## What determines the timing of menopause? There are a number of factors that can affect the timing of the onset of menopause. - Genetics. Knowing when your mother or older sisters went through menopause can help predict when it will happen to you and how you will feel. - First period. Women who started their periods later than their peers tend to enter menopause earlier. - Number of births. As a general rule, multiple pregnancies delay menopause. On the contrary, in women who have not given birth, it begins earlier. - Oral contraceptives (OC) intake. Long-term use of combined OC distances menopause. - Lifestyle. A healthy lifestyle helps to prolong the reproductive period, while hard physical labor, poor nutrition, and bad habits shorten it. - State of health. Gynecological surgeries, especially the removal of ovaries, bring menopause closer. ## The first signs Changes in a woman's body start 3-4 years before the menopause begins. This transitional period is called perimenopause. It is characterized by ===a change in the menstrual cycle as the periods can become either too frequent or too infrequent. The cycle becomes irregular. In addition, there are vasomotor symptoms such as hot flashes or night sweats, sleep problems, depression, forgetfulness, decreased libido, and the hair and skin become drier and thinner. Some women gain weight, and joint pain may also occur. ## Last chance During perimenopause, hormone levels begin to fluctuate and ovarian function begins to decline, but this does not mean fertility stops. It is possible to get pregnant as long as ovulation continues. The pregnancy rate for premenopausal women is 10-20 % at ages 40-44 and 12 % at ages 45-49. > 75 % of pregnancies in women in their 40s are unplanned. ## Is there a test for menopause? - To assess the state of the hormonal system a number of tests may be prescribed, including the following: - [Estradiol](#https://l.orna.me/more/library/biomarker?id=46) - Luteinizing hormone ([LH](#https://l.orna.me/more/library/biomarker?id=120)) - Follicle-stimulating hormone ([FSH](#https://l.orna.me/more/library/biomarker?id=75)) - LH and FSH index - [Prolactin](#https://l.orna.me/more/library/biomarker?id=68) - Thyroid hormone ([TSH](#https://l.orna.me/more/library/biomarker?id=137)) - Antimüllerian hormone (AMH). On the 5th-7th day of the cycle, an ultrasound of the small pelvis is performed to determine the state of the ovaries and endometrium. These tests can show a trend and give an idea of fertility, but there is no test that can calculate the exact date of menopause.