Menopause & long-term health - ovarian ageing
Woman in midlife learning about ovarian ageing, perimenopause and long-term menopause health
ovarian Ageing and Menopause: What It Could Mean for Women’s Long-Term Health
This article is adapted from Loretta Dignam’s feature, “Ovarian ageing and longevity in women”, published in the Autumn 2026 edition of Menopause Matters.
Menopause is often talked about in terms of symptoms: hot flushes, night sweats, poor sleep, brain fog, mood changes, vaginal dryness and changes in periods.
But menopause is much more than a collection of symptoms.
It is a significant hormonal and biological transition, and emerging research into ovarian ageing is helping scientists better understand why the menopause transition may have implications not only for how women feel today, but also for their long-term health and healthy ageing.
The ovaries are considered one of the fastest-ageing organs in the human body. Their function begins to decline decades before many other organs show comparable age-related changes. Researchers are increasingly studying the ovary not simply as a reproductive organ, but as a potential indicator of wider biological ageing. Research from Columbia University Irving Medical Center describes the ovaries as the fastest-ageing organ in the body and highlights growing interest in what ovarian ageing may tell us about ageing more broadly.
What is ovarian ageing?
Ovarian ageing is the gradual decline in the structure and function of the ovaries.
Women are born with their lifetime supply of eggs, and both the number and quality of those eggs decrease with age. Anti-Müllerian hormone, or AMH, can be used as one marker of ovarian reserve, although ovarian ageing involves much more than egg depletion alone.
Age-related changes can also occur in:
ovarian blood supply
immune signalling
inflammatory pathways
mitochondrial and cellular energy production
tissue repair
communication between cells within the ovary
Research increasingly suggests that ovarian ageing is an active biological process affecting the whole ovarian environment, rather than simply a countdown of the number of remaining eggs. More recent research from Yale School of Medicine supports this broader view of ovarian ageing. Researchers found age-related disruption in ovarian tissue organisation, cellular communication, immune activity and inflammatory signalling before reproductive cycles had ceased
Why ovarian ageing matters beyond fertility
The ovaries are not only reproductive organs. They are also endocrine organs, producing hormones including oestrogen and progesterone.
Those hormones have effects throughout the body, including the:
brain, bones, heart and blood vessels, metabolism, skin, bladder, vagina, joints
As ovarian function changes during perimenopause and hormone levels fluctuate and eventually decline, the effects can therefore extend far beyond fertility.
This is why menopause is better understood as a whole-body hormonal transition, rather than simply the end of periods.
Menopause and longevity: it is about healthspan, not simply lifespan
When we talk about longevity, it is important to distinguish between lifespan and healthspan.
Lifespan is how long we live.
Healthspan is how many of those years are spent in good physical and mental health, with mobility, cognitive function, sexual wellbeing and a good quality of life.
Women tend to live longer than men, yet often spend more years experiencing chronic illness or disability. Researchers sometimes describe this as the gender health paradox.
Ovarian ageing and the loss of reproductive hormones may be one contributor to that picture, particularly because oestrogen influences bone, cardiovascular, metabolic, brain and musculoskeletal health.
Following menopause, lower oestrogen exposure is associated with a number of changes, including:
accelerated bone loss and increased osteoporosis risk
changes in cholesterol and cardiovascular risk
altered body composition and insulin sensitivity
vaginal and urinary symptoms
sleep disturbance
joint and muscle symptoms
mood or cognitive changes in some women
That does not mean menopause independently causes every health problem that develops in midlife. Genetics, ageing, medical history, smoking, alcohol, diet, physical activity, sleep and stress all remain highly relevant.
But menopause does represent an important opportunity to assess a woman’s health and consider what can be done to protect it for the future.
Ovarian ageing starts before your periods stop
One of the most important messages for women is that ovarian ageing does not suddenly begin at menopause.
Perimenopause can start several years before the final menstrual period.
During this time, hormone levels may fluctuate significantly even while periods continue.
And hot flushes are not necessarily the first sign.
Women may experience:
anxiety or low mood
disrupted sleep
heavier or irregular periods
worsening premenstrual symptoms
migraines
palpitations
joint pain
bladder symptoms
a persistent sense of “not feeling like myself”
This is particularly important because women in their 40s — and sometimes younger — may have symptoms dismissed because they are still menstruating.
Periods do not need to have stopped for perimenopause to be affecting your health or quality of life.
What about early menopause and premature ovarian insufficiency?
Early menopause occurs before the age of 45.
Premature ovarian insufficiency, or POI, occurs before the age of 40.
These conditions warrant particular attention because women may spend a longer period with reduced oestrogen exposure, which can have consequences for bone and cardiovascular health.
For women with POI, NICE recommends offering hormone replacement therapy or a combined hormonal contraceptive, unless contraindicated, and generally continuing treatment until at least the average age of natural menopause.
New research: could inflammation play a role in ovarian ageing?
One particularly interesting area of research is the relationship between inflammation and ovarian ageing.
A 2026 study from Monash University examined mice lacking a gene known as NF-KB1, which is involved in the regulation of inflammation.
The mice began life with a normal number of ovarian follicles, but lost them more quickly than expected and developed features of premature ovarian ageing.
Researchers found evidence of chronic, low-grade inflammation within the ovaries, suggesting that an altered inflammatory environment may contribute to accelerated follicle loss.
This is interesting because chronic inflammation is increasingly recognised as one of the biological hallmarks of ageing.
However, an important caveat is needed: this was a mouse study. The findings cannot simply be applied to women, nor can they explain why an individual woman experiences an early menopause.
What the research does support is the increasingly accepted view that ovarian ageing involves changes within the ovarian environment itself and is not merely about “running out of eggs”.
Can HRT slow ovarian ageing?
This is an important distinction.
Hormone replacement therapy does not reverse ovarian ageing.
It does not restore egg quality, rebuild ovarian reserve or make the ovaries younger.
Its role is to replace some of the hormones that fluctuate and decline during perimenopause and menopause. Major menopause guidelines and professional bodies emphasise that hormone therapy should be considered according to an individual's symptoms, age, medical history and personal risk profile.
For medically suitable women, HRT is the most effective treatment for vasomotor symptoms such as hot flushes and night sweats. It can also help with symptoms affecting sleep, quality of life, and the vagina, vulva, bladder and urinary tract.
HRT can help prevent menopause-related bone loss and reduce fracture risk while treatment continues.
For women with early menopause or POI, HRT is often considered physiological hormone replacement rather than simply symptom treatment.
But HRT should not be positioned as an anti-ageing treatment or a guarantee of longer life.
It is not appropriate for every woman, and prescribing decisions should take into account factors such as:
age
symptoms
time since menopause
personal and family medical history
breast cancer risk
blood-clotting risk
cardiovascular health
treatment dose and route
whether a progestogen is needed
Menopause care should be part of preventive healthcare
Perhaps the most useful way to think about menopause is not as a disease, but as an opportunity.
Midlife is an important time to assess risk factors that may influence health over the coming decades.
A comprehensive menopause or midlife health assessment may consider:
blood pressure
cholesterol and cardiovascular risk
blood glucose and diabetes risk
bone health
weight-bearing and resistance exercise
protein, calcium and vitamin D intake
sleep
stress
smoking and alcohol
pelvic health
sexual wellbeing
mental health
The objective is not to medicalise every woman’s experience.
It is to stop minimising a major biological transition that may affect both current quality of life and future health.
The key message
Ovarian ageing begins long before the final period.
Menopause is not simply the end of fertility. It is a whole-body hormonal transition that can influence symptoms, wellbeing and long-term health.
Emerging research is helping us understand ovarian ageing in much greater detail, including the possible roles of inflammation, immune signalling and the ovarian environment. The science is still developing, but it reinforces the case for earlier recognition, better research and more personalised menopause care.
At The Menopause Hub, we believe menopause care should go beyond simply managing hot flushes.
It should help women understand what is happening in their bodies, treat troublesome symptoms appropriately and take a proactive approach to protecting their bone, cardiovascular, metabolic, sexual and overall health for the years ahead.
Concerned about perimenopause or menopause symptoms?
If you are experiencing symptoms of perimenopause or menopause, or you would like to discuss HRT or your longer-term health, you can book an appointment with one of our menopause doctors at The Menopause Hub.
FAQ: Ovarian Ageing and Menopause
At what age do ovaries start ageing?
Ovarian function declines gradually throughout adult life and tends to accelerate during the mid-to-late 30s. This happens well before the average age of menopause, which is approximately 51. The ovaries are not only reproductive organs. They are also endocrine organs, producing hormones that influence tissues throughout the body. This is one reason researchers are becoming increasingly interested in the relationship between ovarian ageing and women's health beyond fertility.
Is ovarian ageing the same as menopause?
No. Ovarian ageing is the gradual decline in ovarian structure and function over time. Menopause is reached after a woman has had her final menstrual period.
Can you be in perimenopause while still having periods?
Yes. Perimenopause commonly begins several years before the final period, and symptoms can occur even while periods remain regular or continue intermittently.
Does HRT stop ovarian ageing?
No. HRT does not stop or reverse ovarian ageing. It replaces some of the hormones that fluctuate and decline during perimenopause and menopause and can be very effective for appropriate women.
Does menopause affect long-term health?
Menopause itself does not cause every condition associated with ageing, but declining oestrogen exposure is relevant to areas including bone, cardiovascular, metabolic and genitourinary health. Midlife can therefore be an important opportunity for preventive healthcare.
As always,
Yours in menopause
Loretta Dignam