The Timing of the Age at Which Natural Menopause Occurs

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Methodologic Concerns

Most studies of the menopausal transition have been cross-sectional, rather than longitudinal, in design, providing an opportunity for distortion of the true picture of the timing of the final natural menstrual period, particularly for understanding factors that precede and may affect the timing of menopause. Further, definitions of menopause or the final menstrual period have varied from study to study in terms of the number of months of amenorrhea considered to represent in retrospect the

Summary of Underlying Physiology

Menopause is defined as the cessation of menstruation which reflects cessation of ovulation owing to a loss of ovarian follicles, which in turn results in reduced ovarian production of estradiol, the most biologically active form of estrogen,37, 38 as well as increased circulating concentrations of follicle-stimulating hormone (FSH) and decreased concentrations of inhibin, which inhibits the release of FSH.37 Age at menopause may be more sensitive to varying rates of atresia of ovarian follicles

Conclusion

Despite important methodologic differences, the limitations in the study designs used and the populations studied in the accumulating literature regarding factors that affect the age at which the natural final menstrual period is experienced, an interesting and complex picture is emerging. A number of demographic (eg, education, employment, race/ethnicity), menstrual and reproductive (eg, parity and OC use), familial and genetic, and lifestyle (eg, smoking, weight, physical activity and diet)

Acknowledgments

The Study of Women's Health Across the Nation (SWAN) has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR) and the NIH Office of Research on Women’s Health (ORWH) (Grants NR004061; AG012505, AG012535, AG012531, AG012539, AG012546, AG012553, AG012554, AG012495). Dr Gold was supported by AG012554. The content of this article is solely the responsibility of the author and does not

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