Menopause occurs when the ovaries no longer produce the hormones estrogen and progesterone and stop releasing eggs. Most women naturally experience menopause between the ages of 45 and 55, with 52 being the average age of onset in the United States. You’re considered to be in menopause if you haven’t had a menstrual period for 12 months in a row. By that point, the number of eggs in the ovaries — called the ovarian reserve — drops to about 1,000 from around a million at birth.
Women may want to delay menopause because they want more time for family planning, or to postpone some of its physical and emotional changes. Although you can’t stop the natural process of menopause, you may be able to influence its timing.
The timing of menopause can vary from person to person, but certain factors may lead to starting menopause earlier than average:
Genetics “The timing of menopause is primarily determined by the woman’s genetics,” says Zev Williams, MD, PhD, director of the Columbia University Fertility Center in New York City. If your mother went through menopause early or late, it’s likely you’ll follow a similar timeline.
Body Weight Being underweight is linked to early menopause, says Alexander M. Kotlyar, MD, a board-certified reproductive endocrinologist at Genesis Fertility & Reproductive Medicine in the New York City area. One study of women in India found that about 1 in 5 women who were underweight, with a body mass index (BMI) of less than 18.5, started menopause between the ages of 40 and 44.
Smoking Smoking has been linked to an earlier start of menopause in multiple studies, says Dr. Kotlyar. Women who smoke about a pack a day for 30 years are 50 percent more likely to experience early menopause (between the ages of 40 and 45) compared with nonsmokers, according to one recent study.The longer women smoke, the more likely they are to experience severe menopause symptoms.
Other Factors Poor nutrition may also trigger earlier menopause, says Dr. Williams. Getting your first period at a young age, never having children, vigorous physical activity, and certain dietary patterns like high-carbohydrate or vegetarian diets can all speed up menopause timing.Chemotherapy, surgery to remove the ovaries (oophorectomy), and certain autoimmune diseases and genetic conditions can also interfere with ovarian function, leading to early or premature menopause (when it occurs before age 40).
On the other hand, some factors are linked to later menopause. Women who have had multiple pregnancies, especially if their first pregnancy was at an older age, tend to experience menopause later. Being of Japanese ethnicity, having a higher BMI (within the healthy range), and engaging in moderate physical activity are all associated with later menopause.
The timing of menopause can affect your health in many ways. Estrogen helps protect the heart, keep the bones strong, support brain function, maintain muscle mass, and improve mood.
When estrogen levels drop during menopause, your body loses these protective benefits, says Bruce Dorr, MD, a board-certified obstetrician-gynecologist and senior medical advisor at Biote. Women who experience premature and early menopause spend more years without estrogen’s helpful effects, which can increase their risk of certain health conditions.
How Early Menopause Affects Your Health
The risks of heart disease, weak bones, and fractures (broken bones) are higher for women who enter menopause before age 45.If menopause occurs before age 40, the chances of developing heart problems — such as a heart attack, angina, or stroke — before age 60 goes up significantly.
Bone loss becomes more common during the menopausal years, which can raise the risk of fractures. In a study of over 21,000 postmenopausal women, those who entered menopause before age 40 were more likely to break a bone than those who experienced menopause at 50 or older.
Many women also see their cholesterol levels rise during menopause and may have trouble controlling blood sugar during this transition, which can lead to diabetes and high blood pressure.Experiencing premature menopause can also raise the chances of developing memory problems, depression, and conditions like dementia. “Loss of hormones also negatively impacts urinary incontinence and sexual function,” says Dr. Dorr.
The Benefits of Later Menopause
“Essentially, later menopause equals stronger bones, a stronger heart, better memory,” says Kotlyar. This is because the longer menopause is delayed, the more estrogen the body is exposed to, says Williams.
Each year that menopause gets delayed gives the bones more time under estrogen’s protective effects. Women who enter menopause at age 53 or later tend to have stronger, healthier bones compared with those who experience it earlier.
Starting menopause later — after age 55 — can lead to better heart health. This includes healthier blood vessels and less damage from oxidative stress (an imbalance of free radicals and antioxidants in the body that leads to cell damage).
The longer your body produces estrogen naturally, the better it seems to protect your brain and memory as you age. Compared with women who experienced early menopause, those who started menopause between ages 50 and 52 had about a 24 percent lower risk of developing dementia, according to one study.
Later menopause is also linked to living longer, says Williams. When menopause occurs before age 40, the risk of early death is much higher compared with those who enter menopause at the typical age. The longer your reproductive years last, the longer you tend to live overall.
Genetics play the most important role in determining when menopause begins. But some lifestyle habits can influence the timing and even help delay menopause.
Don’t smoke. Smoking has consistently been linked to earlier menopause. “To potentially delay menopause, avoid smoking,” says Williams. Smoking can affect the ovaries by speeding up aging and reducing the number of eggs, making menopause happen sooner.
Keep a healthy weight. “Maintaining a healthy weight through exercise and a balanced diet is important,” says Kotlyar. Being significantly underweight or overweight may affect when menopause begins.
Eat a nutrient-rich diet. Eating plenty of fruits and vegetables may help delay menopause because they contain antioxidants, which can help fight off harmful substances that can damage your eggs. Include oily fish, such as salmon or sardines, for omega-3 fatty acids. These healthy fats, along with antioxidants, can help keep your ovaries functioning well for longer and help reduce menopausal symptoms like hot flashes and mood changes.
Stay physically active. Regular, moderate exercise may help delay menopause.This includes activities like biking, swimming, or light jogging. Very intense exercise can actually have the opposite effect.
Consider breastfeeding. “Breastfeeding for 7 to 12 months has been associated with a later age of menopause,” says Kotlyar. Women who breastfed for this length of time had about a 28 percent lower risk of early menopause compared with those who breastfed for less than a month. Breastfeeding stops ovulation (when the ovary releases an egg), which may help your eggs last longer.
There are currently no FDA-approved medications to delay menopause, says Williams. Some hormonal treatments, like birth control, can help reduce menopause symptoms, but they don’t delay or prevent menopause and may have side effects like mood changes and blood clots, he adds.
But there is research underway that could change this. “At Columbia University Fertility Center, we are studying whether the oral medication rapamycin can delay menopause by slowing ovarian aging,” says Williams. Rapamycin is an immunosuppressant medication used to prevent organ rejection after transplants, but it’s now being studied for its potential to slow aging in different parts of the body, including the ovaries.
In the Validating Benefits of Rapamycin for Reproductive Aging Treatment (VIBRANT) study, led by Williams and his team, women taking rapamycin weekly lost fewer eggs each month — about 15 instead of the usual 50. This could potentially slow down ovarian aging by 20 percent, which might delay menopause.
Researchers are also looking at the anti-Müllerian hormone, or AMH. AMH levels reflect the ovarian reserve. Higher AMH levels indicate more eggs and a higher reserve, while lower AMH levels suggest a lower reserve.
The idea is that giving AMH injections as a treatment might help delay menopause by slowing down the rate at which a woman loses eggs. “Animal [study] data is suggesting that AMH may delay menopause by many years in rats,” says Dorr. But this research is still very early, and more studies are needed.
Another area of research looks at ovarian tissue cryopreservation, which involves freezing ovarian tissue at a younger age and reimplanting it later. While it’s not a medication, early research suggests it could someday help delay menopause by years, or even decades, depending on how and when the tissue is used.
While we can’t delay menopause yet, there are treatments that can help manage its effects, says Kotlyar. Hormone replacement therapy (HRT), delivers small doses of estrogen and often progesterone. It can help relieve symptoms like hot flashes, night sweats, vaginal dryness, and mood swings, and prevent bone loss.
“The main risk of HRT is a small risk of blood clots, but the overall benefits far outweigh the risks of HRT,” Kotlyar says. There’s also an increased risk of heart disease, stroke, blood clots that form in the veins, and dementia if you begin HRT 10 years after menopause starts or are older than 60.
Genetics play the biggest role in determining when menopause begins, but factors like smoking, being underweight, and poor nutrition can bring it on earlier.
Later menopause provides health benefits because it extends your exposure to estrogen’s protective effects on your heart, bones, and brain.
Lifestyle changes like avoiding smoking, maintaining a healthy weight, staying physically active, and breastfeeding may help delay menopause.
Research is ongoing to find ways to delay menopause, including studies on medications like rapamycin and anti-Müllerian hormone (AMH) injections.
