Trends in Age at Natural Menopause and Reproductive Life Span Among US Women, 1959-2018

Appiah, Duke; Nwabuo, Chike C.; Ebong, I.; Wellons, Melissa; Winters, Stephen J.

doi:10.1001/jama.2021.0278

Cited by 76 publications

(49 citation statements)

References 5 publications

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“…This provides fundamental new insight into the underlying basis for the long known correlation between number of cumulative ovulations and ovarian cancer ( 67 ), and could influence choice between contraceptives that block follicular rupture (and presumably ovarian fibrosis) versus those that do not. Recent epidemiological studies find that hormonal contraceptive use (which suppresses ovulation) is associated with later natural menopause ( 68 , 69 ).…”

Section: Discussionmentioning

confidence: 99%

Female reproductive life span is extended by targeted removal of fibrotic collagen from the mouse ovary

et al. 2022

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The female ovary contains a finite number of oocytes, and their release at ovulation becomes sporadic and disordered with aging and with obesity, leading to loss of fertility. Understanding the molecular defects underpinning this pathology is essential as age of childbearing and obesity rates increase globally. We identify that fibrosis within the ovarian stromal compartment is an underlying mechanism responsible for impaired oocyte release, which is initiated by mitochondrial dysfunction leading to diminished bioenergetics, oxidative damage, inflammation, and collagen deposition. Furthermore, antifibrosis drugs (pirfenidone and BGP-15) eliminate fibrotic collagen and restore ovulation in reproductively old and obese mice, in association with dampened M2 macrophage polarization and up-regulated MMP13 protease. This is the first evidence that ovarian fibrosis is reversible and indicates that drugs targeting mitochondrial metabolism may be a viable therapeutic strategy for women with metabolic disorders or advancing age to maintain ovarian function and extend fertility.

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Section: Discussionmentioning

confidence: 99%

Female reproductive life span is extended by targeted removal of fibrotic collagen from the mouse ovary

et al. 2022

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“…Especially in females, the impairment of sex hormones (estrogen, in particular) signaling has more negative consequence on hepatic health, likely a consequence of the alteration of the strict interplay between metabolism and reproduction gained by the female liver during evolution [ 75 , 79 ]. In this view, the increased lifespan of women, that is not properly balanced by increased reproductive lifespan [ 457 , 458 ], and the risk factors of the nowadays lifestyle (obesity, unbalanced dietary regimens, low physical activity) may impact more negatively on hepatic health of aging women than men, pointing to the need of new actions to support the research in this field. Furthermore, sex hormones signaling contributes to sex dimorphic expression of drug-metabolizing enzymes in the liver [ 47 , 459 , 460 , 461 ], leading often to drug-induced hepatotoxicity and to higher risk of adverse drug reaction in females compared to males [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Beyond the X Factor: Relevance of Sex Hormones in NAFLD Pathophysiology

Torre

2021

Cells

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Non-alcoholic fatty liver disease (NAFLD) is a major health issue worldwide, being frequently associated with obesity, unbalanced dietary regimens, and reduced physical activity. Despite their greater adiposity and reduced physical activity, women show a lower risk of developing NAFLD in comparison to men, likely a consequence of a sex-specific regulation of liver metabolism. In the liver, sex differences in the uptake, synthesis, oxidation, deposition, and mobilization of lipids, as well as in the regulation of inflammation, are associated with differences in NAFLD prevalence and progression between men and women. Given the major role of sex hormones in driving hepatic sexual dimorphism, this review will focus on the role of sex hormones and their signaling in the regulation of hepatic metabolism and in the molecular mechanisms triggering NAFLD development and progression.

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“…Fifth, data on menopausal state and estrogen replacement therapy were not available in this data set, so a subgroup analysis for age <50 versus ≥50 years was performed, which is the mean age of menopause in the United States for the past 2 decades. 34 Sixth, this analysis was not designed to directly compare the outcomes of different revascularization strategies (ie, endovascular or surgical) between women and men. Finally, the clinical reasoning for choosing one revascularization technique versus the other could not be determined.…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in Trends and In‐Hospital Outcomes Among Patients With Critical Limb Ischemia: A Nationwide Analysis

Elbadawi

Barssoum

Megaly

et al. 2021

JAHA

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Background Critical limb ischemia (CLI) represents the most severe form of peripheral artery disease and is associated with significant mortality and morbidity. Contemporary data comparing the sex differences in trends, revascularization strategies, and in‐hospital outcomes among patients with CLI are scarce. Methods and Results Using the National Inpatient Sample database years 2002 to 2015, we identified hospitalizations for CLI. Temporal trends for hospitalizations for CLI were evaluated. The differences in demographics, revascularization, and in‐hospital outcomes between both sexes were compared. Among 2 400 778 CLI hospitalizations, 43.6% were women. Women were older and had a higher prevalence of obesity, hypertension, heart failure, and prior stroke. Women were also less likely to receive any revascularization (34.7% versus 35.4%, P <0.001), but the trends of revascularization have been increasing among both sexes. Revascularization was associated with lower in‐hospital mortality among women (adjusted odds ratio [OR], 0.76; 95% CI, 0.71–0.81) and men (adjusted OR, 0.69; 95% CI, 0.65–0.73). On multivariable analysis adjusting for patient‐ and hospital‐related characteristics as well as revascularization, women had a higher incidence of in‐hospital mortality, postoperative hemorrhage, need for blood transfusion, postoperative infection, ischemic stroke, and discharge to facilities compared with men. Conclusions In this nationwide contemporary analysis of CLI hospitalizations, women were older and less likely to undergo revascularization. Women had a higher incidence of in‐hospital mortality and bleeding complications compared with men. Sex‐specific studies and interventions are needed to minimize these gaps among this high‐risk population.

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Trends in Age at Natural Menopause and Reproductive Life Span Among US Women, 1959-2018

Abstract: Author Contributions: Drs Beard and Morrison had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Cited by 76 publications

References 5 publications

Female reproductive life span is extended by targeted removal of fibrotic collagen from the mouse ovary

Female reproductive life span is extended by targeted removal of fibrotic collagen from the mouse ovary

Beyond the X Factor: Relevance of Sex Hormones in NAFLD Pathophysiology

Sex Differences in Trends and In‐Hospital Outcomes Among Patients With Critical Limb Ischemia: A Nationwide Analysis

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