EMAS position statement: Predictors of premature and early natural menopause

Abstract

Introduction: While the associations of genetic, reproductive and environmental factors with the timing of natural menopause have been extensively investigated, few epidemiological studies have specifically examined their association with premature (< 40 years) or early natural menopause (40-45 years). Aim: The aim of this position statement is to provide evidence on the predictors of premature and early natural menopause, as well as recommendations for the management of premature and early menopause and future research. Materials and methods: Literature review and consensus of expert opinion. Results and conclusions: Strong genetic predictors of premature and early menopause include a family history of premature or early menopause, being a child of a multiple pregnancy and some specific genetic variants. Women with early menarche and nulliparity or low parity are also at a higher risk of experiencing premature or early menopause. Cigarette smoking (with a strong dose-response effect) and being underweight have been consistently associated with premature and early menopause. Current guidelines for the management of premature and early menopause mainly focus on early initiation of hormone therapy (HT) and continued treatment until the woman reaches the average age at menopause (50-52 years). We suggest that clinicians and health professionals consider the age at menopause of the relevant region or ethnic group as part of the assessment for the timing of HT cessation. In addition, there should be early monitoring of women with a family history of early menopause, who are a child of a multiple pregnancy, or who have had early menarche (especially those who have had no children). As part of preventive health strategies, women should be encouraged to quit smoking (preferably before the age of 30 years) and maintain optimal weight in order to reduce their risk of premature or early menopause.

Factors that influence natural menopause onset in China: a cross-sectional study

“…The results of this study suggest that the natural age of menopause in Chinese women is 49.49 ± 3.67 years old, and factors that may affect the age of natural menopause include body weight, age of menarche, marital status, frequent tea drinking, dietary supplements, oral contraceptive use, and safe period contraception methods. Our research showed that weight may be related to the age of menopause, which is consistent with the report by other papers [21][22][23][24]. The age of menarche was signi cantly related to the age of menopause, similar to previous research in Norwegian women [25].…”

“…Unexhausted follicles can continue to mature, secrete estrogen, and expel the ovum. Marital status, frequent tea drinking, dietary supplements, oral contraceptive, and safe period contraception were related to the age of menopause, which are also consistent with current reports [21][22][23][24][26][27][28].…”

“…Researchers have shown that the number of pregnancies is related to the age of menopause [21][22][23][24][26][27][28][29]. However, our study shows that there is no correlation between the times of fertility and the age of menopause.…”

“…People with earlier menarche age have earlier menopause; those with later menarche age have relatively late menopause age. Delayed ovulation time and follicle exhaust time may lead some women to have later menopause age which may be correlated to later menarche age [21][22][23][24]. Due to the late menarche, the ovulation time is delayed, and the ovarian follicle exhaustion time is also delayed.…”

How much total ovarian tissue can be removed without compromising ovarian function? An animal study

“…Indeed, OTCT may be not successful or may no longer be possible because of deterioration of the primary cancer and/or development of metastases, and these patients will develop POI with all its negative consequences. The prevalence of POI is as high as 7% in UK, which may be higher than 10% in China, of which 20-56% are caused by iatrogenic factors, and radiotherapy and/or chemotherapy can cause POI in 70-100% of women [3][4][5][6].…”