What is the average age for menopause in the US? The average age for menopause in the US is between 45 and 55 years old. Let’s explore the details of the menopausal transition and the common signs and symptoms women may experience.

Understanding the Menopausal Transition

Menopause is a normal part of aging for women, not a disease or disorder. It is defined as the point in time 12 months after a woman’s last menstrual period. The years leading up to that point, when women may have changes in their monthly cycles, hot flashes, or other symptoms, are called the menopausal transition or perimenopause.

The menopausal transition most often begins between ages 45 and 55, and it usually lasts about seven years, though it can be as long as 14 years. The duration can depend on lifestyle factors such as smoking, age it begins, and race and ethnicity. During perimenopause, the body’s production of estrogen and progesterone, two hormones made by the ovaries, varies greatly.

The menopausal transition affects each woman uniquely and in various ways. The body begins to use energy differently, fat cells change, and women may gain weight more easily. You may experience changes in your bone or heart health, your body shape and composition, or your physical function.

Is it Menopause?

If you are having symptoms that are common during menopause, your doctor may ask questions about your age, symptoms, and family history to determine if it really is the menopausal transition causing your problems. In some cases, your doctor may suggest a blood test to check your follicle-stimulating hormone (FSH) and estradiol (E2) levels to rule out any other causes for the changes you’re experiencing.

While the menopausal transition may commonly be referred to as “menopause,” true menopause doesn’t happen until one year after a woman’s final menstrual period. For that reason, a woman who does not want to get pregnant should continue to use birth control for at least a full 12 months after her last period.

Menopause and Postmenopause

Menopause can also be triggered by a hysterectomy or surgical removal of the ovaries, which produce hormones. If you have surgery to remove your uterus or ovaries and are not taking hormones, you will experience symptoms of menopause immediately.

After menopause, women enter postmenopause. Postmenopausal women are more vulnerable to heart disease and osteoporosis. During this time, it is important to continue to eat a healthy diet, be active, and make sure you get enough calcium for optimal bone health.

Common Signs and Symptoms of Menopause

As levels of estrogen decrease, you could have various symptoms. Many women experience mild symptoms that can be treated by lifestyle changes such as avoiding caffeine or carrying a portable fan. Some women don’t require any treatment at all, but for others, symptoms can be more severe.

Changes in Your Period

This might be what you notice first. Your periods may no longer be regular. They may be shorter or last longer. You might bleed more or less than usual. These are all normal changes, but to make sure there isn’t a problem, see your doctor if:

• Your periods happen very close together.
• You have heavy bleeding.
• You have spotting.
• Your periods last more than a week.
• Your periods resume after no bleeding for more than a year.

Hot Flashes

Many women have hot flashes, which can last for many years after menopause. They may be related to changing estrogen levels. A hot flash is a sudden feeling of heat in the upper part or all of your body. Your face and neck may become flushed. Red blotches may appear on your chest, back, and arms. Heavy sweating and cold shivering can follow. Hot flashes can be very mild or strong enough to wake you up (called night sweats). Most hot flashes last between 30 seconds and 10 minutes. They can happen several times an hour, a few times a day, or just once or twice a week.

Managing Menopause Symptoms

While the menopausal transition can bring a variety of symptoms, there are ways to manage them. Lifestyle changes, such as avoiding caffeine or using a portable fan, can help with mild symptoms. For more severe symptoms, talking to your doctor about treatment options, including medications, may be beneficial.

The menopausal transition is a normal part of a woman’s life, and understanding the process can help women better navigate this time. By being aware of the common signs and symptoms, and working with their healthcare providers, women can find ways to manage any challenges they may face during this transition.

What Is Menopause? | National Institute on Aging

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Larissa is experiencing the menopausal transition, a normal part of aging for women. Menopause is not a disease or disorder. This time in a woman’s life is often full of other transitions in addition to physical ones: Women may be caring for aging parents or relatives, supporting their children as they move into adulthood, or taking on new responsibilities at work.

Some women don’t have any trouble with menopausal symptoms and may even feel relieved when they no longer need to worry about painful periods or getting pregnant. For other women, the menopausal transition can bring hot flashes, trouble sleeping, pain during sex, moodiness and irritability, depression, or a combination of these symptoms. Some may decide to talk with their doctor about lifestyle changes or medications to treat their symptoms.

Understanding the menopausal transition

Menopause is a point in time 12 months after a woman’s last period. The years leading up to that point, when women may have changes in their monthly cycles, hot flashes, or other symptoms, are called the menopausal transition or perimenopause.

The menopausal transition most often begins between ages 45 and 55. It usually lasts about seven years but can be as long as 14 years. The duration can depend on lifestyle factors such as smoking, age it begins, and race and ethnicity. During perimenopause, the body’s production of estrogen and progesterone, two hormones made by the ovaries, varies greatly.

The menopausal transition affects each woman uniquely and in various ways. The body begins to use energy differently, fat cells change, and women may gain weight more easily. You may experience changes in your bone or heart health, your body shape and composition, or your physical function.

Is it menopause?

If you are having symptoms that are common during menopause, your doctor may ask questions about your age, symptoms, and family history to determine if it really is the menopausal transition causing your problems. In some cases, your doctor may suggest a blood test to check your follicle-stimulating hormone (FSH) and estradiol (E2) levels to rule out any other causes for the changes you’re experiencing.

Read and share this infographic about staying healthy during and after menopause.

While the menopausal transition may commonly be referred to as “menopause,” true menopause doesn’t happen until one year after a woman’s final menstrual period. For that reason, a woman who does not want to get pregnant should continue to use birth control for at least a full 12 months after her last period.

Menopause can also be triggered by a hysterectomy or surgical removal of the ovaries, which produce hormones. If you have surgery to remove your uterus or ovaries and are not taking hormones, you will experience symptoms of menopause immediately.

After menopause, women enter postmenopause. Postmenopausal women are more vulnerable to heart disease and osteoporosis. During this time, it is important to continue to eat a healthy diet, be active, and make sure you get enough calcium for optimal bone health.

What are the signs and symptoms of menopause?

Estrogen is used by many parts of a woman’s body. As levels of estrogen decrease, you could have various symptoms. Many women experience mild symptoms that can be treated by lifestyle changes such as avoiding caffeine or carrying a portable fan. Some women don’t require any treatment at all, but for others, symptoms can be more severe. The severity of symptoms varies greatly around the world and by race and ethnicity.

Here are the most common changes you might notice at midlife. Some may be part of aging rather than directly related to menopause.

Change in your period. This might be what you notice first. Your periods may no longer be regular. They may be shorter or last longer. You might bleed more or less than usual. These are all normal changes, but to make sure there isn’t a problem, see your doctor if:

• Your periods happen very close together.
• You have heavy bleeding.
• You have spotting.
• Your periods last more than a week.
• Your periods resume after no bleeding for more than a year.

Hot flashes. Many women have hot flashes, which can last for many years after menopause. They may be related to changing estrogen levels. A hot flash is a sudden feeling of heat in the upper part or all of your body. Your face and neck may become flushed. Red blotches may appear on your chest, back, and arms. Heavy sweating and cold shivering can follow. Hot flashes can be very mild or strong enough to wake you up (called night sweats). Most hot flashes last between 30 seconds and 10 minutes. They can happen several times an hour, a few times a day, or just once or twice a week. Find information on managing hot flashes in Hot Flashes: What Can I Do?

Bladder control. A loss of bladder control is called incontinence. You may have a sudden urge to urinate, or urine may leak during exercise, sneezing, or laughing. The first step in treating incontinence is to see a doctor. Bladder infections also can occur in midlife.

Sleep. Around midlife, some women start having trouble getting a good night’s sleep. Maybe you can’t fall asleep easily, or you wake too early. Night sweats might wake you up. And if you wake up during the night, you might have trouble falling back to sleep. Learn how to improve your sleep during the menopausal transition and beyond in Sleep Problems and Menopause: What Can I Do?

Vaginal health and sexuality. After menopause, the vagina may become drier, which can make sexual intercourse uncomfortable. Read about options for addressing vaginal pain during sex in Sex and Menopause: Treatment for Symptoms. You may also find that your feelings about sex are changing. You could be less interested, or you could feel freer and sexier because after one full year without a period, you can no longer become pregnant. However, you could still be at risk for sexually transmitted diseases (STDs), such as gonorrhea or HIV/AIDS. Your risk for an STD increases if you have sex with more than one person or with someone who has sex with others. If so, make sure your partner uses a condom each time you have sex.

Mood changes. You might feel moodier or more irritable around the time of menopause. Scientists don’t know why this happens. It’s possible that stress, family changes such as growing children or aging parents, a history of depression, or feeling tired could be causing these mood changes. Talk with your primary care provider or a mental health professional about what you’re experiencing. There are treatments available to help.

Your body seems different. Your waist could get larger. You could lose muscle and gain fat. Your skin could become thinner. You might have memory problems, and your joints and muscles could feel stiff and achy. Researchers are exploring such changes and how they relate to hormones and growing older.

In addition, for some women, symptoms may include aches and pains, headaches, and heart palpitations. Follow up with a doctor. Because menopausal symptoms may be caused by changing hormone levels, it is unpredictable how often women will experience symptoms and how severe they will be.

• My Menoplan Tool

  My Menoplan is an evidence-based online resource developed by NIA-funded researchers to help people learn about the symptoms and treatments of menopause and create a personalized plan. Learn more on the My Menoplan website.

Treating menopause symptoms: What’s right for me?

Deciding whether and how to treat the symptoms of menopausal transition can be complicated and personal. Discuss your symptoms, family and medical history, and preferences with your doctor. No matter what you decide, see your doctor every year to talk about your treatment plan and discuss any changes you want to make.

Learn about options to help you manage hot flashes, sleep problems, and sex problems during the menopausal transition.

For more information on menopause

Office on Women’s Health                                             
Department of Health and Human Services
800-994-9662
www. womenshealth.gov

American College of Obstetricians and Gynecologists
800-673-8444 
[email protected]
www.acog.org

North American Menopause Society
440-442-7550
[email protected]
www.menopause.org

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

Content reviewed:
September 30, 2021

Menopause basics | Office on Women’s Health

Menopause is when your period stops permanently. Menopause is a normal part of a woman’s life. It is sometimes called “the change of life.” Menopause does not happen all at once. As your body transitions to menopause over several years, you may have menopause symptoms and irregular periods. The average age for menopause in the United States is 52.

What is menopause?

Menopause is when your periods stop permanently and you can no longer get pregnant. You have reached menopause only after it has been a full year since your last period. This means you have not had any bleeding, including spotting, for 12 months in a row.

After menopause your ovaries make very low levels of the hormones estrogen and progesterone. These low hormone levels can raise your risk for certain health problems. 

What is perimenopause, or the transition to menopause?

Perimenopause (PER-ee-MEN-oh-pawz), or the menopausal transition, is the time leading up to your last period. Perimenopause means “around menopause.”

Perimenopause is a long transition to menopause, or the time when your periods stop permanently and you can no longer get pregnant. As your body transitions to menopause, your hormone levels may change randomly, causing menopause symptoms unexpectedly.  During this transition, your ovaries make different amounts of the hormones estrogen (ES-truh-jin) and progesterone (proh-JES-tuh-RONE) than usual.

Irregular periods happen during this time because you may not ovulate every month. Your periods may be longer or shorter than usual. You might skip a few months or have unusually long or short menstrual cycles. Your period may be heavier or lighter than before. Many women also have hot flashes and other menopause symptoms during this transition.

When does the transition to menopause usually start?

Perimenopause, the transition to menopause, usually starts in a woman’s mid- to late 40s.¹ On average, women are in perimenopause for four years before their periods stop.

How will I know if I am starting the transition to menopause?

Sometimes it can be hard for you and your doctor to tell whether you are in perimenopause, the transition to menopause:

• Symptoms: Tell your doctor or nurse about any menopause symptoms, such as hot flashes or trouble sleeping.
• Irregular periods: Track your periods. Irregular periods may be your first sign of menopause.
• Hormone levels: Your doctor may test the amount of hormones in your blood if your periods stopped at an early age (before 40). Doctors don’t usually recommend this test unless there is a medical reason to do so. This is because, for most women, hormone levels go up and down in an unpredictable way during the transition to menopause. So it is difficult to tell for sure whether you have gone through menopause or are getting close to it based on this blood test.

How will menopause affect me?

Symptoms of menopause may begin suddenly and be very noticeable, or they may be very mild at first. Symptoms may happen most of the time once they begin, or they may happen only once in a while. Some women notice changes in many areas. Some menopausal symptoms, such as moodiness, are similar to symptoms of premenstrual syndrome (PMS). Others may be new to you. For example:

• Your menstrual periods may not come as regularly as before. They also might last longer or be shorter. You might skip some months. Periods might stop for a few months and then start up again.
• Your periods might be heavier or lighter than before.
• You might have hot flashes and problems sleeping.
• You might experience mood swings or be irritable.
• You might experience vaginal dryness. Sex may be uncomfortable or painful.
• You may have less interest in sex. It may take longer for you to get aroused.

Other possible changes are not as noticeable. For example, you might begin to lose bone density because you have less estrogen. This can lead to osteoporosis, a condition that causes bones to become weak and break easily. Changing estrogen levels can also raise cholesterol levels and increase your risk for heart disease and stroke.

Talk to your doctor about possible treatment for your menopause symptoms if they bother you.

How long does the transition to menopause last?

Perimenopause, the transition to menopause, can last between two and eight years before your periods stop permanently. For most women, this transition to menopause lasts about four years. You will know you have reached menopause only after it has been a full year since your last period. This means you have not had any bleeding, including spotting, for 12 months in a row.

Should I continue using birth control during the transition to menopause?

Yes. You can still get pregnant during perimenopause, the transition to menopause, even if you miss your period for a month or a few months. During perimenopause you may still ovulate, or release an egg, on some months.

But it is impossible to know for sure when you will ovulate. If you don’t want to get pregnant, you should continue to use birth control until one full year after your last period. Talk to your doctor about your birth control needs. Learn more about different birth control methods. 

You can’t get pregnant after menopause, but anyone who has sex can get sexually transmitted infections (STIs, or STDs) (PDF, 187 KB). If you are not in a monogamous relationship in which you and your partner have sex with each other and no one else, protect yourself by using a male condom or dental dam correctly every time you have vaginal, oral, or anal sex. After menopause you may be more likely to get an STI from sex without a condom. Vaginal dryness or irritation is more common after menopause and can cause small cuts or tears during sex, exposing you to STIs.

When does menopause usually happen?

Menopause happens when you have gone 12 months in a row without a period. The average age of menopause in the United States is 52. The range for women is usually between 45 and 58.² One way to tell when you might go through menopause is the age your mother went through it.³

Menopause may happen earlier if you:

• Never had children. Pregnancy, especially more than one pregnancy, may delay menopause.⁴
• Smoke. Studies show smoking can cause you to start menopause up to two years earlier than women who don’t smoke.⁵

Certain health problems can also cause you to start menopause earlier.

Menopause usually happens on its own. However, you may enter menopause earlier than you normally would if you have had chemotherapy or surgery to remove both ovaries. Learn more about early menopause on our Early or premature menopause page. 

What happens after menopause?

After menopause you will no longer be able to get pregnant and you will no longer get a period. If you have any type of vaginal bleeding after menopause, you should see a doctor as soon as possible. Vaginal bleeding after menopause is not normal and can mean that you have a serious health problem.  

You may experience any of the following after menopause:

• Low hormone levels. With menopause, your ovaries make very little of the hormones estrogen and progesterone. Because of changing hormone levels, you may develop certain health risks, including osteoporosis, heart disease, and stroke.
• Menopause symptoms instead of period problems. After menopause, most women get relief from period problems or menopause symptoms. However, you may still experience symptoms such as hot flashes because of changing estrogen levels. One recent study found that hot flashes can continue for up to 14 years after menopause.^6,7
• Vaginal dryness. Vaginal dryness may be more common post-menopause. Learn more about treatments for vaginal dryness.

Did we answer your question about menopause?

For more information about menopause, call the OWH Helpline at 1-800-994-9662 or check out the following resources from other organizations:

• Aging changes in the female reproductive system — Information from the National Library of Medicine
• Health & Aging: Menopause — Information from the National Institute on Aging (NIA)
• Menopause — Information from the Eunice Kennedy Shriver National Institute of Child Health and Human Development
• Menopause Flashes — Web magazine from the North American Menopause Society
• Perimenopause: Changes, Treatment, Staying Healthy — Information from the Association of Reproductive Health Professionals
• Perimenopause: Rocky road to menopause — Article from the Harvard Medical School

Sources

1. Grady, D. (2006). Management of Menopausal Symptoms. New England Journal of Medicine; 355: 2338–2347.
2. Shifren, J.L., Gass, M.L.S., for the NAMS Recommendations for Clinical Care of Midlife Women Working Group. (2014). The North American Menopause Society Recommendations for Clinical Care of Midlife Women. Menopause; 21(10): 1038–1062.
3. Mishra, G.D., Cooper, R., Tom, S.E., Kuh, D. (2009). Early life circumstances and their impact on menarche and menopause. Womens Health; 5: 175–190.
4. Avis, N.E., McKinlay, S.M. (1991). A longitudinal analysis of women’s attitudes toward the menopause: Results from the Massachusetts Women’s Health Study. Maturitas; 13: 65–79.
5. women.smokefree.gov. (n.d.). 11 Harmful Effects of Smoking on Women’s Health 
6. Avis, N.E., Crawford, S.L., Greendale, G., Bromberger, J.T., Everson-Rose, S.A., Gold, E.B., et al. (2015). Duration of Menopausal Vasomotor Symptoms Over the Menopause Transition. JAMA Internal Medicine; 175(4): 531–539.
7. Tepper, P.G., Brooks, M.M., Randolph, J.F., Crawford, S.L., Khoudary, E., Gold, E.B., et al. (2016). Characterizing the trajectories of vasomotor symptoms across the menopausal transition. Menopause; 23(10): 1067–1074.

All material contained on these pages are free of copyright restrictions and maybe copied, reproduced, or duplicated without permission of the Office on Women’s Health in the U.S. Department of Health and Human Services. Citation of the source is appreciated.

Page last updated:
January 6, 2023

How to delay the onset of menopause – an educational portal about women’s health Women First

Contents

• At what age does menopause occur?
• Age and stages of menopause
• Factors affecting the age of menopause
• Medications for menopause

Menopause increases the risks for women’s health and provokes accelerated aging. The question of how to delay the onset of menopause worries any woman. Is it possible to slow down the biological clock, what factors can bring or delay the onset of menopause, are there methods to reduce menopause symptoms and health consequences? The experts of the portal Women First tell.

At what age does menopause occur

The ancient Greek scientist Aristotle noted that menopause in women occurs at the age of 40. Back in the early 20th century, only a third of women lived to the age of menopause, and in the 90s in Russia menopause occurred on average at 45 years. And today, in Africa and Latin America, most women complete the menopausal transition by age 45, and in India by age 47. However, women living in cities in North America, Europe, and Russia today experience menopause later in life. For European countries, the average age of menopause is 52 years, for the USA – 51.2 years, for Russia – 51.4 years.

However, although women in more socially and economically developed countries experience a later menopause, this period still inevitably comes in the life of every woman.

Age and stages of menopause

Completion of the reproductive period takes place in several stages:

• Late reproductive age. After 40 years, reproductive function is preserved, but gradually decreases due to a decrease in progesterone and a reduction in the follicular phase. This period can last from two to five years.
• Premenopause (menopausal transition). On average, it falls on the age of 45 to 47 years. The cyclical nature of menstruation and the nature of menstruation change, periods of amenorrhea occur, symptoms of menopause increase. The menopausal transition lasts an average of 2 to 3 years, but can be delayed up to 8 years or even more.
• Menopause. A clinical sign of the onset of menopause is the absence of menstruation in a woman for 12 months (under the age of 50 – 24 months). The production of female sex hormones stabilizes at a low level, which causes significant changes in health and well-being.
• Postmenopausal. 1 year after the cessation of menstruation, the menopausal transition is fully completed. Symptoms associated with menopause occur less frequently and lose intensity. However, the long-term effects of estrogen deficiency persist and may increase over time without concomitant therapy.

A sharp decrease in estrogen production in women over 50 provokes the development of conditions such as:

• Cardiological problems. Postmenopausal women are 2 to 3 times more susceptible to cardiovascular disease.
• Decreased bone mass. Bone loss begins as early as the menopausal transition and accelerates during menopause.
• Atrophic changes in the genitourinary system. On the part of the genital organs, there is a reduction in the size of the cervix, atrophy of the endometrium, dryness of the mucous membrane. Changes in the urinary system can lead to incontinence, atrophic cystitis.
• Deterioration of skin and hair. The lack of estrogen disrupts the production of collagen in the skin, which makes it lose its elasticity faster and becomes more prone to wrinkling. The hairline on the head thins, and the vellus hair on the face, on the contrary, can become thicker and thicker.

Although the severity of symptoms of menopause may vary from woman to woman, it is impossible to avoid them completely. But is there a chance to delay aging and on what factors does the time of menopause depend?

Factors affecting age at menopause

On a population scale, the time of menopause is affected by the general standard of living. But the main factor that determines the timing of menopause in an individual woman is heredity. Most likely, menopause will come to you at about the same age as to your close relatives (mother, sister, aunt). Some individual genetic faults and diseases can lead to early or premature menopause, however, in general, women in the same family enter menopause at about the same age with a variation of 1 to 2 years.

Modern research shows that several factors and lifestyle habits can also influence the age of menopause.

• History of breastfeeding. A large study, which used data from more than 100,000 participants, showed that women who breastfed during the first 7 to 12 months of a child’s life had a significantly lower risk of early and premature menopause. Adjusting for breastfeeding time, one pregnancy reduced this risk by 8%, two pregnancies by 16%, and three pregnancies by 22%. A woman who collectively breastfed her children for at least 25 months was 27% less likely to have a premature menopause than a woman who stopped breastfeeding before her baby was one month old.
• Level of education. Several studies, as well as a meta-analysis of 26 studies in 24 countries, found a clear association between women’s educational attainment and time to menopause. More educated women enter menopause on average 1 to 2 years later than women with a low level of education. The reasons for this stratification are not yet completely clear, but are probably related to the standard of living.
• Moderate alcohol consumption. Although alcoholism provokes an earlier onset of menopause, women who drink alcohol in moderation (1-3 drinks per week) go through menopause on average later than women who completely abstain from alcohol. However, the difference is not so significant that the possible benefits of drinking alcohol outweigh the potential harms of alcohol.
• Sufficient and varied diet with high protein levels. A large amount of fruits and protein in the diet, as well as sufficient intake of calories, is associated with a later onset of menopause. The risk of early menopause is reduced in women who eat more oily fish and dairy products. Also, menopause occurs on average later in women with a higher BMI than in underweight women, since adipose tissue is able to regulate the amount of estrogen.
• Smoking. This is the most serious factor that brings the onset of menopause closer. Age at menopause in women who smoke is on average 1 to 2 years lower than in non-smokers.

Thus, by making certain lifestyle changes, a woman can, if not delay the onset of menopause, then at least reduce the risk of premature menopause. However, the situation is complicated by the fact that changes in the body that affect the age of completion of the reproductive period are laid much earlier than the first precursors of menopause. Quitting smoking at a late reproductive age, a woman, no doubt, will improve her health, but she will no longer be able to delay menopause. If you have already encountered the first symptoms of menopause, the processes of premenopause cannot be stopped or slowed down, but their intensity and frequency can be reduced.

Menopause drugs

Existing medications are not designed to delay menopause, but to help reduce symptoms and possible harm to health during hormonal changes in the body. Since the first symptoms of menopause may appear several years before the cessation of menstruation, drug therapy can improve the quality of life of a woman when she suffers from frequent and intense hot flashes, urogenital atrophy, and other unpleasant phenomena associated with premenopause.

To combat these symptoms, hormone replacement therapy is prescribed, which involves taking estrogen and progesterone preparations, or estrogen alone (for women with a hysterectomy).

Replacement therapy can reduce many of the health risks associated with a decrease in estrogen levels, in particular, it prevents bone loss, reduces the effect of menopause on the heart and blood vessels, and relieves hot flashes. The appointment of replacement therapy should be carried out only by a doctor after collecting an anamnesis and a complete examination of the patient.

In addition to hormonal drugs, other means may be prescribed to alleviate the symptoms of menopause and improve the patient’s well-being:

• Antidepressants – reduce the frequency and intensity of hot flashes.
• Calcium and vitamin D – prevent osteoporosis and problems of the cardiovascular system.
• Other vitamin complexes and nutritional supplements – can help improve the condition of hair and skin, normalize heat transfer, stabilize the psycho-emotional state.

We emphasize once again: 90% of the time for the onset of natural menopause is laid down in genetics. Other factors affect the biological clock only to a small extent. However, the right diet, moderate physical activity, giving up bad habits and following the doctor’s recommendations will help you go through the menopause without complications and serious health consequences.

• Menopausal syndrome: symptoms and mechanism of their occurrence is the key to understanding pathogenetic treatment alternatives. Dicke G.B. breast cancer. Mother and child. 2019;2(1):57-64. DOI: 10.32364/2618-8430-2019-2-1-57-64.
• Menopause. Dreval A.V. breast cancer. 2018;1(I):3-7.
• Association of Parity and Breastfeeding With Risk of Early Natural Menopause. Christine R. Langton; Brian W. Whitcomb; Alexandra C. Purdue-Smithe. AMA Network Open. 2020;3(1):e1919615.
• The influence of educational level in peri-menopause syndrome and quality of life among Chinese women. Zheren Huang, Junyu Shi Wenhua, Liu Shuangshuang, Wei Zhifen Zhang. Gynecological Endocrinology, vol 36, 2020, Issue 11.

RUS2254206 (v1.0)

Age of menopause: implications for clinical practice

Author:
I.I. Knyazkova

12/26/2016

The problem of physiological aging of women, despite the large number of studies conducted in this direction, remains relevant. The change in the demographic structure of society in the second half of the 20th century led to an increase in the proportion of women in the older age group in the population. By the end of the last century, the average life expectancy of women in economically developed countries increased to 80 years. Yes, in 2009In the same year, among the population aged 60 years and over, there were 83 men for every 100 women, and 59 men aged 80 years and over. In more developed regions, there were 74 men of the same age per 100 women aged 60 and over (70 in Europe), and only 49 per 100 women aged 80 and over (46). In less developed countries, there were 89 men per 100 women aged 60 years and over, 70 men aged 80 years and over, and 85 and 74 men, respectively, in the least developed countries. According to forecasts, the number of women aged 60 and over in 2050 will approach one billion, so the issues of maintaining, maintaining their health and quality of life are becoming increasingly important medical and socio-economic importance.

According to WHO, in most countries of the world life expectancy for women after 50 years ranges from 27 to 32 years. Thus, a woman spends more than a third of her life in a state of deficiency of female sex hormones. The number of women entering menopause is increasing every year. This figure is expected to reach 1.2 billion by 2030. The significant variability and unpredictable nature of endocrine changes during the reproductive aging of women, especially during the transition to menopause, when a number of relevant clinical symptoms indicate the approach of menopause and cause concern to a woman, attracts the attention of doctors all specialties.

Fig. Stages of the end of the reproductive period in women in vivo

Definition. The period of menopause is a natural biological process of transition from the reproductive period to old age, which includes several phases (Fig.). There are natural and artificial menopause, the latter may be associated with surgery, exposure to radiation, the use of cytostatics and other reasons. Perimenopause is a transitional stage in a woman’s life from the reproductive period to menopause. According to WHO, this is a period of age-related decline in ovarian function, mainly after 45 years, including perimenopause and one year after menopause or 1 year after the last spontaneous menstruation. With the physiological course of the premenopausal period, there is a gradual extinction of ovarian function, which is clinically characterized by the onset of menopause. Pre- and postmenopause – the transition from the reproductive period to the post-reproductive period with the loss of childbearing and the extinction of hormonal function (table).

The mechanism of the development of age-related aging and the consequences of turning off the reproductive function of a woman V.M. Dilman described it as follows: “In the mechanism and manifestations of menopause, violations of homeostasis are quite obvious, and, therefore, by definition, menopause is a disease. But menopause is a disease not only by definition, but also in essence. For example, a decrease in the level of classical estrogens in the body contributes to the development of osteoporosis, which, in turn, is often the cause of bone fractures, often ending in death in old age. Estrogen deficiency accelerates the development of atherosclerosis.

An increase in the concentration of gonadotropins probably contributes to ovarian cancer, since contraceptive steroids, which have an antigonadotropic effect, reduce the incidence of this tumor. A decrease in the content and rate of dopamine metabolism in the hypothalamus causes mental depression, sometimes reaching the severity of involutional psychosis during menopause. But if menopause is a disease, then it is in many ways a special disease. According to the theory of V.M. Dilman, menopause can also be called a hypothalamic disease, since it is changes in the hypothalamus that cause the cessation of childbearing function. Thus, although aging and menopause are diseases, they are not incurable because they are based on dysregulation, a process that is in principle controllable.

In accordance with modern ideas, menopause is a long process, which is based on the decline and cessation of ovarian function, and menopause is the most striking event in menopause. Around this event, reproductive aging processes before and after menopause are evaluated. These processes do not take place in isolation, since everything in the body is interconnected. Since the sex hormones produced by the ovaries affect many organs and tissues, as the level of sex hormones decreases, estrogen deficiency symptoms may occur.

Statistics. According to publications from 26 countries, the average age of menopause is 49. 24 years (SD±1.73). It has been established that the age of natural menopause depends on genetic factors associated with the region, ethnicity and other factors, in particular socio-economic status, lifestyle and culture. A recent meta-analysis by D. Schoenaker et al., which included 46 studies in 24 countries, found that the average age of menopause was 48.8 years (95% CI 48.3-49.2) with interstudy heterogeneity partly due to geographic region. It has been shown that the lowest average age of menopause is noted in the countries of Africa, Latin America, Asia and the Middle East, and the highest in Europe, Australia and the United States. It was found that education and work were associated with a later age of menopause. The mechanism underlying these associations remains unclear, but associations with lifestyle factors such as hard physical work, smoking, and eating habits have been noted. So, smoking was associated with a decrease in the age of menopause by 1 year. There was a trend towards a later onset of menopause with obesity.

A number of studies have noted that an increase in body mass index (BMI) was associated with a later onset of menopause. It was found that the menopausal period in women with BMI >25 developed later than in women with BMI <25. It has been shown that overweight and obese women have higher levels of estrogens in the blood in combination with lower levels of sex hormone-binding globulin, which may contribute to delaying menopause. At the same time, clinical studies evaluating the relationship between BMI and menopausal age have shown conflicting results, as both higher and lower BMI values ​​are reported to be associated with early menopause.

In addition, a number of studies have found no correlation between BMI and timing of menopause. Among the reasons for this heterogeneity of results may be the ethnicity and culture of the populations studied, as well as the statistical methods used. Cigarette smoking was also found to be associated with lower BMI and early menopause.

Of note is the fact that lower social class in childhood and throughout adulthood was associated with early menopause. Adverse childhood experiences may include domestic overcrowding, father’s occupation, lack of hot water in the house, shared bedroom, and lack of access to a car. Some of the relationships between educational attainment, occupation, and age at menopause may explain childhood experiences.

Age at menopause is an indicator of ovarian function and aging, and therefore a critical factor in women’s health. Both early and late ages of menopause have been found to be associated with adverse health outcomes for postmenopausal women, emphasizing the importance of identifying factors throughout the life cycle that could potentially influence this indicator.

Age at natural menopause is an important risk factor for morbidity and mortality. Women with early menopause are more likely to develop osteoporosis, obesity, metabolic syndrome, and cardiovascular disease. According to the Framingham Study, the risk of cardiovascular disease and its complications in women falls on the period of 40-55 years, which is the age characteristic of the onset of perimenopause. In the future, cardiovascular diseases are observed in more than half of the female population of the older age group. A number of studies have provided conflicting data on the effects of income, occupation, marital status, menarche age, smoking, and stress on reproductive ability and menopausal age. It has been proven that receptors for female sex hormones are present not only in the heart and blood vessels, but also in the brain; changes in the level of these hormones through imbalance of neurotransmitters contribute to the development of neuropsychiatric disorders.

A Korean study of 3,176 women aged 40 to 70 examined the effect of stress on the age of natural menopause. It was shown that women with a high level of stress in everyday life had a lower average age of menopause than women with a low level of stress (50. 17±3.7 and 50.58±3.5 years, respectively, p<0, 05). This correlation was maintained after adjusting for age, BMI, menstrual regularity, and income of individuals.

According to Selye’s definition, stress is a stress reaction that occurs as a non-specific response of the body to the action of extreme and unfavorable environmental factors (stressors). Stressors (physiological or psychological) activate the hypothalamic-pituitary-adrenal axis and the autonomic nervous system. Thus, secretion of corticotropin-releasing factor from the hypothalamus is noted, which stimulates the anterior lobe of the pituitary gland, where adrenocorticotropic hormone begins to be intensively synthesized. The latter stimulates the release of corticosteroids (cortisol) from the adrenal cortex.

Corticotropin-releasing factor is a neurotransmitter involved in the coordination of endocrine, autonomic, behavioral and immune responses to stress, its administration causes stress-like conditions. The purpose of this process is the adaptation of the body to environmental conditions. However, an intense and prolonged stress response can develop from an adaptive to a pathogenic basis for various diseases. Thus, excessive stress in everyday life can lead to the development of diabetes mellitus, arterial hypertension, hyperlipidemia, cardiovascular diseases, cognitive impairment, depression, digestive diseases and chronic fatigue.

It is assumed that the development and progression of these diseases is promoted by hyperactivity of the hypothalamic-pituitary-adrenal axis in response to stress and elevated levels of stress hormones (corticosteroids and catecholamines). In addition, elevated levels of stress hormones can lead to gynecological conditions such as amenorrhea or early menopause.

The list of references is in the editorial office.

Continued in the next issue.

Thematic issue “Gynecology, Obstetrics, Reproductology” No. 3 (23), June 2016

• Number:
• Thematic issue “Gynecology, Obstetrics, Reproductology” No. 3 (23), June 2016

29.06.2023

Obstetrics/gynecologyTherapy and family medicineVagility and rheumatic diseases: current aspects of management in light of international recommendations

an important interdisciplinary problem, oscillators of concomitant rheumatic pathology, zocrema rheumatoid arthritis, systemic scleroderma and scleroderma, may be included in violation of vagity and the state of health of the mother of the fetus. Current aspects of therapy in the category of vaginal drugs are used to treat various drugs, which have proven to be effective and safe in controlling inflammation and pain syndrome, and non-steroidal antiseptic drugs.
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06/29/2023

Obstetrics/gynecology Micronization of progesterone in obstetric practice: efficiency and safety

qi, ovaries, milk deposits and the brain, as well as repairing a sing infusion on non-reproductive tissues of the cardiovascular, cystic , central nervous, immune and metabolic systems (replacement of water, electrolytes, lipids, carbohydrates, proteins, zocrema components in hemostasis and fibrinolysis).