Age at natural menopause in relation to all-cause and cause-specific mortality in a follow-up study of US black women

Abstract

Objectives Early age at natural menopause has been associated with increased all-cause mortality in several studies, although the literature is not consistent. This relation has not been examined among African American women. Study design Data were from the Black Women’s Health Study, a follow-up study of African-American women enrolled in 1995. Among 11,212 women who were naturally menopausal at entry to the study or during follow-up through 2008, we assessed the relation of age at natural menopause to all-cause and cause-specific mortality. At baseline and biennially, participants reported on reproductive and medical history, including gynecologic surgeries and exogenous hormone use. Mortality data were obtained from the National Death Index. Multivariable Cox proportional hazard models were used to estimate mortality rate ratios (MRR) and 95% confidence intervals (CI) for categories of age at menopause. Results Of 692 deaths identified during 91,829 person years of follow-up, 261 were due to cancer, 199 to cardiovascular diseases and 232 to other causes. Natural menopause before age 40 was associated with increased all-cause mortality (MRR=1.34, 95% CI 0.96-1.84, relative to menopause at 50-54 years; P-trend=0.04) and with the subcategories of death considered--cancer, cardiovascular disease, and all other causes. The associations were present among never and ever users of postmenopausal female hormones and among never and ever smokers. Conclusions In this large prospective cohort of African-American women, natural menopause before age 40 was associated with a higher rate of all-cause and cause-specific mortality. These findings provide support for the theory that natural menopause before age 40 may be a marker of accelerated somatic aging.

Ages at menarche and menopause and reproductive lifespan as predictors of exceptional longevity in women: the Women's Health Initiative

“…Age at menopause was classified into the following categories according to the literature: <40, 40-44, 45-49, 50-54, or ≥55 years. 14,15,19 Reproductive lifespan was defined as the difference between ages at menopause (natural or surgical) and menarche and categorized into quartiles (<33, 33-37, 38-40, or >40 years). Parity was defined as the number of term pregnancies.…”

Puberty and perimenopause: Reproductive transitions and their implications for women's health

“…This finding is consistent with previous research in Norway (Jacobsen, Heuch, & Kvale, 2007) and California (Jacobsen et al, 2009) that found a 2.4 and 4.5% (respectively) reduced risk of overall mortality associated with a one-year delay in onset of menarche. Many studies have also linked all-cause mortality to an early age at menopause (some studies indicate earlier than age 40, while others suggest the relationship occurs prior to age 45) (Gold, 2011; Jacobsen, Heuch, & Kvale, 2003; Li et al, 2013; Mondul et al, 2005; Ossewaarde et al, 2005; Shuster et al, 2010). Studies also have found that women who experienced menopause prior to age 40 experience mortality ranging from 35–95% higher compared with women who reported menopause occurring at age 50 years or older (Gold et al, 2001).…”

“…While there is growing evidence that reproductive timing is associated with a number of specific diseases (as discussed in the sections above), some argue that early reproductive timing is a biological marker of cumulative stress (Barkow, 1984; Belsky, Steinberg, & Draper, 1991; Chisholm, Quinlivan, Petersen, & Coall, 2005) or accelerated somatic aging (Li et al, 2013; Svejme, Ahlborg, Nilsson, & Karlsson, 2012). …”

Association of menopause age and N-terminal pro brain natriuretic peptide

“…Early menopause has been linked with greater cardiovascular disease (CVD) risk, 1–3 and shown to be associated with a greater incidence of heart failure (HF), 4 coronary artery disease and stroke. 5 CVD is the leading cause of death in women 6 and early diagnosis is useful for optimization of care and improvement in therapy.…”