Late menopause is not so common, and therefore not much is said about it. However, in some regions of the world, it occurs in more than 10% of women (1).  

To find out when menopause normally begins, different countries have established age averages. In general, the estimations are that the last menstruation occurs between 45 and 55 years of age (2).  

Thus, if a woman stops menstruating before the age of 45, we speak of early menopause. On the other hand, it will be classified as “late” when bleeding continues beyond the age of 55 years (3). 

Possible causes 

Women who have amenorrhoea after the age of 55 years often share some common characteristics. However, it is still unclear why menopause may be delayed (4). Among the most frequent associated factors are the following: 

• Genetics: family history has an influence (5). 

• Lifestyle: smoking and heavy alcohol consumption are two habits that have been associated with early menopause, while regular exercise may delay it (4). 

• Reproductive history: women who have had several pregnancies tend to experience menopause later. Also, those who used hormonal contraceptives (6). 

• Obesity: fat tissue is hormonally active. Therefore, women who are overweight or obese tend to have their last menstrual period later than the rest (4). 

• Underlying diseases: disorders such as thyroid problems or diabetes can affect the functions of the uterus and ovaries by modifying the timing of menstrual cycles (1). 

Symptoms and signs of late menopause

The delay in the onset of the last menstrual period is the determining sign. But beyond age, the symptoms and signs do not differ from those typical of menopause, which occur between 45 and 55 years of age (2,3). Among them, we can mention the following (2,7): 

• Problems falling asleep. 

• Changes in mood, such as irritability, anxiety, or symptoms of depression. 

• Vaginal dryness, which causes discomfort during sexual intercourse. 

• Hot flushes, i.e., sudden episodes of intense heat, with sweating and reddening of the skin. 

• Increased risk of cardiovascular and bone diseases due to decreased oestrogen levels. 

• Weight gain or changes in body fat distribution, with accumulation around the abdomen and hips. 

• Presence of irregular periods in the months prior to the last menstrual period, with or without intermenstrual bleeding. 

Possible consequences 

Late menopause has the following positive consequences:  

• By having oestrogen action for more years, women reduce the risk of suffering from some diseases. In addition, they can avoid hormone replacement therapy (1). 

• Bone health is enhanced. Ultimately, delaying the onset of the last menstrual period may decrease the risk of osteoporosis (1). 

• Oestrogens have a cardioprotective effect. Consequently, women with late menopause are less exposed to cardiovascular risk factors, such as increased cholesterol (1). 

On the other hand, it should be mentioned that a longer time of hormonal exposure is associated with increased risk for some types of cancer. In particular, breast, uterine and ovarian cancers (8). 

How to maintain an optimal quality of life during late menopause? 

Late menopause can trigger a series of complex emotions and mixed feelings in women. Talking to others of the same age who have already stopped menstruating may generate anxiety about not being in the same stage (9). 

The support of friends, family and loved ones is of great help. There are even climacteric support groups that serve to share experiences and learn about similar situations (10). 

Adopting a healthy lifestyle is also useful when going through this stage. This includes a balanced diet, regular exercise, sufficient sleep and avoiding alcohol and tobacco consumption (10). 

And when faced with the classic symptoms of menopause, many women find relief in various practises. For example, meditation, yoga and cognitive behavioural therapy have shown to be beneficial for some women during this transitional stage (11). 

So, if you are over 55 and continue to have menstrual cycles, do not be alarmed. You can discuss your concerns about late menopause with a healthcare professional. In a consultation, they will offer you specific guidance for your situation. 

Referencias bibliográficas 

1. Vatankhah H, Khalili P, Vatanparast M, Ayoobi F, Esmaeili-Nadimi A, Jamali Z. Prevalence of early and late menopause and its determinants in Rafsanjan cohort study. Sci Rep [Internet]. 2023 [cited 2024 May 08];13(1):1–8. Available from: https://www.nature.com/articles/s41598-023-28526-y

2. NHS. Overview menopause [Internet]. National Health System 2022 May 17 [cited 2024 May 08]. Available from: https://www.nhs.uk/conditions/menopause/

3. Peacock K, Carlson K, Ketvertis KM. Menopause [Internet]. StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507826/

4. Arinkan SA, Gunacti M. Factors influencing age at natural menopause. J Obstet Gynaecol Res [Internet]. 2021 [cited 2024 May 08];47(3):913–20. Available from: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/jog.14614

5. Bae H, Lunetta KL, Murabito JM, Andersen SL, Schupf N, Perls T, et al. Genetic associations with age of menopause in familial longevity. Menopause [Internet]. 2019 [cited 2024 May 08];26(10):1204–12. Available from: https://journals.lww.com/menopausejournal/abstract/2019/10000/genetic_associations_with_age_of_menopause_in.19.aspx

6. Roman Lay AA, do Nascimento CF, Horta BL, Dias Porto Chiavegatto Filho A. Reproductive factors and age at natural menopause: A systematic review and meta-analysis. Maturitas [Internet]. 2020 [cited 2024 May 08];131:57–64. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0378512219304529

7. NHS. Symptoms menopause [Internet]. National Health System 2022 May 17 [cited 2024 May 08]. Available from: https://www.nhs.uk/conditions/menopause/symptoms/

8. Dunneram Y, Greenwood DC, Cade JE. Diet, menopause and the risk of ovarian, endometrial and breast cancer. Proc Nutr Soc [Internet]. 2019 [cited 2024 May 08];78(3):438–48. Available from: https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/diet-menopause-and-the-risk-of-ovarian-endometrial-and-breast-cancer/4AF83873A97A4EDC72D0E5E4DCAD4F7B

9. Refaei M, Mardanpour S, Masoumi SZ, Parsa P. Women’s experiences in the transition to menopause: a qualitative research. BMC Womens Health [Internet]. 2022 [cited 2024 May 08];;22(1). Available from: https://pubmed.ncbi.nlm.nih.gov/35219295/

10. NHS. Things you can do. Menopause [Internet]. National Health System 2022 May 17 [cited 2024 May 08]. Available from: https://www.nhs.uk/conditions/menopause/things-you-can-do/

11. Djapardy V, Panay N. Alternative and non-hormonal treatments to symptoms of menopause. Best Pract Res Clin Obstet Gynaecol [Internet]. 2022 [cited 2024 May 08];81:45–60. Available from: https://www.sciencedirect.com/science/article/pii/S1521693421001693