Early menarche, nulliparity and the risk for premature and early natural menopause

Abstract

STUDY QUESTIONAre parity and the timing of menarche associated with premature and early natural menopause?SUMMARY ANSWEREarly menarche (≤11 years) is a risk factor for both premature menopause (final menstrual period, FMP <40 years) and early menopause (FMP 40–44 years), a risk that is amplified for nulliparous women.WHAT IS KNOWN ALREADYWomen with either premature or early menopause face an increased risk of chronic conditions in later life and of early death. Findings from some studies suggest that early menarche and nulliparity are associated with early menopause, however overall the evidence is mixed. Much of the evidence for a direct relationship is hampered by a lack of comparability across studies, failure to adjust for confounding factors and inadequate statistical power.STUDY DESIGN, SIZE, DURATIONThis pooled study comprises 51 450 postmenopausal women from nine observational studies in the UK, Scandinavia, Australia and Japan that contribute to the International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE).PARTICIPANTS/MATERIALS, SETTING, METHODSAge at menarche (categorized as ≤11, 12, 13, 14 and 15 or more years) and parity (categorized as no children, one child and two or more children) were exposures of interest. Age at FMP was confirmed by at least 12 months of cessation of menses where this was not the result of an intervention (such as surgical menopause due to bilateral oophorectomy or hysterectomy) and categorized as premature menopause (FMP before age 40), early menopause (FMP 40–44 years), 45–49 years, 50–51 years, 52–53 years and 54 or more years. We used multivariate multinomial logistic regression models to estimate relative risk ratio (RRR) and 95% CI for associations between menarche, parity and age at FMP adjusting for within-study correlation.MAIN RESULTS AND THE ROLE OF CHANCEThe median age at FMP was 50 years (interquartile range 48–53 years), with 2% of the women experiencing premature menopause and 7.6% early menopause. Women with early menarche (≤11 years, compared with 12–13 years) were at higher risk of premature menopause (RRR 1.80, 95% CI 1.53–2.12) and early menopause (1.31, 1.19–1.44). Nulliparity was associated with increased risk of premature menopause (2.26, 1.84–2.77) and early menopause (1.32, 1.09–1.59). Women having early menarche and nulliparity were at over 5-fold increased risk of premature menopause (5.64, 4.04–7.87) and 2-fold increased risk of early menopause (2.16, 1.48–3.15) compared with women who had menarche at ≥12 years and two or more children.LIMITATIONS, REASONS FOR CAUTIONMost of the studies (except the birth cohorts) relied on retrospectively reported age at menarche, which may have led to some degree of recall bias.WIDER IMPLICATIONS OF THE FINDINGSOur findings support early monitoring of women with early menarche, especially those who have no children, for preventive health interventions aimed at mitigating the risk of adverse health outcomes associated with early menopause.STUDY FUNDI...

The genetic relationship between female reproductive traits and six psychiatric disorders

“…We report a novel shared genetic architecture between female reproductive traits, i.e. association between AFB and AMP and negligible association between AMC and AMP) should be further investigated in a future study to identify the exact mechanism of menarche and menopause in relation to reproductive success 43 .…”

Current ecology, not ancestral dispersal patterns, influences menopause symptom severity

“…We also observe that women who have more children report an earlier ANM, and on average women who live away from their natal group have higher parity. Currently, there is conflicting data on the relationship between menopause timing and fertility, with some research indicating that nulliparity or low fertility associates with an earlier menopause (Mishra et al, ; Mozumdar & Agrawal, ), and other reporting a negative relationship between number of children and ANM (Ahuja, ).…”

“…Covariates were held constant in each analyses and selected based on existing literature on the demographic correlates of menopause symptoms and timing, and also based on the data we had available. These included parity (Li et al, ; Mishra et al, ; Parazzini, ; Wang et al, ), whether the woman was financially secure over the past year (as a measure of socioeconomic position/financial stress; Lawlor, Ebrahim, & Smith, ; Schoenaker, Jackson, Rowlands, & Mishra, ), body mass index (BMI; Ahuja, ; Li et al, ; Maru, Verma, Verma, & Shrimal, ; Parazzini, ; Sapre & Thakur, ; Tao et al, ; Wang et al, ; Zhu et al, ), and smoking habits (Ayatollahi, Ghaem, & Ayatollahi, ; Bjelland, Hofvind, Byberg, & Eskild, ; Gold et al, , ; McKnight et al, ; Nagel, Altenburg, Nieters, Boffetta, & Linseisen, ; Özdemir & Çöl, ; Parazzini, ; Sapre & Thakur, ; Tao et al, ; Wang et al, ). In addition, age was included in the model when looking at symptom duration and symptom severity, and menopause status when looking at symptom severity, to control for the possibility that retrospective accounts of menopause may differ to current reporting.…”

Premature Ovarian Failure: ESHRE Guidelines and Current Studies

“…In einer rezent publizierten Kohortenstudie wurde bei Überlebenden nach Krebserkrankungen in der Kindheit eine Prävalenz der POI von 10,8 % festgestellt [5]. Dementsprechend konnte auch in neueren Arbeiten eine Prävalenz für POI in der Allgemeinbevölkerung von 2 % [6]…”