Hormonal changes associated with menopause may appear years earlier than previously recognized. Digest
The final menstrual period marks a single point in a longer hormonal transition. A new study examined the onset of hormonal changes and the timing of accompanying physiological shifts throughout the body.
Researchers analyzed more than 300 million lab test results from two large datasets, covering about 36,000 women in US health surveys and 1.3 million women in Israeli medical records. The analysis estimated how different health markers change in the years before and after menopause, accounting for variation in its timing among women. These patterns were also compared with those seen in men to help distinguish menopause-related changes from general aging.
- Abrupt shifts occurred in 52 of 90 physiological measures around menopause, compared with more gradual changes in men. These included measures related to reproductive hormones, bone, liver function, and blood lipids.
- Changes in reproductive hormones, including anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), and estradiol, began accelerating an estimated 12–15 years before menopause.
- Current hormone replacement therapy users showed smaller shifts than nonusers in many measures, especially those related to bone, liver, kidney function, and fluid balance.
- Osteoporosis, heart attack, and stroke became increasingly prevalent after menopause, while anemia became less prevalent.
- Sleep difficulties and depressive symptoms increased temporarily around menopause.
The early hormonal changes reflect the gradual loss of ovarian follicles. As their number declines, AMH falls and changes in hormonal feedback allow FSH to rise, even while estrogen production is largely maintained. Closer to menopause, estrogen levels become more variable and eventually fall more sharply. Because estrogen receptors are found throughout the body, this decline can affect many organs. However, tissues differ in their sensitivity to estrogen and how quickly they respond, which may help explain why some measures shift abruptly while others change more gradually.
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Two women of the same age may be at different points in the menopausal transition. A better understanding of menopause timing could therefore help move preventive care beyond chronological age to account for the physiological changes accompanying reproductive aging.
In Q&A #43, I discuss menopause and the benefits and risks of hormone replacement therapy.