Abstract
The timing of natural menopause has implications for several health endpoints; in particular, it is a risk factor for breast cancer. The authors investigated factors influencing the timing of natural menopause among 95,704 women with a mean age of 59.7 years (10th-90th percentile range, 47.0-71.0) in five racial/ethnic groups in the Multiethnic Cohort Study, including non-Latina Whites, Japanese Americans, African Americans, Native Hawai'ians, and Latinas. The authors investigated whether race/ethnicity and several lifestyle and reproductive characteristics were associated with the timing of natural menopause. Race/ethnicity was a significant independent predictor of the timing of natural menopause. Other factors, including smoking, age at menarche, parity, and body mass index, did not significantly alter the race/ethnicity-specific hazard ratios. Relative to non-Latina Whites, natural menopause occurred earlier among Latinas (US-born Latinas: hazard ratio (HR) = 1.10, 95% confidence interval (CI): 1.07, 1.14; non-US-born Latinas: HR = 1.25, 95% CI: 1.21, 1.30) and later among Japanese Americans (HR = 0.93, 95% CI: 0.90, 0.95). These results support the hypothesis that the timing of natural menopause is driven by a combination of genetic, reproductive, and lifestyle factors.
Highlights
The timing of natural menopause has implications for several health endpoints; in particular, it is a risk factor for breast cancer
Relative to non-Latina Whites, natural menopause occurred earlier among Latinas (US-born Latinas: hazard ratio (HR) 1⁄4 1.10, 95% confidence interval (CI): 1.07, 1.14; non-US-born Latinas: HR 1⁄4 1.25, 95% CI: 1.21, 1.30) and later among Japanese Americans (HR 1⁄4 0.93, 95% CI: 0.90, 0.95)
It may be attributed to methodological issues, including differing or problematic methods of classification of menopausal status, use of convenience samples such as hospital patients, potentially inaccurate recall in retrospective assessment of age at event and covariate information, inconsistent treatment of hormone therapy users, lack of data on demographic and physiologic covariates, and paucity of data on diverse populations (see reviews by the World Health Organization [23] and Crawford [24])
Summary
The timing of natural menopause has implications for several health endpoints; in particular, it is a risk factor for breast cancer. Relative to non-Latina Whites, natural menopause occurred earlier among Latinas (US-born Latinas: hazard ratio (HR) 1⁄4 1.10, 95% confidence interval (CI): 1.07, 1.14; non-US-born Latinas: HR 1⁄4 1.25, 95% CI: 1.21, 1.30) and later among Japanese Americans (HR 1⁄4 0.93, 95% CI: 0.90, 0.95) These results support the hypothesis that the timing of natural menopause is driven by a combination of genetic, reproductive, and lifestyle factors. Lifestyle and reproductive factors such as smoking and parity have been associated with the timing of natural menopause; the variance in age at natural menopause that is explained by such factors is estimated to be low, less than 10 percent [6] Observational studies implicating familial factors in the timing of natural menopause [7, 8] and twin studies showing significant heritability for age at natural menopause [9,10,11,12], has supported the hypothesis that the timing of natural menopause is a heritable trait
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