Association of age at menarche and menopause, reproductive lifespan, and stroke among Chinese women: Results from a national cohort study

Abstract

Background: The association between age of menarche, age of menopause, reproductive lifespan and risk of stroke in Chinese women remains unclear and requires further clarification.<break><break>Methods: A stratified multi-stage random sampling method was used to select participants at baseline in 2012-2015. The participants? basic information was collected through a standardized questionnaire by professional investigator and examined by trained medical personnel. Follow-up was completed in 2019 to collect the stroke events. The Cox proportional hazards models were used to evaluate hazard ratios between reproductive factors and stroke risk. <break><break>Results: Overall, 11,256 women (5,155 non- menopausal women and 6,101 menopausal women) were included (mean [standard deviation] age, 55.2 [12.9] years). The risk was highest in women with menarche at age ≥17 years (HR, 1.290; 95%CI, 0.959~1.733) and with reproductive lifespan ≤28 years (HR, 1.643; 95%CI, 1.041~2.595). Age at menarche was positively associated with risk of stroke (HR, 1.086; 95%CI, 1.006~1.172). There was a negative association between age at menopause and stroke risk in women with 2 live births (HR, 0.897; 95%CI, 0.834~0.964). Reproductive lifespan was negatively associated with risk of stroke (HR, 0.963; 95%CI, 0.946~1.027). Subgroup analysis also showed that association between age at menarche, reproductive lifespan and stroke events.<break><break>Conclusions: Chinese women with late age at menarche and shorter reproductive lifespan have higher risk of stroke according to a large prospective study.

A mini-review of the evidence for cerebrovascular changes following gender-affirming hormone replacement therapy and a call for increased focus on cerebrovascular transgender health

“…Cisgender women have a lower risk of cardiovascular and cerebrovascular disease compared to cisgender men up until menopause, at which point their risk significantly increases (Hayward et al, 2000;Aggarwal et al, 2018). Earlier menarche and longer reproductive lifespan are also associated with lower risk of stroke, suggesting a beneficial influence of lifetime exposure to oestrogen on the cerebrovascular system [Chen et al, 2023; relatedly, lifetime oestrogen exposure also shows associations with better memory score and larger medial temporal cortical volumes (Steventon et al, 2023)]. Animal models demonstrate that 10.3389/fnhum.2023.1303871 oestrogen increases vasodilation (Tostes et al, 2003), decreases pathological vasoreactivity (Wassmann et al, 2001), and increases CBF and angiogenesis (Robison et al, 2019).…”

“…While some studies report reduced CBF and CVR following menopause, high-quality evidence and consistent menopausal criteria are lacking (Ruediger et al, 2021). A confounding factor is the impact of age and physical fitness at menopause age on cerebrovascular health (Chen et al, 2023;Moir et al, 2023;Ruediger et al, 2023). A recent systematic review of the influence of sex hormones on cerebrovascular function in human subjects suggested that, though there were often differences between high and low hormonal states, the directions were not consistent (Skinner et al, 2021).…”