Menopause Is Different If You’ve Never Had Children — Here’s How, and Why It Matters

Your menstrual period can vary with age, hormones, family history, and health conditions. Some of the factors that affect your period can also influence when menopause starts. They can also affect the kinds of symptoms you have during menopause and perimenopause. One of these factors is your pregnancy history.

Hormone changes during pregnancy affect all parts of a woman’s body. And they can impact the age when menopause begins and the symptoms that go along with it.

Does pregnancy affect menopause?

Pregnancy may affect the age at which you go through menopause.

For most women around the world, menopause happens between the ages of 45 and 55. In the U.S., the average age for menopause is 52. How old you are when your periods stop depends on factors like:

• Your genes

• Whether you’ve taken oral contraceptives or hormone therapy

• Whether you smoke or have smoked in the past

• Social factors, like income level and education

• Nutrition

• Pregnancy and breastfeeding 

If a woman stops having periods before the age of 45, it’s called early menopause. If her periods stop before the age of 40, it’s called premature menopause. Pregnancy and breastfeeding seem to lower the likelihood of early and premature menopause. 

This may happen because of the number of eggs in your ovaries. You are born with a fixed number of eggs. During pregnancy, ovulation stops, so the ovaries don’t release eggs. Nursing may also put a pause on ovulation for some women. Women who spend more time pregnant or nursing may ovulate later into life. And that could lead to menopause happening at a later age.

Do you go through menopause early if you’ve never been pregnant?

If you’ve never been pregnant, it doesn't mean you’ll definitely experience early menopause. But your chances may be higher.

In the United States, about 5% of women go through menopause before age 45. Around 1% experience menopause before the age of 40. 

One study looked at more than 50,000 women from different countries who had already gone through menopause. The researchers compared women with different pregnancy histories. They found that:

• Women who hadn’t given birth had more than twice the risk of starting menopause before the age of 40. They also had a higher chance of starting menopause between the ages of 40 and 44. 

• If the women who never had children also had their first period before the age of 12, their risk of premature menopause was about 5 times higher. 

There are many reasons why women may not have biological children. It may be a matter of choice, circumstance, or because of a health condition that affects fertility. But each reason may involve different factors that influence the age when menopause begins. 

Some of these factors include:

• Oral contraceptive use: Birth control pills may delay the age when menopause begins, especially when taken for many years. At the very least, oral contraceptives don’t appear to increase the risk of early menopause. 

• Tubal ligation: Having a tubal ligation might increase the risk of early menopause. That’s because after the procedure, a little less blood is supplied to your ovaries. 

• A history of infertility: Infertility, regardless of what causes it, may be a risk factor for early menopause. But researchers are still studying why this happens.

• Pregnancy loss: Miscarriage and stillbirth are also associated with early menopause.

• Endometriosis: People with endometriosis can have trouble getting pregnant. In one large study, women with endometriosis had a higher risk of early menopause. This was especially true if they never used oral contraceptives or had not given birth.

• Polycystic ovarian syndrome (PCOS): The hormone imbalances common in PCOS can also affect fertility. But unlike endometriosis, women with PCOS may begin menopause at a later age.

Are menopause symptoms worse if you’ve never been pregnant?

Hormones, pregnancy, and health conditions can all impact the age when menopause begins. These factors may also influence the type and severity of perimenopausal and menopausal symptoms. 

During midlife and menopause, women who have experienced infertility may have a higher risk of: 

• Depressed mood

• Feeling irritable

• Trouble sleeping 

• Vaginal dryness

• Less interest in sex

Some studies suggest that women who haven’t been pregnant or haven’t had children are less likely to have hot flashes and vaginal dryness. But other studies found that these women were more likely to experience menopausal symptoms.

This suggests that many aspects of physical and mental health likely come into play when it comes to menopause symptoms. For some women who have never been pregnant, certain symptoms may be worse. But that won’t be true for everyone.

What can help with menopause if you’ve never been pregnant?

Most experts recommend treatment with hormone replacement therapy (HRT) for women who begin menopause before the age of 45. Treatment is usually continued at least until the age that menopause starts for most women. The goal is to help prevent some of the long-term health conditions that can occur with early menopause. 

Menopause before the age of 45 is a risk factor for:

• Cardiovascular diseases like heart attack and stroke

• Osteoporosis and osteopenia (fragile bones)

• Depression and anxiety

• Dementia symptoms, like problems with thinking and remembering

HRT may help to lower the risk of these conditions. If you’ve never been pregnant, here are some additional options to consider:

• Nutrition: Certain foods, especially oily fish and legumes, may help to delay the age you begin menopause. On the other hand, processed foods made with refined wheat or rice may increase your risk of early menopause.

• Not smoking: On average, people who smoke go through menopause 1-2 years earlier than those who don’t. Quitting also lowers your risk of health conditions like heart disease that can happen with early menopause.

• Exercise: Regular physical activity can help to balance hormones. Along with a nutritious diet and not smoking, exercise improves the health of your heart, bones, and brain.

• Sleep habits: Menopause can affect your sleep. And not getting enough quality sleep can make some menopause symptoms worse. Develop a regular sleep routine to get the best rest you can.

• Mind-body practices: Try yoga, mindfulness-based stress reduction, and cognitive behavioral therapy (CBT). All of these may help ease menopause symptoms.

• Vitamins and supplements: Evidence varies for how well different vitamins and supplements work for symptoms like hot flashes. Talk with a healthcare professional before starting over-the-counter (OTC) medications, herbal remedies, or supplements.

• Hormonal treatments: Oral contraceptives may help to prevent early menopause. They can also help regulate menstrual periods and treat symptoms during perimenopause.

• Mental well-being: Take care of your mental health. This is helpful advice for all women approaching or experiencing menopause. But it may be especially important for those who have gone through infertility treatments or experienced pregnancy loss.

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Written by:

Anne Jacobson, MD, MPH

Anne Jacobson, MD, MPH has been a board-certified physician since 1999. She was a full-scope family physician (inpatient, outpatient, obstetrics, and office procedures) in the Cook County Ambulatory Health Network for 15 years.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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