Can a woman not be in menopause at 65 years old?

Yes, It Is Possible to Not Be Menopausal at 65

While extremely rare, a woman can still be premenopausal at age 65, though this represents a highly unusual outlier from normal physiology. 1

Normal Menopause Timing

• Menopause typically occurs between ages 45-56 years in 90% of women, with a median age of approximately 51 years 2, 3
• In North America specifically, the median age is 51.4 years, with 95% of women reaching menopause between ages 45-55 years 2, 4
• Late-onset menopause is defined as menopause occurring after age 55 1

Evidence for Continued Menstruation Beyond Age 65

• A documented case report exists of a 65-year-old woman who had never experienced menopause and continued to have menstrual cycles throughout her geriatric years 1
• In this case, the patient presented with vaginal bleeding that was initially assumed to be postmenopausal bleeding, but laboratory testing revealed LH and FSH levels in the premenopausal range, confirming ongoing ovarian function 1
• Prior to this case report, a thorough literature search revealed no other documented cases of extended menstrual cycles continuing through the entirety of a woman's geriatric years 1

Clinical Diagnostic Approach at Age 65

For women aged 60 years or older, the American College of Obstetricians and Gynecologists states that no laboratory testing is required or recommended for menopause diagnosis, as age alone is sufficient for clinical diagnosis 3

This guideline assumes the statistical norm, but creates a potential pitfall:

• If a woman at age 65 reports ongoing menstrual bleeding, do not automatically assume it is postmenopausal bleeding 1
• Measure FSH and estradiol levels to determine if she is truly premenopausal versus having pathologic postmenopausal bleeding 1
• Both FSH and estradiol must be evaluated together, as both must be in postmenopausal ranges to confirm menopausal status 3, 5

Clinical Implications

The practical significance of this rare phenomenon includes:

• Women who have not experienced menopause by age 65 may still require contraceptive counseling if sexually active, as fertility, while extremely unlikely, cannot be completely excluded 3
• Such patients require thorough gynecologic evaluation to exclude pathology (fibroids, endometrial hyperplasia, malignancy) that could cause bleeding 1
• The importance of taking a complete gynecologic history in geriatric patients cannot be overstated, rather than making assumptions based on age alone 1

Bottom Line

While the vast majority of women will be postmenopausal by age 65, documented cases prove that continued ovarian function at this age, though extraordinarily rare, is physiologically possible. Any woman at age 65 reporting menstrual bleeding should have FSH and estradiol levels checked before assuming postmenopausal bleeding, as she may represent one of these exceptional cases of extended reproductive function 1.