Among nonusers of menopausal hormone therapy or a hormonal intrauterine device Among smokers, no such dose response pattern was observed. Within all subgroups above, however, we estimated less than 1 year difference in mean age at menopause between menarche groups.
Median duration of the reproductive period was 38 years IQR: 35—41 years , and mean duration was Thus, the later menarche occurred, the shorter was the median reproductive period. Among women with menarche at age 9 years or earlier, the reproductive period was at least 9 years longer than among women with menarche at age 17 years or later median: 43 versus 34 years.
Accordingly, the HR for menopause from menarche increased with increasing age at menarche. Figure 3 illustrates the probability of menopause at any time after menarche for each menarche group. Table III Associations of age at menarche with duration of the reproductive period among women in the BreastScreen Norway, — Associations of age at menarche with duration of the reproductive period among women in the BreastScreen Norway, — Probability of menopause according to age at menarche as estimated by the Kaplan—Meier method; follow-up time since menarche.
In this retrospective cohort study of women in Norway, the median age at menopause was 51 years, and age at menopause was almost independent of age at menarche. Accordingly, women with early menarche had, on average, several years longer interval from menarche to menopause reproductive period than women with late menarche. Our study is the largest yet to explore the association of age at menarche with age at menopause.
Thus, we had statistical power to estimate age at menopause for women with very early or very late menarche, and also to study the shape of the associations. We used data from the BreastScreen Norway during the years — Women who did not answer the questions about age at menarche or menopause, or who had outlying values, were not included in the data analyses.
However, age at menarche and age at menopause in our study were very similar to other reports from Norway Bjelland et al. It is therefore unlikely that a possible skewed selection to our study will have biased the estimated association of age at menarche with age at menopause.
Information about age at menarche and age at menopause in whole years was obtained by self-reports in questionnaires. Particularly, age at menarche may have been erroneously reported by some women since the time interval from the event to data collection was long. Similar results have been reported for age at menopause Rodstrom et al. Age at menopause is typically defined retrospectively as 12 months without menstrual periods Soules et al. In our study, time since the last menstrual period was not reported.
In accordance with a previous study Hahn et al. Also errors in reporting of surgery on the uterus and ovaries may have occurred Phipps and Buist, Imprecise reporting of menopause may have deflated our estimated associations, but we have no reason to believe that possible erroneous reporting of age at menopause was differential by age at menarche.
Based on a literature review of factors associated with age at menarche and menopause, and the assumption that age at menarche is truly related to age at menopause, we evaluated possible confounding factors of the associations using directed acyclic graphs Pearl, A confounding factor is a common cause of both the exposure menarche and the outcome menopause.
Smoking and adult BMI have been associated with age at menopause Parente et al. We have little reason to assume that women were smokers or had high BMI before puberty, and therefore, we did not consider these factors as possible confounders. If age at menopause truly is independent of age at menarche, such a finding is expected to be consistent within different groups of women.
Thus, we repeated our main analyses within subgroups of women according to their current smoking status and BMI. We found similar associations in subgroups as for the sample as whole. Most prior studies of the association of age at menarche with age at menopause have included relatively few women van Keep et al.
Therefore, they lacked statistical power to study separately women at the boundaries of the age at menarche distribution e. In our study, the high statistical power could lead to misinterpretations of the findings; small statistically significant differences could be erroneously interpreted as clinically important differences.
Also, many prior studies have estimated the association of age at menarche with menopause without applying a time to event approach van Keep et al. Thus, their reported age at menopause may represent underestimates, and the relationship of age at menarche with age at menopause may possibly be biased. Likewise, women who were still having menstrual periods contributed with follow-up time until the time of data collection.
Such exclusion may have introduced sources of bias, since healthy women have been overrepresented. However, the most recent studies of the association of age at menarche with age at menopause have censored women at the attained age at surgery Henderson et al.
Some women start using systemic hormone therapy prior to menopause and may therefore have vaginal bleedings that mask the occurrence of natural menopause. The statistical handling of women who use systemic hormone therapy prior to menopause differs between studies Gold, , or is not described Otero et al. As in recent studies Dratva et al. In additional data analyses, we censored women at age of startup of systemic hormone therapy, as suggested in some studies Henderson et al.
By applying such an approach, our estimated associations did not change notably data not shown. We lacked information about age at startup of systemic hormone therapy for Also use of oral contraceptives can mask the occurrence of natural menopause. Unfortunately, age at cessation of oral contraceptive use was not reported.
It is therefore unlikely that oral contraceptives use has masked natural menopause for a large proportion of women in our study. Some studies that have aimed to identify determinants of age at menopause included many factors in addition to age at menarche in multivariable data analyses, such as smoking, adult BMI and parity Henderson et al.
These factors may mediate the association of age at menarche with age at menopause, and adjustment for mediating factors may introduce biases in the estimates Schisterman et al. Our results confirm results from previous studies that current smokers reach menopause 1—2 years earlier than nonsmokers Parente et al.
Many prior studies that have used time to event analysis in their data analytic approach Kato et al. To our knowledge, no such studies have reported that age at menopause decreases with increasing age at menarche. The largest study yet, including women in the UK during the years —, reported that age at menopause increases linearly with increasing age at menarche Ruth et al. The Ruth et al. Unlike previous studies, we allowed for a non-linear association of age at menarche with age at menopause in our data analytic approach.
We found that the HR of menopause was almost identical in all menarche groups at age 15 years or earlier, and that women with menarche at age 16 or 17 years or later had a lower HR of menopause, as compared to the other menarche groups. Thus, age at menarche was non-linearly associated with age at menopause.
We did not observe such a dose response relation among smokers, but the statistical power in the boundaries of age at menarche was rather low in this subgroup and type two errors may have occurred. We are aware of no studies that have estimated the duration of the reproductive period according to age at menarche by using a time to event approach. Nevertheless, our results are similar to a Chinese cohort study of 33 postmenopausal women, aged 40—70 years Dorjgochoo et al.
By using a linear regression model, they estimated that women with menarche at age 11 years or earlier had at least 5. Overall, their reported duration of the reproductive period was almost 4 years shorter than in our study.
However, they included only women who had undergone menopause in the data analyses Their study sample may therefore represent a selection of women with early menopause, and the duration of the reproductive period may be underestimated. We found that age at menopause was close to 51 years, and almost independent of age at menarche. Our findings therefore suggest that the onset of menarche and the onset of menopause are regulated by different biological mechanisms Apter and Hermanson, ; Broekmans et al.
The number of ovarian follicles reaches its maximum during fetal life, and atresia of the ovarian follicles starts before a woman is born Baker, It is assumed that menopause occurs when the number of ovarian follicles has declined to below Richardson and Nelson, ; Faddy and Gosden, Our results do not suggest that the number of menstrual cycles during life course is important for the timing of menopause, although each menstrual cycle recruits several ovarian follicles that degenerate.
The rate of follicle atresia, independent of the number of menstrual cycles, may be more important Ginsberg, Age at menopause was almost independent of age at menarche. Although age at menarche shows great inter-individual variation, menarche occurs between age 10 and 16 years in most girls Rees, It is possible that lean girls who exercise at high levels adapt a lifestyle in adult life which could delay menopause Schoenaker et al.
Hence, our findings suggest that women with early menarche have a longer reproductive period and higher cumulative exposure to endogenous sex hormones, such as estrogens and progestogens, than women with late menarche.
The increased risk of breast cancer in women with early menarche Collaborative Group on Hormonal Factors in Breast Cancer, ; Wu et al. The independent effect of early menarche and of the duration of the reproductive period on breast cancer risk is being debated Collaborative Group on Hormonal Factors in Breast Cancer, Also, endometrial cancer Dossus et al.
Whether age at menarche is an independent risk factor for these diseases, or a proximate measure for the duration of the reproductive period, is to our knowledge not known. Once you start the approach to menopause your monthly cycle can be seriously disrupted.
In the early stages, estrogen can peak earlier and bring on heavy periods and breast tenderness. If it peaks later, periods are likely to be lighter or missing, and low estrogen symptoms can appear. This includes symptoms such as hot flashes and night sweats; excessive anxiety; changes in the condition of skin, hair, and nails; low mood, low libido; dryness —vaginal, skin, eye; joint aches and pains; fatigue; memory lapses.
This phase where you are still getting some kind of period is called peri-menopause. The symptoms in a way can act as an invitation or catalyst to live life differently. And really what is the alternative? Ignore, push-down and keep plowing through until you hit retirement? The same longing for completion and fulfillment emerges A girl has a hormonally mediated opportunity to connect with her soul's purpose, learn to listen to her intuition, and establish a strong sense of herself during the time when both her brain and body are blooming.
Within a few short years, when her hormone levels are stable once more, she will have reached a new level of maturity and power. This provides an enormous opportunity for healing at both ends of the mother-daughter spectrum.
A woman is in menopause when she has not had her period for one year. Normally the hormonal chaos has started to taper off. If not, adrenal health is important to address, in fact, it's also important to address during peri-menopause. Because these tiny glands that sit on top of your kidneys will play an increasingly important role in a woman's health as she transitions to menopause. The adrenal glands gradually take over the production of the sex hormones from the ovaries.
But the adrenals also have another important function and that is to produce stress hormones - which will always be prioritized over sex hormones.
For those who experience menopause symptoms, treatments and support are available. Around menopause, various physical and mental changes can occur, causing symptoms. Some of these start before menopause, and some continue after it. As a female approaches the end of the reproductive stage, but before menopause begins, estrogen levels start to fall.
This reduces the chances of becoming pregnant. The first sign that menopause is approaching is usually periods occurring less regularly. They may come more or less frequently than usual, and they may be heavier or lighter. Anyone who has concerns about menstrual changes should see a doctor, as these changes can also indicate pregnancy or some health issues.
Is it normal to have brown spotting after menopause? Vaginal dryness, itching, and discomfort may start during perimenopause and continue into menopause. A person with any of these symptoms may experience chafing and discomfort during vaginal sex.
Also, if the skin breaks, this can increase the risk of infection. Atrophic vaginitis , which involves thinning, drying, and inflammation of the vaginal wall, can sometimes occur during menopause. Various moisturizers, lubricants, and medications can relieve vaginal dryness and associated issues.
Learn more about atrophic vaginitis here. Hot flashes are common around the time of menopause. They cause a person to feel a sudden sensation of heat in the upper body. The sensation may start in the face, neck, or chest and progress upward or downward. Some people experience night sweats and cold flashes, or chills, in addition to or instead of hot flashes. Hot flashes usually occur in the first year after menstruation ends, but they can continue for up to 14 years after menopause.
What does a hot flash feel like? Find out here. Getting plenty of exercise and avoiding heavy meals before bedtime can help with managing these issues, but if they persist, contact a healthcare provider.
Click here for some tips on how to get better sleep. Depression , anxiety, and low mood are common during menopause. It is not unusual to experience times of irritability and crying spells. Hormonal changes and sleep disturbances can contribute to these issues. For example, distress about low libido or the end of fertility can contribute to depression during menopause. While feelings of sadness, irritability, and tiredness are common during menopause, they do not necessarily indicate depression.
However, anyone who experiences a low mood for 2 weeks or longer should see a doctor, who will be able to advise about the best course of action. Anyone who has concerns about sleep or any changes related to menopause should contact a healthcare provider. An article published in suggests that there may, in some cases, be a link between menopause and suicide. Anyone who is thinking about suicide should seek help from a counselor or health professional. There are also anonymous hotlines available.
In the lead-up to menopause two-thirds of women may have difficulty with concentration and memory. Keeping physically and mentally active, following a healthful diet, and maintaining an active social life can help with these issues.
For example, some people benefit from finding a new hobby or joining a club or a local activity. People may experience :. Perimenopause, which can last for several years, typically begins when a woman is in her late forties, though it can start earlier or later.
During perimenopause , the period becomes less regular and a woman can experience night sweats, trouble sleeping, hot flashes, vaginal dryness, and mood problems. Menopause is, of course, a normal part of aging that every woman will go through, usually by her early fifties. The hormones estrogen and progesterone, which control menstruation, will decrease during this time, resulting in less regular periods.
The lack of estrogen and progesterone hormones being produced can take a toll on the body: postmenopausal women lose an average of 25 percent of their bone mass by age 60, largely due to the loss of estrogen. The loss of estrogen can also result in a higher risk for coronary artery disease.
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