Abstract
BackgroundWhile menarche indicates the beginning of a woman's reproductive life, relatively little is known about the association between age at menarche and subsequent morbidity and mortality. We aimed to examine the effect of lower age at menarche on all-cause mortality in older Australian women over 15 years of follow-up.MethodsData were drawn from the Australian Longitudinal Study of Ageing (n = 1,031 women aged 65-103 years). We estimated the hazard ratio (HR) associated with lower age at menarche using Cox proportional hazards models, and adjusted for a broad range of reproductive, demographic, health and lifestyle covariates.ResultsDuring the follow-up period, 673 women (65%) died (average 7.3 years (SD 4.1) of follow-up for decedents). Women with menses onset < 12 years of age (10.7%; n = 106) had an increased hazard of death over the follow-up period (adjusted HR 1.28; 95%CI 0.99-1.65) compared with women who began menstruating aged ≥ 12 years (89.3%; n = 883). However, when age at menarche was considered as a continuous variable, the adjusted HRs associated with the linear and quadratic terms for age at menarche were not statistically significant at a 5% level of significance (linear HR 0.76; 95%CI 0.56 - 1.04; quadratic HR 1.01; 95%CI 1.00-1.02).ConclusionWomen with lower age at menarche may have reduced survival into old age. These results lend support to the known associations between earlier menarche and risk of metabolic disease in early adulthood. Strategies to minimise earlier menarche, such as promoting healthy weights and minimising family dysfunction during childhood, may also have positive longer-term effects on survival in later life.
Highlights
While menarche indicates the beginning of a woman's reproductive life, relatively little is known about the association between age at menarche and subsequent morbidity and mortality
The timing and development of the reproductive system can be viewed as a continuum across the lifespan [1] in which there is an intimate association with underlying metabolic processes, reproductive function and, potentially, chronic disease risk
The onset of menarche is an important milestone in a woman's reproductive career, and appears to be meaningfully related to a range of emergent chronic disease risk factors, and subsequent morbidity and mortality in later-life
Summary
While menarche indicates the beginning of a woman's reproductive life, relatively little is known about the association between age at menarche and subsequent morbidity and mortality. The onset of menarche is an important milestone in a woman's reproductive career, and appears to be meaningfully related to a range of emergent chronic disease risk factors, and subsequent morbidity and mortality in later-life. An association between lower age at menarche - that is, < 12 years [2] - and an increased risk of uterine cancer [3] and breast cancer [4,5] is well established. One explanation for the latter is that earlier menarche alters patterns. Lakshman et al.'s recent large study [13] partly addresses these limitations, but did not include some potentially important covariates such as age at menopause
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