Q&A: Can You Predict the Timing and Length of the Menopausal Transition?

Here, we’ll look at the average age of menopause and why it might start earlier or later for you.

“Variations in what is considered ‘normal’ menopause [...] are influenced by genetics, ovarian reserve, lifestyle factors, medical conditions, and socioeconomic factors,” says Natalia Echeverri, MD, the clinical service chief of obstetrics and gynecology at Baptist Health in South Miami, Florida.

For this reason, says Dr. Faubion, it does matter when menopause occurs.

Racial and Social Disparities

In the United States, Black and Hispanic women are more likely to have early or premature menopause than Caucasian women, says Dr. Echeverri. “Asian women experience fewer flashes and night sweats than other populations,” she adds.

• Black and Hispanic women have a 3.7 to 4.1 percent chance of early menopause, compared with 2.9 percent for white women.
• This group also has a 1.4 percent chance of premature menopause, compared with 1 percent for white women.
• Black women have an 80 percent chance of vasomotor symptoms, or hot flashes, lasting on average 10.1 years, while 65 percent of white women have these symptoms for an average of 6.5 years.

“Symptoms of menopause, like hot flashes, brain fog, or vaginal dryness, don’t just suddenly appear overnight,” says Echeverri. “They’re actually the outward signs of a gradual hormonal transition that starts several years before.”

• Lighter or shorter periods,
• Less-regular periods
• Hot flashes
• Night sweats
• Vaginal dryness
• Mood changes
• Sleep problems
• Brain fog

“There is data on how long non-vasomotor menopausal symptoms like brain fog, sleep problems, and mood changes typically last, although there's wide variation between individuals,” Echeverri says.

Brain fog can make you feel confused or unable to think straight, and it may go on for some time after menopause. “Brain fog may start in late perimenopause and last through even postmenopause, typically one to five years,” explains Echeverri. “Estrogen has a neuroprotective effect, so cognitive changes may be more pronounced during periods of rapid hormonal fluctuation.” Hormones with a neuroprotective effect are those that help protect your brain and nervous system.

For some people, sleep problems can persist long after menopause. Echeverri says “sleep disturbances usually start in perimenopause and can last through postmenopause as well.”

She adds, “For many, it begins to improve about two to four years [after starting], but about 35 percent of women can have long-term issues with this, especially if the individual has other associated conditions that affect their sleep quality.”

A key component of menopause is a reduction in your estrogen levels. These levels never go back up to where they were before, which means some symptoms, such as vaginal dryness, usually stay for good. Lubricants can help overcome this problem during sex.

“The question I always ask women when they ask when they’re going to enter menopause is, ‘When did your mom go through menopause?’ because that is very often predictive,” says Lauren Streicher, MD, a clinical professor of obstetrics and gynecology at Northwestern University and the host of the podcast Inside Information: Menopause Midlife and More. “If she went through menopause early or late, you may, too,” she says.

These genes affect the health of a woman’s eggs. If certain genes cause the eggs and ovaries to age faster, menopause will likely happen earlier. If you and your mother or daughter share certain genetic factors, you may have similar timing.

• Irregular bleeding
• Hormone levels
• Smoking
• Use of hormonal contraception
• Relationship status
• Physical activity
• Alcohol consumption
• Education level
• Body mass index
• Childbirth
• Age when menstruation started

Some of these are probably stronger indicators than others to estimate the approach of menopause, the study authors noted. But this was a small study, and more research is needed to better understand how each potential factor links to menopause timing.

Similarly, if you’re drinking more alcohol before menopause happens, it doesn’t necessarily mean alcohol induces menopause. As Dr. Streicher says, “This can be a time of added stress for women, and we know that any stressful situation can cause someone to drink more.”

“That intergenerational violence accelerates reproductive aging should come as no surprise,” notes Faubion. “The key question is how to interrupt this devastating cycle of violence.”

While natural menopause happens gradually with age, menopause can also result if you have:

• Surgery to remove your uterus or ovaries

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• Chemotherapy or pelvic radiation treatment for cancer

  [2]

• Some types of gender affirmation therapy

  [16]

• Certain chromosomal conditions that affect the ovaries
• Autoimmune diseases, such as thyroid disease and rheumatoid arthritis, though this is rare
• Chronic fatigue syndrome

While natural menopause happens gradually with age, menopause can also result if you have:

• Surgery to remove your uterus or ovaries

  [2]

• Chemotherapy or pelvic radiation treatment for cancer

  [2]

• Some types of gender affirmation therapy

  [16]

• Certain chromosomal conditions that affect the ovaries
• Autoimmune diseases, such as thyroid disease and rheumatoid arthritis, though this is rare
• Chronic fatigue syndrome

Does Anything Delay Menopause?

There’s not enough evidence to confirm this, though.

Streicher says she has patients who think they will go through menopause early because they started having periods at a young age, and some believe this means they will run out of eggs earlier. But this isn’t the case, Streicher says. “When you go through menopause is really about the aging of eggs and what causes them to age more quickly,” she explains.

“The average age of menarche (the onset of menstruation) in the United States has gotten younger for a variety of reasons, but that hasn’t made women go through menopause earlier,” adds Streicher.

You can still get pregnant until menopause, although it becomes less likely over time.

“No matter when you experience natural menopause, your chances of getting pregnant after the age of 40 are low,” says Faubion. “But you can still become pregnant as you’re transitioning to menopause, and you still need to use birth control if you don’t want to conceive,” she says.

Although maintaining good overall health is important for a variety of reasons, it won’t necessarily translate to later menopause, says Streicher.

“I have women who tell me, ‘I have a healthy diet, I’m thin, I work out all the time, and I look young. I’m sure I’m not going to go through menopause early, and when I do, I won’t have hot flashes and other symptoms.’ I wish I could say that was true, but it’s not,” she says.

For now, though, more research is needed to confirm these factors and any possible effects on reproductive aging.

“It would be helpful for every woman to know exactly when menopause will arrive,” Faubion says. She explains that being able to predict this age could help women address issues such as cardiovascular disease and osteoporosis, where the risks increase after menopause, or decide whether to have a hysterectomy.

“If menopause is going to be a few months or a year from now, you may choose to wait it out; if it’s going to be five years from now, you might want to go ahead and have an invasive procedure with a more definitive solution,” says Faubion.

Faubion adds that it could also help with managing menopause symptoms or deciding which type of birth control to use. “If you’re [...] experiencing a lot of bleeding in perimenopause, it would be helpful to know when it will stop,” she adds

• The timing and length of the transition into menopause varies widely.
• The average age at menopause in the United States is 52, but about 5 percent experience it naturally before age 45. In other words, they have early or premature menopause.
• Certain factors, including menstrual cycle length, smoking, and body weight, may be linked to early menopause.
• It’s difficult to predict when menopause will happen, but genetic and other research may one day make this easier.