Consequences of changes in reproductive patterns on later health in women: a life course approach

Abstract

© 2009 The Royal College of Obstetricians and Gynaecologists. This chapter presents a life course approach to the study of how changes in the reproductive patterns of women may affect their future health. A life course approach examines how biological, behavioural and social factors throughout life (and across generations) act independently, cumulatively and interactively to influence reproductive function.1 Reproductive health throughout a woman’s life is influenced by factors in utero, in childhood and in the adult environment as well as by intergenerational factors. Reproductive health also acts as a marker for her underlying health and her propensity to suffer from chronic diseases in later life.1 Considerable changes in reproductive patterns have occurred over the past few decades, with women having children at later ages and achieving smaller family sizes.2 However, there have also been secular changes in other factors that influence health in later life. For example, many countries, including the UK, the USA and Australia, have experienced a rise in the prevalence of obesity3 and a decline in rates of hormone replacement therapy (HRT) use.4–6 This chapter concludes with a discussion of the implications for research aimed at predicting health in later life and with some recommendations for how future studies should be conducted. Reproductive function A woman’s reproductive function cannot be directly measured but is instead indicated by a range of reproductive events and characteristics that occur across her reproductive life. Menarche heralds the beginning of a female’s reproductive life and menopause signals its end, as defined by the initiation and termination of menses.