Natural Menopause Research Articles

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.

The predictive role of monocyte-lymphocyte ratio and plateletlymphocyte ratio in postmenopausal osteoporosis

Objective. To investigate the relationship between neutrophil to lymphocyte ratio (NEU/LY), monocyte to lymphocyte ratio (MO/LY), platelet to lymphocyte ratio (PLT/LY), mean platelet volume to lymphocyte ratio (MPV/LY), mean platelet volume to platelet ratio (MPV/PLT), plateletcrit to platelet ratio (PCT/PLT) and postmenopausal osteoporosis. Materials and Methods. The data of the patients who were admitted to Ümraniye Training and Research Hospital between January 2017 and July 2020 and had both bone mineral densitometry and hemogram tests on the same day were retrospectively scanned. A number of 177 patients who had been in natural menopause for at least one year and did not have any chronic disease nor used any medication were first divided into 3 groups: a number of 48 patients with osteoporosis, 103 with osteopenia and 26 patients included in the control group. Later on, 177 patients were divided into two groups: 151 patients with low bone mineral density and 26 patients were included in the control group. Results. There was no difference between the three groups in terms of NEU/LY, MPV/LY, MPV/PLT and PCT/PLT. The MO/LY ratio and PLT/LY ratio were statistically significantly higher in the osteoporosis group (p = 0.002, p <0.001, respectively). The MO/LY ratio was significantly higher in the group with low bone mineral density compared to the control group (p = 0.011), while there was no statistical difference between the two groups in terms of PLT/LY ratio (p = 0.281). Conclusions. This study shows that MO/LY and PLT/LY are quite simple and cheap markers that can be used in the diagnosis of postmenopausal osteoporosis and MO/LY in the diagnosis of postmenopausal low bone mineral density.

The relation of number of childbirths with age at natural menopause: a population study of 310 147 women in Norway.

STUDY QUESTIONDoes age at natural menopause increase with increasing of number of childbirths?SUMMARY ANSWERAge at menopause increased with increasing number of childbirths up to three childbirths; however, we found no further increase in age at menopause beyond three childbirths.WHAT IS KNOWN ALREADYPregnancies interrupt ovulation, and a high number of pregnancies have therefore been assumed to delay menopause. Previous studies have had insufficient statistical power to study women with a high number of childbirths. Thus, the shape of the association of number of childbirths with age at menopause remains unknown.STUDY DESIGN, SIZE, DURATIONA retrospective population study of 310 147 women in Norway who were 50–69 years old at data collection.PARTICIPANTS/MATERIALS, SETTING, METHODSThe data were obtained by two self-administered questionnaires completed by women attending BreastScreen Norway, a population-based screening program for breast cancer. The associations of number of childbirths with age at menopause were estimated as hazard ratios by applying Cox proportional hazard models, adjusting for the woman’s year of birth, cigarette smoking, educational level, country of birth, oral contraceptive use and body mass index.MAIN RESULTS AND THE ROLE OF CHANCEWomen with three childbirths had the highest mean age at menopause (51.36 years; 95% CI: 51.33–51.40 years), and women with no childbirths had the lowest (50.55 years; 95% CI: 50.48–50.62 years). Thus, women with no childbirths had higher hazard ratio of reaching menopause compared to women with three childbirths (reference group) (adjusted hazard ratio, 1.24; 95% CI: 1.22–1.27). Beyond three childbirths, we estimated no further increase in age at menopause. These findings were confirmed in sub-analyses among (i) women who had never used hormonal intrauterine device and/or systemic menopausal hormonal therapy; (ii) women who were born before 1950 and (iii) women who were born in 1950 or after.LIMITATIONS, REASONS FOR CAUTIONInformation about age at menopause was based on self-reports.WIDER IMPLICATIONS OF THE FINDINGSIf pregnancies truly delay menopause, one would expect that women with the highest number of childbirths had the highest age at menopause. Our results question the assumption that interrupted ovulation during pregnancy delays menopause.STUDY FUNDING/COMPETING INTEREST(S)This work was supported by the South-Eastern Norway Regional Health Authority [2016112 to M.S.G.] and by the Norwegian Cancer Society [6863294-2015 to E.K.B.]. The authors declare no conflicts of interest.TRIAL REGISTRATION NUMBERN/A.

Surgical menopause: A toolkit for healthcare professionals

Surgical menopause (bilateral oophorectomy) is commonly undertaken during a hysterectomy to treat various medical conditions. Menopausal symptoms can be particularly severe due to the sudden loss of ovarian function. This clinical toolkit is intended to guide healthcare professionals caring for women undergoing surgical menopause. Women commonly experience vasomotor symptoms, sexual dysfunction and an increased risk of cardiovascular and osteoporotic disease. Compared with a natural menopause, loss of libido can be more pronounced following a surgical menopause. Hormone Replacement Therapy (HRT) plays a significant role in managing surgical menopause, especially in women aged under 45years old. All women undergoing surgical menopause should have adequate counselling regarding the hormonal consequences of surgery and the role of HRT with a view to provide individualised, patient-centred care.

Risk of de novo cancer after premenopausal bilateral oophorectomy

Hysterectomy is one of the most frequent gynecologic surgeries in the United States. Women undergoing hysterectomy are commonly offered bilateral oophorectomy for ovarian and breast cancer prevention. Although bilateral oophorectomy may dramatically reduce the risk of gynecologic cancers, some studies suggested that bilateral oophorectomy may be associated with an increased risk of other types of cancer, such as lung cancer and colorectal cancer. However, the results are conflicting. To study the association between bilateral oophorectomy and the risk of subsequent cancer of any type. This population-based cohort study included all premenopausal women who underwent bilateral oophorectomy for a nonmalignant indication before the age of 50, between January 1, 1988 and December 31, 2007 in Olmsted County, Minnesota, and a random sample of age-matched (±1 year) referent women who did not undergo bilateral oophorectomy. Women with cancer before oophorectomy (or index date) or within 6 months after the index date were excluded. Time-to-event analyses were performed to assess the risk of de novo cancer. Cancer diagnosis and type were confirmed using medical record review. Over a median follow-up of 18 years, the risk of any cancer did not significantly differ between the 1562 women who underwent bilateral oophorectomy before natural menopause and the 1610 referent women (adjusted hazard ratio, 0.82; 95% confidence interval, 0.66-1.03). However, women who underwent bilateral oophorectomy had a decreased risk of gynecologic cancers (adjusted hazard ratio, 0.15; 95% confidence interval, 0.06-0.34) but not of nongynecologic cancers (adjusted hazard ratio, 0.99; 95% confidence interval, 0.78-1.26). In particular, the risk of breast cancer, gastrointestinal cancer, and lung cancer did not differ between these 2 cohorts. Use of estrogen therapy through the age of 50 years in women who underwent bilateral oophorectomy did not modify the results. Women who underwent bilateral oophorectomy before menopause have a reduced risk of gynecologic cancer but not of other types of cancer including breast cancer. Women at average risk of ovarian cancer should not consider bilateral oophorectomy for the prevention of breast cancer or other nongynecologic cancers.

Age at menopause among rural and urban women in the state of Campeche, Mexico.

The purpose of this study was to examine age at natural menopause among women of Maya and non-Maya ancestry living in urban and rural communities in the state of Campeche, Mexico. Women ages 40 to 60 (n = 543) participated in semi-structured interviews and anthropometric measures. The last names, languages spoken, and the birthplace of the woman, her parents, and her grandparents were used to determine Maya or non-Maya ethnicity. Recalled age at natural menopause was compared across four communities; analysis of variance was used to compare means and Kaplan-Meier analyses were used to compare medians. Probit analysis was also used to estimate median ages at menopause. Cox regression analyses were applied to identify variables associated with age at menopause. Mean recalled age at natural menopause across all sites was 46.7 years, ranging from 47.8 years in the city of Campeche to 43.9 years in the rural Maya communities in the municipality of Hopelchén. Median ages at menopause across all sites were 50.55 years by probit analysis and 50.5 years by Kaplan-Meier. Variables associated with a later age at menopause included higher socioeconomic status, higher parity, and a later age at menarche. The early mean recalled age at menopause in southern Hopelchén was consistent with previous studies in the Yucatán peninsula. As expected, probit and Kaplan-Meier analyses demonstrated later ages at menopause. Contrary to our expectations, Maya/non-Maya ethnicity was not associated with age at menopause. Demographic and reproductive factors were more important than ethnicity in explaining variation in age at menopause within the state of Campeche, Mexico.

A Prospective Study of Factors Affecting Age at Menopause among the Bandar-E-Kong Cohort

Menopause is a natural period of women’s life and can be affected by several factors. This paper describes and identify the age of natural menopause and its associated factors based cohort study in Iran. In this study, we used data of Bandar-e-Kong study. This prospective cohort study includes 2,334 woman’s aged between 18 to 70 years old, which was conducted from March 2016 to February 2019. All women completed data collection forms includes a validated questionnaire survey. Data were analyzed using chi-square test, independent t test, and ANOVA as well as a multivariate linear regression model. The total of participants with the age range of 18-70 years, 894 were menopause females. The mean age of menopause was 48.31 ± 6.34 years with a minimum of 20 and a maximum of 66 years. The number of pregnancies, duration of breastfeeding, level of education, residency, presence of thyroid disease, and body mass index affected the age of menopause. This study suggests that number of pregnancy was associated with menopausal age. According to the results of this study, the existence of appropriate educational programs to promote awareness and lifestyle in postmenopausal women is essential.

Genetic Insights Into Biological Mechanisms Governing Human Ovarian Ageing

(Abstracted from Nature 2021;596:393–397) The age of reproductive senescence (age of natural menopause [ANM]) in developed countries is approximately 50–52 years; however, natural fertility ceases approximately 10 years before menopause. Societal trends have shifted with women choosing to delay childbearing to older ages, increasing the need for assisted conception technology.

Association between body mass index, waist circumference, and age at natural menopause: a population-based cohort study in Chinese women

ABSTRACT The purpose of the study was to investigate whether premenopausal body mass index (BMI) and waist circumference (WC) influence age at menopause. A total of 2116 women aged 35–64 years from two communities of the CMCS Beijing cohort were recruited in 1992 and followed up to 2018. Of 1439 premenopausal women at baseline, 6 women data were missing. Finally, 1433 women were included for analysis. Overweight was defined as BMI 24–27.99 kg/m2. Central obesity was defined as WC ≥80 cm. Age at menopause was categorized as <45 years, 45–49 years, 50–51 years (reference), and >51 years. Multinomial logistic regression models were used to estimate relative odds ratios (RORs) and 95% confidence intervals (CIs). Compared to women with normal weight and normal WC, overweight women with normal WC had higher risk of menopause at >51 years (ROR 1.64, 95% CI 1.10–2.45; P = .01); and overweight women with central obesity had higher risk of menopause at not only >51 years (ROR 1.82, 95% CI 1.13–2.93; P = .01) but also <45 years (ROR 3.13, 95% CI 1.20–8.43; P = .02) and 45–49 years (ROR 2.76, 95% CI 1.71–4.46; P < .001). When overweight women combine with central obesity, the risk of early menopause will increase in some of them.

Risk-Reducing Salpingo-Oophorectomy and the Use of Hormone Replacement Therapy Below the Age of Natural Menopause: Scientific Impact Paper No. 66 October 2021: Scientific Impact Paper No. 66.

This paper deals with the use of hormone replacement therapy (HRT) after the removal of fallopian tubes and ovaries to prevent ovarian cancer in premenopausal high risk women. Some women have an alteration in their genetic code, which makes them more likely to develop ovarian cancer. Two well-known genes which can carry an alteration are the BRCA1 and BRCA2 genes. Examples of other genes associated with an increased risk of ovarian cancer include RAD51C, RAD51D, BRIP1, PALB2 and Lynch syndrome genes. Women with a strong family history of ovarian cancer and/or breast cancer, may also be at increased risk of developing ovarian cancer. Women at increased risk can choose to have an operation to remove the fallopian tubes and ovaries, which is the most effective way to prevent ovarian cancer. This is done after a woman has completed her family. However, removal of ovaries causes early menopause and leads to hot flushes, sweats, mood changes and bone thinning. It can also cause memory problems and increases the risk of heart disease. It may reduce libido or impair sexual function. Guidance on how to care for women following preventative surgery who are experiencing early menopause is needed. HRT is usually advisable for women up to 51 years of age (average age of menopause for women in the UK) who are undergoing early menopause and have not had breast cancer, to minimise the health risks linked to early menopause. For women with a womb, HRT should include estrogen coupled with progestogen to protect against thickening of the lining of the womb (called endometrial hyperplasia). For women without a womb, only estrogen is given. Research suggests that, unlike in older women, HRT for women in early menopause does not increase breast cancer risk, including in those who are BRCA1 and BRCA2 carriers and have preventative surgery. For women with a history of receptor-negative breast cancer, the gynaecologist will liaise with an oncology doctor on a case-by-case basis to help to decide if HRT is safe to use. Women with a history of estrogen receptor-positive breast cancer are not normally offered HRT. A range of other therapies can be used if a woman is unable to take HRT. These include behavioural therapy and non-hormonal medicines. However, these are less effective than HRT. Regular exercise, healthy lifestyle and avoiding symptom triggers are also advised. Whether to undergo surgery to reduce risk or not and its timing can be a complex decision-making process. Women need to be carefully counselled on the pros and cons of both preventative surgery and HRT use so they can make informed decisions and choices.

Causal and observational evidence on the role of early menopause in hypertension

Abstract Introduction Blood pressure has been suggested as potential factor contributing to the increased risk of cardiovascular disease observed in women experiencing early menopause (&amp;lt;45 years). However, whether the association between early menopause and hypertension is causal remains unclear (1,2). Purpose To evaluate the observational and causal association between age at natural menopause (ANM) and blood pressure (BP) traits in Caucasian women. Methods Cross-sectional and one-sample Mendelian randomization (MR) study was conducted in 4451 postmenopausal women from two different cohort studies. Hypertension was defined as a systolic BP (SBP) ≥140 mmHg, and/or diastolic BP (DBP) ≥90 mmHg, and/or the use of antihypertensive medication. Multivariable linear and logistic regressions were implemented in the observational analysis. We calculated a weighted genetic risk score with 54 variants associated with ANM (GRS-ANM) (3). The genetic variants were previously identified in a genome wide association study (4), after that we implemented two-stage least squares in the one-sample MR. Estimates from all cohorts were pooled through meta-analysis Results The pooled analysis across cohorts showed early menopause, compared to menopause between 50–54 years, to be associated with lower DBP (β=−1.31 mmHg, 95% CI: −2.43; −0.18), while no association was found between other ANM categories and DBP. Similarly, the pooled analysis of both cohorts did not show an association of ANM with SBP, neither as a continuous variable nor by category. One year of later onset of menopause was associated with higher odds of developing hypertension (Odds ratio (OR): 1.02, 95% CI: 1:00; 1.04) while no association was found for the ANM categories and hypertension (Table 1). Results of the evaluation of MR assumption, supported their compliance, the GRS-ANM was associated with observed ANM and explained between 1.4% and 3.4% of the ANM variance in the included cohorts, F statistic values were among 11.15 and 40.63 (Figure 1). We found no association between GRS-ANM and SBP, DBP or hypertension (Table 1). Conclusion The present study does not support the hypothesis that early onset of menopause is associated with higher BP. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): The CoLaus study was and is supported by research grants from GlaxoSmithKline, the Faculty of Biology and Medicine of Lausanne, and the Swiss National Science Foundation (grants 33CSCO-122661, 33CS30-139468 and 33CS30-148401).Zayne M. Roa-Díaz has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 801076, through the SSPH+ Global PhD Fellowship Programme in Public Health Sciences (GlobalP3HS) of the Swiss School of Public Health.

Menopausal symptoms in epithelial ovarian cancer survivors: a GINECO VIVROVAIRE2 study

ObjectiveWe have previously shown that epithelial ovarian cancer (EOC) and its treatments have negative effects on long-term quality of life (QoL) and fatigue. The present multicenter study investigated the main menopausal symptoms and gynecological management of EOC survivors (EOCS). Methods166 patients with relapse-free ≥3 years after the end of treatment attended a consultation with a gynecologist, including a questionnaire related to vasomotor symptoms (VMS) and sexuality, a clinical examination, a blood sample and an osteodensitometry. QoL, fatigue, insomnia and mood disorders were measured with validated questionnaires and correlated to VMS. VMS and QoL were assessed according to natural menopause (NM) or surgical menopause (SM). ResultsMean age at the survey was 62 [21–83] years and stage III/IV (48%). Mean delay since the end of treatment was 6 years. Fifty-nine patients (36%) had SM. Half of patients reported VMS. Seventy-two percent of EOCS with SM had VMS compared to 41% with NM (P < .001). VMS were not associated with poor global QoL, fatigue, insomnia or mood disorders. Two-thirds of EOCS reported a decrease in libido. Patients with SM showed a greater decrease in libido than NM (P < .02). Fourteen percent of them had osteoporosis and 50% osteopenia. Among the 85 patients with VMS, 80 did not receive HRT after cancer treatment. At the time of the survey, only 7 (4%) patients were receiving hormone replacement therapy (HRT). ConclusionsVMS and sexual disorders are frequently reported by EOCS, particularly among patients with SM. Most EOCS with menopausal symptoms could benefit from HRT to improve these symptoms.

Predictors of age at menopause and psychiatric symptoms among postmenopausal females in Jordan

Objective This study evaluated the impact of various factors on age at natural menopause as well as psychiatric symptoms including anxiety and depression among postmenopausal women in Jordan. Methods A cross-sectional study was conducted and included females with natural menopause (n = 450). A structured interview-based questionnaire was used to collect data about subjects’ sociodemographics, health, reproductive and environmental factors. Hospital anxiety and depression scale (HADS) was used to assess psychiatric symptoms. Factors associated with age at natural menopause, depression, or anxiety were identified. Results The mean age at natural menopause was 49.5 ± 4.8 years. Mothers' age at menopause, the regularity of cycles, age at last pregnancy and diabetes were significant positive predictors of age at menopause (p < 0.05). The mean anxiety and depressive scores were 6.52 ± 4.26 and 6.77 ± 3.44 respectively. Age, high school education, being nonsmoker and breastfeeding history were inversely associated with anxiety but only cycle length and multiparous were positively associated with anxiety (p < 0.05). While education and being nonsmoker were negatively associated with depression, hypertension was a positive predictor. Conclusions The results reveal several environmental, health, and reproductive predictors of age at menopause or psychiatric symptoms among postmenopausal women in Jordan.

Association of diet with the onset of natural menopause: a systematic review and meta-analysis

Background: Onset of natural menopause (ONM) is associated with an increased risk of cardiovascular diseases (CVDs) and overall mortality. Diet intake has been suggested to play an important role in determining at which age of natural menopause occurs, but the current results are not consistent.

Integrated in-depth bioinformatic analysis suggests RELCH/KIAA1468, LINC02341, and AKAP11 as candidate genes for ages at menarche and menopause

Polymorphisms of the TNFRSF11A and TNFSF11 genes were reported for their association with age at menarche (AAM) and age at natural menopause (ANM). However, the biological mechanisms underlying this association remain largely unclear. The aim of the study: This study was to determine biological processes backing the observed genetic associations. Materials and methods: Fortyfour SNPs were analyzed using in silico approach and ten publicly available online databases and tools. Results: TNFRSF11A and TNFSF11 are highly pleiotropic genes that play a role in many metabolic processes. However, among that variety, lipid metabolism and cell survival and apoptosis seem the most biologically plausible mechanisms, through which these genes contribute to AAM and ANM. The analysis identified several mechanisms underlying the previously determined association of the TNFRSF11A and TNFSF11 genes with AAM and ANM and suggested RELCH/KIAA1468, LINC02341, and AKAP11 as new candidate genes for the traits.

Symptomatology of Postmenopausal Women Presenting at Punjab Rangers Hospital, Lahore

Objective: To describe the immediate symptoms of the post menopausal women attending Punjab Rangers Hospital Lahore. To see the effects of these symptoms on quality of life (QOL). Study Design: This was a descriptive type of study that was carried out at the Department of Gynecology and Obstetrics at Punjab Rangers Hospital. Setting: O&amp;G OPD at Punjab Rangers Teaching Hospital Sample Size: 100 patients with menopause were studied for symptomatology and these symptoms affect the quality of life. Sample Collection: Sample collection was done by a non-probability convenient method. Inclusion Criteria: All patients who attended gynae opd at Punjab rangers hospital with:  Natural menopause  Above 45 years  Below 55 years  With no other Gynecological problems Exclusion Criteria: All those patients were excluded from the study that had  Surgical menopause  Perimenopause  History of depressive illness  Women on antidepressant  Women on HRT  Below 45 YEARS Data Collection: The questionnaires based on menopausal rating scale for symptomatology and quality of life were generated to see the impacts of these symptoms on life. The educated patients filled questionnaires. I filled out questionnaires of illiterate patients outdoors myself. Data Analysis: An analysis of data was done by using computer software SPSS. Data master sheet was developed. Frequency tables and graphs were generated The data was analyzed by using computer software SPSS.. Confidence interval was calculated for important frequency tables. Cross tabulation was done for marital status,parity,literacy,smoking and chi-square was applied as a test of significance. 65% patients described that their quality of life decreased after menopause especially due to vasomotor and psychological symptoms. 35% of patients were happy and satisfied after their menopause.Besides menopause there were other stresses of middle life, which made life worse. Subject: The study was performed during the period November2020 to May 2021.Sample was collected by a non probability convenient method and 100 patients were selected. Data was collected by questionnaire provided to patients attending the outpatient department. Data was analyzed with a computer software system by using SPSS. Results: The mean age observed was 49 years and frequency distribution of symptoms were:Hot flushes 60%, Night sweats 55% ,Insomnia 50% ,Mood changes 60% ,Anxiety 50% ,Irritability 50% ,Memory loss 30% ,Vaginal dryness 10%, Dyspareunia 10% ,Loss of libido 15% ,Urethral symptoms 25% ,Lethargy and general body aches 75% .65% patients described that their QOL had decreased after menopause. 35% patients described no effect. Conclusion: To promote the awareness in women about menopause, HRT and other alternatives which can improve their QOL

A Radiographic Study on the Effect of Menopause on Proximal Femoral Angle Parameters

Aim: In this study we aimed to investigate the effects of menopause on the femoral inclination angle (FIA) and femoral Alsberg angle (FAA) parameters in pelvic anteroposterior radiography.Methods: The FIA and FAA data were retrospectively reviewed in a total of 133 female subjects with natural menopause (the menopause group) and regular menstrual cycles (the control group) who were admitted to our orthopedics and traumatology clinic and underwent anteroposterior pelvic X-ray examination between October 2019 and June 2020.Results: There was a statistically significant difference between the menopause and control groups in terms of age (p&amp;lt;0.001), right-side FAA values (p&amp;lt;0.001), and right- and left-side FIA values (p&amp;lt;0.001 and p=0.026, respectively). Only the left-side FAA values did not differ significantly between the groups (p=0.446). All parameter measurements were higher in the menopause group.Conclusion: The finding that the FIA and FAA values were higher in the menopause group could be attributed to the fact that menopause occurs in the later decades of life and brings along changes in lifestyle. We recommend that the presence of menopause as a factor that can affect bone structure and metabolism in various ways should also be considered in studies on bone morphometry.

Premature menopause among women in India: Evidence from National Family Health Survey-IV.

Women who experience premature menopause either due to biological or induced reasons have a longer duration of exposure to severe symptoms and adverse health consequences when compared to those who undergo menopause at later age. Despite the fact that premature menopause has a profound effect on the health of women, there has been limited study on this issue. Therefore, this study attempted to determine the prevalence and factors associated with premature menopause among 302 557 women aged 25-39 years in India. This study utilized secondary data from the fourth round of the National Family Health Survey-IV (NFHS-4), conducted during 2015-2016 in India. Descriptive statistics and multinomial logistic regression were used for statistical analyses of the data. The results revealed that the prevalence of premature menopause in this sample of Indian women was 3.7%, out of which 2.1% of women had experienced natural premature menopause, whereas 1.7% had surgical premature menopause. The prevalence of premature menopause was highest in the southern region of India. Factors like age, education, wealth index, place of residence, smoking status, children ever born, age at first birth, use of hormonal contraception, sterilization, and body mass index were found to be associated with premature menopause in India. A sizeable proportion of women in India are attaining menopause prematurely. Furthermore, the percentage and likelihood of experiencing premature menopause are relatively high among rural women, women with higher parity, early age at childbearing, and women who smoke.

After Surgical Menopause, Should Menopausal Hormonal Therapy Started Only Before the Age of 45 Years?

The published study Compliance and health consequences of menopausal hormonal therapy after surgical menopause: A retrospective study in Thailand showed that menopausal hormonal therapy soon after bilateral oophorectomy before the age of natural menopause in Thailand possibly prevented subsequent osteopenia compared with menopausal hormonal therapy non-users, also without significant adverse breast outcomes comparing between hormonal therapy users and non-users. According to that study, additional data showed that the number of early hormonal users (initiated before age 45 years) who continued hormonal therapy until at least 50 years old (average natural menopausal age in Thailand) is less than that of late hormonal users (initiated at age ?45 years). Therefore, hormonal replacement therapy after bilateral oophorectomy before the age of natural menopause, in the absence of contraindication, should be commenced soon at any age after surgery and maintained until at least the age of natural menopause to prevent possible long-term adverse health outcomes from early estrogen deprivation.

Age at Natural Menopause and Blood Pressure Traits: Mendelian Randomization Study.

Observational studies suggest that early onset of menopause is associated with increased risk of hypertension. Whether this association is causal or due to residual confounding and/or reverse causation remains undetermined. We aimed to evaluate the observational and causal association between age at natural menopause (ANM) and blood pressure traits in Caucasian women. A cross-sectional and one-sample Mendelian randomization (MR) study was conducted in 4451 postmenopausal women from the CoLaus and Rotterdam studies. Regression models were built with observational data to study the associations of ANM with systolic and diastolic blood pressure (SBP/DBP) and hypertension. One-sample MR analysis was performed by calculating a genetic risk score of 54 ANM-related variants, previously identified in a genome-wide association study (GWAS) on ANM. In the two-sample MR analysis we used the estimates from the ANM-GWAS and association estimates from 168,575 women of the UK Biobank to evaluate ANM-related variants and their causal association with SBP and DBP. Pooled analysis from both cohorts showed that a one-year delay in menopause onset was associated with 2% (95% CI 0; 4) increased odds of having hypertension, and that early menopause was associated with lower DBP (β = −1.31, 95% CI −2.43; −0.18). While one-sample MR did not show a causal association between ANM and blood pressure traits, the two-sample MR showed a positive causal association of ANM with SBP; the last was driven by genes related to DNA damage repair. The present study does not support the hypothesis that early onset of menopause is associated with higher blood pressure. Our results suggest different ANM-related genetic pathways could differently impact blood pressure.