As women enter perimenopause, they may wonder what causes menopause to occur at a certain age. The North American Menopause Society reports the average age for the natural onset of menopause is 51, but some women can enter menopause as early as age 40.
A growing body of evidence suggests that genetics play an important role in determining menopausal age. However, certain environmental and lifestyle factors, as well as cancer treatment, can also affect the onset of menopause.
Menopause Age and Heredity
A large cohort study of more than 200,000 women of European ancestry published in Nature identified 290 genetic variants that were associated with the age at which women enter reproductive senescence, as determined by ovarian reserve. Many of these variants are part of the pathway that repairs DNA. Researchers also examined a second population of more than 78,000 women of East Asian ancestry and found that although many of the markers were the same, they affected menopause to a greater or lesser degree than in the European population.
A 2021 study published in the journal Menopause asserts that genetic factors appear to influence vasomotor symptoms of menopause, such as hot flashes and night sweats. Similar to the findings of the Nature study, these influences may differ across various racial and ethnic groups.
Finally, a separate meta-analysis published in Menopause in 2019 pinpointed genetic variants that were associated with delayed menopause based on familial longevity. For instance, women who bore children after age 40 were four times more likely to live to 100 or beyond.
The value of these studies lies partly in the treatment options they could inform—for example, targeted gene therapies to extend fertility, rather than treating infertility—and partly in their potential for helping physicians one day predict a patient's menopausal age. This could provide more options and earlier fertility care for the small percentage of women who experience early menopause. It could also prove helpful in managing the effects of menopause that negatively affect a patient's quality of life, including vulvovaginal atrophy and recurrent urinary tract infections. An additional study published in Menopause found that women who were treated for genitourinary symptoms of menopause at an earlier age showed a more robust response to treatment.
Lifestyle Factors That Affect Onset of Menopause
Menopause can occur at an earlier age due to several lifestyle factors, including smoking and a high body mass index. However, the extent of the influence of these factors on age at menopause remains unclear. Notably, the authors of the Nature study found that a genetic risk score was better able to predict premature ovarian failure—which occurs when women reach menopause before age 40—than smoking status.
Menopause can also occur as a result of chemotherapy. Patients who have been diagnosed with cancer should be counseled on their fertility preservation options if they are considering pregnancy in the future.
Discussing Genetics With Patients
When patients ask if the age of menopause is hereditary, OB/GYNs should feel confident in accurately describing the genetic link. In the future, genetic testing might help identify women at greater risk for early menopause, which could help improve family planning and fertility treatment. For now, the best advice for patients may be to have a clear understanding of their family medical history and their risk factors.
