Will My Generation Be the Last to Experience Menopause?

Not long ago, this question would have seemed odd to me. I always thought that everyone with ovaries, including myself, would eventually undergo what’s often referred to as “the change of life.” Lately, though, researchers are challenging what we considered established truths about human biology. They’re asking provocative questions: “What if menopause occurs much later?” or even, “What if it could be entirely prevented?”

In recent years, patients have had access to a wider range of medications to alleviate menopausal symptoms like hot flashes and vaginal dryness. More notably, newer treatments—some in clinical trials—aim to tackle the underlying issue: they seek not just to mask symptoms but potentially to slow down the aging of ovaries, delaying, or perhaps halting, the hormonal changes that typically come with midlife. “For the first time in history, we may have the means to delay or possibly eliminate menopause,” said Kutluk Oktay, a reproductive surgeon and ovarian biologist at Yale University, in a press release last year.

As someone who covers reproductive health, I’ve been inundated with updates on research like this. Being an elder millennial approaching the uncertainty of perimenopause, which some studies indicate can start as early as a person’s 30s, I find these developments intriguing but also somewhat unsettling.

On one side, the decline in estrogen associated with menopause is linked to various health issues, from heart disease to osteoporosis. Delaying menopause even by five years could lead to significant improvements in women’s health and reduce mortality, said Zev Williams, director of the Columbia University Fertility Center. “It’s an exciting prospect,” he added.

However, the notion of completely eliminating menopause brings up valid concerns. It sometimes feels like another way of suggesting that women should remain perpetually youthful and fertile. In a cultural landscape where public figures, like JD Vance, speak dismissively about the worth of postmenopausal women, I find it disconcerting to treat a natural aging process as something that needs fixing.

Still, if the concept of stopping menopause raises questions, it also presents a chance to reflect on our lives as we age. It prompts discussions about balancing health concerns with the acknowledgment that, like everyone else, women age. Ashton Applewhite, author of “This Chair Rocks: A Manifesto Against Ageism,” noted, “You can’t stop aging, or you’re dead.”

For context, it helps to understand the ovaries—the reproductive organs responsible for storing and releasing eggs. Starting at puberty, these glands increase their production of estrogen, influencing various bodily changes. Throughout the reproductive years, ovaries produce hormones in alignment with a monthly cycle to prepare for potential pregnancy. However, by a person’s late 30s, estrogen production begins to wane. By the mid-40s, most individuals enter perimenopause, characterized by fluctuating estrogen levels. This hormonal decline typically leads to symptoms like irregular periods and hot flashes.

The symptoms that many attribute to menopause often begin during perimenopause, ranging from mildly annoying to profoundly debilitating. Recently, perimenopause has gained significant media attention, with companies eager to market solutions for its challenges. Conditions like hot flashes can lead to loss of workplace productivity, costing the U.S. economy an estimated $1.8 billion annually. Moreover, low estrogen can lead to vaginal dryness, causing discomfort during sexual activity and sometimes persistent pain.

Eventually, ovaries cease egg production, marking the onset of menopause, which is diagnosed after a full year without a menstrual period. This typically occurs around age 51, although Black and Latina women often reach menopause earlier than their white counterparts. While some symptoms, like dryness, may persist post-menopause, others, like hot flashes, often improve.

Hormonal shifts around menopause are also associated with heightened risks of heart disease, according to Stephanie Faubion, director of the Mayo Clinic’s Center for Women’s Health. Blood pressure, cholesterol, and insulin resistance—which can lead to diabetes—often escalate during this phase. Bone density, too, tends to decrease, elevating the risk of osteoporosis as menopause advances.

Given all this, it’s understandable why experts increasingly ponder whether menopause is something we could avoid altogether.

Currently, hormone therapy—including estrogen alone or combined with progesterone—exists to manage menopausal symptoms. Although once frowned upon following a 2002 study linking it to breast cancer, medical professionals now assert that benefits typically outweigh the risks. For instance, estrogen can drastically reduce hot flashes and even mitigate cardiovascular risks while in use.

Research shows that illnesses like dementia and heart disease occur less frequently in women than men—until ovarian function wanes. “If we can safely extend ovarian longevity, we might allow the ovary to confer its health benefits for a longer duration,” Williams explained.

While estrogen therapy can compensate for some of the hormones that a person’s ovaries no longer produce, it doesn’t halt ovarian aging. Some researchers are exploring more invasive options. In a recent study, Oktay and his team utilized mathematical models to assess how ovarian tissue cryopreservation might function in healthy individuals. This process involves removing a section of an ovary, freezing it, and later re-implanting it—typically done for cancer patients. Used in healthy individuals under 40, this method could significantly delay menopause.

Oktay’s team has begun preserving ovarian tissue from healthy patients, intending to reintroduce it around menopause. However, actual results will take time to materialize, as they have to await years of data collection. Past use in cancer survivors indicates it does restore ovarian function.

Approximately 10% of women enter menopause at 55 or older, which is associated with better health outcomes and a lower likelihood of developing osteoporosis or diabetes than those who experience menopause earlier. Oktay noted, “We’re essentially asking—why not allow everyone this benefit?”

Meanwhile, Williams’ team is pursuing a less invasive method through an initial human trial of rapamycin, an oral medication used as an immunosuppressant. Studies in animals suggest that it may extend lifespan, with implications for human longevity. Preliminary findings indicate that rapamycin might also prolong ovarian function and fertility.

Currently, 50 women aged 35 to 45 are participating in the trial, taking either rapamycin or a placebo. Researchers are assessing mood, memory, sleep quality, and ovarian function through blood tests and ultrasounds. Although they haven’t gathered results yet, no serious side effects have been observed thus far.

However, the aim isn’t just to extend fertility; as Williams put it, “that’s something I consider regularly,” but equally to enhance the health benefits attributed to ovaries—in hopes of reducing chronic illness risk.

Research in this area is generating considerable excitement, as the idea of delaying menopause is gradually gaining attention. During the latter part of the Biden administration, Jill Biden initiated a women’s health initiative focused on exploring this concept.

As expressed by Renee Wegrzyn, who leads this initiative, it’s fascinating that we generally accept the eventual failure of the ovaries. “It’s a bit extraordinary that we all just accept this reality,” she said.

While some harbor skepticism about the potential positive outcomes of delaying menopause, issues surrounding illness correlations are not always straightforward. Faubion raised a thought-provoking question: “Is it cause and effect? Do those who experience menopause later have healthier ovaries because they generally maintain better health?”

Moreover, the prolonged function of ovaries, and thus increased exposure to estrogen, might come with its own risks, including a heightened likelihood of breast cancer or blood clots. The benefits might not be universally applicable, as individuals may experience varied health outcomes.

In terms of undergoing more invasive procedures, ethical considerations arise. “What are the ethics involved in removing a healthy organ from a healthy individual just to delay menopause?” Faubion mused.

Despite these concerns, Oktay defended ovarian tissue cryopreservation as a minimally invasive laparoscopic procedure that can coincide with other necessary surgeries. Many subjects in their research have family histories of severe menopause-related conditions, making them more inclined to want to delay the transition.

Yale’s Minkin finds the experimental treatments to be promising, especially for extending fertility. Still, she questions whether such advanced methods are necessary for managing the physical aspects of menopause, noting, “We have many straightforward options for hormone therapy.”

Certain individuals, particularly cancer survivors, may not be able to use hormone therapies, making new treatments crucial. Additionally, some experts see advantages in postponing menopause, particularly for those who transition early—around 1% of women experience menopause before 40 and 5% before the age of 45. Factors such as cancer treatments or autoimmune disorders can lead to premature menopause; thus, new methods to address this might represent a net benefit for wider public health.

Early menopause can be profoundly distressing, especially for those wishing to become parents. However, for those entering menopause at average ages, the transition often brings social or emotional rewards, despite physical hardships.

“It’s liberating,” Applewhite remarked. “Say goodbye to mood swings and the constant fear of unexpected pregnancies.”

Denise Pines, creator of the menopause summit WisePause, added, “I haven’t met a woman who wants to deal with menstruation every month.”

Interestingly, research indicates that many women experience increased happiness as they age, particularly post-midlife. This uplift might come from less time spent on childcare and familial duties. Some anthropologists theorize that human females live beyond reproductive years partly to assist with grandparenting—a notion referred to as the “grandmother hypothesis.” Minkin provided an alternate view: In early human communities, pregnant individuals couldn’t engage in heavy lifting, making grandmothers the laborers, as they could manage tasks like moving rocks.

Even the challenging aspects of menopause, such as night sweats or hot flashes, can serve as a useful “disruptor” in one’s life, Pines stated. “Women who typically give their energy outward suddenly need to shift focus back to themselves.”

This shift can encourage a complete re-evaluation of life, including priorities and relationships, Pines noted, making it an opportune time for self-discovery.

Applewhite appreciates the growing awareness surrounding menopause and endorses hormone therapy for managing symptoms, stating, “I’m not advocating for avoiding all medical interventions.” Yet, she expresses concern over framing menopause as a condition to be eliminated, remarking it is troubling to pathologize inevitable aspects of aging, especially for women, whose aging is often stigmatized. “In a patriarchal world, a woman’s value is tied to her ability to reproduce,” she observed. This stigma contributes to the scarcity of research on older women’s health, as they are often viewed as no longer being valuable.

Despite the allure of extending healthy lifespans, I find myself struggling with the implications of it all. I have seen firsthand how liberating it can feel to conclude reproductive years, and I, too, have encountered frustrations with a medical focus on reproductive capabilities over other health aspects. While I aspire to maintain my health as I age, I also desire acceptance of the aging process—not just internally, but in the perceptions of those around me.

Applewhite emphasizes the value of reimagining later life as a phase rich with strength, freedom, and possibilities. I share that sentiment and hope to embrace aging rather than evade it.

When discussing these concerns with Williams, he questioned if I would feel similarly about treatments for other bodily functions—like the heart or liver. “You’d want to maintain those functions,” he noted. Yet, “the discussion shifts when the topic turns to ovarian aging.”

This observation makes sense, especially since the health outcomes he and others aim to enhance are not purely about maintaining fertility or adhering to societal standards of youth. They center around overall well-being: cardiovascular and mental health, which I deeply value.

Williams contended that understanding ovarian aging could ultimately help normalize discussions about menopause and aging in general. He noted that breaking down stigma—like that surrounding recurrent miscarriage—has happened when knowledge replaces myths and taboos.

It’s critical to acknowledge that the research landscape surrounding menopause, like many areas of reproductive health, is at risk under current political climates. Confirming this, I found that Jill Biden’s menopause initiative was recently removed from its online presence, and Wegrzyn was dismissed earlier this year. In a time when vital medical research faces unprecedented challenges, it’s hard to dismiss treatments that have the potential to enhance health.

After speaking with Williams and others, I’m not opposed to a medication that could promote longevity without debilitating health effects. Yet, I’m increasingly aware that external factors are just as significant to our well-being as internal changes.

When I asked Pines about her hopes for individuals in perimenopause and menopause, she expressed a desire for a future where these life stages are openly discussed and not trivialized. She advocated for workplace support for those experiencing perimenopause-related symptoms, along with insurance coverage for treatments. Additionally, she called for better training for medical professionals on these topics, which is, unfortunately, often lacking.

“Once we establish those frameworks,” she concluded, “our society can begin to regard aging and older women in a different light.”