Late Menopause

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Menopause refers to cessation of menstrual period for twelve months in a row. This naturally occurs in majority of women between age 45 and 55 years. Though menopause refers to the date at which menstruation ceases, it is diagnosed after 12 months of consecutive cessation of menses. However, when a woman is still menstruating at age 55 and above, she is said to be experiencing late menopause. 

The time of menopause is individualised, just as the time of commencement of menstruation (menarche). Therefore, late menopause is a normal variation as seen in other natural processes in humans. Factors such as parents (genetics), menstrual cycle patterns, medication and lifestyle may, however, influence the timing of menopause. 

What are the risk factors for late menopause? 

  1. Family history – If the mother of a woman experiences late menopause, there is every tendency that she will also experience same. This is likely to be genetic programming for that particular woman.
  2. Obesity – In obese women (BMI ≥ 30kg/m2), fat cells produce oestrogen. This oestrogen continues to stimulate the lining of the womb, which in turn sheds after a while as menstruation. Normal BMI is between 18.5 and 24,9. Those who are between 25 and 29.9 are overweight while those with BMI of 30 and beyond are obese.
  3. Disorders of thyroid gland – Women with disorders of thyroid gland can have disruption of their menstrual cycle. This is due to the disruption of the body’s metabolism generally, including the hormones controlling menstrual cycle. Thyroid disorders may also mimic menopausal symptoms.
  4. Menstrual cycle patterns – Starting menstruation late may lead to late menopause, while maintaining similar range of reproductive years with women who started menstruating earlier. For example, a woman who started menstruating at 10 years and stopped at age 50 years and another woman who started menstruating at 16 years and stopped at 56 years may have menstruated for same number of years but the latter experienced late menopause.
  5. High oestrogen levels – Women with naturally high oestrogen levels may experience late menopause. This is because the oestrogen continuously stimulates the lining of the womb to subsequently result in menstruation.
  6. Pregnancies – Women who have many pregnancies and those who have pregnancies into late their 40s and early 50s tend to experience late menopause. This may be due to the disruption of hormone regulation by pregnancy hormones.
  7. Contraceptive pills – Women on birth control pills may experience late menopause. Whether this is because the drug masks menopause by creating artificial bleeding when the ovaries have stopped producing oestrogen or it has direct effect on the ovaries in delaying menopause is not certain.

What are the beneficial effects of late menopause?

Delayed complications of menopause – The presence of oestrogen till later years in women helps delay the onset of osteoporosis (loss of bone mass resulting in easy fracture), hot flushes and dryness of vagina, resulting in pain during sexual intercourse. Since the reproductive hormones protect against heart disease and its complications, the onset of these diseases, such as hypertension, heart failure etc may also be delayed.

Adverse effects of late menopause

Due to the continued presence of oestrogen for a prolonged period, there is an increased risk of uterine, ovarian and breast cancers in women with late menopause.

Prevention of adverse effects of late menopause

To prevent the cancers associated with late menopause, the following measures are necessary:

  1. Regular pelvic examination by doctors (annually)
  2. Regular pap smears (every three years for those with normal findings in the previous one)
  3. Regular mammograms (every two years)
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