Late menopause: The causes, symptoms and management

You’ve heard it countless times: the average age of menopause is 51.

But what if you’re glancing at the calendar, celebrating yet another birthday in your mid-fifties, and those typical menopausal symptoms are nowhere on your horizon? While there’s ample information about early or premature menopause, discussions about late menopause often get overshadowed. If you’re that woman wondering why your body is marching to a different drumbeat, this guide is for you. Dive with us into the intricacies of late onset menopause, its causes, health implications, and management.

What is late menopause?

Late menopause, also known as late-onset menopause or delayed menopause, is when you go through menopause at a later age than average.

 For most women, menopause, the natural end of the menstrual cycle, occurs between 45 and 55, with 51 being the average age in most Western countries. But that’s not always the case. Menopause occurring after age 55 is generally accepted as late menopause.

How common is late menopause?

As previously noted, the widely accepted average age for menopause is 51. It’s easy to see that and think something’s amiss if you’re 52 and still having periods. That’s certainly not the case.

With these statistics in mind, you might be wondering about the underlying reasons. Let’s unpack the causes behind late-onset menopause.

What are the causes of late-onset menopause?

Genetic factors             

It’s important to say that experiencing menopause at 55 or older isn’t like having a medical condition; it’s simply the upper end of the normal spectrum. Why might you reach menopause later than most other women? Very often, that’s down to genetics. As discussed in this article, at least 290 genes determine when you’ll reach menopause. Genetic factors are thought to be responsible for around half the variation in your age at menopause.

The genetic influence from your mother’s side of the family is known to be very strong. Those from the father’s side have been much less studied, so we understand far less about those. For now, looking at the age at which your mum and her relatives reached menopause will give you the best clues about when you will.

Many of the genes that help determine when you’ll reach menopause are involved in DNA repair. Not only does this ensure the store of eggs in the ovaries stays healthier for longer, thus delaying menopause, but they also keep other body tissues in a good state of order and can prevent damaged DNA from causing cancer. As we’ll see, these good genes are also associated with a longer life expectancy.

While our genes play a foundational role, our choices and surroundings also contribute to the story. Let’s look into how lifestyle and environmental factors influence the onset of menopause.

Lifestyle and environmental factors

While genetic factors are undeniably critical, your life choices also play a significant role. For example, smoking can bring your menopause forward by a year and a half, as can being single.

Diet has some surprising effects on the timing of menopause. Much like finely tuning an instrument, the foods we choose to consume can alter the rhythm of our menopausal journey. A diet high in refined carbs can lead to menopause a year and a half earlier, as can drinking a soft drink each day. Conversely, a portion of oily fish every day increases the age at menopause by three years and four months, whilst fresh legumes (beans and peas) can delay menopause by almost a year. 

You might expect that a vegetarian diet, generally regarded as being very healthy, would also delay menopause. In fact, it actually has the opposite effect. Vegetarians tend to experience menopause about ten months earlier.

A higher vitamin D intake can help prevent early menopause, but only if the vitamin D comes from food, usually low-fat dairy products. Taking vitamin D supplements doesn’t offer the same protection. Similarly, a high dietary intake of vitamin B6 is associated with a delay in menopause of seven months and a high zinc intake by four months. Again, these effects are seen with diets rich in these vitamins and minerals rather than when taken as supplements.

Are there health risks when menopause occurs late?

There’s no doubt that early menopause is something to avoid. Early menopause tends to bring worse symptoms that go on for years. The long-term consequences can be serious, too, with higher rates of heart disease, strokes, dementia, diabetes and more. In contrast, having a later menopause is mostly a good thing.

A 2005 Dutch study of over 12,000 women showed that each year menopause was delayed, resulted in a 2% decrease in both cardiovascular disease and mortality. That means that women whose menopause was after 55 lived, on average, two years longer than those whose menopause arrived before 40.

Two factors seem to be involved: 

1. Firstly, estrogen is as vital for the body as oil is for a car. A delay in the timing of menopause means a more prolonged exposure of the tissues to normal estrogen hormone levels (since these fall at menopause). The result is stronger bones, less osteoporosis and fewer fractures, less dementia, less cardiovascular disease and a healthier metabolism, with less diabetes and metabolic syndrome.
2. Secondly, earlier menopause may be due not only to faster ovarian ageing but to faster ageing of the body overall. Later menopause may be a sign of more effective body repair mechanisms – it’s those genes at play again.

One downside to more prolonged exposure to estrogen is a higher risk of estrogen-sensitive cancers such as breast, uterine and ovarian cancers. Even though fatal forms of these cancers are 5% higher in women with late menopause, the increased life expectancy remains. It has been estimated that the increased risk of breast cancer for each year’s delay to menopause is about the same as taking HRT for a year.

The bottom line is that the benefits of a later menopause outweigh any increased risks. This is reflected in the longer life expectancy.

With the health implications in mind, one may also wonder: does a later onset of menopause alter the typical symptoms women face? 

Are menopause symptoms different if you reach menopause late?

As you’ll know, the symptoms of menopause are legion, so every woman’s experience is different. If your menopause comes later, you’ll still be at risk of all the same symptoms. 

The good news is that they tend to be milder and last for less time. As we discussed in our article on the timing of hot flashes, for example, if you start having hot flashes at 55 or above, they’ll last for ‘just’ six years, on average, compared to ten years for someone whose hot flashes start at 44.

How is late menopause diagnosed?

The diagnosis of late-onset menopause is no different from that occurring at an ‘average’ age. Typically, menopause is diagnosed based on the regularity or otherwise of your menstrual cycle and typical symptoms, like hot flashes, night sweats and brain fog. You can read more about the stages of menopause and how to recognise them in our article on the subject.

While diagnosis revolves around observing symptoms and cycle regularity, the implications of late menopause extend beyond just its onset. For instance, the impact on fertility and the potential for pregnancy is a concern for many.

What about fertility and pregnancy with late natural menopause?

It’s worth remembering that as long as you’re ovulating and having periods, pregnancy remains a possibility, albeit with some nuances as age progresses. For this reason, it is recommended that you use contraception until a year after your final period (two years if your last period occurs before you’re 51).

In reality, the risk of pregnancy is very low. Spontaneous pregnancy is very low in women over 50, and after 47, 85% of pregnancies will end in miscarriage. That said, the US National Vital Statistics Report shows that 1 in 10,000 US women over 50 gave birth in 2021 to a total of 1041 babies. The oldest mother was 54. The advice to use contraception until a year after your last period is sound.

Embracing the journey

Menopause, whether early, on time, or late, is a natural and transformative phase in a woman’s life. For those who experience late-onset menopause, it can often feel like treading uncharted waters in the absence of widespread information. Yet, as we’ve uncovered, late menopause is not only relatively common but carries with it a blend of benefits and considerations. Genetics, lifestyle choices, and even the food we consume all play intricate roles in this timing.

While longer exposure to estrogen brings some health advantages, including a generally increased life expectancy, it’s essential to remain aware of the associated health risks and continue regular medical check-ups. Always consult with healthcare professionals about any concerns, ensuring you’re well-equipped for this next chapter of life.

The world of menopause is vast and diverse, just like the experiences of the women who journey through it. Regardless of when it begins, understanding, preparation, and self-compassion remain the keys to navigating its course with grace and confidence.

Practical takeaways: navigating late-onset menopause

Understanding the Timing: While the average age for menopause is 51, it’s not a set age. Some women enter menopause in their mid-40s, while others may not start menopause until after the age of 55. It’s essential to understand that menopause can occur at various times. There isn’t a set age when menopause should start.

The Role of Genetics: Your genetics, especially from your mother’s side, can greatly influence the timing of menopause. If your mother went through menopause later in life, there’s a chance you might too.

Lifestyle and Environmental Influence: Factors like diet, smoking, and even being single can delay or advance the onset of menopause. For instance, a diet high in oily fish can delay menopause, while a high intake of refined carbs might usher it in earlier.

Health Implications: Women who enter menopause late generally have an extended exposure to estrogen, which can be both a boon and a bane. While this prolonged exposure is associated with health benefits like a reduced risk of cardiovascular disease, it’s also linked to a slightly increased risk of estrogen-sensitive cancers. Overall, though, you’re likely to live longer.

Symptom Management: Experiencing menopause later doesn’t exempt you from its symptoms. However, the good news for women experiencing late-onset menopause is that these symptoms tend to be milder and shorter-lived.

Continued Vigilance: Even if you’re entering your menopause late, regular medical check-ups are crucial. Especially since late menopause is associated with some health risks. Also, remember that even in the lead-up to menopause, there’s still a risk of pregnancy. Contraception should be considered until a year after your final period.

Remember, Menopause is Natural: Regardless of age, every woman goes through menopause. It’s not a disease but a natural phase in a woman’s reproductive years. Treatments are available to manage menopausal symptoms, and it’s essential to consult a healthcare professional for personalized guidance.