Type and Timing of Menopause and Later Life Mortality among Women in the Iowa Established Populations for the Epidemiological Study of the Elderly (EPESE) Cohort

Abstract

Background: The relationship between menopausal characteristics and later life mortality is unclear. We tested the hypotheses that women with surgical menopause would have increased all-cause and cardiovascular mortality compared with women with natural menopause, and that women with earlier ages at natural or surgical menopause would have greater all-cause and cardiovascular mortality than women with later ages at menopause. Methods: Women who participated in the Iowa cohort of the Established Populations for the Epidemiologic Study of the Elderly (n = 1684) reported menopausal characteristics and potential confounding variables at baseline and were followed up for up to 24 years. Participants were aged 65 years or older at baseline and lived in rural areas. We used survival analysis to examine the relationships between menopausal characteristics and all-cause and cardiovascular mortality. Results: A total of 1477 women (87.7% of respondents) died during the study interval. Women with an age at natural menopause ‡ 55 years had increased all-cause and cardiovascular disease mortality compared with women who had natural menopause at younger ages. Type of menopause and age at surgical menopause were not related to mortality. These patterns persisted after adjustment for potential confounding variables. Conclusions: Among an older group of women from a rural area of the United States, later age at natural menopause was related to increased all-cause and cardiovascular mortality. Monitoring the cardiovascular health of this group of older women may contribute to improved survival times.

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

“…The association of age at surgical menopause with mortality has also been inconsistent across studies. 16,17,19,20,24,25 A prior study among white women observed reduced mortality with increased (i.e., ≥40) reproductive years. 28 …”

“…Previous studies used varying methods to determine age at natural or surgical menopause, making direct comparisons with our results difficult. 14,17-20 For example, some studies determined age at menopause by asking whether menstruation stopped due to natural or surgical reasons, without querying history of hysterectomy or bilateral oophorectomy; 17,20 thus, misclassification may have biased findings. Our definition of age at menopause was comprehensive by taking into account age at final menstrual period, hysterectomy, and bilateral oophorectomy.…”

Menopause, atherosclerosis, and coronary artery disease

“…One of the longest cohort studies of age at menopause and CVD is the Iowa Established Populations for the Epidemiological Study of the Elderly (Iowa EPESE), which included 1684 women from rural Iowa who were age ≥65 at baseline and were followed for up to 24 years[15]. Women whose reported menopause age was late (≥55 years) had an increased risk of all-cause and CVD mortality compared to women with an earlier menopause.…”

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.…”