Lifestyle factors that may influence the age you’ll reach menopause

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Menopause marks the point in time when a woman’s body stops producing and releasing eggs and is, therefore, the time in most women’s lives when they stop having periods. Doctors often define the menopause as when a woman has not had any vaginal bleeding for 12 months or more.

Symptoms of menopause, which can start before the menopause and end some years after, vary quite a lot between individuals but may include a change in menstrual cycle (periods cease), hot flushes, night sweats, and mood swings. Some women may also notice headaches, weight gain, vaginal dryness, or a loss of interest in sex. Certain women experience many different menopausal symptoms, whereas others have very few.

The average age of the menopause in the UK is 51 years, with most women going through it between the ages of 49 to 52 years. The average woman now spends over a third of her life (38%) after the menopause, and as such it is an important topic to be aware of. 1

In reality, like many other normal physiological processes, there is a wide variety in what is classed as “normal”. In the UK, anything between the ages of 45 and 55 falls in this category. Interestingly, the age at which a woman goes through the menopause is often similar to the age that her mother went through the menopause. While genetics play a big role, there are a number of other factors that can influence this process as well. All these factors result in the natural variety in the age menopause is experienced.2

Premature menopause, also known as premature ovarian insufficiency (POI), is when a woman goes through the menopause before the age of 40. It affects about 1% of women and in many individuals a specific cause is not known. It is important to speak to your doctor if you believe you are going into early menopause as there are certain factors that need to be reviewed, such as looking at your bone health.3,4

What influences the age a woman reaches the menopause?

The age at which a woman’s mother and close female relatives naturally reach the menopause is the single biggest predictor of the age a woman should expect to reach the menopause.

Women from certain ethnic groups appear to go through the menopause at slightly different ages. Typically, Hispanic and African-American women reach the menopause a little earlier than their Caucasian counterparts. Chinese and Japanese women on the other hand tend to reach the menopause a little later. Why this is, we do not know. 5

The biggest single lifestyle factor that affects the health of your ovaries is smoking. Women who smoke are more likely to go through the menopause earlier than non-smokers. Therefore, if you smoke and your mother did not, there is a good chance you may go through the menopause at a younger age than she did. 6

Surgery can also have an effect. Following hysterectomy (removal of the uterus), women tend to reach the menopause slightly earlier than women that still have a uterus even though their ovaries remain present.  The average age of menopause after hysterectomy is 45 so it really can make a difference of a few years. Surgery to or near the ovaries can result in damage of healthy ovarian tissue. This can contribute to an earlier menopause, especially in individuals that have repeat surgeries. 7

Cancer treatments often affect the age at which a women reaches the menopause. Chemotherapy drugs are designed to damage and kill rapidly growing cells. Unfortunately, this results in damage to healthy cells, too. As a result, many women go through a temporary menopause whilst having chemotherapy. For some, their cycles may return following treatment, however, in some they do not. Even women whose periods do return will expect to have a menopause a couple of years earlier than they otherwise would have. 8

Certain autoimmune disorders, such as Schmidt’s syndrome (which affects the way numerous hormones are produced), Addison’s disease, and thyroid disorders can result in an earlier menopause. So can certain infections, such as mumps and certain types of tuberculosis, as these cause damage to the ovaries. 9

Women with eating disorders may reach menopause at an earlier age, as may those under extreme physical stress, or those doing excessive exercise. Some experts believe that anything that causes your ovaries to produce less oestrogen and progesterone may result in an accelerated menopause.

The surgical menopause

This is slightly different in that women enter this if they have their ovaries surgically removed. This may have been done at the same time as hysterectomy, as a result of several ectopic pregnancies, or to protect a woman who is at increased risk of ovarian cancer.

Factors that don’t seem to affect the age of menopause

Interestingly, the age that a woman has their first period (menarche) does not seem to be a significant factor, and neither do the number of pregnancies, or periods of breastfeeding.

Similarly, hormonal contraception appears to have no significant effect on age of menopause either. Why is this? It is thought that although contraception and breastfeeding usually stop ovulation (release of the egg), they don’t affect the age-related loss of follicles from the ovary. Follicles contain oocytes (immature egg cells), and a certain number of follicles are lost each month simply due to the normal aging process, irrespective of pregnancy or ovulation. 10,11

The best way to look at the age of menopause is as a spectrum. There is very little that we can do to delay it, but certain factors may bring it forward. However, many of these are outside our control, so it is neither worth worrying about it, nor trying to predict the age at which you will go through menopause.

References

  1. Royal college of Obstetrics and Gynaecologists, ‘Patients: Menopause and women’s health in later life’, [website], https://www.rcog.org.uk/en/patients/menopause/, (accessed 16 March 2017).
  2. NICE, ‘Menopause: diagnosis and management’, NICE guideline NG23, 2015, https://www.nice.org.uk/guidance/ng23, (accessed 16 March 2017).
  3. Grady, ‘Clinical practice. Management of menopausal symptoms’, N Engl J Med, vol. 355, no. 22, 2006, pp. 2338-47.
  4. Okeke et al., ‘Premature Menopause’, Annals of Medical and Health Sciences Research, vol. 3, no.1, 2013, pp. 90-95.
  5. Panay and E. Kalu, ‘Management of premature ovarian failure’, Best Practice Res Clinical Obstetrics Gynaecology, no. 23, 2009, pp. 129–40.
  6. Okeke, ‘Premature Menopause’, 90-95.
  7. Grady, ‘Clinical Practice’, 2338-47.
  8. Panay, ‘Management of premature ovarian failure’, 129-40.
  9. Okeke, ‘Premature Menopause’, 90-95.
  10. Grady, ‘Clinical Practice’, 2338-47.
  11. Okeke, ‘Premature Menopause’, 90-95.

Dr. Jennifer Kelly MBChB(hons) MRCGP DRCOG

Jennifer is a General Practitioner, medical writer, parent, and founder of the Grace Kelly Ladybird Trust, registered charity for childhood cancer awareness and research (www.gracekellyladybird.co.uk). She also has a particular interest in women’s and children’s health, and enjoys medical writing, particularly helping make medical information easily accessible to those who want to find out more.

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