Predicting How Long the Menopausal Transition Will Last and When You’ll Reach Menopause: Questions and Answers
Experts reveal what factors influence the timing of the menopausal transition and why it matters.
“Is this normal?” has to be one of the most common questions posed to doctors about a host of health-related signs and symptoms, from the crackling sound your knees make when you take the stairs to the number of times your sleep is interrupted each night.
And it’s often the question women pose to their ob-gyn when they begin to notice changes in their monthly period or have their first hot flash. When it comes to the menopause transition, what’s the normal age, and more importantly, why does it matter?
The average age of menopause is 51, and it does matter, in part because the timing of menopause can be predictive of other health issues, according to Stephanie S. Faubion, MD, the director of the Office of Women’s Health at the Mayo Clinic in Jacksonville, Florida, and the medical director of the North American Menopause Society (NAMS).
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“There are many negative health consequences linked to early menopause, including a higher risk of osteoporosis and fracture, heart disease, cognitive impairment and dementia, and early death,” says Dr. Faubion.
If you have questions about when you’ll experience menopause and if you can do anything to change it, keep reading for answers.
1. At What Age Do Most Women Reach Menopause?
The medical definition of menopause is no menstrual bleeding for a year, according to Lauren Streicher, MD, a clinical professor of obstetrics and gynecology and the medical director of the Northwestern Center for Menopause and the Northwestern Center for Sexual Medicine in Chicago.
Most women experience menopause between age 40 and 58, and the average age at menopause is 51, according to the North American Menopause Society.
Many women are surprised when they go through menopause in their forties because they think they’re too young, but it’s not unusual, says Dr. Streicher.
2. What Age Is Considered Early for Menopause?
If you reach menopause before age 40, that is considered premature menopause, says Faubion. “This occurs in about 1 to 2 percent of women,” she says.
“Experiencing menopause at 40 to 45 years of age is called early menopause, and that occurs in about 5 to 7 percent of the population, so it’s safe to say that at least 7 percent of women are going to go through menopause early or prematurely,” says Faubion. Menopause at age 46 or older is considered normal, she says.
3. How Long Will Menopausal Transition Symptoms Last?
Menopause is technically one full year without bleeding, and perimenopause is the stage before the final menstrual period, also known as the menopausal transition. Puberty and perimenopause are similar in that they both involve hormonal changes, and the transitions can take place over several years. Some medical organizations, such as the American Osteopathic Association, refer to perimenopause as “reverse puberty” in women.
According to NAMS, this phase can last four to eight years, and it comes with symptoms caused by hormone fluctuations, such as mood swings, poor sleep, and hot flashes.
The age at which a woman begins perimenopause can help predict how long the transition to menopause will last, according to research published in the journal Menopause in February 2017. The authors found that perimenopause lasted longer in women who started the transition at a younger age, and the women had more symptoms, such as hot flashes.
4. Does the Age My Mother Reached Menopause Mean Anything?
Most likely your mom’s age at menopause will provide a clue. “When we look at the things that are the greatest determinants for when someone is going to go through menopause, genetics seems to be one of the most important things,” says Streicher.
A woman’s race or ethnicity can influence when she goes through menopause, too, she says. Findings from the Study of Women’s Health Across the Nation (SWAN) indicate that women of color tend to begin perimenopause and menopause at earlier ages than white women.
“The question I always ask women when they ask when they’re going to go through menopause is, ‘When did your mom go through menopause?’ because that is very often predictive,” says Streicher.
“There’s a lot of truth in that. You may follow what happened with your mother; if she went through menopause early or late, you may, too,” she says.
5. Could Alcohol Consumption or Cigarette Smoking Influence When Menopause Occurs?
Although it can be difficult for scientists to tease out specific factors that impact when a woman goes through natural menopause, there is a growing body of research in this area.
One such study, published online in April 2021 in Menopause, the journal of NAMS, looked at several aspects of women’s health and lifestyle, while also controlling for different variables in an attempt to zero in on what could be influencing the timing of the transition.
“They found that there are factors that do seem predictive of when a woman will approach menopause, such as higher estradiol and follicle-stimulating hormone (FSH) levels, which we’ve known for a while," says Streicher. “Irregular menstrual bleeding and hot flashes were also indicators of earlier menopause,” she adds.
One new finding concerned alcohol consumption. Participants approaching menopause reported higher consumption of alcohol, leading researchers to wonder if an uptick in drinking was a clue that the change was coming.
That makes sense, says Streicher. “This can be a time of added stress for women, and we know that any stressful situation can cause someone to drink more,” she says.
Although this study didn’t find a strong association with smoking, other research has indicated that smoking is related to early onset of menopause, says Streicher.
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6. Does Menstrual Cycle Length or Menopause Symptoms Influence the Timing of Menopause?
Women with shorter menstrual cycles, defined as less than 25 days, are more likely to reach menopause early than women with normal-length cycles (26 to 34 days), according to a study of 634 women published in Menopause on August 23, 2022.
Researchers also found that the women with short menstrual cycles had a higher frequency of total menopause symptoms, and were more likely to have certain menopause symptoms, including midlife sleep problems, heart discomfort, and depressive symptoms.
More research is needed to confirm these findings, especially studies that separately evaluate women with a usual cycle length of fewer than 21 days, according to the authors.
7. Does Having More Children Delay Menopause?
Because pregnancy puts menstruation and ovulation on “pause,” it’s been theorized that a high number of pregnancies may delay menopause, but the findings of a Norwegian study published in Human Reproduction in February 2020 belie that assumption.
After analyzing data on close to 300,000 women, investigators found that women with three childbirths had the highest average age at menopause, at 51.36 years old, and that women who had never given birth had the lowest, at an average of 50.55 years of age.
But women who had had more than three childbirths didn’t go through the menopause transition later, which is what would be expected if pregnancies truly delay menopause, according to the researchers. The authors concluded that the results “question the assumption that interrupted ovulation during pregnancy delays menopause.”
8. Is There a Link Between Trauma and the Timing of the Menopause Transition?
In a study published in March 2022 in Menopause, researchers found that a mother’s own childhood physical abuse and her child’s own sexual abuse both were associated with an earlier age of menopause: mothers who were physically abused in childhood and had a child who experienced regular sexual abuse reached menopause 8.78 years earlier than mothers without a history of personal abuse or abuse of their child.
The authors attribute this association to “allostatic load,” which refers to how stress experienced over one’s life course can accumulate and eventually exceed a person’s coping resources, says the lead author, Holly Foster, PhD, a professor of sociology at Texas A&M University in Brazos County, Texas.
It’s thought that this chronic stress buildup can impact the release of certain hormones and potentially suppress the immune system. “Over time this can lead to accrued wear and tear on one’s body, known metaphorically as the ‘weathering hypothesis.’ This finding is illustrative of how violence, both to oneself, but also to one’s children, contributes to maternal allostatic load, accelerating their reproductive aging,” says Dr. Foster.
This study is important because it investigates the cumulative impact of intergenerational violence on reproductive aging, says Faubion. “That intergenerational violence accelerates reproductive aging should come as no surprise. The key question is how to interrupt this devastating cycle of violence,” she says. Addressing the issue will require multiple sectors, including social change, policy and education, adds Faubion.
9. What Else Affects When a Woman Will Finally Stop Having Menstrual Periods?
Researchers continue to explore a number of factors that may influence the timing of menopause.
The level of education a woman has completed is one thing that seems to correlate with menopause timing, says Faubion. “Women who have more education tend to go through menopause later,” she says.
A study published in January 2020 in JAMA Network Open found that pregnancy and breastfeeding may reduce the risk of early menopause.
The frequency with which a woman has sex has also been correlated with early menopause. A study published January 15, 2020, in Royal Society Open Science found that frequent sexual activity was associated with a higher age of natural menopause.
10. I Got My First Period Early. Does That Mean I’ll Go Through Menopause Early?
“I have many patients tell me, ‘I know I’m going to go through menopause earlier because I started my period really early,’” says Streicher. “The reason women think that is because they think menopause occurs when you run out of eggs. This isn’t going to happen; we’re born with millions of eggs and many of those are never used. When you go through menopause is really about the aging of eggs and what causes them to age more quickly,” she says.
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, she says.
11. Are Women Who Aren’t Experiencing Menopausal Symptoms Still Fertile?
“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.
Streicher confirms this, saying, “Fertility and menopause are not the same thing; there are plenty of women who are pumping out estrogen and menstruating and are not fertile.” If you’re sexually active, it’s important to consult with your doctor before making any decisions about birth control to avoid unwanted pregnancy.
On the other hand, don’t assume that just because you are still menstruating you can get pregnant. Women who are concerned that they may have trouble conceiving or think they may experience menopause early and still want children should discuss options such as egg freezing with their doctor, says Streicher.
12. Will Being Super Healthy Delay Menopause?
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.
Body weight might matter, though. “We do know that the extremes of weight, in someone who is very obese or someone with very low body weight, may impact the onset of menopause, but for the majority of women in the middle it doesn’t seem to have a big impact,” says Streicher.
13. Predicting Natural Menopause: Why Does Age Matter?
If there’s not a lot that women can do to change when they’ll experience menopause, why does predicting it even matter?
It would be helpful for every woman to know exactly when menopause will arrive. Beyond recognizing and addressing issues such as increased cardiovascular disease risk and risks related to bone health, if a woman knows her age of menopause and how long the perimenopause transition will last, it could help her make important health decisions, says Faubion.
“If you’re bleeding like crazy it would be helpful to know,” she says.
As of now, research hasn’t uncovered a way to determine when a woman will go into menopause, but that information could be useful in making decisions such as whether to have a hysterectomy or other invasive procedures, says Faubion. “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,” she says.
The ability to predict when menopause will occur could also help with managing menopause symptoms or deciding which type of birth control to use, adds Faubion.