Abstract The timing of natural menopause has been linked to numerous chronic disease risks in later life. The mean age at menopause has shown a steady increase across birth cohorts, but the trends of premature (< 40 years) and early menopause (40–44 years) are less clear. Some women do not experience natural menopause but instead undergo bilateral oophorectomy (surgical menopause) and/or hysterectomy. In this chapter, we summarise the evidence for biological and social factors across the life course that affect the timing of menopause, and the factors leading to decision-making about hysterectomy, including the presence of fibroids. The review covers the progress made as cohort studies have matured. In particular, we discuss the factors that influence age at menopause, including genetic factors, prenatal exposures, adverse childhood experiences, and reproductive, social, and behavioural factors. We also highlight evidence on vasomotor symptoms over the menopausal transition and the current guidelines on the use of menopausal hormone therapy.