Menopause: Birth Control and Age of Onset

This is a rather silly question, well two in fact and they are completely unrelated.

I was wondering if taking certain birth control pills and other contraceptives delay the onset of menopause because they prevent ovulation.  I realize I could have that completely wrong but that is why I am asking.

Also can women with breast implants breastfeed, I have just always been curious.

I like both of these questions a lot because they're interesting and I don't know the answers off the top of my head.  I'm going to have to do some digging for you!  I'll break it up into two entries.  Today, menopause and birth control.

On superficial digging (Wikipedia, Our Bodies Ourselves, Mayo Clinic, and other assorted sites on women's health), I was not able to find any mention of the pill and how it relates to the age of onset of menopause.  I learned that menopause is the result of a massive shift in hormonal function of the ovaries, and this appears to be much more complex than simply running out of eggs.  At first glance, there seems to be no record of a relationship between taking the pill and extending your years of menstruation.

I did, however, find these interesting correlations from Our Bodies, Ourselves:

• The higher your education, income, and job status, the later your age of menopause is likely to be.
• Women now have generally later menopause than women a century ago.
• Women in the US have later age of menopause than in a couple of developing nations that have been studied
• One pregnancy tends to result in a slightly later onset of menopause than no pregnancy, and two pregnancies makes it even slightly later.

OBO suggests that nutritional differences are likely the cause of the socioeconomic and standard-of-living correlations.  The better your nutrition, the longer your body is likely to be capable of producing offspring.  That makes sense.  On the other hand, nutrition isn't the only difference here. 

Woman of high socioeconomic status in the modern first world are probably the most likely of all groups to be on hormonal contraceptive for a long period of time at some point in their adult lives.  Wealthy, well educated, employed people tend to have best access to health care in the US, and therefore the best access to birth control pills.  Our nutrition today is possibly better than a century ago, but then again, there are surely more women on the pill now than back before it existed!  The pregnancy correlation is interesting too.  If each pregnancy lasts about nine months, that's nine periods you don't have, nine eggs not released, and if you breastfeed after you give birth, your hiatus of ovulation could be well over a year.  Maybe that does push the date back some.

Nothing's ever simple.  You could make a converse argument that women without plentiful, well rounded nutrition probably don't ovulate every four weeks anyway, so if it were as simple as running out of eggs, then it would be the malnourished who undergo menopause latest, but clearly that is in stark contrast with the observations above.

All this led me to Pubmed for more details.  I found two abstracts on the subject, Factors Associated With Early Menopause, and Determinants of The Age of Natural Menopause.  These both suggest some delay of menopause from use of birth control pills, but the more recent one (published in 2002) calls for better long-term study before drawing a definite conclusion.  Maybe these studies exist by now, but I did not find them in my limited search.

Here is my take on the matter:

I think it is highly likely that use of hormonal contraceptive would somewhat delay the onset of menopause in much the same way that having a child appears to.  I do not think that this delay will ever be more than a few years, so I don't think that a generation of women who use the pill for decades will suddenly be having periods well into their 70s or 80s, but it may push you out to menopause at 54 instead of 51 (which is average). 

There appear to be other factors that have a bigger, more measurable and well-studied impact on the age of your menopause.  Genetics definitely play a role.  If your mom's menopause came really early or really late, yours likely will too.  The length of your periods seems to be a factor, the shorter your periods, the sooner your menopause is likely to come.  Smoking seems to cause early menopause, perhaps because of some toxicity or modification in blood supply to the ovaries.

Your question was so simple, but the answer appears to be awfully complex!  It's not as being born with a certain number of eggs and reaching menopause when you use them up, but I think there is probably some relationship there, and that might well mean that using your birth control pills for a long time pushes back your menopause deadline by a coupe of years.  I don't know if that's a good or bad thing.  Later menopause means more years of getting your period and having to worry about birth control, but it also means that you push back a hormone shift that is very uncomfortable for many and tends to bring with it new problems like bone density loss.  It's a mixed bag.

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Woman of high socioeconomic status in the modern first world are probably the most likely of all groups to be on hormonal contraceptive for a long period of time at some point in their adult lives.