comparable.
The analysis of age at natural menopause in a number of studies has been calculated as a simple mean, rather than using the less-biased survival or multivariable time-to-event analytic approaches. These last two approaches include more information and observations for every woman studied, because all women are included but withdrawn or censored when they experience surgical menopause, start using menopausal hormone therapy or oral contraceptives (OC; which generally masks the natural cessation of menses), or are still premenopausal.34 Also, the accuracy of reporting of age at menopause can vary by whether menopause was natural and by duration from the time of the final menstrual period to the time of the interview about menopause, the latter being directly affected by the age group of the study sample. 35 Further, in some studies that have reported age at menopause, it is unclear if the age at the final menstrual period is being reported, the more frequent approach, or if the age at cessation of menses plus 1 year of amenorrhea, the World Health Organization’s definition of menopause.31 is what is reported, a more rare occurrence.36 Most studies do not use a hormonally based definition of menopause.
Recently, more information has been published regarding differences in the timing of menopause experienced by samples of women of different socioeconomic, racial/ethnic, and lifestyle backgrounds, and standardization of instruments and definitions has increased, resulting in a fuller, clearer, and more insightful picture regarding the underlying physiology.
SUMMARY OF UNDERLYING PHYSIOLOGY
Menopause is defined as the cessation of menstruation which reflects cessation of ovulation owing to a loss of ovarian follicles, which in turn results in reduced ovarian production of estradiol, the most biologically active form of estrogen,37,38 as well as increased circulating concentrations of follicle-stimulating hormone (FSH) and decreased concentrations of inhibin, which inhibits the release of FSH. 37 Age at menopause may be more sensitive to varying rates of atresia of ovarian follicles39 than to the absolute number of oocytes depleted,40 but menopause is reached when depletion of follicles reaches approximately 1000 (from a peak of 5 million follicles at mid-gestation and 2 million at birth).41,42 The age at which sufficient depletion of follicles occurs is affected by the number of follicles achieving migration to the gonadal ridge during gestation, their mitotic abilities until mid-gestation, and the rate of follicular atresia.42,43
As circulating estrogen concentrations decline during the menopausal transition, variations in the regularity, timing, and nature of menstrual bleeding may occur.44 As menstrual cycles become increasingly irregular, bleeding may occur after an inadequate luteal phase or without ovulation,44 usually indicated by a short luteal phase, characteristic of women over the age of 40 years. 45,46 Such cycles may be associated with insufficient FSH (or insufficient FSH responsiveness of the follicle) in the follicular phase, in turn resulting in lower luteal phase estrogen and progesterone secretion. Lack of a corpus luteum, resulting in estrogen secretion (even hyperestrogenicity45,47) unopposed by progesterone, may lead to profuse bleeding.
The nature and timing of bleeding may vary both within and between women. What is known about the host, environmental, or lifestyle factors that may affect such variation is summarized herein. Although some factors have been identified that are associated with early age at natural menopause, the relation of many has not been examined, and most have not been examined in relation to duration of the perimenopause.
Factors Related to Timing of Menopause
Results from cross-sectional studies have indicated that endocrine changes characteristic of the onset of the perimenopause begin at around age 45. 48 The median age at menopause among white women from industrialized countries ranges between 50 and 52 years and at onset of the perimenopause is 47.5 years,49–53 with slight evidence of increasing age at menopause over time.53–57 These onsets seem to vary by race and ethnicity58–60 and are affected by demographic and lifestyle factors.50,51,55,57–69 Although some studies have reported no familial relationship, 1 study has reported that age at menopause was positively associated with maternal age at menopause,61 and 1 recent study has shown genetic control of age at menopause in a study of twins.70 However, a number of potentially modifiable factors which may affect estrogen metabolism, including body mass index (BMI), diet (particularly calories and alcohol intake), and passive smoke exposure have not been examined, nor has the time-varying effect of these and of the other factors that have been previously identified been examined in longitudinal analyses of sufficiently large and diverse study populations.
International and geographic differences
Several studies have indicated that women living in developing countries (including Latin America, Indonesia, Singapore, Pakistan, Chile, and Peru) experience natural menopause several years earlier than those in developed countries.71–76 Some work has also indicated that women living in urban areas have a later natural menopause than women in rural areas.62 Women living at high altitude in the Himalayas or in the Andes of Peru undergo natural menopause 1 to 1.5 years earlier than those living at lower altitudes or in less rural areas.72,77–79 It is unclear whether these geographic and international differences in the age at natural menopause reflect genetic, socioeconomic, environmental, racial/ethnic, or lifestyle differences and whether and how these affect physiology.
Some studies have reported that African American59 and Latina58,60 women have natural menopause about 2 years earlier than white women. However, 1 small study in Nigeria reported the average age at menopause to be 52.8 years,80 over 1 year later than that generally reported for white women in industrialized nations. Mayan women, despite their high parity (see Reproductive History), have been reported to experience natural menopause fairly early, at about age 45.81 In contrast, Asian women tend to have similar age at menopause to Caucasian women,58,82 although Thai women have been reported to have a lower median age at menopause, at age 49.5 years, despite their high parity,83 and Filipino Malay women have been reported to have an earlier average age at natural menopause at 47 to 48 years.84
Differences by socioeconomic status
A number of studies have observed that lower social class, as measured by the woman’s educational attainment or by her own or her husband’s occupation, is associated with an earlier age at natural menopause.51–54,57,58,61,71,85,86 However, results from a British birth cohort indicated that early life socioeconomic status (SES) was more strongly associated than adult status with age at natural menopause,87 although even the relation of early life SES was greatly attenuated when adjusted for childhood cognitive ability and having been breastfed. 88 One study found that education was more strongly associated with age at natural menopause than occupation.52 Most studies that have examined the relation of marital status have found that single women undergo an earlier natural menopause, and this association cannot be explained by nulliparity.52,89,90
Menstrual and reproductive history
The age at which the final natural menstrual period occurs may be a marker for hormonal status or changes earlier in life.91 In the landmark Treloar longitudinal study of largely white, well-educated women, those whose median menstrual cycle length between the ages of 20 and 35 years was fewer than 26 days underwent natural menopause 1.4 years earlier than women with cycle lengths between 26 and 32 days, whereas a later natural menopause (mean = 0.8 year later) was observed in women with cycle lengths of 33 days or longer.92 In addition, 9 or more days of variability in cycle length has been associated with a later age at natural menopause in this and other studies,52,59 although 1 study reported an earlier natural menopause in women with irregular menses. 53
Increasing parity, particularly among women of higher SES, has also been associated with later age at natural menopause,50–52,55,57,58,61,90,91,93–96 consistent with the theory that natural menopause occurs after oocytes have been sufficiently depleted.93 Although some studies have reported no familial relationship, 1 study reported that women’s age at natural menopause was positively associated with their mother’s age at natural menopause,61 and 1 study of twins showed genetic control of age at natural menopause.70 Age at menarche has been fairly consistently observed not to be associated with age at menopause, after adjusting for parity and cycle length,52,53,55,83,89,97,98 as have prior spontaneous abortion, age at first birth, and history of breastfeeding.52,97,98
A number of studies have reported that women who have used OCs have a later age at natural menopause.52,58,61,63,72,98 an observation that is also consistent with the theory that OCs delay depletion of oocytes. However, the finding has not been wholly consistent across studies, because 1 study reported that this delay became nonsignificant after a time-dependent adjustment for when OCs were used,52 and another study reported that OC users had a significantly earlier natural menopause than nonusers, although this association was not consistent across 5-year age groups.50
Body mass and composition
Several studies have examined the relation of body mass to age at menopause, with inconsistent findings. Some studies have reported that both increased BMI (indicated by weight over height squared) and upper body fat distribution (indicated by waist-to-hip ratio) were associated with later age at natural menopause50,57,96,99,100 and increased sex hormone concentrations.100 However, at least as many other studies have reported no significant association of BMI with age at natural menopause.51,52,54,59,101,102 Some studies have found a relationship between lower weight69 or increased upper body fat distribution101 and earlier age at natural menopause, particularly among smokers. One study reported earlier natural menopause in women on weight reduction programs or who had gained more than 26 pounds between the ages of 20 and 45 years.59
Some of these apparently inconsistent findings may be explained by differences in study design (cross-sectional or retrospective vs prospective) or analysis (eg, inadequate or varying control of confounding variables or survival analysis vs. comparison of crude means). In general, the better designed and analyzed studies have shown no relation of body mass or body fat distribution to age at the final natural menstrual period. Although body mass and composition may be related to age at natural menopause, they are also related inversely to physical activity, alcohol consumption, and education, and positively related to infertility and parity.103 Further research is needed in which all of these potentially confounding variables are simultaneously controlled in the statistical analyses of data from large study samples to be able to assess adequately the independent contribution or interactive effect of body mass and composition and these other factors on the age at the natural final menstrual period and duration of menopause transition, using appropriate longitudinal study design and data analysis techniques.
Familial, genetic, and early childhood factors
In recent years, studies of factors related to age at natural menopause have begun to focus on genetic factors that may be related. Results of family and twin studies suggest that familial and genetic factors may play an important role, with estimates of heritability ranging from 30% to 85%.70,104,105 In 1 relatively large cross-sectional study and 1 large longitudinal British birth cohort study, a strong association was found between mothers’ and daughters’ ages at natural menopause,88,106 which have also been found in a few other smaller studies,107–109 but few longitudinal studies have investigated this relationship. One European genome-wide association study of nearly 3000 women identified 6 single nucleotide polymorphisms in 3 loci on chromosomes 13, 19, and 20 associated with age at natural menopause.110 A Dutch study showed that polymorphisms of an estrogen receptor gene were associated with earlier natural and surgical menopause. 111 Results of genome-wide association studies, using samples from thousands of women in the Nurses’ Health Study and the Women’s Genome Health Study, identified 13 single nucleotide polymorphisms on 4 chromosomes that were associated with age at menopause.112 Analyses of candidate genes from 9 biologically plausible pathways, using the same samples from the same women in these 2 studies, indicated that the steroid hormone metabolism and biosynthesis pathways were associated with age at natural menopause and that genes involved in premature ovarian failure were also significantly associated with age at menopause.113 Two single nucleotide polymorphisms of the tumor necrosis factor receptor family have also been shown to be significantly associated with age at natural menopause.114
A number of analyses have been conducted on prospective data collected across the lifespan from a nationally representative birth cohort of nearly 1600 British women born in 1946 and followed to age 53 years, the Medical Research Council National Survey of Health and Development. These analyses have revealed that women who had a low weight at 2 years of age had an earlier natural menopause,115 whereas those who were heaviest at 2 years of age had a later natural menopause.89 Those who were breastfed had a later natural menopause.115 Another cohort study in England also found that low weight at 1 year of age was associated with earlier natural menopause.116 However, an Australian twin study and the English cohort study found no association of birth weight with age at natural menopause.116,117 The British birth cohort and other cohort studies have shown that poorer cognitive ability in childhood was associated with earlier natural menopause,118–120 suggesting that perhaps markers in early life may determine not only age at natural menopause, but may also predict the adverse health outcomes that are associated with early age at menopause. Further, additional findings from the British birth cohort indicate that women whose parents divorced early in their lives had an earlier natural menopause than other women, suggesting that early life stressors may also be related to early menopause. 87,88
Active and passive smoke exposure
Perhaps the single most consistently shown environmental effect on age at menopause is that women who smoke stop menstruating 1 to 2 years earlier than comparable nonsmokers.50,51,55,57–59,61,63–68,86,96,121 and have a shorter perimenopause.122 Some studies have shown a dose–response effect on atrophy of ovarian follicles, in that heavy smokers have an earlier natural menopause than light smokers.61,67,69,123,124 Former smokers have only a slightly earlier age at natural menopause than those who never smoked, and increased time since quitting diminishes the difference.123,125 The latter observation of only a slightly earlier natural menopause in former smokers is inconsistent with the presumed toxic effect of smoking on ovarian follicles, resulting in their atrophy and thus earlier menopause, because such an effect should be nonreversible so that former smokers would also experience the earlier natural menopause observed in current smokers. If the dose–response effect is a true effect, the apparent paradox might partly be explained by fewer years of smoking and thus toxic exposure to the ovaries in former smokers than in current smokers of similar age.
The polycyclic aromatic hydrocarbons in cigarette smoke are known to be toxic to ovarian follicles126,127 and thus could result in premature loss of ovarian follicles and early natural menopause among smokers. Because drug metabolism is enhanced in smokers,128 estrogen also may be more rapidly metabolized in the livers of smokers, which could lead to an earlier reduction of estrogen levels.99 Further, smoking has also been observed to have antiestrogenic effects.129 Greater prevalence of hysterectomy among premenopausal smokers than nonsmokers100,123 apparently does not account for smokers having an earlier natural menopause.130 Only 1 study has shown that nonsmoking women whose spouses smoked had an age at natural menopause resembling that of smokers131; thus, very little is known about the effect of passive or secondhand smoke exposure on the age at which the final natural menstrual period is experienced.
Although almost nothing is known about the relations of occupational or other environmental factors to age at the final natural menstrual period and duration of the menopausal transition, occupational exposures and stressors (such as shift work, hours worked, hours spent standing, and heavy lifting) have been related to increased risk of adverse pregnancy outcomes132–135 and changes in menstrual cycle length and variability as well as fecundability.136–139 In addition, such environmental exposures as dichlorodiphenyltrichloroethane and polychlorinated biphenyls have been shown to have estrogenic activity and to be associated with an increased risk of breast cancer,140,141 although this association has not been consistently observed.142,143 Thus, the presumed endocrine effects of such exposures make it reasonable to expect that occupational and environmental exposures may be related to endocrine disruption that is reflected in altered age at natural menopause. One study showed a modest effect on age at natural menopause in women in Seveso, Italy, who were exposed to 2,3,7,8-tetrachlorobenzo-p-dioxin, a halogenated compound that may affect ovarian function, during a chemical plant explosion in 1976.144 Another study showed that exposure to 1,1-dichloro-2,2-bis(p-chlorophenyl) ethylene was also associated with earlier natural menopause.145
Physical activity is associated with a number of changes in hormonal parameters [estradiol, progesterone, prolactin, luteinizing hormone (LH), and FSH), both during and after intense physical activity.146–148 The concentrations of these hormones tend to be lower at rest among women who are physically active.146,147,149,150 Also, athletes tend to have a later age at menarche and increased occurrences of anovulation151 and amenorrhea152 and, among those who menstruate, a shortened luteal phase and reduced mean and peak progesterone levels. 104,149 Although physical activity is associated with decreased concentrations of reproductive hormones and frequency of ovulation, few studies have examined the effect of exercise on age at natural menopause, although 1 modestly sized study reported no relationship,59 and 1 large study of Chinese women showed a later age at natural menopause associated with leisure time physical activity during adolescence and adulthood.94
One early study from Papua, New Guinea, suggested that malnourished women ceased menstruation about 4 years earlier than well-nourished women,153 consistent with other studies showing that women with greater weight62,69 and height89 may have a later age at natural menopause. Findings regarding the relationship of specific dietary patterns to age at menopause have been inconsistent. For example, vegetarians were observed to have an earlier age at natural menopause in 1 study,154 whereas another study in Japan reported that higher green and yellow vegetable intake was significantly associated with later age at natural menopause. 155 Further, a large cross-sectional study of Japanese women found that higher intakes of fat, cholesterol, and coffee were significantly associated with earlier natural menopause after controlling for age, total energy, parity, menarche age, and relative weight.156 A longitudinal study of nearly 5000 German women observed that high carbohydrate consumption and high intake of vegetable, fiber, and cereal products were related to an earlier age at natural menopause, whereas higher intake of total fat, protein, and meat were associated with a later natural menopause.157 The large, prospective Shanghai Women’s Health Study found that higher total intake of calories, fruits, and protein was significantly associated with later age at natural menopause, whereas vegetable, fat, soy, and fiber intakes were not significantly related to age at menopause.94 Inclusion of meat in the diet of vegetarians has been observed to increase the episodic releases of LH and FSH and the length of the menstrual cycle. 158 Thus, meat may modify the interaction of hormones along the hypothalamic-pituitary-ovarian axis. A couple of studies have reported that increased meat or alcohol consumption is significantly associated with later age at menopause, after adjusting for age and smoking.61,121 Dietary fiber (whose intake tends to be inversely related to meat intake) may interrupt enterohepatic circulation of sex hormones, leading to the lower circulating estrogen concentrations among vegetarian women.159 Nonetheless, a low-fat, high-carbohydrate intervention diet to prevent breast cancer in over 2600 women with extensive mammographic density followed for an average 7 years did not influence the timing of natural menopause, except a significantly earlier natural menopause was observed in those with low BMI who were on the intervention diet.160
Premenopausal women administered soy have shown increased plasma estradiol concentrations and follicular phase length, delayed menstruation, and suppressed midcycle surges of LH and FSH. 161 Among postmenopausal women fed soy, FSH and LH did not decrease significantly, nor did sex hormone-binding globulin increase, and little change occurred in endogenous estradiol or body weight, although a small estrogenic effect on vaginal cytology was observed.162 However, the role of dietary fiber, phytoestrogens, fat, protein, and other nutrients in affecting age at menopause and duration of the perimenopause remains to be systematically studied, but has potentially important implications for prevention of chronic disease in midlife and older women.
Despite important methodologic differences, the limitations in the study designs used and the populations studied in the accumulating literature regarding factors that affect the age at which the natural final menstrual period is experienced, an interesting and complex picture is emerging. A number of demographic (eg, education, employment, race/ethnicity), menstrual and reproductive (eg, parity and OC use), familial and genetic, and lifestyle (eg, smoking, weight, physical activity and diet) factors seem to be important determinants of the age at which natural menopause occurs. Smoking, lower parity, and lower SES have been found fairly consistently to be associated with earlier menopause, an indicator of reduced longevity. However, the relationships with African American and Latina race/ethnicity, vegetarian diet, and undernutrition, body mass and composition, and physical activity have been inconsistent, possibly owing to varying methodologic approaches and limitations ().
Factors related to earlier and later age at natural menopause
|Factors Consistently Related to Earlier Age at Natural Menopause (References)||Factors Inconsistently Related to Age at Natural Menopause (References)|
|Low socioeconomic status51–54,57,58,61,71,85–88||Race/ethnicity58–60,80–84|
|Low/parity50–52,55,57,58,61,90,91,93,96||Body mass index or body com position50–52,54,57,59,62,69,98–101|
|Not using oral contraceptives50,52,58,61,63,72,98||Physical activity59,94|
|Active smoking50,51,55,57–59,61,63–69,86,96,121,124–126||Dietary (vegetable, meat, fat, fiber) intake61,121,153–157,160|
Other relationships remain largely unexplored (eg, passive smoke exposure and occupational and other environmental exposures). Therefore, much remains to be learned about how these factors affect follicular atresia and hormone levels and thus determine the onset and potentially the duration of the perimenopause and the timing of the final menstrual period. Furthermore, increased understanding of the underlying physiologic mechanisms of these influences needs to include potential genetic, metabolic, and racial/ethnic differences in physiologic responses to lifestyle factors and other environmental exposures and the interaction of genetic factors with these lifestyle and environmental factors. Increasing knowledge about these relationships ultimately offers women and their health care providers enhanced understanding and choices, based on greater knowledge, to deal with the individual presentations of menopause.
The Study of Women’s Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR) and the NIH Office of Research on Women’s Health (ORWH) (Grants NR004061; AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, AG012495). Dr Gold was supported by AG012554. The content of this article is solely the responsibility of the author and does not necessarily represent the official views of the NIA, NINR, ORWH or the NIH.
1. Cooper GS, Sandler DP. Age at natural menopause and mortality. Ann Epidemiol. 1998;8:229–35. [PubMed] [Google Scholar]2. Wise AM, Krajnak KM, Kashon ML. Menopause: the aging of multiple pacemakers. Science. 1996;273:67–70. [PubMed] [Google Scholar]3. Snowdon DA, Kane RL, Beeson WL, et al. Is early natural menopause a biologic marker of health and aging? Am J Public Health. 1989;79:709–14. [PMC free article] [PubMed] [Google Scholar]4. Ossewaarde ME, Bots ML, Verbeek ALM, et al. Age at menopause, cause-specific mortality and total life expectancy. Epidemiology. 2005;16:556–62. [PubMed] [Google Scholar]5. Jacobsen BK, Heuch I, Kvale G. Age at natural menopause and all-cause mortality: a 37-year follow-up of 19,731 Norwegian women. Am J Epidemiol. 2003;157:923–9. [PubMed] [Google Scholar]6. De Kleijn MJ, van der Schouw YT, Verbeek AL, et al. Endogenous estrogen exposure and cardiovascular mortality risk in postmenopausal women. Am J Epidemiol. 2002;155:339–45. [PubMed] [Google Scholar]7. Van der Schouw YT, van der Graaf Y, Steyerberg EW, et al. Age at menopause as a risk factor for cardiovascular mortality. Lancet. 1996;347:714–8. [PubMed] [Google Scholar]8. Jacobsen BK, Nilssen S, Heuch I, et al. Does age at natural menopause affect mortality from ischemic heart disease? J Clin Epidemiol. 1997;50:475–9. [PubMed] [Google Scholar]9. Hu FB, Grodstein F, Hennekens CH, et al. Age at natural menopause and risk of cardiovascular disease. Arch Intern Med. 1999;159:1061–6. [PubMed] [Google Scholar]10. Atsma F, Bartelink ML, Grobbec DE, et al. Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: a meta-analysis. Menopause. 2006;13:265–79. [PubMed] [Google Scholar]11. Cui R, Iso H, Toyoshima H, et al. JACC Study Group. Relationships of age at menarche and menopause, and reproductive year with mortality from cardiovascular disease in Japanese postmenopausal women: the JACC study. J Epidemiol. 2006;16:177–84. [PMC free article] [PubMed] [Google Scholar]12. Jansen SC, Temme EH, Schouten EG. Lifetime estrogen exposure versus age at menopause as mortality predictor. Maturitas. 2002;43:105–12. [PubMed] [Google Scholar]13. Jacobsen BK, Knutsen SF, Fraser GE. Age at natural menopause and total mortality and mortality from ischemic heart disease: the Adventist Health Study. J Clin Epidemiol. 1999;52:303–7. [PubMed] [Google Scholar]14. Lisabeth LD, Beiser AS, Brown DL, et al. Age at natural menopause and risk of ischemic stroke The Framingham Heart Study. Stroke. 2009;40:1044–9. [PMC free article] [PubMed] [Google Scholar]16. Joakimsen O, Bonaa KH, Stensland-Bugge E, et al. Population-based study of age at menopause and ultrasound assessed carotid atherosclerosis: the Tromso Study. J Clin Epidemiol. 2000;53:525–30. [PubMed] [Google Scholar]17. Parazzini F, Bidoli E, Franceschi S, et al. Menopause, menstrual and reproductive history, and bone density in northern Italy. J Epidemiol Community Health. 1996;50:519–23. [PMC free article] [PubMed] [Google Scholar]18. Kritz-Silverstein D, Barrett-Connor E. Early menopause, number of reproductive years, and bone mineral density in postmenopausal women. Am J Public Health. 1993;83:983–8. [PMC free article] [PubMed] [Google Scholar]19. Van Der Voort DJ, Van Der Weijer PH, Barentsen R. Early menopause: increased fracture risk at older age. Osteoporos Int. 2003;14:525–30. [PubMed] [Google Scholar]20. Kelsey JL, Gammon MD, John EM. Reproductive factors and breast cancer. Epidemiol Rev. 1993;15:36–47. [PubMed] [Google Scholar]21. Monninkhof EM, van der Schouw YT, Peeters PH. Early age at menopause and breast cancer: are leaner women more protected? A prospective analysis of the Dutch DOM cohort. Breast Cancer Res Treat. 1999;55:285–91. [PubMed] [Google Scholar]22. De Graaff J, Stolte LA. Age at menarche and menopause of uterine cancer patients. Eur J Obstet Gynecol Reprod Biol. 1978;8:187–93. [PubMed] [Google Scholar]23. Franceschi S, La Vecchia C, Booth M, et al. Pooled analysis of 3 European case-control studies of ovarian cancer: II. Age at menarche and at menopause. Int J Cancer. 1991;49:57–61. [PubMed] [Google Scholar]24. Kaaks R, Lukanova A, Kurzer MS. Obesity, endogenous hormones, and endometrial cancer risk: a synthetic review. Cancer Epidemiol Biomarkers Prev. 2002;11:1531–43. [PubMed] [Google Scholar]25. Xu WH, Xiang YB, Ruan ZX, et al. Menstrual and reproductive factors and endometrial cancer risk: results from a population-based case-control study in urban Shanghai. Int J Cancer. 2004;108:613–9. [PubMed] [Google Scholar]26. Rivera CM, Grossardt BR, Rhodes DJ, et al. Increased cardiovascular mortality after early bilateral oophorectomy. Menopause. 2009;16:15–23. [PMC free article] [PubMed] [Google Scholar]27. Lokkegaard E, Jovanovic Z, Heitmann BL, et al. The association between early menopause and risk of ischaemic heart disease: influence of hormone therapy. Maturitas. 2006;53:226–33. [PubMed] [Google Scholar]28. Woods NF, Mitchell ES, Adams C. Memory functioning among midlife women: observations for the Seattle Midlife Women’s health Study. Menopause. 2000;7:257–65. [PubMed] [Google Scholar]29. Halbreich U, Piletz J, Halaris A. Influence of gonadal hormones on neurotransmitters, receptor, cognition and mood. Clin Neuropharmacol. 1992;15(Suppl A):590A–1A. [PubMed] [Google Scholar]30. Kok HS, Kuh D, Cooper R, et al. Cognitive function across the life course and the menopausal transition in a British birth cohort. Menopause. 2006;13:19–27. [PubMed] [Google Scholar]31. World Health Organization . Research on the menopause in the 1990s. World Health Organization; Geneva (Switzerland): 1996. [Google Scholar]32. Skolnick AA. At third meeting, menopause experts make the most of insufficient data. JAMA. 1992;268:2483–5. [PubMed] [Google Scholar]33. Avis NE, Kaufert PA, Lock M, et al. The evolution of menopausal symptoms. Baillieres Clin Endocrinol Metab. 1993;7:17–32. [PubMed] [Google Scholar]34. Cramer DW, Xu H. Predicting age at menopause. Maturitas. 1996;23:319–26. [PubMed] [Google Scholar]35. Hahn RA, Eaker E, Rolka H. Reliability of reported age at menopause. Am J Epidemiol. 1997;146:771–5. [PubMed] [Google Scholar]36. Sowers MF, LaPietra MT. Menopause: its epidemiology and potential association with chronic diseases. Epidemiol Rev. 1995;17:287–302. [PubMed] [Google Scholar]37. Gosden RG. Biology of the menopause: the causes and consequences of ovarian ageing. Academic Press; London: 1985. [Google Scholar]38. Burger HG, Dudley EC, Hopper JL. The endocrinology of the menopausal transition: a cross-sectional study of a population-based sample. J Clin Endocrinol Metab. 1995;80:3537–45. [PubMed] [Google Scholar]39. Soule MR, Bremner WJ. The menopause and climacteric: endocrinologic basis and associated symptomatology. J Am Geriatrics Soc. 1982;30:547. [PubMed] [Google Scholar]40. Thomford PJ, Jelovsek FR, Mattison DR. Effect of oocyte number and rate of atresia on the age of menopause. Repro Toxicol. 1987;1:41–51. [PubMed] [Google Scholar]41. Faddy MJ, Gosden RG, Gougeon A, et al. Accelerated disappearance of ovarian follicles in mid-life: implications for forecasting menopause. Hum Reprod. 1992;7:1342–6. [PubMed] [Google Scholar]43. Aydos SE, Elhan AH, Tukun A. Is telomere length one of the determinants of reproductive life span? Arch Gynecol Obstet. 2005;2727:113–6. [PubMed] [Google Scholar]44. Sherman BM, West JH, Korenman SG. The menopausal transition: analysis of LH, FSH, estradiol and progesterone concentrations during menstrual cycles of older women. J Clin Endocrinol Metab. 1976;42:629–36. [PubMed] [Google Scholar]45. Santoro N, Rosenberg-Brown J, Adel T, et al. Characterization of reproductive hormonal dynamics in the perimenopause. J Clin Endocrinol Metab. 1996;81:1495–1501. [PubMed] [Google Scholar]46. Upton GV. The perimenopause: physiologic correlates and clinical management. J Reprod Med. 1982;27:1–28. [PubMed] [Google Scholar]47. Shideler SE, DeVane GW, Kalra PS, et al. Ovarian pituitary hormone interactions during the menopause. Maturitas. 1989;11:331–9. [PubMed] [Google Scholar]48. Trevoux R, DeBrux J, Castaneir M, et al. Endometrium and plasma hormone profile in the peri-menopause and post-menopause. Maturitas. 1986;8:309–26. [PubMed] [Google Scholar]49. McKinlay SM, Brambilla DJ, Posner JG. The normal menopause transition. Maturitas. 1992;14:103–15. [PubMed] [Google Scholar]50. Greendale G, Hogan P, Kritz-Silverstein D, et al. Age at menopause in women participating in the postmenopausal estrogen/progestins interventions (PEPI) trial: an example of bias introduced by selection criteria. Menopause. 1995;2:27–34. for the PEPI trial investigators. [Google Scholar]51. Luoto R, Laprio J, Uutela A. Age at natural menopause and sociodemographic status in Finland. Am J Epidemiol. 1994;139:64–76. [PubMed] [Google Scholar]52. Stanford JL, Hartge P, Brinton LA, et al. Factors influencing the age at natural menopause. J Chron Dis. 1987;40:995–1002. [PubMed] [Google Scholar]53. Magursky V, Mesko M, Sokolik L. Age at the menopause and onset of the climacteric in women of Martin district, Czechoslovakia. Int J Fertil. 1975;20:17–23. [PubMed] [Google Scholar]54. Gold EB, Sternfeld B, Brown C, et al. The relation of demographic and lifestyle variables to symptoms in a multi-racial/ethnic population of women aged 40-55 years. Am J Epidemiol. 2000;152:463–73. [PubMed] [Google Scholar]55. van Noord PAH, Dubas JS, Dorland M, et al. Age at natural menopause in a population-based screening cohort: the role of menarche, fecundity, and lifestyle factors. Fertil Steril. 1997;68:95–102. [PubMed] [Google Scholar]56. Flint M. Is there a secular trend in age of menopause. Maturitas. 1978;1:133–9. [PubMed] [Google Scholar]57. Rodstrom K, Bengtsson C, Milsom I, et al. Evidence for a secular trend in menopausal age: a population study of women in Gothenburg. Menopause. 2003;10:538–43. [PubMed] [Google Scholar]58. Gold EB, Bromberger J, Crawford S, et al. Factors associated with age at menopause in a multi-ethnic population of women. Am J Epidemiol. 2001;153:865–74. [PubMed] [Google Scholar]59. Bromberger JT, Matthews KA, Kuller LH, et al. Prospective study of the determinants of age at menopause. Am J Epidemiol. 1997;145:124–33. [PubMed] [Google Scholar]60. Alvarado G, Rivera R, Ruiz R, et al. Characteristicas del patron de sangrado menstrual en un grupo de mujeres normales de Durango. Ginecol Obstetr Mex. 1988;56:127–33. [PubMed] [Google Scholar]61. Torgerson DJ, Avenell A, Russell IT, et al. Factors associated with onset of menopause in women aged 45-49. Maturitas. 1994;19:83–92. [PubMed] [Google Scholar]62. MacMahon B, Worcester J. Age at menopause, United States 1960-1962. Vital Health Stat. 1966;19:1–19. [PubMed] [Google Scholar]63. Palmer JR, Rosenberg L, Wise LA, et al. Onset of natural menopause in African American women. Am J Public Health. 2003;93:299–306. [PMC free article] [PubMed] [Google Scholar]64. McKinlay SM, Bifano NL, McKinlay JB. Smoking and age at menopause in women. Ann Intern Med. 1985;103:350–6. [PubMed] [Google Scholar]65. Andersen FS, Transbol I, Christiansen C. Is cigarette smoking a promoter of the menopause. Acta Med Scand. 1982;212:137–9. [PubMed] [Google Scholar]66. Hiatt RA, Fireman BH. Smoking, menopause, and breast cancer. J Natl Cancer Inst. 1986;76:833–8. [PubMed] [Google Scholar]67. Hartz AJ, Kelber S, Borkowf H, et al. The association of smoking with clinical indicators of altered sex steroids—a study of 50,145 women. Pub Health Rep. 1987;102:254–9. [PMC free article] [PubMed] [Google Scholar]68. Brambilla DJ, McKinlay SM. A prospective study of factors affecting age at menopause. J Clin Epidemiol. 1989;42:1031–9. [PubMed] [Google Scholar]69. Willett W, Stampfer MJ, Bain C, et al. Cigarette smoking, relative weight and menopause. Am J Epidemiol. 1983;117:651–8. [PubMed] [Google Scholar]70. Snieder H, MacGregor AJ, Spector ID. Genes control cessation of a woman’s reproductive life: a twin study of hysterectomy and age at menopause. J Clin Endocrinol Met. 1998;83:1875–80. [PubMed] [Google Scholar]71. Castelo-Branco C, Blümel JE, Chedraui P, et al. Age at menopause in Latin America. Menopause. 2006;13:706–12. Erratum in: Menopause 2006;13:850. [PubMed] [Google Scholar]72. Gonzales GF, Villena A. Age at menopause in central Andean Peruvian women. Menopause. 1997;4:32–8. [Google Scholar]73. McCarthy T. The prevalence of symptoms in menopausal women in the Far East: Singapore segment. Maturitas. 1994;19:199–204. [PubMed] [Google Scholar]74. Samil RS, Wishnuwardhani SD. Health of Indonesian women, city-dwellers of perimenopausal age. Maturitas. 1994;19:191–7. [PubMed] [Google Scholar]75. Wasti S, Robinson SC, Akhtar Y, et al. Characteristics of menopause in three groups in Karachi, Pakistan. Maturitas. 1993;16:61–9. [PubMed] [Google Scholar]76. Blumel J, Cubillos M, Brandt A, et al. Some clinical aspects of menopause. Rev Chil Obstet Ginecol. 1988;53:278–82. [PubMed] [Google Scholar]77. Kapoor AK, Kapoor S. The effects of high altitude on age at menarche and menopause. J Biometeor. 1986;30:21–6. [PubMed] [Google Scholar]78. Beall CM. Ages at menopause and menarche in a high altitude Himalayan population. Ann Hum Biol. 1983;10:365–70. [PubMed] [Google Scholar]79. Flint MP. PhD dissertation. City University of New York; 1974. Menarche and menopause in Rajput women. [Google Scholar]80. Otolorin EO, Adeyefa I, Osotimehin BO, et al. Clinical, hormonal and biochemical features of menopausal women in Ibadan, Nigeria. Afr J Med Sci. 1989;18:251–5. [PubMed] [Google Scholar]81. Beyene Y. Cultural significance and physiological manifestations of menopause, a bicultural analysis. Culture Med Psychiatr. 1986;10:47–71. [PubMed] [Google Scholar]82. Boulet M. The menopause and the climacteric in seven Asian countries. In: Sixth International Congress on the Menopause. Parthenon; New Jersey: 1990. [Google Scholar]83. Chompootweep S, Tankeyoon M, Yamarat K, et al. The menopausal age and climacteric complaints in Thai women in Bangkok. Maturitas. 1993;17:63–71. [PubMed] [Google Scholar]84. Ramoso-Jalbuena J. Climacteric Filipino women: a preliminary survey in the Philippines. Maturitas. 19:183–90. [PubMed] [Google Scholar]85. Lawlor DA, Ebrahim S, Smith GD. The association of socio-economic position across the life course and age at menopause: the British Women’s Heart and Health Study. Br J Obstet Gynecol. 2003;110:1078–87. [PubMed] [Google Scholar]86. Santoro N, Brockwell S, Johnston J, et al. Helping midlife women predict the onset of the final menses: SWAN, the Study of Women’s Health Across the Nation. Menopause. 2007;14:415–24. [PubMed] [Google Scholar]87. Hardy R, Kuh D. Social and environmental conditions across the life course and age at menopause in a British birth cohort study. BJOG. 2005;112:346–54. [PubMed] [Google Scholar]88. Mishra G, Hardy R, Kuh D. Are the effects of risk factors for timing of menopause modified by age? Results from a British birth cohort study. Menopause. 2007;14:717–24. [PubMed] [Google Scholar]89. Brand PC, Lehert PH. A new way of looking at environmental variables that may affect the age at menopause. Maturitas. 1978;1:121–32. [PubMed] [Google Scholar]90. McKinlay S, Jefferys M, Thompson B. An investigation of the age at menopause. J Biosoc Sci. 1972;4:161–73. [PubMed] [Google Scholar]91. Whelan EA, Sandler DP, McConnaughey DR, et al. Menstrual and reproductive characteristics and age at natural menopause. Am J Epidemiol. 1990;131:625–32. [PubMed] [Google Scholar]92. Treloar AE, Boynton RE, Behn BG, et al. Variation of the human menstrual cycle through reproductive life. Int J Fertil. 1966;12(Pt 2):77–126. [PubMed] [Google Scholar]93. Soberon J, Calderon JJ, Goldzieher JW. Relation of parity to age at menopause. Am J Obstet Gynecol. 1966;96:96–100. [PubMed] [Google Scholar]94. Dorjgochoo T, Kallianpur A, Gao Y-T, et al. Dietary and lifestyle predictors of age at natural menopause and reproductive span in the Shanghai Women’s Health Study. Menopause. 2008;15:924–33. [PMC free article] [PubMed] [Google Scholar]95. Loh FH, Khin LW, Saw SM, et al. The age of menopause and the menopause transition in a multiracial population: a nation-wide Singapore study. Maturitas. 2005;52:169–80. [PubMed] [Google Scholar]96. Reynolds RF, Obermeyer CM. Age at natural menopause in Spain and the United States: results from the DAMES project. Am J Hum Biol. 2005;17:331–40. [PubMed] [Google Scholar]97. Parazzini F, Negri E, LaVecchia C. Reproductive and general lifestyle determinants of age at menopause. Maturitas. 1992;15:141–9. [PubMed] [Google Scholar]98. van Keep PA, Brand PC, Lehert PH. Factors affecting the age at menopause. J Biosoc Sci Suppl. 1979;6:37–55. [PubMed] [Google Scholar]99. Lindquist O, Bengtsson C. Menopausal age in relation to smoking. Acta Med Scand. 1979;205:73–7. [PubMed] [Google Scholar]100. Daniell HWP. Smoking, obesity, and the menopause. Lancet. 1978;2:373. [PubMed] [Google Scholar]101. den Tonkelaar I, Seidell J. Fat distribution in relation to age, degree of obesity, smoking habits, parity and estrogen use: a cross-sectional study of 11,825 Dutch women participating in the DOM project. Int J Obesity. 1990;14:753–61. [PubMed] [Google Scholar]103. Kaye S, Folsom A, Prineas RJ, et al. The association of body fat distribution with lifestyle and reproductive factors in a population study of postmenopausal women. Int J Obesity. 1990;14:583–91. [PubMed] [Google Scholar]104. Kok HS, van Asselt KM, van der Schouw YT, et al. Genetic studies to identify genes underlying menopause age. Hum Reprod Update. 2005;11:483–93. [PubMed] [Google Scholar]105. Van Asselt KM, Kok HS, Pearson PL, et al. Heritability of menopausal age in mothers and daughters. Fertil Steril. 2004;82:1348–51. [PubMed] [Google Scholar]106. Torgerson DJ, Thomas RE, Reid DM. Mothers and daughters menopausal ages: is there a link? Eur J Obstet Gynecol Reprod Biol. 1997;74:63–6. [PubMed] [Google Scholar]107. Cramer DW, Xu H, Harlow BL. Family history as a predictor of early menopause. Fertil Steril. 1995;64:740–5. [PubMed] [Google Scholar]108. DeBruin JP, Bovenhuis H, VanNoord PA, et al. The role of genetic factors in age at natural menopause. Hum Reprod. 2001;16:2014–8. [PubMed] [Google Scholar]109. Murabito JM, Yang Q, Fox C, et al. Heritability of age at natural menopause in the Framingham Heart Study. J Clin Endocrinol Metab. 2005;90:3427–30. [PubMed] [Google Scholar]110. Stolk L, Zhai G, Van Meurs JB, et al. Loci at chromosomes 13, 19 and 20 influence age at natural menopause. Nat Genet. 2009;41:645–7. [PMC free article] [PubMed] [Google Scholar]111. Weel AE, Uitterlinden AG, Westendorp IC, et al. Estrogen receptor polymorphism predicts the onset of natural and surgical menopause. J Clin Endocrinol Metab. 1999;84:3146–50. [PubMed] [Google Scholar]112. He C, Kraft P, Chen C, et al. Genome-wide association studies identify loci associated with age at menarche and age at natural menopause. Nat Genet. 2009;41:724–8. [PMC free article] [PubMed] [Google Scholar]113. He C, Kraft P, Chasman DI, et al. A large-scale candidate gene association study of age at menarche and age at natural menopause. Hum Genet. 2010;128:515–27. [PMC free article] [PubMed] [Google Scholar]114. Lu Y, Liu P, Recker RR, et al. TNFRSF11A and TNFSF11 are associated with age at menarche and natural menopause in white women. Menopause. 2010;17:1048–54. [PMC free article] [PubMed] [Google Scholar]115. Hardy R, Kuh D. Does early growth influence timing of the menopause? Evidence from a British birth cohort. Hum Reprod. 2002;17:2474–9. [PubMed] [Google Scholar]116. Cresswell JL, Egger P, Fall CH, et al. Is the age of menopause determined in-utero? Early Hum Dev. 1997;49:143–8. [PubMed] [Google Scholar]117. Treloar SA, Sadrzadeh S, Do KA, et al. Birth weight and age at menopause in Australian female twin pairs: exploration of the fetal origin hypothesis. Hum Reprod. 2000;15:55–9. [PubMed] [Google Scholar]118. Kuh D, Butterworth S, Kok H, et al. Childhood cognitive ability and age at menopause: evidence from two cohort studies. Menopause. 2005;12:475–82. [PubMed] [Google Scholar]119. Richards M, Kuh D, Hardy R, et al. Lifetime cognitive function and timing of the natural menopause. Neurology. 1999;53:308–14. [PubMed] [Google Scholar]120. Whalley LJ, Fox HC, Starr JM, et al. Age at natural menopause and cognition. Maturitas. 2004;49:148–56. [PubMed] [Google Scholar]121. Kinney A, Kline J, Levin B. Alcohol, caffeine and smoking in relation to age at menopause. Maturitas. 2006;54:27–38. [PubMed] [Google Scholar]122. McKinlay SM, Brambilla DJ, Posner JG. The normal menopause transition. Maturitas. 1992;14:103–15. [PubMed] [Google Scholar]123. Adena MA, Gallagher HG. Cigarette smoking and the age at menopause. Ann Human Biol. 1982;9:121–30. [PubMed] [Google Scholar]124. Jick H, Porter J, Morrison AS. Relation between smoking and age of natural menopause. Lancet. 1977;1:1354–5. [PubMed] [Google Scholar]125. Midgett AS, Baron JA. Cigarette smoking and the risk of natural menopause. Epidemiol. 1990;1:464–80. [Google Scholar]126. Mattison DR, Thorgierssen SS. Smoking and industrial pollution and their effects on menopause and ovarian cancer. Lancet. 1978;1:187–8. [PubMed] [Google Scholar]127. Essenberg JM, Fagan L, Malerstein AJ. Chronic poisoning of the ovaries and testes of albino rats and mice by nicotine and cigarette smoke. West J Surg Obstet Gynecol. 1951;59:27–32. [PubMed] [Google Scholar]129. Michnovicz J, Hershcopf R, Naganuma H, et al. Increased 2-hydroxylation of estradiol as a possible mechanism for the anti-estrogenic effect of cigarette smoking. N Engl J Med. 1986;315:1305–9. [PubMed] [Google Scholar]130. Krailo MD, Pike MC. Estimation of the distribution of the age at natural menopause from prevalence data. Am J Epidemiol. 1983;117:356–61. [PubMed] [Google Scholar]131. Everson RB, Sandler DP, Wilcox AJ, et al. Effect of passive exposure to smoking on age at natural menopause. Br Med J. 1986;293:792. [PMC free article] [PubMed] [Google Scholar]132. Mamelle N, Laumon B, Lazar P. Prematurity and occupational activity during pregnancy. Am J Epidemiol. 1984;119:309–22. [PubMed] [Google Scholar]134. Beaumont JJ, Swan SH, Hammond SK, et al. Historical cohort investigation of spontaneous abortion in the Semiconductor health Study: methods and analyses of risk in fabrication overall and in fabrication work groups. Am J Ind Med. 1995;28:735–50. [PubMed] [Google Scholar]135. Swan SH, Beaumont JJ, Hammond SK, et al. Historical cohort study of spontaneous abortion among fabrication workers in the Semiconductor Health Study; agent-level analysis. Am J Ind Med. 1995;28:751–70. [PubMed] [Google Scholar]137. Messing K, Saurel-Cubizolles MG, Bourgine M, et al. Menstrual cycle characteristics and work condition of workers in poultry slaughterhouses and canneries. Scand J Work Environ Health. 1992;18:302–9. [PubMed] [Google Scholar]138. Eskenazi B, Gold EB, Samuels SJ, et al. Prospective assessment of fecundability of female semiconductor workers. Am J Ind Med. 1995;28:817–32. [PubMed] [Google Scholar]139. Gold EB, Eskenazi B, Hammond SK, et al. Prospectively assessed menstrual cycle characteristics in female wafer-fabrication and nonfabrication semiconductor employees. Am J Ind Med. 1995;28:799–816. [PubMed] [Google Scholar]140. Falck F, Jr, Ricci A, Jr, Wolff MS, et al. Pesticides and polychlorinated biphenyl residues in human breast lipids and their relation to breast cancer. Arch Environ Health. 1992;47:143–6. [PubMed] [Google Scholar]141. Wolff MS, Toniolo PG, Lee EW, et al. Blood levels of organochlorine residues and risk of breast cancer. J Natl Cancer Inst. 1993;85:648–52. [PubMed] [Google Scholar]142. Krieger N, Wolff MS, Hiatt RA, et al. Breast cancer and serum organochlorines: a prospective study among white, black and Asian women. J Natl Cancer Inst. 1994;86:589–99. [PubMed] [Google Scholar]143. Hunter DJ, Hankinson SE, Laden F, et al. Plasma organochlorine levels and risk of breast cancer. N Engl J Med. 1997;337:1253–8. [PubMed] [Google Scholar]144. Eskenazi B, Warner M, Marks AR, et al. Serum dioxin concentrations and age at menopause. Environ Health Perspect. 2005;113:858–62. [PMC free article] [PubMed] [Google Scholar]145. Cooper GS, Savitz DA, Millikan R, et al. Organochlorine exposure and age at natural menopause. Epidemiol. 2002;13:729–33. [PubMed] [Google Scholar]146. Cummings SR, Kelsey J, Nevitt MC, et al. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev. 1985;7:178–208. [PubMed] [Google Scholar]147. Bonen A, Ling WH, Belcastro AN, et al. Profiles of selected hormones during menstrual cycles of teenage athletes. J Appl Physiol. 1981;50:545–51. [PubMed] [Google Scholar]148. Jurkowski JE, Joanes NL, Walker C, et al. Ovarian hormonal responses to exercise. J Appl Physiol. 1978;44:109–14. [PubMed] [Google Scholar]149. Loucks AB, Mortola LF, Girtoon L, et al. Alterations in the hypothalamic-pituitary-ovarian and the hypothalamic-pituitary-adrenal axes in athletic women. J Clin Endocrinol Metab. 1989;68:402–11. [PubMed] [Google Scholar]150. Jasienska G, Ziomkiewicz A, Thune I, et al. Habitual physical activity and estradiol levels in women of reproductive age. Eur J Cancer Prev. 2006;15:439–45. [PubMed] [Google Scholar]151. Bernstein L, Ross RK, Lobo RA, et al. The effects of moderate physical activity on menstrual cycle patterns in adolescence: implications for breast cancer prevention. Br J Cancer. 1987;55:681–5. [PMC free article] [PubMed] [Google Scholar]152. Loucks AB, Horvath SM. Athletic amenorrhea: a review. Med Sci Sports Exer. 1985;17:56–72. [PubMed] [Google Scholar]153. Scragg RFR. Menopause and reproductive span in rural Nuigini. Proc Ann Symp Papua New Guinea Med Soc. 1973:126–44. [Google Scholar]154. Baird DD, Trlavsky FA, Anderson JJB. Do vegetarians have earlier menopause? Proc Soc Epidemiol Res. 1988:907–8. [Google Scholar]155. Nagata C, Takatsuka N, Kawakami N, et al. Association of diet with the onset of menopause in Japanese women. Am J Epidemiol. 2000;152:863–7. [PubMed] [Google Scholar]156. Nagata C, Takatsuka N, Inaba S, et al. Association of diet and other lifestyle with onset of menopause in Japanese women. Maturitas. 1998;29:105–13. [PubMed] [Google Scholar]157. Nagel G, Altenburg HP, Nieters A, et al. Reproductive and dietary determinants of the age at menopause in EPIC-Heidelberg. Maturitas. 2005;52:337–47. [PubMed] [Google Scholar]158. Hill PB, Garbaczewski L, Daynes G, et al. Gonadotrophin release and meat consumption in vegetarian women. Am J Clin Nutr. 1986;43:37–41. [PubMed] [Google Scholar]159. Adlercreutz H, Mousavi Y, Loukovaara M, et al. Lignans, isoflavones, sex hormone metabolism and breast cancer. In: Hochberg R, Naftolin F, editors. The new biology of steroid hormones. Raven Press; New York: 1992. pp. 145–54. [Google Scholar]160. Martin LJ, Greenberg CV, Kriukov V, et al. Intervention with a low-fat, high-carbohydrate diet does not influence the timing of menopause. Am J Clin Nutr. 2006;84:920–8. [PubMed] [Google Scholar]161. Cassidy A, Bingham S, Setchell KDR. Biological effects of a diet of soy protein rich in isoflavones on the menstrual cycle of premenopausal women. Am J Clin Nutr. 1994;60:333–40. [PubMed] [Google Scholar]162. Baird DD, Umbach DM, Lansdell L, et al. Dietary intervention study to assess estrogenicity of dietary soy among postmenopausal women. J Clin Endocrinol Metab. 1995;80:1685–90. [PubMed] [Google Scholar]
Should I be worried about late-onset menopause? » Professor Andreas Obermair
4 years ago
At what age do you expect menopause to occur? How does it affect your health and cancer risk?
Menopause occurs when a woman’s ovaries stop releasing hormones. Naturally, a woman’s production of estrogen and progesterone hormones decrease in her late forties, which may cause menstrual periods eventually stopping. The age where most women become menopausal is between 50 and 54 years. In this context menopause is defined as not having a menstrual cycle for 12 consecutive months. As the hormone levels decrease, this may come with symptoms such as hot flushes, headaches, insomnia, mood swings and depression. Some women don’t have symptoms at all. Others may have symptoms at varying severity for 5 to 10 years.
Age and menopause
There is no set age when menopause should start, but according to the Australasian Menopause Society the average age is 51. If a woman is 55 or older and still hasn’t begun menopause, it is considered late-onset menopause. Menopause that occurs before age 40 is called premature. Up to 8% of women may have early menopause. Removal of both ovaries (bilateral oophorectomy) before the normal menopause is called “surgical menopause”. Menopause can also be induced by chemotherapy or radiotherapy to a woman’s pelvis.
Cancer risk and age at menopause
According to the American Society of Clinical Oncology, women who experience late-onset menopause have an increased risk of uterine and breast cancer. This is due to having an increased exposure to hormones such as estrogen. As women menstruate longer, they have more ovulations which also increases the risk of ovarian cancer. Women with a long reproductive life, menarche (onset of periods) before the age of 12 years and menopause after age 55 years have an increased risk of these hormone-dependent cancers. A pooled analysis of data from more than 400,000 women found for every year older a woman was at menopause, breast cancer risk increased by approximately 3%.
Benefits of late-onset menopause
It’s not all bad news, research findings suggest that later age at menopause and longer reproductive lifespan may result in longer life expectancy. Even though women who reach menopause later are at a higher risk for breast, uterine and ovarian cancers, women who go through menopause late are at a lower risk for heart disease and stroke.
A study of 12,123 postmenopausal women followed for 17 years found that age-adjusted mortality was reduced 2% with each increasing year of age at menopause. Though the risk of dying from uterine or ovarian cancer was 5% higher, ischemic heart disease was 2% lower for those with later menopause, and the overall effect was an increased lifespan. Life expectancy in women with menopause after age 55 years was 2 years longer than those with menopause before the age of 40 years.
Another study indicated women with longer reproductive years are more likely to live to 90 years of age. The study collected data from 16,251 participants, starting between 1993 and 1998 and followed for 21 years. Women who menstruated for more than 40 years were 13% more likely to reach age 90 years than those who had less than 33 reproductive years. Women who were at least 50 years of age when their menstrual cycles stopped were about 20% more likely to reach age 90 years than women who entered menopause before the age of 40 years.
Women who experience late-onset menopause also suffer less from osteoporosis, have stronger bones, and develop fewer bone fractures.
How do I decrease my cancer risk after menopause?
Late-onset menopause usually occurs because of a genetic predisposition. If your mother went through menopause late, chances are you may also. A study found that late menopause is not uncommon among obese women because fat tissue produces estrogen. If you are worried about your age and menopause exercise, eat a healthy diet, don’t smoke, and maintain a healthy body weight which can have a plethora of health benefits. Regular mammograms and Pap smears are also important for women experiencing late-onset menopause. Remember, pap smears have changed to the HPV test in December 2017.
If you wish to receive regular information, tips, resources, reassurance and inspiration for up-to-date care, that is safe and sound and in line with latest research please subscribe here to receive my blog, or like Dr Andreas Obermair on Facebook. Should you find this article interesting, please feel free to share it.
What is the age of menopause? How will I know when to expect the menopause?
Many of us are caught off-guard by the first signs of menopause. We wouldn’t expect to have menopausal symptoms while we still have periods. What does it mean to be in the menopause?
Menopause age can vary widely – it usually takes place between the ages of 48 and 55.
What age do women go through menopause at?
There’s a lot of confusion out there, I find a lot of women, myself included, wonder ‘what age do you expect menopause?’ For most of us, the menopause will happen between the ages of 48 and 55. The average age for women to experience menopause in Ireland is 50 years. We can start to experience symptoms up to eight years before that time, during a phase called ‘perimenopause’. For some of us, menopause could commence in our 30s and for others in our 50s. You will also find that most information available concerning menopause will give you slightly different average ages or age ranges. This can lead to confusion, but it is because we are all different.
For most of us, our last period will be preceded by the phase of menopausal changes and transition known as the perimenopause. During this phase, we may experience a wide variety of symptoms of the menopause including hot flushes, mood swings, insomnia and anxiety. Some symptoms will be barely perceptible. Others will be intense. Some of us may experience these symptoms but may not associate them directly with the menopause as they can be quite commonplace, such as a lack of confidence, anxiety, a loss of interest in sex and difficulty sleeping.
What age do you expect menopause?
It is true that the age at which we reach menopause is related to the age at which our mothers reached menopause. Women who have had babies late in their childbearing years tend to have a later menopause. Some women may go through early or premature menopause – before the age of 40, and again this may be hereditary. There is not necessarily a link between the onset of puberty and menopause. For example, if your periods started late you will not always have late menopause.
What is the average age for menopause in Ireland?
When and how menopause begins varies from one woman to the next. However, the average menopause age for Irish women is 50. Menopause is defined as the point when you have your last ever period. It will only be in retrospect that you are aware of this occurrence, and you will need to have had no periods for 12 months for menopause to have occurred. Most of our symptoms take place during the phase called perimenopause, 4-8 years before menopause. When women talk about going through the menopause, this is the stage that they are really talking about.
Other symptoms, such as osteoporosis and urinary incontinence, are more likely to occur after the menopause.
For most women, the key symptoms of menopause ease one year after their final period. At this stage hormone fluctuations become more stabilised. However, for some of us, symptoms carry on longer, many years after the time of official onset of menopause. It is also possible, in rare cases, for some women to have occasional symptoms, such as hot flushes, into their 60s and sometimes 70s.
How Long Does Menopause Last on Average? > Project Access-Collin County
The menopausal transition, or simply “menopause,” is a normal part of female aging. Once you start the transition, you’ll probably want to know exactly how long symptoms will last.
While every woman is different, here’s what to expect on average.
All women experience menopause, with several different symptoms.
Menopause symptoms may include:
- Hot flashes
- Sleep problems
- Pain during sex
In few cases, women don’t have trouble with these symptoms. Once the menopausal transition is complete, you will no longer have to worry about periods or getting pregnant.
For most women, menopause is a relief that feels freeing in many ways. Getting through the transition, however, can be trying.
Knowing about how long your symptoms will last can help you focus on the light at the end of the tunnel. While you’re going through abrupt hot flashes and night sweats that keep you awake at night as well as irritability from lack of sleep, knowing that you’re just X amount of days from it being over can ease your mind.
While there is no guarantee of exactly how long the transition will last, you can get a good idea of where you are on the journey by understanding the process and studying an average timeline.
The Average Timeline for Menopause
The menopause age range varies by more than a decade. The average age is 51, but menopause can start in women from their mid-40s to late 50s. Most women experience the menopause stage in this age range, while some report symptoms into their 60s.
Late menopause and early menopause are possible, and can occur for a variety of reasons, such as surgeries or hormonal changes.
Symptoms such as mood swings, vaginal dryness, and hot flashes mark the start of the change. Premenopausal symptoms and age can vary. Talk to your doctor if you’re not sure whether you’re beginning the menopausal transition.
The premenopausal stage can last from 10 months to four years. It involves the body gradually decreasing in estrogen production. Premenopause officially ends when a women does not have her period for 12 consecutive months. At this point, the woman enters menopause.
From the start of premenopause to the final cessation of all menopausal symptoms, the average transition takes between two and 10 years. There are some women who go through the process more quickly or more slowly than usual.
If you experience early or late menopause, you may need to add or subtract a year or two to this average timeline. Every woman should rely on medical professionals to assess symptoms, estimate the duration and prescribe treatments for symptom relief.
Do You Have Early or Late Menopause?
Figuring out if you’re going through the transition early or late can help you gain a better understanding of how long menopause will last. If you start having irregular periods in your mid-40s, you may be experiencing early or premature menopause.
Heavy bleeding, spotting, a period after a year of no periods, or periods that are noticeably longer or shorter than normal can all signal early menopause, especially in combination with other common menopausal symptoms.
If you are 55 or older and still haven’t noticed menopause symptoms, your doctor may diagnose you with late-onset menopause.
Late menopause may actually have some health benefits, while early menopause could potentially cause problems. During menopause, the production of estrogen and progesterone by the ovaries declines. In early-onset menopause, this cessation may cause problems such as osteoporosis. The longer your ovaries produce estrogen and progesterone, the longer you can avoid osteoporosis.
If you’re still having periods in your late 50s and 60s, see your doctor. Each woman’s reproductive system is different, so don’t be alarmed until you’ve spoken to a doctor.
Treating Menopause Symptoms
You may experience one or several symptoms, or hardly any symptoms at all. You may not notice premenopausal symptoms until you’ve almost reached the menopause phase. Your entire transition could finish in just a few years, or could last longer than a decade.
Everyone is unique, and there is no concrete answer. It takes seeing a primary doctor to evaluate your symptoms, locate where you are on the general timeline, and estimate how much longer you will have to put up with symptoms.
While you are combating symptoms for an unknown period of time, look into common forms of relief. If you have medical conditions exacerbating the symptoms of menopause, such as arthritis, chronic pain, anxiety or depression, your doctor can help address these issues to potentially reduce menopause symptoms.
Menopause is a normal part of life, and several tried-and-true treatment options exist to help control and tolerate common symptoms. You can maintain your desired lifestyle while experiencing menopause with a tailored treatment plan.
Article link – https://www.azgyn.com/blog/how-long-does-menopause-last-on-average/
Arizona Gynecology Consultants
Menopause – an overview | ScienceDirect Topics
Bone Density and Calcium Mobilization
Menopause represents a vulnerable time for a woman’s skeletal health. Estrogen declines associated with menopause increase bone remodeling, leading to an imbalance between bone formation and bone resorption.153,154 This increase in bone remodeling persists over several years and becomes associated with an increased rate of bone loss.155,156 Early cross-sectional studies compared bone mineral density (BMD) in pre-, peri-, and postmenopausal women and generally reported lower BMD in the peri- and post- menopausal periods.157–159 However, these cross-sectional studies could not determine when bone loss began or the rates of bone loss during various phases of the transition.160
To our knowledge, the first longitudinal study of bone loss during the menopausal transition was published by Riggs et al. in 1987.161 A total of 139 women were followed for a median of 2 years and were classified as post-menopausal if they had no menstrual periods for 6 or more months and estradiol levels were lower than 50 pg/ml. All other women were classified as premenopausal. BMD was measured by older methods, e.g., single and dual photon absorptiometry techniques which have lower precision than the methods in use today. BMD at the mid-radius did not change before menopause, but decreased by about 1% per year after menopause. For lumbar spine, there was significant bone loss both before (−1.32 %/yr) and after (−0.97 %/yr) menopause. These results suggested that bone loss at primarily trabecular bone sites such as the vertebrae decrease substantially before menopause.
Other earlier studies showed bone loss in the perimenopausal period, but not in the premenopausal period.162 The first longitudinal study using state-of-the-art dual energy x-ray absorptiometry (DXA) demonstrated significant change in femoral neck BMD, but not lumbar spine BMD among perimenopausal women.163 Finally, a longitudinal study of 75 women with a mean age of 46 years at baseline, who were followed for 9.5 years, showed that bone loss began about 2–3 years before menopause and ended 3–4 years after the last menses.164 The total loss in the spine and femoral neck was 10.5% and 5.3%, respectively, over the menopausal period. Results suggested that menopausal bone loss is a composite of loss caused by estrogen deprivation and age for the hip, but estrogen deprivation alone for the spine.164
In SWAN, BMD was measured annually in 1,902 African American, Caucasian, Chinese, or Japanese women.165 Little change occurred in lumbar spine or total hip BMD during the pre- or early perimenopause. Bone loss accelerated markedly in the late perimenopause, with an average loss of 0.018 g/cm2yr (1.6%) and 0.010 g/cm2yr (1.0%) from the spine and hip, respectively (P<0.001 for both). In postmenopausal women, rates of spine and hip bone loss were 0.022 g/cm2yr (2.0%) and 0.013 g/cm2yr (1.4%) respectively (P<0.001 for both).
Bone loss during the late peri- and postmenopause was approximately 35–55% slower in women in the top (kg>77.3) versus lowest tertiles (kg<60.7) of body weight. Apparent ethnic differences in rates of spine bone loss were largely explained by differences in body weight.
Although BMD is a major determinant of bone strength, it does not capture important aspects of bone quality, including the microarchitecture and geometry of bone. Transmenopausal changes in trabecular bone structure were described in 28 women who underwent paired transilial biopsies pre- and 12 months after the FMP.166 Bone volume/total volume declined, trabecular number decreased by almost 13%, while trabecular spacing increased by 7% with an overall 10% decrease in apparent density.166
Bone strength is also a function of bone size, with larger bones conferring greater strength. Changes in bone size were described in 108 women followed from the time of menopause for a mean period of 15 years.167 The medullary bone diameter and periosteal diameter increased while BMD decreased, all of which were correlated with serum estradiol levels. These results suggest that periosteal apposition may compensate in part for the decreased bone strength. Thus, focusing solely on bone density across the menopause may miss important changes in bone strength that are reflected in the trabecular architecture and bone size.
Several mechanisms likely underlie bone loss at menopause. Estrogen deficiency leads to T-cell activation, and studies in mice have shown that ovariectomy does not induce bone loss in mice depleted of T-cells with T-cell antibodies.168 Activation of T-cells by ovariectomy increases T-cell production of TNF, a cytokine that stimulates osteoclast formation by potentiating the activity of RANKL, and by promoting production of RANKL by osteoblast cells.169 Gene expression also differs in pre- and postmenopausal women.170
In SWAN, FSH level and increases in FSH were found to correlate strongly with changes in BMD.171 Estradiol levels were not significant, but this may be due to assay variability rather than biology. Estradiol was shown to correlate with changes in BMD, with higher levels being associated with slower rates of bone loss and inversely associated with changes in periosteal diameter.167
Bone loss in women with oophorectomy has not been sufficiently studied.172 Studies of women with early natural menopause (before 45 years of age) differ greatly regarding the subsequent impact on osteoporosis and fractures.60,173–177 A number of studies relate menopause to biochemical markers of bone turnover.178 One study of 178 women aged 29–78 found that the estrogen decline after menopause occurred simultaneously with changes in biochemical indices of bone turnover.179 Many researchers have observed a rise in serum osteocalcin levels, which has been positively correlated with bone loss of menopause,157,179–184 although studies have reported different menopause phase-specific patterns.180,182 Urinary calcium has been found to increase at the menopause179,180,182,183,185 and after the menopause.179,185 This increased calcium excretion has been shown to be negatively associated with bone density and bone mineral content.176,185
The responsiveness of the vitamin D system to estrogen may also contribute to the bone loss observed with menopause. 1,25-dihydroxyvitamin D is an integral part of the hormonal environment that maintains calcium balance by regulating calcium absorption from the intestine, calcium resorption from the skeleton, and calcium retention in the kidney. Sowers186 has shown that there is a significantly greater 1,25-dihydroxyvitamin D level in premenopausal women versus postmenopausal women.
Study finds genetic signals that might be used to predict early menopause
A large new study scanned the genes of hundreds of thousands of women near the age of menopause and turned up hundreds of genetic signals that the researchers said might help predict and prevent early menopause, as well as treat infertility and improve women’s reproductive health in the future.
The study, published in Nature, identified 290 genetic variants, many of them part of a pathway that repairs DNA, associated with the age at which women enter menopause. Researchers also found that changing the levels of two of these DNA repair genes delayed menopause in mice. The study broadens the understanding of how genes, specifically those in the DNA-damage response pathway, could influence the reproductive life span in women.
The average age at which women start menopause is about 51 years, and is brought on by a decrease of ovarian reserve, the capacity to produce healthy eggs. But there is significant variation in the age of menopause onset, determined by genetics and environmental factors. Although the environmental factors that influence menopause, like smoking and chemotherapy, are well-studied, the genetic factors had remained a black box.
Studying the underlying biology and genetics of menopause has proven difficult because a woman’s supply of eggs are mostly formed before birth and studying it in adult humans often means taking a sample of ovarian tissue. “If you were studying muscle or skin, you can take a biopsy of those tissues,” said Anna Murray, a geneticist at the University of Exeter in the U.K. and author of the new study. “Nobody’s going to biopsy a woman’s ovaries — it’s very precious tissue.”
To get around these difficulties, researchers looked to genetic studies called genome-wide association studies, or GWAS. Two such previous studies had identified around 60 genetic regions associated with the timing of menopause.
Now the multi-institutional team looked at the genes of a much larger group of women, about 200,000, between 40 and 60 years old, and found nearly 300 genetic signals associated with menopause timing. Similar to the results of their previous studies, many of the genetic regions they identified are involved in processes that respond to DNA damage to maintain cells’ health or induce cell death if necessary. Still, the researchers were surprised by how prevalent this pathway was in their findings. “I don’t know if other traits have found this level of enrichment for one particular process,” said Murray.
Using the identified variants, the authors produced a risk score to see if they could predict which individuals were likely to have premature ovarian insufficiency, which occurs when women reach menopause before the age of 40. Although it was a weak predictor, the risk score identified women who started menopause by 40 better than smoking status.
Two DNA-repair genes, Chek1 and Chek2, stood out for their strong association with menopause timing. Women who lacked a working Chek2 protein had menopause three and a half years later than those who had normal Chek2, and female mice bred without the Chek2 gene had more eggs than normal mice when they were older, effectively extending their reproductive life span.
On the other hand, introducing a copy of the Chek1 gene into the mice also extended their reproductive life span, but by enabling production of more eggs after birth, which took longer to deplete. These different mechanisms “really highlight the complexity in the processes that go into the ovarian reserve,” said Rong Li, cell biologist at Johns Hopkins University and professor of the National University of Singapore who studies cellular processes of development.
In the future, researchers hope these findings could lead to therapeutics to extend fertility in women, though it may not be a straightforward process, Murray said. While early menopause was associated with increased risk of type 2 diabetes and worse bone health, it was also associated with decreased risk of breast and ovarian cancer. To avoid detrimental effects of delaying menopause, researchers suggest that therapeutics could be used in the short-term like targeting certain genes to enhance egg production during IVF cycles, for example.
Targeting DNA-repair genes with treatments could also have unintended consequences. Li suggests that other genes may be better targets. “[DNA-damage response genes] are a bit scary to manipulate because [by inhibiting them] you could get cancer,” said Li, who was not involved with the study but has collaborated with Perry. “Other pathways might be better and safer targets for intervention.”
More simply, the findings could also be used to provide women with more information about the approximate age when they would get menopause. Predictions about menopause age could inform women of their risk of developing conditions like breast cancer and help their decisions about when to have children, which could help them avoid unnecessary procedures, like infertility treatments.
But because most of the study was done on women of European ancestry, the findings need to be replicated in different populations, said Corrine Welt, an endocrinologist at the University of Utah who studies the genetics of early menopause and who was not involved in the study. When the study did look at women from East Asian ancestry, it found that many of the genetic signals held up but the size of the effect of these genetic regions on menopause timing was different than those in women with European ancestry.
Murray hopes future studies could improve menopause age prediction by also including non-genetic factors that are known to influence ovarian reserve like smoking. Researchers are hopeful that women’s reproductive health is finally getting the attention it deserves, which could open the door for more studies and ultimately better health outcomes.
“I think with studies like this, we are making a lot of headway,” said Welt. “Let’s study all the female reproductive problems with genetics, because, unfortunately, it’s been an underserved aspect of medicine.”
What Age Does Menopause Start In Women?
It’s a perfectly reasonable question that is unfortunately really hard to answer. However, there are signs that can help a woman get an idea of where her body is in the journey and behaviors that can influence the onset of menopause, so read on ….
The average age for onset of menopause (12 months without a period) is 51 in the United States. But every woman’s experience of menopause is as unique as she is, so she may be fully menopausal in her late-40s or mid-50s, or still regular in her late-50s!
There are a lot of factors that impact when a woman begins the transition to her menopausal body, and we’ll look into what they are and how you can get a sense of what your body is doing.
How does a woman know she’s starting menopause?
For many women, the transitional period before menopause (called “perimenopause”) can start as early as her mid-30s. Many women start noticing symptoms in their early 40s.
Often the first sign a woman notices is an irregularity in her periods. Where once it was every 28 days, lasted for five, had a pretty consistent flow pattern, etc., now it’s a little more frequent, longer, and heavier periods, or a little less frequent, shorter, and lighter, or some combination of any of these.
Skipped months happen as well, but note: it is possible to get pregnant during perimenopause, so if you want to avoid pregnancy, use contraception until you’ve gone a full 12 months without a period.
Other early symptoms may include night sweats, hot flashes, vaginal feminine dryness, interrupted sleep, and perimenopause PMS mood swings, according to the North American Menopause Society.
How long does perimenopause last?
If you type this question into an Internet search engine, you’ll probably find several sources claiming the “average” for perimenopause is four years.
We haven’t really found that to be the case. It may be that women coming to Gennev for help are suffering more and have been suffering longer, but we find perimenopause of eight to ten years is not unusual.
And unfortunately, the symptoms don’t necessarily end with the last period. Hot flashes, vaginal issues such as dryness and frequent urinary tract infections, incontinence, poor sleep and other symptoms can carry on for years after.
What causes menopause?
Menopause is a completely natural process that every woman eventually experiences. It happens when the body is running low on viable eggs.
Women are born with all their eggs already in place – somewhere between 1-3 million of them. As she matures and ages, eggs are lost to ovulation or die off normally. As her egg reserve gets low (perhaps as low as 10,000 or fewer at menopause), her body produces less estrogen, triggering the process known as perimenopause.
What age will I start menopause?
What most women are probably asking when they ask this question is, “At what age will I start perimenopause?” since that’s actually when noticeable symptoms arise for most of us.
It’s pretty much impossible to tell a woman when her menopause will occur – unless menopause is the result of a medical intervention such as breast cancer treatment or hysterectomy.
However, there are factors that may help her understand her body better. According to an article in the National Center for Biotechnology Information (NCBI), the following may have some impact on when a woman begins her menopause transition.
- Genetics. This is probably one of the biggest determining factors for menopause that occurs naturally (rather than as the result of surgery or other external factors). For many women, the age your mother or other female blood relatives (aunts, sisters) was at menopause is a reasonable indicator of the age you’ll be (ish). However, other factors may serve to alter a woman’s genetic start and end date.
- Age at first period. If you started menstruating early, you may also enter menopause earlier.
- Pregnancies. Women who have never been pregnant or never completed a pregnancy past 20 weeks may enter menopause sooner. Alternatively, women who have had multiple pregnancies past 20 weeks may delay menopause.
- Birth control, age at first pregnancy. Taking the Pill or other oral birth control may delay menopause, as can having a “later” first pregnancy.
- One ovary. A unilateral oophorectomy (one ovary removed, one remaining) may prompt earlier menopause.
- Lifestyle factors. Smoking, lower socioeconomic status, and less formal education may all play a role in causing a woman to enter menopause sooner.
While getting to the “not having periods” part of life may sound attractive, there are health risks associated with menopause, mainly because we lose the protective benefits of estrogen on our brains, bones, hearts, and more.
If you’re still unsure where you are in the menopause transition, the best way to learn more about your body is to talk with an experienced, menopause specialist ob/gyn. Describe your symptoms, share your period tracker, talk about lifestyle and behavior.
You probably don’t need to bother having hormone levels tested – they shift so much during perimenopause that a quick snapshot will only tell you where levels are now, which may not be where they are tomorrow or even an hour from now. If you’re on hormonal birth control, you will likely need to come off it – possibly for a few months – to see where your body truly is.
Yes, it can be hard to pinpoint where your body is in the menopause transition, but that doesn’t mean you’re being unreasonable to want to know! Your future health depends to a very real extent on decisions you make now, and the more information you have, the more informed your decisions can be.
So make an appointment with a menopause specialist. Find out beforehand what kinds of questions you should be ready to answer. If you need to find a menopause specialist, you can book an appointment with Gennevs telemedicine service or refer to our artilce Find a Menopause Specialist Near You.
The more women we speak with, the more we discover that so many of us were really not prepared for perimenopause: so many symptoms, often quite severe, and they started earlier than we expected! There’s a reason few of us have heard the word “perimenopause” – because we don’t discuss it. We’d like to challenge everyone reading this article to share it. Let’s open up the conversation so no woman is left frightened and confused by the natural course her body is taking. Come talk with us (and invite other women!) in our community forums, on our Facebook page, or in Midlife & Menopause Solutions, our closed Facebook group (open to anyone who is experiencing or will experience menopause.)
90,000 Menopause. Help – RIA Novosti, 17.11.2010
Perimenopause – This period begins, on average, 4 years before menopause (average age 47.5 years) and lasts for 12 months after the cessation of menstruation.
The first sign of perimenopause is changes in the menstrual cycle, both in duration and in the amount of blood loss.
Menopause is the time of the last natural bleeding (menstruation). It can only be established after 12 months without bleeding (amenorrhea).The average age of menopause is 51.3 years, although women who smoke can reach menopause 1.5-2 years earlier.
Postmenopause – 12 months after menopause, women enter the postmenopausal period – a period until the end of life, marked by a deficiency of female sex hormones.
Menopause is the result of a complex process of changes in the body caused by the extinction of ovarian function.
Depending on the cause that caused the onset of menopause, distinguishes between physiological, pathological and artificial menopause :
– Physiological menopause is a normal process of ovarian failure as a result of age-related changes and in most women occurs between 40 and 50 years.Over time, ovulation becomes infrequent, the menstrual cycle is disrupted, and eventually menses stop (usually between the ages of 45 and 55).
– Pathological (premature) menopause is a gradual or sudden cessation of menstruation before the age of 40 for an unknown reason. In the premature onset of menopause, factors such as diseases (primarily tumors of the female organs), unhealthy diet, exhaustion, severe emotional stress, radiation exposure and surgery that affect the blood supply to the ovaries play a role.
– Artificial menopause can occur after radiation therapy or certain surgical procedures such as removal of the ovaries.
In some women, against the background of a decrease in the adaptive capabilities of the body, climacteric syndrome develops, complicating the course of the natural climacteric period. This happens as a result of the growing deficiency of female sex hormones.
The manifestations of the climacteric syndrome include:
Hot flashes is a sensation when rising waves of heat begin in the chest area and spread to the neck, face, arms.Hot flashes occur on average once an hour and usually last 3-4 minutes. Increase in blood pressure to high numbers is possible. Hot flashes are often followed by significant sweating and then chills; they can occur at any time, even at night during sleep (this is called night sweats).
Three out of four women experience hot flashes during menopause, but only one in four can have hot flashes for more than 5 years.
Vaginal dryness can result from decreased levels of estrogen in the body.With a lack of estrogen, the walls of the vagina lose their elasticity, become thinner and secrete less secretion.
Urinary incontinence also develops due to low levels of estrogen in the body, which reduces the muscle tone of the genitourinary tract.
Weakness, fatigue, irritability, and poor sleep are also observed.
In addition, in the first few years after menopause, bone loss occurs very quickly, and vascular changes begin to progress, from which a woman was previously protected by a high level of estrogen hormones.These changes increase the risk for women of osteoporosis (increased fragility of bones, which leads to frequent fractures, the worst of which is a hip fracture), as well as the risk of heart disease.
It is important to remember that menopause is not a disease, but the physiological state of the female body. Therefore, the course of this period largely depends on the attitude of the woman herself towards him.
Menopause: Myths and Reality | OncoProfi Kazan
On the one hand, menopause is the same obligatory stage in a woman’s life as birth, puberty, etc.etc., on the other hand, this physiological process has become overgrown with so many myths and fables that it has become not only the hero of anecdotes and complaints, but also the main “horror story” that frightens all women from a very young age.
Let’s try to discuss some of the most common myths around menopause in order to finally get to the bottom of the truth.
Myth 1. Menopause is a sign of aging. In fact, menopause is a sign of the cessation of ovarian function, i.e. the process of maturation of oocytes, which in our understanding corresponds to the monthly.Therefore, menopause is a sign of the termination of reproductive function. However, it should be remembered that the average age of menopause is 51 years (42-58), which corresponds to the period of life when a woman, enriched with life experience, loving and appreciating herself, enters her second youth. What kind of aging is this? Moreover, with the help of gynecologists-endocrinologists, it is now possible to individually select hormone replacement therapy, which will improve both the well-being and the condition of the skin. If menopause occurs before the age of 40, it is already called “premature menopause.”This is no longer a physiological process, but a medical condition that requires examination and treatment by gynecologists.
Myth 2. Menopause is necessarily accompanied by a deterioration in the quality of a woman’s life: hot flashes, malaise, headaches, bad mood, etc. In fact, some women can go through menopause without the above symptoms. This is usually inherited. In all other women, who make up the vast majority, these symptoms can be reduced and even eliminated with the right hormonal or herbal remedies, as well as a healthy lifestyle and dietary advice.
Myth 3. Menopause is about the same for all women. No no and one more time no! Your menopause will be only yours: individual and unlike anyone else. Like your body, your period and labor. This is not the menopause of your grandmother, mom, sister, and even more so, your neighbors and girlfriends.
Therefore, dear ladies, before, on the advice of a friend, take the “miracle medicine that oh-how-it-helped her”, remember that:
- During the period of menopause, there is a peak in the incidence of malignant neoplasms (breast cancer, ovarian cancer, cervical cancer), therefore, it is during this period that it is NECESSARY to be examined annually by oncologists.
- Taking any medications, and even more so hormonal ones, without the appointment and supervision of doctors is dangerous to health! Taking many homeopathic remedies and dietary supplements, without proven therapeutic activity, at best, will only damage the contents of your wallet, and at worst, lead to the development of diseases.
Thus, for women who respect themselves and their health, who are regularly preventively examined by gynecologists and oncologists, menopause is another stage in life when you can love and be loved, or just be a beautiful and adored woman.And to everyone else … we recommend reading the article again!
Cysts are a kind of fluid-filled sacs that can form in any part of the body, incl. and in the ovaries. Ovarian cysts are common. Ovarian cysts are especially likely to form during childbearing years.
There are several different types of ovarian cysts. The most common of these is a functional cyst that forms during ovulation.This is due to the fact that the egg cannot be released from its sac (follicle), has not matured, or the follicle does not dissolve after the release of the egg.
Other types of cysts include:
- Polycystic ovary syndrome (PCOS) – follicles in which eggs mature normally, cannot open, and cysts form.
- Endometriomas – Occur in women with endometriosis when cells in the lining of the uterus proliferate and spread to other parts of the body, including the ovaries.Endometriomas can be very painful and cause infertility.
- Cystadenomas – These cysts form from cells on the surface of the ovaries and are often filled with fluid.
- Dermoid Cysts – Contains cells from other parts of the body (skin, hair, teeth, etc.).
Symptoms of ovarian cysts
Very often ovarian cysts do not have any clinical manifestations: patients do not complain about anything, until by chance, during routine medical examinations, they are not detected.However, ovarian cysts can cause serious problems if the stem is twisted, bleeding, or ruptured.
In case of the following symptoms or complaints, you should immediately consult a specialist, as these symptoms may also indicate ovarian tumors.
Symptoms of cysts and ovarian tumors:
- Pain or bloating
- Difficulty urinating or frequent urge to urinate
- Dull pain in the lower back
- Pain during intercourse
- Painful periods and heavy bleeding
- Weight gain
- Nausea or vomiting
- Loss of appetite, fast satiety.
During your examination, if you suspect ovarian cysts or tumors, you may be offered the following types of examination: examination by a gynecologist-oncologist, ultrasound of the pelvic organs (transvaginal or transabdominal), examination of the level of hormones in the blood (LH, FSH, estradiol, etc.) testosterone), analysis for tumor marker CA-125. In some cases, for further examination and clarification of the picture, laparoscopy, computed tomography and other types of high-tech examinations may also be needed.
Dear women, take care of yourself and your health, and remember that the best treatment is timely prevention and regular examinations by specialists will help to identify and prevent the development of many diseases in time.
Everything you need to know about the diagnosis of endometriosis
Endometriosis is a disease in which tissue normally found in the inner layer of the uterus grows in other parts of the body: in the ovaries, fallopian tubes, on the outer surface of the uterus, in the intestines or in other internal organs.As hormone levels change during the menstrual cycle, this tissue sloughs off from the organs where it is attached, causing painful adhesions and scar tissue to form.
The most common symptom of endometriosis is pain before, during and after menstruation. In some women, the pain is so intense that it causes temporary disability, may occur before or after intercourse, or during intestinal motility or urination.Sometimes endometriosis is accompanied by chronic pelvic or lumbar pain. However, most women with endometriosis may have little or no symptoms.
Sometimes the first and only sign of endometriosis is infertility. Approximately one third of women with endometriosis have infertility, but the causes of this condition are not yet fully understood. On the other hand, modern medicine has reached such heights that at present this infertility is curable, and the very fact of pregnancy contributes to the treatment of endometriosis.
What are the causes of endometriosis?
Currently, doctors have not found a reason why endometrial tissue begins to grow in atypical places, but there are several theories. According to one theory, the development of the disease is associated with a hereditary factor: some endometrial cells in the body are present from the moment of birth. Another theory is that cells migrate to the pelvic area during menstruation, through the bloodstream, or during a cesarean section. Another theory explains this disease by a decrease in immunity.
Who is at risk for endometriosis?
Endometriosis is more common in the following women:
- Age 30-40 years old,
- Have no children,
- Monthly longer than 7 days,
- Menstrual cycles shorter than 28 days,
- Menstruation started earlier than 12 years old,
- Have a mother or sister who has endometriosis.
If you have one or more risk factors, you should see a professional gynecologist for a complete examination and treatment.With a timely diagnosis, endometriosis can be completely cured, however, with a chronic long course of the disease, irreversible changes occur, leading to the surgical removal of the affected organs (ovaries, fallopian tubes, uterus, etc.).
Take care of your health! Sign up for a consultation with our specialists
90,000 The age of menopause in women depends on their sexual activity
Scientists have found that sexual contact can delay the onset of menopause.Meanwhile, in the absence of sexual activity, the female body switches to “grandmother’s mode” earlier.
Typically, menopause occurs between the ages of 45 and 55. This is a natural change – the final cessation of menstrual cycles, after which the woman loses the opportunity to conceive a child.
In a new study, researchers from University College London found that the age at menopause in women depends on their sexual activity.
Experts analyzed the data of nearly three thousand women obtained in the framework of the American study of women’s health Study of Women’s Health Across the Nation.
At the time of the beginning of observations (1996-1997) the participants were from 42 to 52 years old. On average, they had two children. Most of the women were in legal or civil marriage.
In the proposed questionnaires, the participants reported the frequency of various sexual contacts over the past six months (including oral sex and other “non-classical” love pleasures).
Most women (64%) admitted to having sex on average once a week.
At the start of the study, none of the participants had yet entered menopause. 46% were in early perimenopause (beginning to experience the characteristic signs of menopause, such as changes in the menstrual cycle and hot flashes). The remaining 54% were premenopausal (they showed no signs of perimenopause).
Observations and polls have been carried out for ten years. During this time, more than 1,300 participants (45%) went through menopause – an average of 52 years old.
Data analysis showed that women who had sex (during the study period) weekly and monthly were 28% and 19% less likely to have menopause, respectively, than those who had sex less than once a month …
The researchers also took into account the general health of the participants and factors such as estrogen levels, education, body mass index, smoking, and the age at which the women began to menstruate.
“The results of our research indicate that if a woman does not have sex and she has no chance of getting pregnant, the body decides not to invest energy in ovulation, as it would be pointless,” – said the first author of the work Megan Arnot (Megan Arnot) …
Probably, the female body makes a biological energy compromise: it stops “investing” energy in ovulation, switching to other types of activity, for example, taking care of grandchildren, the scientist believes.
Actually, the results of the work confirm the hypothesis of the grandmother, which says that at a certain period of life it becomes more important for women to take care of their existing offspring than the birth of new children, and therefore their body stops reproductive function.
In addition, during ovulation, the immune defense of the female body is reduced, which makes it more susceptible to disease. Most likely, the body takes this into account, too, at some point deciding that the risk is not justified.
“Menopause is, of course, inevitable for women, and there are no behavioral interventions to prevent the cessation of fertility. However, our results indicate that the timing of menopause may be adaptive and dependent on the likelihood of getting pregnant,” co-author of the work is Professor of Evolutionary Anthropology Ruth Mace (Ruth Mace).
For more details on this research, see an article in the Royal Society Open Science.
By the way, earlier, experts accused men of the onset of female menopause, who in adulthood instinctively give preference to younger women who are able to reproduce offspring.
Also “Vesti.Nauka” (nauka.vesti.ru) talked about the fact that women whose menopause occurs early are more at risk of developing heart disease in the future.At the same time, overly thin ladies run the risk of entering menopause before the age of 45.
90,000 Preparing for menopause – first signs
If you are unsure of what to expect, the symptoms of menopause can shock you, so learn to recognize the signs and prepare well.
A woman is considered to have reached menopause if she has not had her period for 12 consecutive months. But at the earliest stage, called perimenopause, many changes occur in the body.It is during this period that you first get hot flashes, you sweat at night, your periods become irregular, and your mood often changes.
Hot flashes is a state of sharp unbearable heat in the chest and on the face. They are usually accompanied by redness and sweating. It is better to wear multi-layered clothing made from natural fabrics. In this case, you will not be so unbearably hot, and it will be easy to take off unnecessary clothes. Night sweats are a kind of night hot flashes, in the morning you can be wet through and through.Open the window at night and turn on the electric fan next to the bed. Menopausal women may have trouble sleeping. Therefore, special efforts must be made to create a comfortable environment for yourself before going to bed.
Other symptoms of menopause are weight gain and depression. Eating well, cutting back on stimulants such as coffee and alcohol, and improving your mood can help you manage them. Often during this period, women find it difficult to cope with stress and the feeling of being cut off from the world.Enlist the support of loved ones and find ways to cope with stress: yoga or meditation will help a lot during this difficult period.
Irregular periods during perimenopause are normal. But it may come as a surprise to you after many years of regular cycle. Be ready – always carry pads like Libresse Ultra. During menopause, bladder weakness can also develop as a result of a decrease in the amount of estrogen in the abdominal muscles, which makes it more difficult to keep the bladder closed.To avoid unpleasant moments and not to stain your laundry, carry TENA Lady products in your purse.
The most important thing in preparing for menopause is to acknowledge the changes that are taking place, discuss them with a friend or loved one, and adjust your lifestyle. And then you will not feel lost and unhappy.
90,000 Menopause Problem Solving – Medicinas sabiedriba ARS
Menopause is a physiological process that affects any woman at a certain age.This is the time when at least 12 months have passed since the last menstruation and the end of the hormonal function of the ovaries is clinically observed. The average age at menopause is 51.
There are three stages of the menopause period:
- Premenopause is the period of initial decline in ovarian function until the complete cessation of menstruation.
- Perimenopause is a transition period from the reproductive phase with regular ovulatory cycles and corresponding cyclical changes in the reproductive system to the state after the cessation of menstruation within 12 months after the last.
- Postmenopause is the last part of menopause, continuing until the end of a woman’s life.
Symptoms of menopause can be different and vary in intensity. Some women do not have such complaints or they are minimal, while at the same time it is very difficult for others.
One of the first manifestations of menopausal complaints is hot flashes. During this period, there may be sweating, irritability, headaches, palpitations. Later, there may be complaints of vaginal dryness and itching, urinary incontinence, dry skin, soreness during intercourse.Vague bone pains may also be added, which lead to osteopenia and osteoporosis.
In such a difficult period for a woman, a comprehensive general examination, elimination and correction of unwanted clinical symptoms of menopause is necessary.
Depending on the manifestations of menopause, we conduct examinations necessary for each client, which are prescribed by a doctor. Examinations can be of all kinds – we suggest:
When the necessary examinations have been carried out, an experienced specialist will select the appropriate means to make the menopause a free, eventful, active and creative period of life.
What you need to know and do with menopause
Nature is arranged so that a woman goes through several stages during her life. First, the girl becomes a woman – she starts menstruating and has the opportunity to become pregnant and give birth to children. By the age of 50, when carrying a pregnancy, giving birth to healthy children and raising them is already problematic, the next stage begins – the stage of attenuation of the reproductive function, which manifests itself as the cessation of menstruation – menopause.
Climax does not occur instantly. And not even in half a year – a year. This process develops systematically and in stages, it can last 2-5 years.
The average age of its onset in women is 52 years. But this is preceded by various, but quite definite complaints that appear precisely at menopause. And with this complex of complaints, women of 45-50 years old most often turn to a therapist (according to various statistics, up to 80% of women after 50 years of age are observed and receive treatment from a therapist, while a gynecologist provides, at best, advice).Meanwhile, more often than not, these are the first signs of menopause and the approaching menopause. These complaints include:
- excessive sweating
- hot flashes (sometimes, up to 20-30 times a day)
- increase in blood pressure,
- vision problems,
- increased headaches,
- frequent urination,
- irritability, depression,
- decreased sex drive,
- dry skin,
- vaginal dryness,
- hair problems (loss),
- a sharp significant increase in weight (in the absence of changes in lifestyle and nutrition).
All these are hormone-dependent processes: “The late reproductive period and the period of menopause is associated with a deficiency of the main female sex hormones – estrogens. Estrogen deficiency is associated not only with a complex of vegetative-vascular disorders, but also with psycho-emotional and metabolic-endocrine manifestations. Further, such estrogen-deficient states as dryness in the vagina, frequent urination, etc., make themselves felt. Osteoporosis is a separate serious problem ”(Ekaterina Alekseevna Reisner, Ph.MD, obstetrician-gynecologist)
It is also arranged by nature that a healthy woman should go through a period of menopause without any special inconveniences, noticing only that menstruation has stopped. “However, due to poor ecology, highly artificial nutrition, incessant stress and a sedentary lifestyle, the internal adaptive reserves of the female body are depleted by menopause and cannot ensure a smooth transition to a new stage of life – menopause” (Alexander Sergeevich Gavrilenko, Ph.D., obstetrician-gynecologist, homeopath).
What to do?
Yes, when such complaints appear, you can first visit a therapist or specialized specialists (neurologist, ophthalmologist, urologist, cardiologist, etc.). If no pathological conditions have been identified, then the next mandatory step is a visit to the gynecologist. But you can immediately contact a gynecologist. In the Territory of Health, we always conduct a general examination of women of this age in order to assess the state of women’s health:
- doing mammography,
- we are doing ultrasound of the small pelvis and abdominal cavity.
- we take scraping for oncocytology,
- we look at the indicators of LH and FSH in the blood,
- we look at the indicators of the coagulation system,
- we are watching the level of sugar, cholesterol,
- assess the condition of the veins in the legs (externally and with the help of USG (ultrasound),
- we are performing densitometry (assessment of bone density).
The sooner you seek help, the softer the correction of your condition can be, the more effective the help (including hormonal ones!) Will be.At the first stage – when you are just entering the late reproductive period, and when changes in the body, at times, are noticeable only by blood tests for hormones (LH FSH) – may be enough targeted herbal medicine, individually selected homeopathy, acupuncture, yoga, qigong. In some cases, temporary relief can be provided by sedatives, electrosleep, etc. But that doesn’t solve the whole problem.
“Of course, it would be correct to approach menopause in the most healthy state that you inherited.To a large extent, individual homeopathic treatment can help preserve and prevent splashing your health. Correctly selected homeopathy will be able to delay the premature onset of menopause and support the fading production of its own hormones, approach the climacteric period softer, without many unpleasant symptoms. “(Alexander Sergeevich Gavrilenko, Ph.D., obstetrician-gynecologist, homeopath)
Hormone replacement therapy.
- This is a quick and effective way to cope with the manifestations of climacteric syndrome and reduce the risk of climacteric complications.“Most women need hormonal adjustments. We can give a “pill” and return it 5-10 years ago! Moreover, the earlier you start taking the selected hormonal drugs, the more lasting the effect they will bring. There is a concept of a “therapeutic window”: if a woman does not take hormones for 5 years after the onset of menopause, then she acts worse. In every cell, in every tissue there are receptors for sex hormones, and if they do not receive them from year to year, the receptors will atrophy. “(Galina Vladimirovna Ovsyannikova, obstetrician-gynecologist). One caveat – hormone replacement therapy is not suitable for everyone, it has many contraindications. According to scientific studies, the positive effect is clearly higher than the possible risks and harm in only 15% of women. That is why women who are on hormone replacement therapy are examined annually in order to understand whether it is possible to continue taking medications further.
- Contrary to popular belief, women on hormone replacement therapy are not at higher risk of cancer than others.It’s just that these women visit a gynecologist regularly, and cancer is diagnosed in them more often at earlier stages. According to oncology, all women of late reproductive age are at risk, regardless of whether they are taking hormones or not.
- “People are often afraid of hormone therapy. At receptions I am often asked the question – “if I drink hormones, will I get fat, will my mustache grow? … And then I answer: “Now, if you do not drink hormones, you risk getting fat, and your mustache may grow.”There is a difference – will the climax start at 50 or will it be postponed until 57? This is a choice of a woman’s quality of life. Her health ”(Galina Vladimirovna Ovsyannikova, obstetrician-gynecologist).
Possible complications of late reproductive age (problems solved by hormone-sensing therapy).
- Endometrial hyperplasia (often occurs when a violation, lengthening of the cycle, when several periods fall out, which then provokes prolonged and heavy bleeding). With hyperplasia, most often – according to the results of an ultrasound scan – they are sent for curettage.And then hormonal blockage of the ovaries is prescribed to avoid the re-growth of the endometrium. We prefer to send for scraping only in extreme cases (with prolonged bleeding, with a high degree of growth). If the growth of the endometrium, detected by ultrasound, is small, then we recommend monitoring until the natural onset of menopause in order to carry out curettage. We will definitely do a “pipe-test”, which allows us to monitor the benign quality of the processes in the uterus with great reliability, take an analysis for tumor markers and release it for follow-up (after three months, then every 6 months).
- Risk of diabetes mellitus. An increase in insulin and blood sugar levels in the pre-menstrual period may indicate a predisposition to diabetes.
- Osteoporosis (fragility of bones). “Densitometry” (examination for bone density) is very important. It is corrected hormonally in combination with calcium supplements.
This is a terrible word – menopause – Science – Kommersant
Menopause in the eyes of women is associated with changes in appearance, loss of physical fitness, the manifestation of chronic diseases, weight gain and psychological discomfort.During this period, women begin to consider themselves less attractive, complain about the loss of cognitive abilities. There is a gap between desires and possibilities, a sad understanding of the finiteness of one’s existence comes.
Men are divided into worthy and unworthy. Women – young and old.
(From correspondence with readers)
Most husbands get so used to their wives that they perceive their wives as they are. Although some note that their friends have a decrease in interest in sex, weight gain, grumpiness and moodiness.A decrease in estrogen levels when the ovaries stop working leads to problems with memory and concentration, mood swings, and a decrease in bone strength due to impaired calcium metabolism. The metabolism slows down, which leads to weight gain. Libido decreases, mucous membranes dry out and become thinner, and sex can become painful. Before menopause, the cardiovascular system of women is protected by estrogen. After menopause, the protective effect disappears and the risk of developing cardiovascular diseases increases.
Guys, killer whales and nucleotides
The reproductive uniqueness of women lies in the fact that ovulation in them, unlike other mammals, is hidden, not accompanied by noticeable external manifestations. But, for example, the owners of cats can tell in detail how the behavior of their pets changes at the time of ovulation. And for cats, pussies are an object of desire only during ovulation. But menstruation, which in women occurs two weeks after ovulation (of course, if fertilization has not occurred), most mammals do not.Our chimpanzee cousins take an intermediate position. During ovulation, the female genitals swell and change color, but they also have menstrual bleeding. It is also interesting that menopause in mammals is a very rare phenomenon. There is age-related extinction of all functions, including reproductive, but early and abrupt menopause, as in human females, is not found in almost anyone.
Ancient and even medieval people lived brightly, but, as a rule, not for long.40 thousand years ago, in the days of hunters and gatherers, if a person did not die in childhood, then he most likely could live for 40 years. The domestication of animals and the development of agriculture, which took place about 10 thousand years BC, led to the emergence of new infections (swine flu, tuberculosis from cows, rhinovirus from horses) and an increase in population density. The positive effect of increasing the amount of food available was offset by a loss in quality due to a decrease in food variety and an increased risk of death from pathogens.The average life expectancy then became less than 30 years. Gradually, people got used to the new conditions, and life expectancy began to increase. With the growth of prosperity, with the development of health care, the onset of maturity and old age was gradually postponed to later years. Against this background, the arrival of menopause 30-40 years before the expected death looks like a mysterious spot.
A third of the life of a modern woman passes after the onset of menopause, and the females of our closest relatives, chimpanzees and orangutans (> 97% similar in genome), die rather quickly after the sexual function decays.
There are three main, consistent hypotheses about why women have menopause.
The first of the hypotheses is based on the simple but sad observation that “all men are good …”. In primates, males prefer mature females. In humans, there is a tendency for older males to mate with young females. This leads to the fact that females drop out of reproduction with age, and “late” (those that do not appear in young) defects of the reproductive apparatus in women accumulate in the population.Therefore, the effect of the loss of the possibility of reproduction could appear due to the uselessness of this function for older women. This hypothesis is indirectly supported by the fact that a person’s face became pretty modern about 40 thousand years ago, when the selection of beauty partners began in human society.
The second hypothesis insists on the need for grandmothers for society. Taking care of their grandchildren and no longer being distracted by their children, grandmothers helped their family survive, supporting young women who gave birth every year and were tortured by childbirth and feeding.Observations of killer whales speak in favor of this hypothesis. The female of these whales has an almost human menopause process at 30–40 years of age. Note that the life expectancy of female killer whales is 90 years, and that of males – only 50. After menopause, killer whale grandmothers take care of the whole flock, share their experience, teach young people the skills of hunting for fish. Why the whale grandfathers do not do this, but prefer to die, we do not know.
The third hypothesis is associated with a too sharp increase in life expectancy.According to this theory, primates also do not reproduce forever, they just do not live in the wild long enough to survive menopause. Observations of chimpanzees and orangutans in captivity have shown that about 30% of females go through menopause, and this does not lead to immediate death of the female. It can be assumed that the age at the onset of menopause should increase, albeit lagging behind life expectancy. Anthropologists believe that in ancient times menopause occurred at 40, in the Middle Ages at 45, and now at 51.Since each next generation gives birth later and later, women with late menopause get a reproductive advantage – it gives a career lady the opportunity to have children. Accordingly, this feature will be consolidated.
Why are these hormones
Which of the problems with the female body does menopausal hormone therapy solve? MHT will help solve the problem of osteoporosis, reduce the risk of diabetes (associated with being overweight), Alzheimer’s disease and bowel cancer.Also, libido and quality of sexual life, achieved by sufficient hydration of the intimate zone, will be preserved. Hormone therapy with estrogen improves skin and hair health, helps women to perceive their age better and improves mood. With the right therapy, large breasts (unfortunately or fortunately) will not grow. Since we are here talking about breasts, recall that menopausal women taking MHT must undergo an annual breast examination.
To illustrate, consider a fictitious situation in which all women on Earth decided to postpone childbearing until the age of forty.Many will not be able to have offspring at all, someone will be able to give birth to one, rare lucky women will acquire numerous offspring. What will this mean in terms of genetics? The next generation will have fewer carriers of genes associated with early menopause. If the reproductive strategy remains unchanged, then after a few generations, the average age at menopause will rise markedly.
A couple of years ago, we confirmed the observations of anthropologists by comparing the DNA of Bronze Age Europeans and modern Europeans (Chekalin et al 2018).Bronze Europeans, in comparison with modern Europeans, had many more nonsynonymous substitutions in the genes responsible for the maturation of eggs. Nonsynonymous substitutions can either lead to the substitution of one amino acid for another, or convert the codon encoding the amino acid into a stop codon – the premature end of the protein sequence. It turns out a protein of a different composition or a shortened one. Such replacements could lead to an earlier stoppage of the reproductive apparatus in women who lived 6 thousand years old.years ago, compared with modern women.
In compensation, modern humans have more substitutions in the genes responsible for smell recognition. We no longer need a sharp scent, since we do not find partners by smell, we do not run away from predators, but we choose food by packaging.
It should be noted that doctors are anxiously observing the opposite trend – early ovarian depletion, leading to premature menopause.
Therapy as said
The onset of menopause is no longer a sentence for a woman in the 21st century.There are a variety of strategies to mitigate age-related changes. Since the process of age-related hormonal deficiency is individual, the safe management of menopause should be supervised by a competent doctor. Menopausal hormone therapy (MHT), based on the compensation of hormone deficiency against the background of the extinction of ovarian function, is one of the approaches in the arsenal of an endocrinologist. For therapy to benefit a woman, the doctor must assess the benefits and risks based on the history, genetics, metabolic characteristics and general health of each patient.
How safe is it to take hormones? Many people fear MHT due to reports of an increase in the incidence of cancer. A 2002 US Women’s Health Institute study found that postmenopausal women taking combination (estrogen and progestin) hormone therapy to relieve symptoms of menopause had an increased risk of breast cancer, heart disease, stroke, blood clots, and urinary incontinence. Although women using combination hormone therapy had a lower risk of fractures and colorectal cancer, these benefits did not outweigh the potential risks.And many refused hormone therapy. It took 12 years of painstaking research to rehabilitate her: in 2014, a review article was published by a group of women doctors at the Mayo Clinic in Rochester, discussing the benefits of using MHT during the first ten years after menopause. It has become clear that a woman’s age and time since the onset of menopause are important variables in influencing the individual benefit to risk ratio of therapy. If less than ten years have passed since menopause, the benefits of MHT usually outweigh the risks.MHT, started early in menopause, will slow the progression of atherosclerotic disease, thereby reducing the risk of cardiovascular disease and mortality. During this window of opportunity, MGT may also provide protection against cognitive decline. In women who went through menopause more than a decade ago, the risk / benefit ratio of MHT is less favorable, especially with regard to the risk of cardiovascular disease and cognitive impairment.
Scientists took the next step in 2017: the North American Menopause Association reported that the risks of menopausal hormone therapy depend on the type of medication (there are tablets, gels, creams, patches, and so on), the duration of use and the timing of the start of treatment.The professionalism of the doctor lies in the individual selection of the type of menopausal hormone therapy, dose, route of administration and duration of use. Laboratory and instrumental studies are needed to maximize the benefits and minimize the risks for each patient individually – with periodic reassessment of the benefits and risks of continuing or stopping menopausal hormone therapy. For women under the age of 60 or within 10 years after the onset of menopause and who have no contraindications (liver disease, varicose veins and malignant diseases), the ratio of benefit and risk is the most favorable.But for women who start MHT 10 years after menopause or over the age of 60, the benefits of hormones are not clear.
There is emerging evidence of the benefits of an integrated approach to the treatment of menopause, where vitamins, dietary supplements and herbal medicines are used in addition to MHT. The use of all drugs and supplements is best coordinated with a specialist.
And of course, we must not forget about proper nutrition and physical activity. If a lady has been involved in sports all her life, then after menopause she will be able to maintain an active lifestyle.For the rest, remembering the figure, only when the extra pounds have already firmly settled on the stomach and hips, it is better to start slowly and carefully, after consulting a doctor and under the supervision of a fitness instructor.
So a slim figure, good memory and firm skin are achieved through hard work and discipline and may require financial costs for doctors and trainers. If you think about beauty and health only in the second half of your life, then it can be more difficult to achieve the desired result.So, to paraphrase the old saying, let’s say: “Take care of the carcass from a young age.”
Tatiana Tatarinova, Head of the Computational Biology Laboratory, University of La Verne and Member of the Coordinating Council of the Russian-American Scientific Association; Anastasia Chemeritskaya, a gynecologist-endocrinologist, is receiving a second degree in healthcare organization at the University of La Verne