Menopause is defined by the absence of a period for 12 consecutive months. On average, most women enter menopause by age 51. In the case of late onset menopause, menstrual periods may not end until someone's late fifties or early sixties. There are several benefits and risks to late onset menopause and the cause can be multifactorial—all of which we explore in this article.
What is Perimenopause?
Perimenopause is a hormone transition period for women where ovarian hormones (estrogen and progesterone) fluctuate and eventually decline, leading to the cessation of ovulation and menstruation.
Many perimenopause symptoms we attribute to menopause symptoms, like hot flashes and night sweats, can start as early as our mid-30's, the pre-menopausal years. As many as 90% of women will seek healthcare to cope with symptoms of perimenopause.
Early perimenopause often begins with much more subtle symptoms like difficulty falling asleep, staying sleep, and flushing just prior to getting your period. As perimenopause progresses many women experience irregular periods, short menstrual cycles, and eventually cycles tend to be farther apart. As the hormones estrogen and progesterone shift further, the symptoms may intensify.
For more on perimenopausal symptoms and treatment, please read this article.
Natural Onset of Menopause
Perimenopause is part of the menopausal transition. As our egg stores diminish, the ovaries decline in hormone production and their response to follicle stimulating hormone (FSH). This results in reduced levels of estrogen circulating in the blood.
In the absence of estrogen, what some refer to as an estrogen deficiency, symptoms like vaginal dryness, bone loss, risk of heart disease, and hair loss can arise.
Menopause is a natural part of biological aging with women typically entering it between the ages of 45 and 55. However, there are certain factors that can place someone into premature menopause, which is discussed in this article—7 Causes of Early Menopause. Menopause before age 45 is considered early menopause.
What is Menopause?
Menopause isn’t a life phase; it’s a single point in time – the one-year mark without menstrual bleeding. After you are period-free for one year, you are considered postmenopausal. Everything before menopause is considered perimenopause.
How long does menopause last? Officially, one day.
But it isn't uncommon to hear women say, “I'm menopausal or I'm in menopause.”
The sign perimenopause is ending is going several months without a period. What can be frustrating is that if you have a period after nine months without one, the 12-month countdown starts over.
Some symptoms that begin in perimenopause may continue for a year or two after menopause, including the brain symptoms like hot flashes, insomnia, and night sweats. However, menopause symptoms related to low estrogen, such as vaginal dryness, may persist or become worse.
Menopause Marks the End of Menstrual Cycles
Menopause marks the official end of the menstrual cycle. Hormones settle at new, lower levels, and you will no longer experience the monthly hormonal fluctuations and associated symptoms like PMS. For many women, they embrace this as a time to celebrate and explore what the next phase of life will bring.
At What Ages Are Perimenopause & Menopause?
The average age of onset for menopause is 51 years old, and the normal age for menopause range is 45 to 55 years old.
The average age of perimenopause is much more variable. Some women will enter early perimenopause in their mid-30s or early 40s. Others won’t begin experiencing menstrual cycle changes until their late 40s or early 50s. It is normal to begin to experience perimenopausal symptoms beginning at age 45 and it can last up to 10 years.
For more on this topic, please read When Does Perimenopause Start and How Long Does it Last?
What is Advanced Maternal Age?
Although rare, it’s possible for a woman to have a pregnancy in her 50s. Because of decline in egg stores and frequency of ovulation in perimenopause, the chances of pregnancy decrease as a woman gets older, and eventually, there is a pregnancy age limit.
Menstruation follows ovulation and in menopause, a woman is no longer ovulating and therefore, she stops menstruating.
But the age in which you have your last child could play a role in delayed or late onset menopause.
Formerly Called Geriatric Pregnancy Age
Advanced maternal age pregnancy used to be called geriatric pregnancy, where a woman’s age becomes a risk factor in pregnancy outcomes, including maternal and infant mortality. It’s well documented that pregnancy after age 35 comes with increased risks. However, to put this in context, older mothers can still have normal, healthy pregnancies.
Pregnancies Above the Age of 35
Women aged 35 or older are in the advanced maternal age category. While many women are able to get pregnant naturally, have a healthy pregnancy, and breastfeed, there are special considerations and additional screenings that are necessary during this time.
The ability to become pregnant naturally will decrease over time due to the number and quality of eggs.
What Causes Late Menopause?
Menopause after age 55 is considered late menopause, and can be influenced by reproductive history, lifestyle factors, genetics, and weight. If your mother experienced menopause later then there is a good chance you will too.
One factor affecting late menopause age is genetics. Menopause is highly heritable because genetics contribute roughly 50% to the age you’ll experience menopause. The best predictor for your menopause age could be your mother’s age at menopause.
Above Average BMI
Body mass index (BMI) is another factor that may delay menopause. Adipocytes (fat cells) produce the hormone estrogen. Increased estrogen production may contribute to more menstrual cycles and a later menopause.
In an analysis of over 24,000 women, a BMI over 30 was associated with higher rates of menopause between 52 and 55 years old. Overweight and obese women were 50% more likely to experience late menopause.
For more information about the relationship between weight and the hormonal changes of perimenopause, please read How to Lose Weight During Perimenopause.
All hormone systems are connected, and thyroid health is crucial for ovulation and healthy menstrual cycles. Thyroid disease or imbalances affect sex hormone levels and potentially the timing of menopause. The reverse is also true; thyroid disorder rates increase in postmenopausal women when estrogen levels are low.
Read this article to learn more about thyroid disease and your menstrual cycle.
Pregnancy in 50s
Several reproductive factors may influence late menopause. While becoming pregnant naturally at fifty years or older is incredibly rare, many women are able to achieve pregnancy at this age through donor eggs and fertility treatments. Because of the hormone changes associated with pregnancy, having a pregnancy in your fifties may delay the onset of menopause.
Having many pregnancies and births (known as multiparity) is another factor that may influence the age of natural menopause. A study in Norway found women with three childbirths had the highest average age of menopause compared to women who have never given birth.
One study conducted in China found that women who had 3 and 4 deliveries were more likely to experience symptoms during perimenopause and menopause but didn’t find a correlation with age of menopause.
Physical activity throughout life also plays a role in the age of menopause because of how exercise influences hormones. Women who are more active in their 20s, 30s, and 40s may experience menopause later than those who are sedentary. In addition, exercise decreases the risk of mental health concerns and chronic disease post-menopause.
More isn’t always better. Too much exercise (as in, consistent daily intense training that high-level athletes may do) may inhibit ovulation and the menstrual cycle, having the opposite effect on menopause timing.
Benefits of Late Onset Menopause
When balanced, estrogen and progesterone are protective hormones for women’s health. In many cases, there are benefits to having a menstrual cycle into your early 50's, which increases tissue exposure to hormones.
Women with low hormones experience symptoms of menopause and the loss of protective hormones, including those that promote bone health. On the other hand, women with a longer reproductive lifespan show decreased risk for morbidity and mortality.
Reduced Risk of Heart Attacks, Strokes, & Osteoporosis
Research suggests that a later age of natural menopause may reduce the risk of many chronic diseases, including:
- Risk for heart disease, including strokes and heart attacks
- Risk for osteoporosis and bone fractures
In addition, later menopause is associated with reduced all-cause mortality and a greater life expectancy.
Implications on Life Expectancy
A 2017 study using Women’s Health Initiative data found a positive correlation between later age of natural menopause and longevity. The total reproductive lifespan, the number of years from menarche (the first period) to menopause (1 year after the last period), is also associated with a longer lifespan.
Health Risks of Late Onset Menopause
For some women, later menopause may be associated with increased estrogen exposure that affects estrogen-related cancer risk, including endometrial cancer. While estrogen is protective, estrogen excess, some forms of estrogen, or an increase in unfavorable estrogen metabolites can be problematic.
Keep in mind, cancer development is a complicated topic, and likely many factors play a role.
Increased Risk of Breast & Endometrial Cancer
The research shows a correlation between late menopause and an increased risk for specific cancers, including breast, endometrial, and ovarian.
Maintaining a healthy lifestyle that supports balanced estrogen levels throughout the reproductive years promotes healthy estrogen metabolism and health benefits (to our brain, bones, heart, skin, etc.) while decreasing risk.
To learn more about the estrogen-cancer connection and lifestyle strategies you can implement now, please read Estrogen and Breast Cancer.
Elements of Menopausal Self-Care
The best time to implement healthy lifestyle habits to support perimenopause and menopause was in your 20s; the second-best time is now. There are many lifestyle interventions, dietary factors, and supplement therapies that can help improve your quality of life and reduce menopausal symptoms.
During perimenopause, the body is adapting to hormonal changes, and it’s the ideal opportunity to implement strategies to make the transition through menopause smooth and reduce the risk for health issues later in life. Here’s how.
Daily movement that totals at least 30 minutes is the minimum amount of time needed to see benefits. For women in menopause, strength training is absolutely necessary to maintain hormonal and cardiometabolic health.
Exercise has many benefits during menopause, including:
- Maintaining strength and lean body mass
- Maintaining bone density
- Combating insulin resistance and supporting balanced blood sugar
- Reducing the risk of chronic disease, including osteoporosis, heart disease, and dementia
Because of these benefits and more, one study notes, “Exercise thus remains the best therapeutic agent available to mitigate menopause-associated metabolic dysfunction and represents a vital behavioral strategy to prevent and alleviate health decline in this population.”
Strength training is particularly beneficial, supporting healthy weight, body composition, and improved metabolic markers such as LDL cholesterol and hemoglobin A1C.
Certain foods and dietary patterns are predictive of menopause age. There is a connection between delayed menopause and consumption of oily fish and legumes, vitamin B6 intake, and zinc-rich diet. Earlier menopause is associated with processed foods, such as refined pasta and rice.
A nutrient-rich, whole-food diet is the best approach for balanced hormones at any age. During perimenopause and menopause, your diet can support balanced blood sugar, hormone metabolism, and aid in the prevention of chronic disease.
You can use this recipe guide as a starting place to support your hormones and health.
While there is no replacement for a healthy diet and exercise, understand that despite your best efforts, hormone replacement therapy may still be necesary.
Hormone Replacement Therapy Considerations
Menopause hormone therapy, also referred to as menopause hormone replacement therapy (HRT), is a strategy for managing the symptoms of menopause while also reducing the risk for cardiovascular disease and other conditions that affect women after menopause.
When having a conversation with your healthcare provider, it’s important to discuss the pros and cons for you, given your medical history, risk factors, and other considerations. In many cases, the benefits of HRT outweigh the risks, but not always. I recommend choosing bioidentical hormone options, many of which are available as standard prescriptions.
Menopause Supplement Strategy
Supplements are a helpful lifestyle tool for hormone health throughout life, particularly in menopause. With so many menopause supplements to choose from, there is the opportunity to personalize your supplement plan and find what makes you feel the best. I’ve written extensively on many supplements to support hormones, and you may want to read these articles for more information and guidance:
Next, let’s dive into support for hormone and for life in menopause.
It also plays a crucial role in immune health, helping modulate inflammation, and may help prevent heart disease and protect against issues with cholesterol.
As a bonus, vitamin D may also help improve mood symptoms among women in menopause.
Vitamin D3 is best taken with vitamin K2 to support cardiovascular health and is more bioavailable when taken with fat, which makes the Dr. Brighten Essentials Vitamin D3/K2 an optimal way to supplement with this key nutrient.
The term hormonal balance can mean a lot of things. In late perimenopause women may use the term to describe the imbalance between estrogen and not enough progesterone. In menopause, they may be describing issues with adrenal hormones, like cortisol, or insulin, as is the case with hyperinsulinemia. And other times, they may be referring to issues with thyroid function.
There is no one supplement to address every endocrine organ (hormone producing tissue) or every type of hormone imbalance women may describe.
But there are key nutrients and herbs that can help support the different issues that arise during each phase of a woman's life.
Nutrients like DIM, sulforaphane, and calcium d-glucarate can help support estrogen metabolism and clearance in the body. That means helping you eliminate the estrogen you no longer need and promoting the healthier metabolites of estrogen. This can be beneficial for those on hormone replacement therapy as well.
These nutrients are best taken together and when it comes to sulforaphane, this should be taken with myrosinase in order to get the most benefits. This is how I formulated the Balance Women’s Hormone Support supplement to enable women to get the most comprehensive estrogen support.
Supporting adrenal health and managing stress through menopause is a must. As ovarian hormones decline, your body will rely more on hormone production from the adrenals. The adrenal glands provide a source of estrogen and testosterone by way of the hormone DHEA.
If you are stressed, burned out, or have HPA-axis dysfunction, you’ll need even more support to bring your adrenals back online to assist through the hormone transitions. Your adrenal gland health supports ample energy, your ability to fall asleep at night, and your resistance to stress.
Adaptogenic herbs, including ashwagandha and rhodiola, and adrenal-supportive micronutrients, including B vitamins and vitamin C, can help the adrenal glands function optimally. Adrenal Support is a comprehensive adrenal health supplement with benefits for women in menopause
Supporting gut health in perimenopause and menopause is essential. A diverse microbiome supports estrogen metabolism, vaginal health, and body composition. Gut health is linked to inflammation and healthy estrogen levels in menopausal women.
Beneficial gut flora may also help prevent UTIs.
Because menopause is associated with a decrease in gut health and microbial diversity, a diet right in a variety of fibers, along with a quality women’s probiotics should be considered for supporting the body.
Probiotics like lactobacillus species and spore forming organisms thrive best when coupled with a prebiotic. This is why we've formulated a blend that supports both gut and vaginal health, while also providing prebiotics and antioxidant support for the urinary tract system, in our Women's Probiotic.
Omega-3 Fatty Acids
Omega-3 fatty acids help with reducing inflammation, support cardiovascular health, are necessary for thyroid health, and may improve insulin sensitivity—all of which can be impacted by estrogen loss that occurs in menopause.
In menopausal women struggling with hot flashes and depressive mood symptoms, omega-3 fatty acids may help improve both of these issues.
A blend of both EPA, which has anti-inflammatory effects, and DHA, which supports brain health, may be the most helpful during menopause. You'll find both of these, along with lipase to enhance absorption and reduce the fishy after taste some omega products can have, in our Omega Plus supplement.
Late Onset Menopause Takeaway
While the average woman experiences perimenopause in her mid-forties and menopause by about age 51, there are women who transition into menopause in their late fifties or early sixties. This is influenced by lifestyle, nutrition, pregnancy history, obesity, when you started your period, and most importantly, genetics.
Late onset menopause may bring health benefits that protect the cardiovascular system, metabolic health, bone density, chronic disease prevention, and cognitive function. But there are some risks associated with it, most notably endometrial cancer risk.
Nutrition, lifestyle and supplement therapy can help ease symptoms and support women through the menopause transition and into menopause, even when they choose hormone replacement therapy or other medical treatments.
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