The association of age at menopause and all-cause and cause-specific mortality by race, postmenopausal hormone use, and smoking status

Abstract

While a mean age at menopause of 51 years has been reported in the United States (U.S.), some U.S. women experience menopause before age 45, possibly increasing risk of cardiovascular mortality; however, the role in all-cause and cerebrovascular-related mortality is unclear. The purpose of this study was to investigate the association between age at menopause and all-cause and cause-specific mortality by race, hormone replacement therapy (HRT) use, and smoking status. REasons for Geographic and Racial Differences in Stroke (REGARDS) is a population-based study of 30,239 participants aged ≥45 years enrolled between 2003 and 2007 of whom 14,361 were postmenopausal women. Age at menopause was defined as <45 (early) or ≥45. All-cause and cause-specific mortality were ascertained through 2013. Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association between age at menopause and mortality, adjusting for baseline measures. Of 11,287 eligible women (6403 white; 4884 black), mean menopause age was 45.2 (SD 7.9) with 1524 deaths over 7.1 years. Significant interactions were detected between early age at menopause (39%) and HRT use in association with all-cause mortality ( p < 0.01), mortality from coronary heart disease ( p = 0.06), and mortality from all other causes ( p = 0.04). An association between early age at menopause and all-cause mortality was observed among ever-HRT users (HR = 1.31, 95% CI: 1.10–1.56), but not never-HRT users (HR = 1.01, 95% CI: 0.85–1.20). There were no differences in associations examined by race or smoking status. Increased all-cause mortality risk was observed for ever-HRT users with menopause before age 45.

Hormonal Replacement Therapy in Menopausal Women with History of Endometriosis: A Review of Literature

“…The risks and benefits of HRT in coronary heart disease (CHD) prevention are controversial, mainly related to age menopause [27]. On the other hand, HRT is considered effective for the prevention of postmenopausal osteoporosis, but it is generally recommended only for women at significant risk [28].…”

Meta-analysis: Early Age at Natural Menopause and Risk for All-Cause and Cardiovascular Mortality

“…After searching four public databases using predefined subject heading terms, we obtained a total of 4,472 articles, and 16 of them involving 321,233 women that assessed the association of early age at natural menopause with all-cause or cardiovascular mortality were eligible for inclusion in the current meta-analysis [12,[18][19][20][21][22][23][24][25][26][27][28][29][30][31].…”

“…According to age at menopause, we divided study subjects into four subgroups: (i) younger than 40 years (premature menopause); (ii) 40-44 years (early menopause); (iii) 45-49 years (relatively early menopause); (iv) 49-52 years BioMed Research International (reference category). According to median follow-up periods (in years), we divided data into two subgroups: (i) less than 13.8 years (HR) [19,22,23,25,30], less than 16.5 years (RR) [12,24,29]; (ii) more than or equal to 13.8 years (HR) [10,18,20,21,26], more than or equal to 16.5 years (RR) [27,28,31]. In terms of location, we grouped studies into three groups: America [12, 19-22, 24, 27-29], Europe [26,31], and Asian [10,18,23,25,30].…”

Menopause and cardiometabolic diseases: What we (don't) know and why it matters

“…[44] Third, the mechanisms underlying menopause transition and CMD associations are not well understood, data are mainly based on traditional risk factors, and few on novel pathways that explain the association between menopause and CMD. [5,45,46] Alternative mechanisms, such as iron metabolism, the role of environmental factors, and the possible role of DNA damage response mechanisms in the association of menopausal and CVD, are some of the emerging hypotheses. [47,48] 4.…”