Menopause Versus Chronologic Aging: Their Roles in Women's Health

Rebecca C. Thurston, PhD; Carrie A. Karvonen-Gutierrez, PhD, MPH; Carol A. Derby, PhD; Samar R. El Khoudary, PhD, MPH; Howard M. Kravitz, DO, MPH; JoAnn E. Manson, MD, DrPH, NCMP


Menopause. 2018;25(8):849-854. 

In This Article

Abstract and Introduction


Midlife, typically defined as age 40 to 65 years, is a critical time for women. This period encompasses both chronologic aging and the reproductive axis aging of the menopause transition. Furthermore, midlife is a time of pronounced changes in body composition, cardiometabolic health, mood, sleep, cognition, and overall functioning, and is a period in the lifespan directly preceding a heightened risk of major chronic diseases, such as cardiovascular disease (CVD). Thus, understanding the relative impact of chronological versus reproductive axis aging on these important health indices is of interest both to shed light on the underlying physiology of these chronic conditions as well as to guide preventive efforts to enhance women's health as they age.

Although a critically important goal, disentangling the relative contributions of chronologic and reproductive aging to women's health is a complex task. Cross-sectional studies are not well equipped to address this question, as women who transition through menopause at earlier versus later ages are not directly comparable. Thus, to rigorously address the relative contributions of chronologic and reproductive aging to women's health, longitudinal studies that follow a cohort from premenopausal years through the menopause transition and into the postmenopause are required. Such studies require large samples and are complex, lengthy, and expensive. The last 25 years, however, have brought critical insights from studies designed to do just that, including the Study of Women's Health Across the Nation (SWAN), the Seattle Women's Health Study, the Melbourne Women's Midlife Health Project, the Healthy Woman Study, and the Penn Ovarian Aging Study (POAS). Here we will touch upon insights generated by these cohort studies and related studies on the relative contributions of chronologic and ovarian aging. Rather than attempting to address all possible bodily systems, here we focus on cardiovascular and cardiometabolic health, body composition and adiposity, sleep, mood, and cognition, as these areas include the leading cause of death in women (eg, CVD) and factors that women report to be important issues during the menopause transition (eg, mood, sleep, cognition, and weight gain/body composition changes).