Menopause occurs when ovaries cease production and a woman has her last period. Once there have been no subsequent periods for 12 months, it is determined that menopause has indeed occurred. The actual date of menopause is then retroactively determined. For instance, if your last period ends on March 11, 2014 and you don’t have a period for 12 months (March 11, 2015), the date of menopause is March 11, 2014. The term postmenopause then applies to the time after the date of menopause – not the date that is a year later.
Like other life phases, postmenopause has unique characteristics when it comes to hormones. Cognitive issues are important, as are bone density issues such as osteoporosis. With regard to the former, the timing of estrogen use is very important. For osteoporosis and similar issues, hormones in earlier life phases are of great impact. Pituitary hormone FSH and LH levels rise during this life phase and progesterone and estrogen hormone levels decline. Because there’s no ovulation, no progesterone is produced.
Age Ranges
In my research, I found a variety of ages listed for the onset of menopause. These are the most common.
| Age ranges | Between 45 and 55 (generally). Maybe to age 60. |
| Average age | 51 |
| Early menopause | Before age 40 |
| Late menopause | After age 55 |
Cause of Injury
According to the CDC, falls are the most common cause of TBIs for people over the age of 45. For those over age 65, falls cause over two-thirds of TBIs (81%). [1] This is different than the childbearing age group. A University of Rochester study found that falls were the second most common cause of TBI for females. Motor vehicle crashes were highest (43.2%) and falls caused 27%. The mean age for that study was 30 years. [2] CDC statistics show that motor vehicle accidents are highest in the 25-44 age group. [3] For adolescent age groups, sports injuries are an increasing cause of TBI injuries reported at hospital emergency departments. Since 2009, they’ve increased 57% for those under 20 years of age. [1]
Some risk factors for falls for older adults are issues common to concussion: gait and balance instability, and vision and cognition. [4] If a woman falls and a concussion results, could she then be at an increased risk for another fall, one which may result in another injury which requires hospitalization or surgery, such as a hip injury? Also, osteopenia and osteoporosis are issues that I think should be considered. Going back to puberty and mid-adolescence, if a girl has issues with amenorrhea or the Female Athlete Triad before age 17, irrevocable bone loss could occur. Bone density issues are one of the three main components of the Triad. If a female has issues with hormones in her earlier years, might that affect the prevalence, type, and severity of falls later in life?
With all this in mind, I’m guessing. Perhaps hormones aren’t the issue as much in later years with regard to falls and cause of injury, particularly over age 65. Perhaps issues in later years are due to hormone insufficiencies earlier in life. That provides all the more reason to focus on hormones in earlier life phases.
Cognition, on the other hand, is a different story.
“Critical Window” Theory
With the prospect of CTE hovering as well as memory and dementia issues, there’s much to consider for the postmenopausal years. Depending on the age at which it is taken, estrogen may help prevent dementia or it could potentially worsen it. This is known as the “critical window” theory. I don’t have time to look into this further at this point, but here’s some information for you in case you want to research it more.
“Women who took estrogen in mid-life but not in late life had a 26 percent decreased risk of developing dementia in old age compared with women who had never taken estrogen at any age, whereas women who took estrogen in late life but not in mid-life had a 48 percent increased risk of dementia compared with non-estrogen-taking women.” [5]
Surgical Menopause and Hormone Replacement Treatment
Several factors may hasten the date of menopause. Surgeries such as hysterectomy are one example. Bilateral oophorectomy to remove ovaries are another. Chemotherapy treatment may also result in early menopause. A longitudinal study released in December 2013 found that women who underwent surgical menopause at an earlier age had an increased risk of Alzheimer’s Disease (AD). [6] [7] Here’s an interesting note with regard to the study. Note the reference to the timeframe of hormone replacement treatment (HRT). This data, perhaps, supports the “critical window” theory.
“HRT use for at least 10 years, when administered within a 5-year perimenopausal window, was associated with decreased decline in global cognition. No associations were seen in women who had natural menopause.” [7]
Note: if you’ve had a hysterectomy and your uterus was removed but the ovaries were left intact, don’t assume you’ve reached menopause. Menopause occurs when the ovaries have ceased production. [8]
Combination of Estrogen and Progestin Hormone Treatment
There was a clinical trial for use of combined estrogen and progestin as part of the Women’s Health Initiative (WHI). In 2002, The National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) stopped the trial because the risk of breast cancer and cardiovascular issues was too high. [9] This was a major study, and you will see references to it in many places.
It’s important to be aware of this. In earlier life phases, combination birth control pills are used to treat menstrual cycle issues. However, these types of birth control pills can cause problems with bone density when the Female Athlete Triad has been diagnosed. [10] It’s an example of why it’s important to focus on BMD issues and the Triad in earlier life phases.
Notable Studies
Here is a list of larger studies regarding postmenopausal women which I’ve seen in the course of my research. Some include perimenopause as well. I don’t have time to research this more at the moment. However, I’m listing them here so you can look into them if you’d like. I can’t comment about the data or anything; these are just here as an FYI.
- WHI study regarding estrogen plus progestin (clinical trial, cancelled in 2002 due to high risk); see above
- SWAN study: Study of Women’s Health Across the Nation (longitudinal study begun in 1994) [11]
- Seattle Midlife Women’s Health Study
Postmenopausal Bleeding
There should be no bleeding after menopause. There is no ovulation and menstrual cycles don’t occur as in previous life phases. There would be no period. Therefore, it’s suggested that a person consult a physician if there is bleeding after menopause.
[1] Traumatic Brain Injury in the United States: Fact Sheet cdc.gov
[2] Bazarian J, Blyth B, Mookerjee S, He H, McDermott M “Sex Differences in Outcome after Mild Traumatic Brain Injury” Journal of Neurotrauma 27:527-539 (March 2010)
[4] Unintentional Fall-Related Injuries Among Massachusetts Older Adults Massachusetts Department of Public Health 2008
[5] Estrogen Therapy’s Link With Dementia Risk Depends on Age When Taken, Study Finds ucfs.edu February 1, 2011
[6] Confirmed: Surgical Menopause Linked to Cognitive Decline medscape.com December 18, 2013
[7] Age at Surgical Menopause Influences Cognitive Decline and Alzheimer Pathology in Older Women neurology.org December 11, 2013
[8] Medical Causes of Menopause webmd.com
[9] US estrogen plus progestin HRT trial stopped due to increased risk of breast cancer, stroke and heart attack CMAJ August 6, 2002
[10] 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad Clinical Journal of Sports Medicine March 2014 Volume 24 Issue 2 pg 96-119
