It’s a brutal and bitter confluence of biology and bureaucracy – just as the restrictions on our reproductive autonomy grow ever more rigid and punitive, the length of our fertile years has never been longer. And for millions of us living in the United States, that means managing if and when we become pregnant, and the mental and physical health risks associated with this prolonged fertility, have never been more important.
As Nicole Karlis de Salon has reported, the average age of onset of puberty has been falling steadily over the past century – although medical experts have no conclusive explanation as to why. In the wake of the Supreme Court’s polarizing Dobbs decision, this decline now has chilling implications, as demonstrated by the recent controversy over a 10-year-old pregnant rape victim’s odyssey to obtain a safe and legal abortion. The fact that the birth rate of children aged 10 to 14 dropped dramatically over the past three decades is testament to the power of reproductive health options available to the most vulnerable among us. But with an ever-shrinking safety net, what happens to those pregnant children now?
Want more health and science stories in your inbox? Subscribe to the weekly show newsletter The vulgar scientist.
Even without pregnancy, reaching puberty at a very young age presents multiple other potential complications. A rapidly maturing body with a brain that is at a different stage of development can be a huge psychological burden. A four-year study from Developmental Psychology found a correlation between the timing of puberty and a “lasting” risk of depression in girls, while a UK study by BMC Public Health found a higher likelihood of “Sexual Risk Taking, Substance Use, and Antisocial Behaviors in Early Adolescence” in children who started menstruating before age 12.
Then there are the physical risks. The Journal of the American Heart Association warns that “early and late age of menarche has been associated with increased risks of coronary heart diseaseand notes that “others have reported that an earlier age at menarche is associated with an increased risk of [cardiovascular disease] and all-cause mortality. Cross-cultural research in Korea points to other possible long-term problems, including obesity and diabetes. Research from the UK also suggests that those who menstruate early are more likely to report heavier bleeding and menstrual pain. Of course, there are genetic and socioeconomic factors to consider when exploring why precocious puberty appears to be associated with certain health risks, but the consequences still need to be better examined and addressed.
Then there is the monetary factor. Rules are very expensive. It’s not just about tampons, pads and cups either. It’s everything from pain relief to replacing clothes to missing school and work days. And the earlier these periods begin, the greater the financial burden.
“A 2020 study in Norway found that the onset of menopause was prolonged for almost three years.”
While the downward trend in the onset of puberty has been well observed and reported in recent years, less has been written about the extension of the onset of menopause. A 2021 research letter in JAMA stated that “trends in increase in age at natural menopause have been reported worldwide. Over the past six decades, the average age at natural menopause has increased by 1.5 years and the average length of reproductive life by 2.1 years.” A 2020 study from Norway and published in Human Reproduction found similar results, noting that since the late 1930s countries, the age of first menstruation has on average decreased, while the onset of menopause lasted nearly three years.
Having periods for decades and decades carries health risks. “More years of ovulatory cycles may increase risk or disease burden for conditions associated with frequent menstruation,” says Tom Hannam, MD, owner of the Hannam Fertility Center in Toronto. “The most common concern here would be endometriosis.” He adds, “More years of estrogen exposure and anovulatory cycles are cancer risk.” Late onset of menopause has been associated with a higher risk of breast, ovarian and endometrial cancer.
There may also be other health issues.
“In most cases, late menopause is caused by estrogen dominance,” says a geriatric registered nurse and contributing author at life support Nancy Mitchell. “This typically occurs in women with thyroid dysfunction because the thyroid plays a fundamental role in hormone regulation. Your OB-GYN may choose to work with an endocrinologist to address this issue.” She adds, just in case anyone needs a reminder, “As long as a woman is menstruating, there is the possibility of having an egg fertilized and implanted during intercourse. Couples should be prepared for the risks of these pregnancies.” And having expanding populations potentially facing high-risk pregnancies should make it very clear, again, why abortion care is health care.
However, there are advantages to all this extended fertility. Late onset of periods or early menopause may be more obvious signs of serious health problems, infertility at autoimmune diseases. Starting early and finishing late, on the other hand, can be an indication of the overall improvement in our modern nutrition and longer lifespans. It also means, through better opportunities for prenatal screening and care, that the biological clock is running slower that a few generations ago. For those who still have the ability and ability to plan their families, this eases the pressure, especially in times of economic uncertainty. And Dr. Hannam posits that maybe instead of postponing menopause later, we could just avoid infertility more effectively.
“Wasting diseases (symptomatic ovarian cysts, aggressive endometriosis) can be treated earlier and more effectively than in the past,” he says, “by preserving fertility at the natural date of menopause rather than precipitating a personal journey too fast”.
Whatever the causes, for many of us our fertile years are getting longer and longer. We need better research on the implications of this on our bodies, and we need more care in managing the pregnancies that may occur at the end of these years. We have to be prepared, because periods can now stretch on for eternities.
on reproductive health and justice