Natural Menopause In Women Research Articles

Age at Natural Menopause in Women Living with HIV: A Cross-Sectional Study Comparing Self-Reported and Biochemical Data.

Early menopause (<45 years) has significant impacts on bone, cardiovascular, and cognitive health. Several studies have suggested earlier menopause for women living with HIV; however, the current literature is limited by reliance on self-report data. We determined age at menopause in women living with HIV and socio-demographically similar HIV-negative women based on both self-report of menopause status (no menses for ≥12 months) and biochemical confirmation (defined as above plus follicle-stimulating hormone level ≥ 25 IU/mL). Multivariable median regression models assessed factors associated with menopause age, controlling for relevant confounders. Overall, 91 women living with HIV and 98 HIV-negative women were categorized as menopausal by self-report, compared to 83 and 92 by biochemical confirmation. Age at menopause did not differ significantly between groups, whether based on self-report (median [IQR]: 49.0 [45.3 to 53.0] vs. 50.0 [46.0 to 53.0] years; p = 0.28) or biochemical confirmation (50.0 [46.0 to 53.0] vs. 51.0 [46.0 to 53.0] years; p = 0.54). In the multivariable model, no HIV-related or psychosocial variables were associated with earlier age at menopause (all p > 0.05). Overall, HIV status per se was not statistically associated with an earlier age at menopause, emphasizing the importance of comparing socio-demographically similar women in reproductive health and HIV research.

Age at natural menopause in women with a history of chronic diseases–A population-based cohort study

ObjectiveThis study was carried out to determine whether chronic diseases can influence age at natural menopause (ANM). Study design and main outcome measuresThis population-based prospective study recruited all eligible women from participants in the Tehran Lipid and Glucose Study (TLGS). The Cox proportional-hazards model (unadjusted and adjusted) was used to assess associations of ANM with chronic diseases, including diabetes mellitus (DM), hypertension (HTN), dyslipidemia, metabolic syndrome (MetS), cardiovascular disease (CVD), chronic kidney disease (CKD), and thyroid disorders, which were not included simultaneously in the model because there were correlations between chronic diseases. ResultsA total of 4662 women, aged 15–50 years, who had not reached menopause at initiation of the TLGS were included. Of these women, 1220 (26.2%) experienced menopause during the study follow-up. In the multivariable Cox regression model adjusted for potential confounders, women with DM [HR:1.75; 95%CI: (1.32, 2.32)], HTN [HR: 2.11; 95%CI: (1.64, 2.72)], MetS [HR: 2.01; 95%CI: (1.57, 2.58)], CVD [HR: 3.02; 95%CI: (1.93, 4.73)], CKD [HR: 2.64; 95%CI: (2.16, 3.22)], and thyroid disorders [HR: 1.41; 95%CI: (1.06, 1.88)] reached menopause earlier, while dyslipidemia was not associated with ANM. ConclusionThis study demonstrates that women with a history of chronic diseases, such as metabolic disorders, cardiovascular events, and CKD, experience menopause earlier than their counterparts without such a history.

Association of age at diabetes complication diagnosis with age at natural menopause in women with type 1 diabetes: The Pittsburgh Epidemiology of Diabetes Complications (EDC) Study.

Vascular damage is thought to have a role in premature ovarian aging. We thus assessed the association between the presence, and age at onset of, vascular diabetes complications and age at natural menopause in women with type 1 diabetes. Female participants of the Epidemiology of Diabetes Complications study with type 1 diabetes who experienced natural menopause and who never received hormone therapy during their menopausal transition were included in the analysis (n=105). Microalbuminuria (MA), overt nephropathy, proliferative retinopathy, confirmed distal symmetric polyneuropathy, and coronary artery disease, were assessed during biennial clinical exanimations for the first 10 years of follow-up and at year 18, 25 and 30. Menopausal status was determined via self-report and sex hormone data. For each complication, separate linear regression models were used to assess whether, compared with women without the complication of interest, an earlier age at complication development (i.e., <30 years of age) was associated with an earlier age at natural menopause. Although results from multivariable linear regression models suggested a similar age at menopause between women with normo-albuminuria and those diagnosed with MA after 30 years of age, menopause occurred 2.06 years earlier (β±SE=-2.06±1.08) among women diagnosed with MA before age 30 (p=0.06). No significant association was observed for other complications. Among women with type 1 diabetes, menopause appears to occur earlier in those diagnosed with MA before age 30 compared to those with normo-albuminuria, suggesting that vascular dysfunction associated with early microvascular disease may affect ovarian aging.

1633-P: Women with Type 1 Diabetes (T1D) Experience a Shorter Reproductive Period Compared with Nondiabetic Women: The Pittsburgh Epidemiology of Diabetes Complications (EDC) Study and the Study of Women’s Health Across the Nation (SWAN)

Evidence suggests that insulin deficiency and hyperglycemia may disrupt the normal function of the female reproductive system, leading to delayed menarche and premature ovarian aging. We compared the length of the reproductive period of women with T1D and women without diabetes. We assessed age at menarche and natural menopause in women with childhood-onset T1D (diagnosed in 1950-80) who participated in the Pittsburgh EDC study’s 2010-16 follow-up (where reproductive history was assessed) and nondiabetic participants from the Pittsburgh site of the SWAN study. Women who had not yet reached natural menopause, had a hysterectomy/oophorectomy before menopause or received sex hormone therapy during the menopausal transition were excluded from analyses. In EDC, covariate data were selected from the follow-up visit where chronological age was closest to the baseline age in SWAN. Reproductive history was self-reported. The Women’s Ischemia Syndrome Evaluation historical and hormonal algorithms were also used to assess menopause status. Women with T1D (n=105) were younger (42.8 vs. 46.0 yrs, p=.0003), more likely to be white (96.2% vs. 68.3%, p&amp;lt;.0001), never smokers (67.3% vs. 48.1%, p=.002), with lower BMI (25.2 vs. 26.5 kg/m2, p=.002) and higher HDL-C (61.0 vs. 53.0 mg/dl, p&amp;lt;.0001) compared with women without diabetes (n=341). Women with T1D were also older at menarche (13.3 vs. 12.6 yrs, p&amp;lt;.0001) but younger at natural menopause (50.1 vs. 51.9 yrs, p&amp;lt;.0001). Adjusting for age, race, smoking status, BMI, HDL, and number of pregnancies, T1D was associated with 3.3 (95% CI: 2.5-4.0) fewer reproductive years. The length of the reproductive period of women with T1D is shorter, having delayed menarche and earlier natural menopause, compared with women without diabetes. Factors that could be related to a shorter reproductive period in T1D should be investigated. Disclosure Y. Yi: None. S.R. El Khoudary: None. R.G. Miller: None. D. Rubinstein: None. K.A. Matthews: None. T.J. Orchard: None. T. Costacou: None. Funding National Institutes of Health (DK34818); Rossi Memorial Fund; National Institute on Aging; National Institute of Nursing Research; Office of Research on Women’s Health

Tubal Ligation and Age at Natural Menopause.

To determine the effect of tubal ligation on age at natural menopause, as a marker of long-term ovarian function. Three preexisting population-based cohorts were included in this cross-sectional study. Data from each cohort was analyzed separately. The cohorts were restricted to women who never smoked and had reached natural menopause, without prior hysterectomy or oophorectomy. The following variables were collected: race, age at menarche, age at menopause, history of hysterectomy or oophorectomy, gravidity and parity, tobacco use, and ever use of hormonal contraception. The type of tubal ligation and age at tubal ligation were manually abstracted in cohort 1. For cohorts 2 and 3, history of tubal ligation was obtained from an institutional form, completed by patient report. The primary outcome, age at natural menopause, was compared between the two groups (those with and without a history of tubal ligation). Inclusion criteria was met by 555 women from cohort 1, 1,816 women from cohort 2, and 1,534 women from cohort 3. Baseline characteristics did not differ between cohorts. The percentage with tubal ligation was the same in all cohorts: 26.0%, 25.5%, and 25.0%, respectively. Women with a tubal ligation were more likely to have had at least one pregnancy and to have used hormonal contraception compared with women without a tubal ligation. There was no significant difference in age at natural menopause in women who underwent tubal ligation (50.1, 49.9, 50.0 years, respectively) compared with those who did not (50.7, 49.6, 50.0 years, respectively). The type of tubal ligation (cohort 1 only) had no effect on age at menopause. Tubal ligation did not affect age at natural menopause in the three large cohorts included in this study.

Puberty timing associated with diabetes, cardiovascular disease and also diverse health outcomes in men and women: the UK Biobank study.

Early puberty timing is associated with higher risks for type 2 diabetes (T2D) and cardiovascular disease in women and therefore represents a potential target for early preventive interventions. We characterised the range of diseases and other adverse health outcomes associated with early or late puberty timing in men and women in the very large UK Biobank study. Recalled puberty timing and past/current diseases were self-reported by questionnaire. We limited analyses to individuals of White ethnicity (250,037 women; 197,714 men) and to disease outcomes with at least 500 cases (~0·2% prevalence) and we applied stringent correction for multiple testing (corrected threshold P < 7.48 × 10–5). In models adjusted for socioeconomic position and adiposity/body composition variables, both in women and men separately, earlier puberty timing was associated with higher risks for angina, hypertension and T2D. Furthermore, compared to the median/average group, earlier or later puberty timing in women or men was associated with higher risks for 48 adverse outcomes, across a range of cancers, cardio-metabolic, gynaecological/obstetric, gastrointestinal, musculoskeletal, and neuro-cognitive categories. Notably, both early and late menarche were associated with higher risks for early natural menopause in women. Puberty timing in both men and women appears to have a profound impact on later health.

Age at natural menopause among patients with systemic lupus erythematosus.

The aim of this study was to estimate the age at natural menopause in women with SLE. One thousand and thirty-nine consecutive SLE patients <60 years of age were surveyed. Demographic and clinical data were queried by a single investigator. SLE characteristics and co-morbidities were retrieved from their medical records. Natural menopause was defined as amenorrhoea ≥12 months in the absence of previous hysterectomy, CYC exposure and severe chronic kidney disease (SCKD). Pregnant women and those with menses during the 12 months prior to interview were considered premenopausal. Median age at menopause was estimated by both logit and survival analyses. In addition, mean age at menopause was calculated for patients aged ≥40 years. Factors associated with age at natural menopause were assessed by Cox regression analysis. A total of 961 SLE women were analysed. At interview, most patients (81.6%) were premenopausal, 7.9% had natural menopause, 6.3% were postmenopausal previously exposed to CYC, 4.1% had undergone hysterectomy before menopause and 0.1% presented with SCKD and amenorrhoea. The mean age at interview was 35.2 years (s.d. 10.1), the mean age at SLE diagnosis was 26.9 years (s.d. 8.6) and the mean duration of disease was 8.2 years (s.d. 7.1). The mean recalled age at menopause was 46.4 years (s.d. 4.7). Median age at menopause estimated by logit and survival analyses were 50.7 and 50.8 years, respectively. Only the age at SLE diagnosis was associated with age at natural menopause. Median age at natural menopause in women with lupus is 50 years. This is consistent with the age at menopause reported in the general population.

High serum androstenedione levels correlate with impaired memory in the surgically menopausal rat: a replication and new findings

After natural menopause in women, androstenedione becomes the primary hormone secreted by the residual follicle-depleted ovaries. In two independent studies, in rodents that had undergone ovarian follicular depletion, we found that higher endogenous serum androstenedione levels correlated with increased working memory errors. This led to the hypothesis that higher androstenedione levels impair memory. The current study directly tested this hypothesis, examining the cognitive effects of exogenous androstenedione administration in rodents. Middle-aged ovariectomised rats received vehicle or one of two doses of androstenedione. Rats were tested on a spatial working and reference memory maze battery including the water-radial arm maze, Morris water maze (MM) and delay match-to-sample task. Androstenedione at the highest dose impaired reference memory as well as the ability to maintain performance as memory demand was elevated. This was true for both high temporal demand memory retention of one item of spatial information, as well as the ability to handle multiple items of spatial working memory information. We measured glutamic acid decarboxylase (GAD) protein in multiple brain regions to determine whether the gamma-aminobutyric acid (GABA) system relates to androstenedione-induced memory impairments. Results showed that higher entorhinal cortex GAD levels were correlated with worse MM performance, irrespective of androstenedione treatment. These findings suggest that androstenedione, the main hormone produced by the follicle-depleted ovary, is detrimental to working memory, reference memory and memory retention. Furthermore, while spatial reference memory performance might be related to the GABAergic system, it does not appear to be altered with androstenedione administration, at least at the doses used in the current study.

The influence of selected environmental factors on the time of natural menopause in women living in the Małopolskie voivodeship

The main objective of the study is to determine which of the chosen environmental factors and selected groups of such factors alter the time of natural menopause in women living in the Małopolska region. Two hundred and thirty two women aged over 40 years were investigated in a cross-sectional survey in Cracow and the surrounding area. Among them 165 women who had undergone natural menopause and had their last bleeding at least 12 month prior to the interview were chosen. To estimate the age at menopause, a retrospective method was used. Univariate and multivariate methods were employed to estimate association of age at natural menopause with factors of interest. Mean age at natural menopause was 50.32 years (SD=3.82). Among biological and socio-economic factors, only the length of the reproductive period (H=106.07; p=0.000) and the age at the time of the first birth (R=0.18; p=0.020) turned out to be associated with the age at natural menopause in the studied group. The length of the smoking period (R=–0.17; p=0.031), the amount (F=3.25; p=0.04) and frequency of alcohol consumed (H=6.95; p=0.031) were the environmental factors related to the time of menopause. Women who drank more and smoked over longer period of time were likely to experience menopause earlier than their less drinking and shorter smoked counterparts. Three factors taken together, frequency of smoking, alcoholic intake and the age the tobacco addiction started (F=3.87; p=0.050), as well as the consumption of strong alcoholic drinks and the early start of tobacco addiction (F=2.85; p=0.026) were significantly related to the occurrence of natural menopause.

Czynniki środowiskowe wpływające na wiek wystąpienia naturalnej menopauzy u kobiet

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Rumianowski B, Brodowska A, Karakiewicz B, Grochans E, Ryterska K, Laszczyńska M. Environmental factors influencing age at natural menopause in women. Menopause Review/Przegląd Menopauzalny. 2012;11(5):412-416. doi:10.5114/pm.2012.31468. APA Rumianowski, B., Brodowska, A., Karakiewicz, B., Grochans, E., Ryterska, K., & Laszczyńska, M. (2012). Environmental factors influencing age at natural menopause in women. Menopause Review/Przegląd Menopauzalny, 11(5), 412-416. https://doi.org/10.5114/pm.2012.31468 Chicago Rumianowski, Bogdan, Agnieszka Brodowska, Beata Karakiewicz, Elżbieta Grochans, Karina Ryterska, and Maria Laszczyńska. 2012. "Environmental factors influencing age at natural menopause in women". Menopause Review/Przegląd Menopauzalny 11 (5): 412-416. doi:10.5114/pm.2012.31468. Harvard Rumianowski, B., Brodowska, A., Karakiewicz, B., Grochans, E., Ryterska, K., and Laszczyńska, M. (2012). Environmental factors influencing age at natural menopause in women. Menopause Review/Przegląd Menopauzalny, 11(5), pp.412-416. https://doi.org/10.5114/pm.2012.31468 MLA Rumianowski, Bogdan et al. "Environmental factors influencing age at natural menopause in women." Menopause Review/Przegląd Menopauzalny, vol. 11, no. 5, 2012, pp. 412-416. doi:10.5114/pm.2012.31468. Vancouver Rumianowski B, Brodowska A, Karakiewicz B, Grochans E, Ryterska K, Laszczyńska M. Environmental factors influencing age at natural menopause in women. Menopause Review/Przegląd Menopauzalny. 2012;11(5):412-416. doi:10.5114/pm.2012.31468.

Compliance with estrogen hormone replacement therapy after oophorectomy: a prospective study

To quantify compliance with using estrogen-only hormone replacement therapy (HRT) up until the time of mean age of natural menopause in women undergoing either bilateral oophorectomy or removal of one remaining ovary at the time of hysterectomy for benign disease. Prospective study. Annual questionnaire follow-up for ten years of women undergoing hysterectomy and bilateral oophorectomy for benign disease aged 46 or less at the time of surgery. Gloucestershire Royal Hospital. Five hundred and twenty-one women recruited over a four-year period from 1994 to 1997. Compliance with HRT use, changes in HRT preparations and reasons for discontinuation. The median age of women at the time of hysterectomy was 42 (range 22-46) years; 4.9% (n = 24) stopped HRT within the first two years and 16.5% (n = 86) by the end of the study. The majority of women were prescribed HRT tablets (253, 48%) and the next most common being patches. In total, there were 1271 episodes of changing HRT, with the range between 0 and 18 changes per woman over the ten-year period. In all, 32% of changes were to a different route of HRT, 19% were to a different preparation of the same route, 18% were to an increased dose of the same preparation and 7% were to a decreased dose of the same preparation. Compliance with HRT use was high throughout the study, although responses decreased after five years. Change to HRT preparations was consistently high across all preparations. Women requiring HRT after surgical menopause need to be supported in finding the right preparation for them.

Life course socioeconomic adversity and age at natural menopause in women from Latin America and the Caribbean

The aim of this study was to assess the association between life course socioeconomic adversity and age at menopause in Latin America and the Caribbean. Data from 4,056 women aged 60 to 79 years randomly selected from seven cities in Latin America and the Caribbean were analyzed. Cox proportional hazards models were used to estimate the probability of age at menopause by indicators of life course socioeconomic adversity. Median age at menopause was 50 years. The following life course socioeonomic indicators were associated with earlier age at menopause: low education (hazard ratio [HR], 1.16; 95% CI, 1.07-1.26) and manual occupation/housewives (HR, 1.12; 95% CI, 1.03-1.20). Other factors associated with earlier age at menopause were current smoking (HR, 1.14; 95% CI, 1.03-1.27), nulliparity (HR, 1.14; 95% CI, 1.02-1.28), and multiparity (five children or more; HR, 1.15; 95% CI, 1.06-1.24). There was a cumulative effect of socioeconomic adversities across the life course. The median age at menopause was lower for women with six indicators of life course socioeconomic adversity compared with women with no adversities (HR, 1.40; 95% CI, 1.10-1.77). Median age at menopause occurs several years earlier in women from Latin America and the Caribbean compared with women from high-income countries. The results support the association between life course socioeconomic adversity and age at menopause.

A gripping reality: oxidative stress, inflammation, and the pathway to frailty

clinical investigators within the field of geriatric medicine aim to get a handle on “frailty.” That aging is an inevitable consequence of staying alive is irrefutable, but why some people manage to do so and maintain stature and function, while others do not, remains an unresolved question.

Age at Natural Menopause in Women Exposed to Diethylstilbestrol in Utero

TM1-O-03 Introduction: A woman's age at natural menopause is related to several important health outcomes, including breast cancer, cardiovascular disease, and overall mortality. Age at menopause may be affected by the size of the original pool of follicles formed during gestation, suggesting that in utero factors could be important in determining menopausal age. Diethylstilbestrol (DES), a nonsteroidal estrogen widely prescribed during the 1950s and 1960s to prevent miscarriage, has been related to numerous reproductive tract abnormalities and adverse health outcomes among prenatally exposed daughters but has not been studied previously in relation to age at menopause. Methods: We analyzed age at natural menopause in 4 combined cohorts of 4210 women exposed to DES in utero, and a comparable group of 1829 nonexposed women, all of whom had exposure status documented by prenatal medical records. The original cohorts were first identified in the 1970s from several different geographic regions in the United States. Women were recontacted by mail questionnaire in 1994, 1997, and 2001. Questions were asked about the occurrence of natural or surgical menopause, hormone replacement therapy, and other risk factors. Survival analysis methods, including Cox proportional hazards modeling, were used to estimate the risk of natural menopause in DES-exposed versus unexposed women. Results: DES-exposed women were approximately 50% more likely to be naturally menopausal than unexposed women at any given age (hazard ratio [HR] = 1.48; 95% CI, 1.28–1.71), controlling for year of birth and original cohort. Adjustment for a broad range of other confounders had little effect on the results. On average, DES-exposed women reached menopause 11 months earlier than unexposed women, which, in our data, was approximately the same effect size as having ever smoked. In a subset of women with information on the total cumulative dose of DES, dose-response effects were found, with a twofold increased risk of menopause among women exposed to >10,000 mg during pregnancy. Interpretation: Women who were exposed to DES in utero tend to reach natural menopause at an earlier age than unexposed women. The causal mechanism for this association is unclear but may be related to a reduction in the size of the original follicle pool, more rapid depletion of follicles, or changes in steroid hormone synthesis and metabolism. Age at natural menopause has been previously related to several exposures, including smoking and parity, but this study is the first to suggest that an in utero exposure may affect reproductive lifespan.

Age at Natural Menopause in Women Exposed to Diethylstilbestrol in Utero

Age at natural menopause is related to several health outcomes, including cardiovascular disease and overall mortality. Age at menopause may be influenced by the number of follicles formed during gestation, suggesting that prenatal factors could influence menopausal age. Diethylstilbestrol (DES), a nonsteroidal estrogen widely prescribed during the 1950s and 1960s, is related to reproductive tract abnormalities, infertility, and vaginal cancer in prenatally exposed daughters but has not been studied in relation to age at menopause. The authors used survival analyses to estimate the risk of natural menopause in 4,210 DES-exposed versus 1,829 unexposed US women based on responses to questionnaires mailed in 1994, 1997, and 2001. DES-exposed women were 50% more likely to experience natural menopause at any given age (hazard ratio = 1.49, 95% confidence interval: 1.28, 1.74). Among women for whom dose information was complete, there were dose-response effects, with a greater than twofold risk for those exposed to >10,000 mg. The causal mechanism for earlier menopause may be related to a smaller follicle pool, more rapid follicle depletion, or changes in hormone synthesis and metabolism in DES-exposed daughters. Age at menopause has been related, albeit inconsistently, to several exposures, but, to the authors' knowledge, this is the first study to suggest that a prenatal exposure may influence reproductive lifespan.

Heritability of Age at Natural Menopause in the Framingham Heart Study

Twin registries and family history studies provide evidence that genetic factors contribute to the onset of menopause, but heritability estimates in population-based samples are limited. We sought to estimate heritability of age at natural menopause in women participating in the multigenerational Framingham Heart Study, a community-based epidemiological study. A total of 1500 original cohort and 932 offspring cohort women from 1296 extended families reported a natural menopause defined as the natural cessation of menses for 1 yr or more. Correlation coefficients were calculated using family correlations in Statistical Applications for Genetic Epidemiology for mother-daughter, sister-sister, and aunt-niece pairs. Heritability was estimated using variance-components methods in the Sequential Oligogenic Linkage Analysis Routines (SOLAR) computer package. Covariates in the multivariable models included generation, number of cigarettes smoked, body mass index, and parity. The mean age at natural menopause was 49.1 and 49.4 yr in original cohort and offspring women, respectively. The multivariable-adjusted correlation coefficients for mother-daughter, sister-sister, and aunt-niece pairs were 0.21, 0.22, and 0.12, respectively. The crude and multivariable-adjusted heritability estimates for age at natural menopause were 0.49 (0.37, 0.61) and 0.52 (0.35, 0.69). Our data suggest that at least 50% of the interindividual variability in menopausal age appears to be attributable to genetic effects.

Age at natural menopause in women with cirrhosis of hepatocellular origin: Alcohol and non-alcohol etiology *1. Oklahoma Transplant Institute, Baptist Medical Center, and Oklahoma Medical Research Foundation, Oklahoma City, OK

Age at natural menopause in women with cirrhosis of hepatocellular origin: Alcohol and non-alcohol etiology *1. Oklahoma Transplant Institute, Baptist Medical Center, and Oklahoma Medical Research Foundation, Oklahoma City, OK

Comparison of age, sex, and incidence rates in human and canine breast cancer.

A 5-year collection of cases of human breast cancer in males and females from the Alameda County Tumor Registry and a 5-year collection of canine cases from the Alameda-Contra Costa Counties Animal Neoplasm Registry were compared on age distribution, crude and age-adjusted incidence rates, and agespecific incidence rate pattern. To facilitate comparisons, ages of dogs were converted to human equivalents. The median ages and overall proportional distribution by age were in close agreement for the 2 sexes of both species. When canine and human incidence were adjusted to the same population distribution, canine age-adjusted incidence rates were 3 times larger in females and 16 times larger in males. Female age-specific rates increased at the same magnitude for both species until the start of the ages of natural menopause in women; then the human rates continued to increase, but slowly, while the canine rates continued to increase at approximately the same exponential value as in the younger age groups. Important similarities and differences between species that may affect breast cancer risk are discussed in the context of the natural history of human breast cancer.