Menopause – Factors Affecting the Menopause

What is Menopause? Menopause refers to the end of your menstrual cycles when ovaries stop producing estrogen.  It is a natural process in which cessation of menstruation occurs for at least 12 months. It is usually experienced within 40-58 years, with an average age in the developed world being 51 years.

Menopause is not a health problem.However, hormonal changes and other factors involved can cause discomfort.

Natural menopause is split into 3 stages:

1.Perimenopause /Menopause Transition

They are the physical signs of menopausal changes. When the estrogen and hormone levels begin to drop, this stage can begin 8 to 10 years before menopause, usually in a woman’s ’40s or even ’30s.  The average length is 4 years, though for certain, it may last for a few months.  There is still a chance that one could get pregnant. (click here to read about when is the best time to get pregnant)

In the last 1-2 years of perimenopause, possible symptoms are highlighted as below:

• Irregular periods – Periods may be longer or shorter; the flow can be lighter or heavier, and one may skip some periods.
• Hot flashes – A sudden feeling of heat over the body.
• Night sweats – A sudden feeling of heat over the body.
• Sleep problems – Sleep disturbances or insomnia occurs with night sweats and hot flashes.
• Mood swings – Irritability or increased risk of depression, anxiety, and nightmares.
• Vaginal dryness – Vaginal tissues may lose lubrication and elasticity, making intercourse painful.
• Bladder problems – Low estrogen may make it vulnerable to urinary or vaginal infections.  Loss of tissue tone may contribute to urinary incontinence.
• Loss of bone – Losing bone is quicker than replacing it increases the risk of osteoporosis (a disease that causes fragile bones).
• Change in the cholesterol levels -increase in HDL (High-density Cholesterol that is a risk factor of heart diseases).
• Weight gain and slowed metabolism
• Breast Tenderness
• Worsening of premenstrual syndrome (PMS)
• Changes in libido and Sex drive.
• Hair loss or thinning hair
• Dry skin, eyes, or mouth
• Pain -Headache, joint, and muscle aches and pains
• Racing heart. 

2.Menopause

When ovaries stop releasing eggs and producing most estrogen, it is diagnosed when a woman hasn’t had a menstrual period for 12 months.

3.Postmenopausal Effects

In the years after menopause, women are at increased risk of several health conditions due to the lower level of estrogen.  Menopausal symptoms such as hot flashes can ease for certain women.

Factors Affecting the Age of Menopause

The average age of natural menopause is around 51.4 for women.  With increasing life expectancy, women will spend up to 40% of their lives in the postmenopausal stage, confirmed by Mayo Clinic.

The age of menopause is 85% genetically related
This means a family history of early menopause is a predictor that you may undergo the same.

A study showed that one reaches menopause after 6-7 years when the menstruation cycle started irregular (1).  Naval Medical Center in San Diego indicated that the later the menopause, the less cognitive decline later in life, and the later a woman is subject to the associated health consequences. These advantages are considered to outweigh the 1% increased risk of breast cancer.

There are also other factors affecting the age of menopause that women can focus on to delay the age of menopause.

1. Smoking. Smokers can pull forward the age of menopause by 1-2 years.  Polycyclic aromatic hydrocarbons present in cigarette smoke are toxic to ovarian follicles, resulting in decreased estrogen levels and menopause. (There are also more to know about smoking than what you already know – read about the untold truth here)
2. Body Mass Index BMI. Szegda and Bertone-Johnson found that women underweight at any age (BMI of less than 18.5 kg/m2) had a 30% increased risk of early menopause compared with women of BMI between 18.5-22.4 kg/m2. Overweight women with BMIs between 25-29.9 kg/m2 had a 21-30% lower risk of early menopause compared to normal-weight women. I (Also curious if you are ‘fit’? Read up to measure your fitness). Meanwhile, contrary to what people generally believe – physical activity level is not associated with incident early menopause. Another study also quoted the risk of early menopause among underweight women.
3. Vitamins. Studies showed that vitamin D from food sources, such as fortified dairy and fatty fish, was associated with a 17% lower risk of early menopause.
4. Plant-based diet. In general, a high intake of a plant-based diet can prolong the reproductive lifespan.
   • High intake of vegetable protein. Based on a recent study, a long-term high intake of vegetable protein such as whole grains, soy, and tofu may protect women from early menopause and prolong reproductive function.  The results showed that women who consumed 6.5% of their daily calories as vegetable protein had a 16% lower risk of early menopause than those whose intake was approximately 4%.  This equals 32.5 grams per day of enriched pasta, breakfast cereal, tofu, and nuts. Some other foods include Lentils, Black Beans, Quinoa, Green Peas, Oatmeal, Pumpkin Seed, and Chia Seeds.
   • High intake of fruits and vegetables. A review of 2014 confirmed that the presence of antioxidants in fruits and vegetables counteracts the adverse effects of reactive oxygen species on the and quality of ovarian follicles.
5. Birth-giving. Natural menopause occurs significantly later than for women who have given birth than nulliparous women.  The exception is older age at first full-term pregnancy.
6. Other factors affecting the age at natural menopause:
   • Socioeconomic status. Low educational attainment and nonemployment can be associated with earlier age at menopause.
   • Use of oral contraceptives. The usage can associate with earlier age at natural menopause.
   • Coeliac disease. If untreated, this can be a risk factor for early menopause. A strict gluten-free diet reduces the risk.
   • Heart disease. Women who had heart disease were significantly younger at natural menopause.
   • Chemotherapy. Chemotherapy is mildly damaging to the ovaries; even the menstrual cycles return; menopause will occur earlier than you otherwise would have.
   • Ovarian surgery. Marcelle Cedars of the University of California San Francisco said that any operation on the ovaries would damage the healthy tissues.  For diagnostic surgery for endometriosis, for example, it is recommended to use medical options such as hormonal suppression to avoid repetitive surgeries.

Health Risks Associated with Menopause

After menopause, your risk of certain medical conditions increases. Examples include:

• Heart and blood vessel (cardiovascular) disease. When estrogen levels decline, cardiovascular disease increases; a study shows the increased risk of CVD (cardiovascular diseases) in women after menopause. In young women who have undergone early or surgical menopause, who do not take estrogen, their risk for heart disease is also higher. Women who have gone through menopause and have other heart disease risk factors, such as the following, are at even greater risk.
• This condition causes bones to become brittle and weak, leading to an increased risk of fractures. From menopause until the age of 60, women lose an average of 25% of the bone mass.
• Urinary incontinence. As the tissues of your vagina and urethra lose elasticity, you may experience frequent, sudden, strong urges to urinate, followed by an involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing, or lifting (stress incontinence). You may have urinary tract infections more often.  Strengthening pelvic floor muscles with Kegel exercises and using a topical vaginal estrogen may help relieve incontinence symptoms.  Hormone therapy may also be an effective treatment option for menopausal urinary tract and vaginal changes, resulting in urinary incontinence.
• Sexual function. Vaginal dryness from decreased moisture production and loss of elasticity can cause discomfort and slight bleeding during sexual intercourse.  Also, decreased sensation may reduce your desire for sexual activity (libido). Water-based vaginal moisturizers and lubricants may help.  If a vaginal lubricant isn’t enough, many women benefit from local vaginal estrogen treatment, available as a vaginal cream, tablet, or ring.
• Elevated Diabetes Risk. Women who hit menopause after turning 55 (or before they turn 46) are more prone to developing Type-2 Diabetes. This is because low Estrogen can increase your body’s resistance to Insulin.
• Weight gain. Many women gain weight during the menopausal transition and after menopause because metabolism slows. You may need to eat less and exercise more to maintain your current weight.

Optimize your Postmenopausal Life

• Regular exercise. A combination of regular cardiovascular and resistance exercises is vital to maintaining heart health.
  • Improve the quality of life and alleviate the psychological symptoms (improve moods).
  • Walking, running, and resistance exercises can improve bone mineral density, thus results in the reduced natural loss of bone density.
  • Less pain and protect against weight gain due to menopausal status.
  • Women exercising every day are 49% less likely to experience hot flashes.
  • Better control of cholesterols and cardiovascular health.
• Meditate. Meditation helps improve insomnia, fatigue, and depression, common problems during mature adulthood.
• Time-restricted diet. Intermittent fasting and time-restricted diets have been proved to offer metabolic benefits, weight loss, and weight stabilization.  This can be a way to combat the potential weight gain due to a slower metabolism.
• Cutting back on caffeine. Jacqueline Thielen, M.D. of Mayo Clinic, advised that postmenopausal women who regularly drank caffeinated beverages — such as coffee, tea, or soda — experienced more bothersome vasomotor symptoms than postmenopausal women didn’t use caffeine.  The same association wasn’t seen in premenopausal or perimenopausal women.

Early Menopause

Nearly one in 10 women experience premature menopause – a final menstrual period before the age of 40, or early menopause – the final period between the ages of 40 and 44 years, is associated with a higher risk of cardiovascular disease, osteoporosis, dementia, Parkinsonism, and early cognitive decline according to MedicalXpress.

Besides the higher risk of adverse future health outcomes, early menopause is problematic as women are increasingly delaying childbearing into their later reproductive years.  Fertility declines drastically during the 10 years leading up to menopause, so early menopause can have profound psychological and financial implications for couples who are unable to conceive as they wish. It can also be due to certain food choices

Early menopause can have profound psychological and financial implications for couples who are unable to conceive as they wish.

How to deal with early menopause?

1. Women who undergo premature menopause are often treated with hormone therapy until age 50 to avoid the increased risk and long-term health consequences associated with the extra years of estrogen loss. It is recommended to use hormone therapy at least until the natural age of menopause (age 51 years). Nonetheless, hormone therapy can help with vaginal dryness yet may not alleviate all of the changes associated with early estrogen loss, particularly mood changes and sexual dysfunction.  As for low sexual desire during early menopause, testosterone therapy may even be appropriate.
   • Hormonal Replacement Therapy with estrogen and progesterone has long been considered to have anti-aging effects; results of larger studies, particularly of the Women’s Health Initiative, have shown that an anti-aging effect is not necessarily to be expected. It has been accused of having a higher cardiovascular risk and increase risk of breast cancer.  However, it has clear, positive preventive effects on osteoporosis, and an early, low-dose estrogen monotherapy can be considered to have advantages.

2. Possible change in the family plans. If you wish to have a family, you may need to consider options such as freezing embryos or eggs through in vitro fertilization with donor eggs (postmenopausal women can safely have babies), adoption, or surrogacy.

3. Get extra support from others. The potential long-term health impact and loss of fertility can be daunting to face alone.  You may need support from family, friends, and healthcare providers to understand your diagnosis, the consequences, and what you can do about it.

For more information on estrogen, there is an excellent article on Medical News Today.

Menopause is far ahead for you to think about right now? Learn about fertility here.