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Menopause has been having a moment. Books, podcasts, TV shows and crowds of influencers are all focused on warning women about what is coming in midlife. But what if you are all prepped and waiting, and menopause just isn’t showing up?
Around 5% of females still need to shop for period products after the age of 55. Aside from the inconvenience of experiencing menstrual bleeding at a time when you might reasonably expect to be free of it, late onset menopause also has some implications for health.
It is not all bad news. There is even some research to suggest that a later age at menopause may result in longer life expectancy. And scientists are now starting to look at delaying menopause, by prolonging the functional lifespan of the ovaries, the glands in which eggs form and the hormones oestrogen and progesterone are made.
In one experiment, transplanting the ovaries of young mice into older ones led to enhanced longevity.* Meanwhile, a trial at Columbia University is looking at using the immunosuppressive drug rapamycin to delay ovarian ageing and so slow the rate at which women lose the protective effects of reproductive hormones.
Oestrogen is particularly potent. There are oestrogen receptor cells all over the body – in the brain, skin, vagina and vulva, bladder wall, etc. And so maintaining a good supply of oestrogen for longer will help delay the weakening of bones and the genito-urinary symptoms that strike women post-menopause, and potentially also benefit cardiac and brain health.
However, continuing oestrogen production for longer may also bring with it an increased risk of developing hormone sensitive cancers, in particular breast and uterine cancer.
“From a breast cancer point of view, we know that total lifetime exposure to oestrogen contributes to some potential risk, but it’s a small ticket item compared with some of the lifestyle factors like body weight and alcohol intake that also influence it,” says Christchurch menopause expert Anna Fenton.
A woman is classed as having gone through menopause when she has been a full year without a period. Fenton, a gynaecological endocrinologist, says if you are still having periods in your late 50s, particularly if the bleeding is erratic or if there is a change in terms of flow, it is worth getting checked out in case something else is going on.
“There are conditions that affect the uterus, including cancer, adenomyosis, fibroids and polyps that might cause erratic bleeding,” she explains. “You may assume it’s just a period when, in fact, it needs to be treated and managed.”
Women with polycystic ovary syndrome may find themselves reaching menopause later than average as they tend to have more follicles and eggs.
“For some women, particularly those with a male hormone imbalance, ovulation can become more regular and predictable the closer they get to menopause, as the hormone imbalance becomes less of an issue. For that group, pregnancy is still a concern,” says Fenton.
All woman over 50 should continue with contraception for 12 months after the final menstrual period, advises the Australasian Menopause Society. For women younger than 50, the return of fertile ovulation is more likely therefore contraception should be used for two years following the final menstrual period.
There are options for those women who are over having periods and impatient to be free of them. Progesterone-releasing IUDs such as the Mirena won’t guarantee that the bleeding will stop altogether, but it will become lighter. In this country, the Mirena is fully funded, although there may be fees for a doctor’s visit and the insertion.
“There are also medications that will stop periods and sometimes we do use those particularly for women whose hormones are very erratic, because the symptoms related to that can be pretty annoying,” says Fenton.
Every woman’s reproductive system is different, and there is no predicting when the menopause transition will begin or how long it is going to last. However, there is one more potential benefit of a later-onset. A 2017 study for the North American Menopause Society suggests that the earlier perimenopause symptoms begin the longer the transition is likely to take.
