Is early natural menopause a biologic marker of health and aging?

Phytoestrogens in postmenopausal indications: A theoretical perspective

This review discusses plant-derived compounds with estrogenic activity. The authors rightly emphasize the need for the intake of foods containing phytoestrogens in view of their positive effects on postmenopausal indications. This is particularly significant in the light of the current wave of enthusiasm for vegetarian food, in general, and phytoestrogens, in particular. Phytoestrogens are plant-derived hormone-like diphenolic compounds of dietary origin. These compounds are weakly estrogenic and could play a role in the prevention of other estrogen-related conditions, namely, cardiovascular diseases, menopausal symptoms, postmenopausal osteoporosis, neuroprotective effects, and hormone-dependent cancers (breast and endometrium cancer).

Comparative endocrinology of aging and longevity regulation

Hormones regulate growth, development, metabolism, and other complex processes in multicellular animals. For many years it has been suggested that hormones may also influence the rate of the aging process. Aging is a multifactorial process that causes biological systems to break down and cease to function in adult organisms as time passes, eventually leading to death. The exact underlying causes of the aging process remain a topic for debate, and clues that may shed light on these causes are eagerly sought after. In the last two decades, gene mutations that result in delayed aging and extended longevity have been discovered, and many of the affected genes have been components of endocrine signaling pathways. In this review we summarize the current knowledge on the roles of endocrine signaling in the regulation of aging and longevity in various animals. We begin by discussing the notion that conserved systems, including endocrine signaling pathways, "regulate" the aging process. Findings from the major model organisms: worms, flies, and rodents, are then outlined. Unique lessons from studies of non-traditional models: bees, salmon, and naked mole rats, are also discussed. Finally, we summarize the endocrinology of aging in humans, including changes in hormone levels with age, and the involvement of hormones in aging-related diseases. The most well studied and widely conserved endocrine pathway that affects aging is the insulin/insulin-like growth factor system. Mutations in genes of this pathway increase the lifespan of worms, flies, and mice. Population genetic evidence also suggests this pathway's involvement in human aging. Other hormones including steroids have been linked to aging only in a subset of the models studied. Because of the value of comparative studies, it is suggested that the aging field could benefit from adoption of additional model organisms.

Oophorectomy, menopause, estrogen treatment, and cognitive aging: clinical evidence for a window of opportunity

The neuroprotective effects of estrogen have been demonstrated consistently in cellular and animal studies but the evidence in women remains conflicted. We explored the window of opportunity hypothesis in relation to cognitive aging and dementia. In particular, we reviewed existing literature, reanalyzed some of our data, and combined results graphically. Current evidence suggests that estrogen may have beneficial, neutral, or detrimental effects on the brain depending on age at the time of treatment, type of menopause (natural versus medically or surgically induced), or stage of menopause. The comparison of women who underwent bilateral oophorectomy with referent women provided evidence for a sizeable neuroprotective effect of estrogen before age 50 years. Several case-control studies and cohort studies also showed neuroprotective effects in women who received estrogen treatment (ET) in the early postmenopausal stage (most commonly at ages 50-60 years). The majority of women in those observational studies had undergone natural menopause and were treated for the relief of menopausal symptoms. However, recent clinical trials by the Women's Health Initiative showed that women who initiated ET alone or in combination with a progestin in the late postmenopausal stage (ages 65-79 years) experienced an increased risk of dementia and cognitive decline regardless of the type of menopause. The current conflicting data can be explained by the window of opportunity hypothesis suggesting that the neuroprotective effects of estrogen depend on age at the time of administration, type of menopause, and stage of menopause. Therefore, women who underwent bilateral oophorectomy before the onset of menopause or women who experienced premature or early natural menopause should be considered for hormonal treatment until approximately age 51 years.

Premature menopause is associated with increased risk of cerebral infarction in Japanese women

OBJECTIVE

: Few epidemiological studies have examined the relationship between age at menopause and stroke incidence, and none have done so in Japanese women. Here, we investigated the relationship between age at menopause and stroke incidence in a large group of Japanese women.

METHODS

: The study participants were 4,790 postmenopausal women aged 36 to 89 years enrolled in the Jichi Medical School Cohort Study, a population-based prospective study. Baseline data were obtained by questionnaire and health checkups between April 1992 and July 1995 in 12 rural areas in Japan. The incidence of all strokes and stroke subtypes was monitored.

RESULTS

: Mean (SD) participant age was 61.0 (6.7) years, and mean (SD) age at menopause was 48.3 (4.8) years. A total of 185 strokes were observed during a mean follow-up of 10.8 years. On adjustment for age, systolic blood pressure, total cholesterol, body mass index, smoking habits, and alcohol drinking habits, hazard ratios (95% CIs) of stroke for women who underwent menopause before age 40 years, at 40 to 44 years, at 45 to 49 years, and at 55 years or after relative to those who underwent menopause at age 50 to 54 years were 1.56 (0.78-3.12), 1.59 (1.00-2.51), 1.28 (0.92-1.78), and 0.83 (0.38-1.81), respectively. However, hazard ratios (95% CI) of cerebral infarction for women who underwent menopause before age 40 years, at 40 to 44 years, at 45 to 49 years, and at 55 years or after relative to those who underwent menopause at age 50 to 54 years were 2.57 (1.20-5.49), 1.49 (0.80-2.78), 1.06 (0.67-1.68), and 1.08 (0.43-2.74), respectively.

CONCLUSIONS

: Our data suggest that Japanese women who undergo menopause before age 40 years are at an increased risk of cerebral infarction. Premature menopause should be considered an indicator of the need for more aggressive medical intervention aimed at the prevention of cerebral infarction.

Premature menopause or early menopause: long-term health consequences

OBJECTIVE

To review and summarize current evidence on the health consequences of premature menopause and early menopause.

METHODS

We reviewed existing literature and combined graphically some results from the Mayo Clinic Cohort Study of Oophorectomy and Aging.

RESULTS

Premature menopause or early menopause may be either spontaneous or induced. Women who experience premature menopause (before age 40 years) or early menopause (between ages 40 and 45 years) experience an increased risk of overall mortality, cardiovascular diseases, neurological diseases, psychiatric diseases, osteoporosis, and other sequelae. The risk of adverse outcomes increases with earlier age at the time of menopause. Some of the adverse outcomes may be prevented by estrogen treatment initiated after the onset of menopause. However, estrogen alone does not prevent all long-term consequences, and other hormonal mechanisms are likely involved.

CONCLUSIONS

Regardless of the cause, women who experience hormonal menopause and estrogen deficiency before reaching the median age of natural menopause are at increased risk for morbidity and mortality. Estrogen treatment should be considered for these women, but may not eliminate all of the adverse outcomes.

Mosaic aging

Although all multicellular organisms undergo structural and functional deterioration with age, senescence is not a uniform process. Rather, each organism experiences a constellation of changes that reflect the heterogeneous effects of age on molecules, cells, organs and systems, an idiosyncratic pattern that we refer to as mosaic aging. Varying genetic, epigenetic and environmental factors (local and extrinsic) contribute to the aging phenotype in a given individual, and these agents influence the type and rate of functional decline, as well as the likelihood of developing age-associated afflictions such as cardiovascular disease, arthritis, cancer, and neurodegenerative disorders. Identifying key factors that drive aging, clarifying their activities in different systems, and in particular understanding how they interact will enhance our comprehension of the aging process, and could yield insights into the permissive role that senescence plays in the emergence of acute and chronic diseases of the elderly.

Fetal environment and early age at natural menopause in a British birth cohort study

BACKGROUND

Early life development may influence the timing of natural menopause through association with size of the initial follicle pool or early follicular loss. This study examines the relationships of birthweight, gestational age and birthweight standardized by gestational age with early menopause in the 1958 British birth cohort study.

METHODS

Study participants were over 2900 women with data on birthweight, gestational age (obtained at birth), menopausal status at age 44-45 years and potential confounding factors. Logistic regression was used to study relationships of birthweight, gestational age and birthweight standardized by gestational age with post-menopausal status by 44-45 years, with and without adjustments for confounding factors.

RESULTS

There was a U-shaped association between birthweight and menopausal status at 44-45 years: women at either extremes of birthweight (<2.5 and >or=4.0 kg) had increased odds of post-menopausal status compared with those weighing 3.0-3.49 kg [odds ratio (OR) = 1.91, 95% confidence interval (CI) 1.08, 3.38; 1.81, 95% CI 1.11, 2.97, respectively]. Women with higher birthweight standardized by gestational age (which indicates faster fetal growth rate) also had increased odds of being post-menopausal by 44-45 years (OR for fastest quarter versus second fastest quarter = 1.80; 95% CI 1.16, 2.81). These associations persisted after adjustment for socioeconomic position at birth, adult smoking status and use of oral contraceptives.

CONCLUSIONS

These findings suggest that variations in fetal environment may be associated with the timing of menopause. Given that extremes of birthweight and higher birthweight standardized by gestational age were associated with earlier age at menopause, mechanisms related to these characteristics that also regulate ovarian function should be investigated further.

Clinical characteristics of bladder urothelial tumors in female patients

OBJECTIVE

The aim of this study was to investigate the influence of age and menopause on the clinical characteristics of bladder urothelial tumors in female patients.

METHODS

We retrospectively reviewed the clinical and pathological data of 215 consecutive female patients with bladder urothelial tumors who were treated at our department from January 2000 to July 2008. To investigate the relationship with age, the clinical characteristics of the patients were first classified into three groups: 50 years or younger, 51 to 69 years, and 70 years or older. Then, the women were classified into two groups: premenopausal and postmenopausal. The tumor characteristics of the two groups were analyzed to define the relationship, if any, with menopause. Furthermore, logistic regression model was constructed to discriminate variables (age and menopause).

RESULTS

The percentage of women with bladder urothelial carcinoma increased with increasing age, and a significant difference was observed among the three age groups (P = 0.003). Painless macroscopic hematuria occurred more frequently in the group of women 50 years or older at the first presentation (P = 0.003). On the other hand, compared with premenopausal women, postmenopausal women were more frequently diagnosed with bladder urothelial carcinoma and had a higher frequency of infiltrating carcinoma (P < 0.001 and P = 0.011, respectively). Logistic regression confirmed associations between menopause and tumor characteristics, controlling for age.

CONCLUSIONS

Our study provided evidence that the natural history of bladder urothelial tumors seemed to differ according to menopause. It was observed that the percentage of bladder urothelial carcinomas increased with menopause. Moreover, there was a tendency for postmenopausal women to present with unfavorable infiltrating carcinoma more frequently.

Mortality and fertility rates in humans and chimpanzees: How within-species variation complicates cross-species comparisons

A grandmother hypothesis may explain why humans evolved greater longevity while continuing to end female fertility at about the same age as do the other great apes. With that grandmother hypothesis in mind, we sought to compare age-specific mortality and fertility rates between humans and chimpanzees, our closest living relatives, and found two puzzles. First, we expected that lower adult mortality in humans would be associated with slower senescence, but the rate of chimpanzee demographic aging falls within the human range. Second, we expected declines in age-specific fertility to be similar in the two species but instead of falling in the thirties as it does in women, fertility remains high into the forties in some chimpanzee populations. We report these puzzles using data from nine human populations and both wild and captive chimpanzees, and suggest that systematic differences in the heterogeneity of surviving adults may explain them.

Aetiology of premature ovarian failure

Premature ovarian failure (POF) is the occurrence of hypergonadotropic hypoestrogenic amenorrhoea in women under the age of 40 years. POF is idiopathic in 74–90% of cases but can be familial (4–33%) or sporadic. The known causes are: genetic aberrations; autoimmune ovarian damage; iatrogenic following surgery, radiotherapy or chemotherapy; environmental factors (viruses, toxins, etc.); and metabolic (galactosaemia, 17 OH deficiency, etc.) Genetic aberrations could involve the X chromosome (monosomy, trisomy or translocations) or be autosomal. Genetic mechanisms include reduced gene dosage and non-specific chromosome effect impairing meiosis, decreasing the pool of primordial follicles and increasing atresia due to apoptosis or failure of follicle maturation. The genes for POF-1 are localized to Xq 21.3–Xq27 and for POF-2 to Xq13.3–21.1. The FMR1 gene is responsible for the fragile X syndrome. It occurs due to CGG expansion of more than 55 repeats at the 5′UTR (Xq 27.3), which is associated with gene silence resulting in mental retardation in males, and POF in female carriers. Autoimmune ovarian damage is caused by the alteration of T-cell subsets and T-cell-mediated injury, increase of autoantibody producing B-cells and a low number of effector supressor/cytotoxic lymphocyte and a decrease of number and activity of natural killer cells. POF can be associated with other non-endocrine and endocrine diseases. The mutations of AIRE gene are responsible for polyendocrinopathies (APS I–III). As the cause of POF is unknown in the majority of cases and the number of women with POF is increasing, the primary goal of scientific groups worldwide should be focused on the study of the aetiology of POF.

Familial aggregation of survival and late female reproduction

Women giving birth at advanced reproductive ages in natural fertility conditions have been shown to have superior postmenopausal longevity. It is unknown whether improved survival is more likely among relatives of late-fertile women. This study compares survival past age 50 of men with and without a late-fertile sister in two populations: Utahns born in 1800-1869 identified from the Utah Population Database and Québec residents born in 1670-1750 identified from the Programme de recherche en démographie historique. Male survival was greater for those with, rather than without, a sister reproducing after age 45, particularly among men with at least three sisters (Utah rate ratio [RR] = .801, 95% CI = 0.687-0.940; Quebec RR = .786, 95% CI = 0.664-0.931). Survival of wives was unaffected by whether their husbands had a late-fertile sister, suggesting a weak influence of unmeasured socioenvironmental factors. These results support the hypothesis that late female fertility and slow somatic aging may be promoted by the same genetic variants.

Increased cardiovascular mortality after early bilateral oophorectomy

OBJECTIVE

To investigate the mortality associated with cardiovascular diseases and the effect of estrogen treatment in women who underwent unilateral or bilateral oophorectomy before menopause.

DESIGN

We conducted a cohort study with long-term follow-up of women in Olmsted County, MN, who underwent either unilateral or bilateral oophorectomy before the onset of menopause from 1950 through 1987. Each member of the oophorectomy cohort was matched by age to a referent woman from the same population who had not undergone any oophorectomy. We studied the mortality associated with cardiovascular disease in a total of 1,274 women with unilateral oophorectomy, 1,091 women with bilateral oophorectomy, and 2,383 referent women.

RESULTS

Women who underwent unilateral oophorectomy experienced a reduced mortality associated with cardiovascular disease compared with referent women (hazard ratio [HR], 0.82; 95% CI, 0.67-0.99; P = 0.04). In contrast, women who underwent bilateral oophorectomy before age 45 years experienced an increased mortality associated with cardiovascular disease compared with referent women (HR, 1.44; 95% CI, 1.01-2.05; P = 0.04). Within this age stratum, the HR for mortality was significantly increased in women who were not treated with estrogen through age 45 years or longer (HR, 1.84; 95% CI, 1.27-2.68; P = 0.001) but not in women treated with estrogen (HR, 0.65; 95% CI, 0.30-1.41; P = 0.28; test of interaction, P = 0.01). Mortality was further increased after deaths associated with cerebrovascular causes were excluded.

CONCLUSIONS

Bilateral oophorectomy performed before age 45 years is associated with increased cardiovascular mortality, especially with cardiac mortality. However, estrogen treatment may reduce this risk.

Earlier age at menopause, work, and tobacco smoke exposure

OBJECTIVE

Earlier age at menopause onset has been associated with increased all-cause, cardiovascular, and cancer mortality risks. The risk of earlier age at menopause associated with primary and secondary tobacco smoke exposure was assessed.

DESIGN

This was a cross-sectional study using a nationally representative sample of US women. A total of 7,596 women (representing an estimated 79 million US women) from the National Health and Nutrition Examination Survey III were asked time since last menstrual period, occupation, and tobacco use (including home and workplace second-hand smoke [SHS] exposure). Blood cotinine and follicle-stimulating hormone levels were assessed. Logistic regressions for the odds of earlier age at menopause, stratified on race/ethnicity in women 25 to 50 years of age and adjusted for survey design, were controlled for age, body mass index, education, tobacco smoke exposure, and occupation.

RESULTS

Among 5,029 US women older than 25 years with complete data, earlier age at menopause was found among all smokers and among service and manufacturing industry sector workers. Among women age 25 to 50 years, there was an increased risk of earlier age at menopause with both primary smoking and SHS exposure, particularly among black women.

CONCLUSIONS

Primary tobacco use and SHS exposure were associated with increased odds of earlier age at menopause in a representative sample of US women. Earlier age at menopause was found for some women worker groups with greater potential occupational SHS exposure. Thus, control of SHS exposure in the workplace may decrease the risk of mortality and morbidity associated with earlier age at menopause in US women workers.

Age at menarche, total mortality and mortality from ischaemic heart disease and stroke: the Adventist Health Study, 1976-88

BACKGROUND

Little is known about the relationship between age at menarche and total mortality and mortality from ischaemic heart disease and stroke.

METHODS

A cohort study of 19 462 Californian Seventh-Day Adventist women followed-up from 1976 to 1988. A total of 3313 deaths occurred during follow-up, of which 809 were due to ischaemic heart disease and 378 due to stroke.

RESULTS

An early menarche was associated with increased total mortality (P-value for linear trend <0.001), ischaemic heart disease (P-value for linear trend = 0.01) and stroke (P-value for linear trend = 0.02) mortality. There were, however, also some indications of an increased ischaemic heart disease mortality in women aged 16-18 at menarche (5% of the women). When assessed as a linear relationship, a 1-year delay in menarche was associated with 4.5% (95% CI 2.3-6.7) lower total mortality. The association was stronger for ischaemic heart disease [6.0% (95% CI 1.2-10.6)] and stroke [8.6% (95% CI 1.6-15.1)] mortality.

CONCLUSIONS

The results suggest that there is a linear, inverse relationship between age at menarche and total mortality as well as with ischaemic heart disease and stroke mortality.

HIV and the menopause

Dramatic improvement in the survival of the HIV population has occurred with the ascendance of highly active antiretroviral therapy (HAART). In the foreseeable future, HIV-infected women who acquired disease during the peak years of the epidemic are expected to survive to experience menopause and even years beyond. The HIV epidemic may be viewed as 'mature', as its earlier victims become part of the geriatric population. Research about the process of menopause in HIV-infected women and, conversely, about HIV infection in women undergoing menopause is currently limited. Existing research suggests that the process of menopause is affected by HIV infection, inasmuch as infected women appear to experience menopause at an earlier age, with greater symptomatology, and with different reproductive hormone profiles compared with HIV-uninfected women. HIV infection also appears to affect bone mineral density, cardiovascular disease and cognition, with some age-related interactions. Lifestyle and demographic factors have pervasive importance for both HIV infection and the menopause in women. This article reviews the current state of knowledge about the menopausal process in HIV-infected women, and the common conditions in postmenopausal women that are likely to be affected by HIV infection. Clinicians should appreciate the potential role of HIV infection in caring for menopause-aged women.

Telomere length and reproductive aging

BACKGROUND

Rate of reproductive aging may be related to rate of biological aging. Thus, indicators of aging, such as short telomere length, may be more frequent in women with a history suggestive of premature reproductive senescence.

METHODS

Telomere-specific quantitative PCR was used to assess telomere length in two groups of women with evidence of reproductive aging: (i) patients with idiopathic premature ovarian failure (POF, N = 34) and (ii) women with a history of recurrent miscarriage (RM, N = 95); and two control groups: (1) women from the general population (C1, N = 108) and (2) women who had a healthy pregnancy after 37 years of age (C2, N = 46).

RESULTS

The RM group had shorter age-adjusted mean telomere length than controls (8.46 versus 8.92 kb in C1 and 9.11 kb in C2, P = 0.0004 and P = 0.02 for C1 and C2, respectively), although short telomeres were not confined to subsets of this group known to have experienced single or multiple trisomic pregnancies. Although sample size is limited, mean telomere length in the POF group was significantly longer than that in C1 (9.58 versus 8.92 kb, P = 0.01).

CONCLUSIONS

Women experiencing RM may have shorter telomeres as a consequence of a more rapid rate of aging, or as a reflection of an increased level of cellular stress. Longer telomere length in the POF group may be explained by abnormal hormone exposure, slow cell division rates or autoimmunity in these women. Despite small sample sizes, these results suggest that different manifestations of reproductive aging are likely influenced by distinct physiological factors.

Menopause does not affect blood pressure and risk profile, and menopausal women do not become similar to men

OBJECTIVE

Menopause is considered to be a cardiovascular risk factor, but this belief is based on opinions rather than on evidence. Confounding effects of age are often neglected.

DESIGN

Population-based study with further subanalysis of case-to-case age-matched cohorts of men and fertile and menopausal women.

SETTING

Epidemiology in primary, public, institutional frame.

PARTICIPANTS

Nine thousand three hundred and sixty-four men and women aged 18-70 years representative of Italian general population followed-up for 18.8 +/- 7.7 years.

MAIN OUTCOME MEASURES

Blood pressure (BP), prevalence and incidence of hypertension, serum total, high-density lipoprotein and low-density lipoprotein cholesterol, glucose tolerance, body adiposity, vascular reactivity, target organ damage, overall and cardiovascular mortality and morbidity, by gender and by menopausal status.

RESULTS

Cross-sectional: crude BP, pressor response to cold, orthostatic BP decrease, BMI, skinfold thickness, fasting and postload blood glucose and insulin, serum lipids, left ventricular mass, serum creatinine, microalbuminuria and augmetantion index were higher in menopausal than in fertile women, and comparable in menopausal women and men, a difference that was no longer present when adjusting for age or considering age-matched cohorts. Longitudinal: BP increase during follow-up, cardiovascular mortality and morbidity were greater in menopausal than in fertile women, and comparable in menopausal women and men, a difference no longer present in age-matched cohorts. Menopausal status was rejected from multivariate Cox analysis also including age.

CONCLUSION

The cardiovascular effects usually attributed to menopause seem to be a mere consequence of the older age of menopausal women.

Prophylactic oophorectomy in premenopausal women and long-term health

OBJECTIVE

To review the data on long-term outcomes in women who underwent prophylactic bilateral oophorectomy, a common surgical procedure that has more than doubled in frequency since the 1960s.

STUDY DESIGN

Literature review of the published data on the consequences of prophylactic bilateral oophorectomy. Special emphasis was given to the Mayo Clinic Cohort Study of Oophorectomy and Aging. Main outcome measures Overall mortality, cardiovascular disease, cognitive impairment and dementia, parkinsonism, osteoporosis, psychological wellbeing and sexual function.

RESULTS

There is a growing body of evidence suggesting that the premature loss of ovarian function caused by bilateral oophorectomy performed before natural menopause is associated with several negative outcomes. In particular, studies have revealed an increased risk of premature death, cardiovascular disease, cognitive impairment or dementia, parkinsonism, osteoporosis and bone fractures, decline in psychological wellbeing and decline in sexual function. The effects involve different organs (e.g. heart, bone, or brain), and different functions within organs (e.g. cognitive, motor, or emotional brain functions). Estrogen treatment may prevent some but not all of these negative outcomes.

CONCLUSION

The potential adverse effects of prophylactic bilateral oophorectomy on heart health, neurological health, bone health and quality of life should be carefully weighed against its potential benefits for cancer risk reduction in women at average risk of ovarian cancer.

Basic infertility including polycystic ovary syndrome

Infertility in women has many possible causes and must be approached systematically. The most common cause of medically treatable infertility is the polycystic ovary syndrome (PCOS). This syndrome is common in young women and is the cause of anovulatory infertility in 70% of cases. It is therefore an important condition to screen and manage in primary care medical settings. In the past 10 years, insulin sensitization with weight loss or metformin has been shown to be a safe and effective treatment for PCOS infertility that eliminates the risk of multiple pregnancy and may reduce the risk of early pregnancy loss as compared with ovulation-inductor drugs. The authors believe metformin should be considered as first-line therapy because it has the advantage to allow for normal single ovulation, for reduced early pregnancy loss, and, most importantly, lifestyle modifications and weight loss before pregnancy. Losing weight not only improves fertility but also reduces adverse pregnancy outcomes associated with obesity.

Potential use of biomarkers for analyzing interpopulation and cross-cultural variability in reproductive aging

OBJECTIVE

The aims of this study were (1) to document the extent of variability in physiological aspects of reproductive aging; (2) to outline those areas where more work is needed to expand our knowledge of this variability; (3) to outline available biomarkers that can be used to measure aspects of reproductive aging, such as ovarian reserve and declining hormone levels; and (4) to note potential problems with the use of these biomarkers in cross-cultural settings.

DESIGN

Literature review of English and French publications using PubMed with no date restrictions.

RESULTS

Substantial variability exists in both cultural and physiological aspects of reproductive aging and menopause. However, the extent of variability across populations for many areas of reproductive aging needs better documentation as well as explanation of sources of this variability. Several biomarkers exist for use in cross-cultural research, including ovarian characteristics such as ovarian volume, ovarian reserve, follicular development, and atresia, and levels of hormones such as follicle-stimulating hormone, inhibin B, and anti-mullerian hormone.

CONCLUSION

We urge that further work be undertaken to evaluate and describe variability in physiological aspects of reproductive aging in cross-cultural settings. Some problems exist in the use of biomarkers to record this variability, particularly in remote settings with few logistical resources.

Time-related trends of age at menopause and reproductive period of women in a Chuvashian rural population

OBJECTIVE

The objective of this study was to examine in an observational, cross-sectional, community-based study the secular trend of age at menopause among women in a rural Chuvashian population and to identify factors associated with age at menopause.

DESIGN

The sample included 316 postmenopausal women born between 1920 and 1950 with mean age at menopause of 48.47 +/- 4.63 (34-58) years. Statistical analyses included simple and multiple linear regression and "whiskers" plots.

RESULTS

Significant association was found between year of birth and age at menopause (beta = 0.194, P < 0.001) and reproduction period (P = 0.193, P < 0.001). Mean values of age at menopause increased from 47.0 years (born during 1920-1925) to maximal values of 49.7 years (born during 1940-1945) and 49.3 years (born during 1945-1950). Mean values of their reproductive period increased from 30.7 (born during 1920-1925) to maximal values of 34.1 (born during 1940-1945) and to 33.7 (born during 1945-1950). Multiple linear regression analysis demonstrated that year of birth was the only statistically significant (P = 0.19, P < 0.01) predictor of age at menopause. Age at menarche can also be a possible predictor of age at menopause (beta = -0.12, P = 0.04).

CONCLUSIONS

The study confirmed certain secular trends of age at menopause and reproductive periods in Chuvashian women. The authors also observed a negative association between age at menarche and age at menopause. The number of children and medical abortions as well as body mass index showed no association with age at menopause.

A prospective analysis of alcohol consumption and onset of perimenopause

OBJECTIVES

We prospectively assessed the association between alcohol consumption and onset of perimenopause in women of late reproductive age using data from the Harvard Study of Moods and Cycles. Specific types of alcoholic beverages - red wine, white wine, beer, and liquor - were evaluated.

METHODS

Among 502 women aged 36-45 years residing in seven Boston communities, we assessed self-reported perimenopausal symptoms over a 5-year period. The onset of perimenopause was defined using changes in menstrual characteristics. We administered a semiquantitative food frequency questionnaire at enrollment to measure regular alcohol consumption during the past year. Hazard ratios (HRs) and 95% confidence intervals were derived from Cox regression models.

RESULTS

No association was found between total alcohol consumption and time to perimenopause. Compared with women consuming <1 alcoholic drink per month, HRs for those drinking red wine in quantities of 1-3 glasses per month, 1 glass per week, or >or=2 glasses per week were all below 1.0, after accounting for other sources of alcohol. Among never smokers, the inverse association with red wine was stronger and a positive association was observed with liquor consumption although numbers were small. No associations were observed with white wine or beer.

CONCLUSION

While there was no association between total alcohol consumption and onset of perimenopause, there was some suggestion of an inverse association between red wine and risk of perimenopause, particularly among never smokers.

Age at menopause and cause-specific mortality in South Korean women: Kangwha Cohort Study

OBJECTIVE

The purpose of this study was to examine the relation between age at natural menopause and all-cause and cause-specific mortality among women.

METHODS

This study used the data of the Kangwha Cohort that was followed up from 1985 to 2001, in particular, for the group of 55 years or older women (n=2658). We calculated the hazard ratio of mortality by the group of age at menopause using the Cox proportional hazards model with adjustment for age, alcohol consumption, education, age at first birth, self-cognitive health level, chronic disease, marital partner, parity, age at menarche, oral contraceptive use and hypertension.

RESULTS

The mean (standard deviation) age at menopause was 46.9 (4.9) years, and the median age was 48 years. After adjusting for the relevant variables, the risk of total death in the early menopause group (<40 years at menopause) was 1.32 times higher than that of the reference group (45-49 years at menopause) (95% confidence interval [CI], 1.05-1.66, p=0.02). For the early menopause group, relative to the reference group, the adjusted hazard ratios of death due to cardiovascular disease and cancer were 1.53 (95% CI, 1.00-2.39, p=0.04) and 2.01 (95% CI, 1.06-3.82, p=0.03), respectively.

CONCLUSION

Through this study, the age at menopause was found to be different between Asian and Caucasian women and the association of age at menopause with death, particularly caused by cardiovascular disease and cancer, was validated. Our study is one of rare studies regarding the age at menopause of Asian women and their risk of mortality, which could be considered to be meaningful.

From menarche to menopause: trends among US Women born from 1912 to 1969

The authors investigated secular trends in age at menarche, age at menopause, and reproductive life span within a population-based cohort of US women. Study subjects were 22,774 women selected randomly as controls for a case-control study. Eligible controls were residents of Wisconsin, Massachusetts, or New Hampshire born between 1910 and 1969. Subjects completed telephone interviews in 1988-2001 and answered questions regarding reproductive and lifestyle factors. Birth cohorts were created using 5- and 10-year periods, and statistical comparisons were performed with analysis of variance. The mean age at menarche decreased by approximately 6 months for those born between 1910 and 1949 (13.1 vs. 12.7 years; p < 0.001), with a subsequent increase to 13.0 years among women born between 1960 and 1969 (p < 0.001). Among naturally menopausal women aged 60 or more years who reported never use of postmenopausal hormone therapy, the authors observed a 17-month increase in the mean age at menopause for those born between 1915 and 1939 (49.1 vs. 50.5 years; p = 0.001) after adjustment for potential confounders. They also observed an increase in the average number of reproductive years (subtracting age at menarche from age at natural menopause), from 36.1 years among women born between 1915 and 1919 to 37.7 years among the 1935-1939 cohort (p = 0.0001). These findings have implications for women's lifetime exposure to circulating endogenous hormones.

Survival patterns after oophorectomy in premenopausal women: a population-based cohort study

BACKGROUND

A statistical model of death due to ovarian cancer, breast cancer, coronary heart disease, hip fracture, and stroke has suggested that women who undergo prophylactic bilateral oophorectomy are at increased risk of death for all causes. We aimed to investigate survival patterns in a population-based sample of women who had received an oophorectomy and compare these with women who had not received an oophorectomy.

METHODS

From an existing cohort of all women who underwent unilateral or bilateral oophorectomy while residing in Olmsted County, MN, USA, in 1950-87, we analysed those who had received an oophorectomy for a non-cancer indication before the onset of menopause. Every member of the cohort was matched by age to a referent woman in the same population who had not undergone oophorectomy. 1293 women with unilateral oophorectomy, 1097 with bilateral oophorectomy, and 2390 referent women were eligible for the study. Women were followed up until death or the end of the study (staggered over 2001-06) by use of direct or proxy interviews, medical records in a records-linkage system, and death certificates.

FINDINGS

Overall, mortality was not increased in women who underwent bilateral oophorectomy compared with referent women. However, mortality was significantly higher in women who had received prophylactic bilateral oophorectomy before the age of 45 years than in referent women (hazard ratio 1.67 [95% CI 1.16-2.40], p=0.006). This increased mortality was seen mainly in women who had not received oestrogen up to the age of 45 years. No increased mortality was recorded in women who underwent unilateral oophorectomy in either overall or stratified analyses.

INTERPRETATION

Although prophylactic bilateral oophorectomy undertaken before age 45 years is associated with increased mortality, whether it is causal or merely a marker of underlying risk is uncertain.

Premature ovarian failure

PURPOSE OF REVIEW

To summarize current knowledge about premature ovarian failure (POF) with an emphasis on recent developments regarding its management.

RECENT FINDINGS

The incidence of POF is increasing largely due to improved survival rates of cancer patients treated with radiation and chemotherapy. Delayed diagnosis and management of POF leads to suboptimal outcomes. Anticipation and early detection of this condition in high-risk women by means of ovarian function testing, followed by early institution of appropriate management could improve outcomes. Choice of strategies should vary depending on the age of onset, associated symptoms and fertility aspirations of the individual, and should change with the patient's advancing age.

SUMMARY

Early assessment of the individual's risk of developing POF, development of a strategic management plan, and timely commencement of infertility and hormone deficiency treatment, together with counselling in an integrated management plan should improve both the short and long-term health of those with POF.

Relationships of age at menarche and menopause, and reproductive year with mortality from cardiovascular disease in Japanese postmenopausal women: the JACC study

BACKGROUND

Early menopause is associated with increased risk of coronary heart disease in Caucasian women. However, this association has not been examined in Asian women.

METHODS

We conducted a 10-year cohort study of 37,965 Japanese post-menopausal women aged 40-79 years in the Japan Collaborative Cohort (JACC) Study. Causes of death were determined based on the International Classification of Disease.

RESULTS

There were 487 mortality of stroke and 178 mortality of coronary heart disease. Late menarche or early menopause, or shorter duration of reproductive period was not associated with risk of mortality from coronary heart disease. However, compared with women with age at menarche ≤13 years, those with age at menarche ≥17 years tended to have increased risk of mortality from stroke: the multivariable hazard ratio was 1.32 (95% confidence interval [CI]: 0.93-1.87, p = 0.10). Compared with women with age at menopause of ≥49 years, those with age at menopause of <49 years tended to have increased risk of coronary heart disease among women aged 40-64 years; the multivariable hazard ratio was 1.85 (95% CI: 0.92-3.73, p = 0.08).

CONCLUSIONS

The possible association between early menopause and coronary heart disease among middle-aged women was consistent with the result of observational studies for Caucasian women, and can be explained by a protective effect of endogenous estrogen on the development of atherosclerosis.

Hypopituitarism and mortality in pituitary adenoma

BACKGROUND AND OBJECTIVE

Previous studies on hypopituitarism and mortality have concluded that insufficient pituitary function is associated with decreased survival. For several reasons the results are difficult to compare - particularly because definitions and treatment of hypopituitarism have varied and various underlying disorders have been included. The purpose was to assess the relationship between mortality and pituitary function.

PATIENTS AND DESIGN

One hundred and sixty consecutive patients (99 men and 61 women) with functionless, suprasellar pituitary adenoma. All were operated on transsphenoidally during the period 1985-1996. Additional radiotherapy was given to 29 patients. Mortality was calculated 12.4 years (median, range 8.1-19.9) after operation. Postoperative hormonal deficits were treated in most, though GH substitution was given only to a minority of patients.

RESULTS

Postoperatively 30% of the patients had normal pituitary function (normal adrenocortical, thyroid and gonadal function), 26% were panhypopituitary and 36% had partial pituitary insufficiency. Forty-one patients had died (34.7 expected) yielding a standard mortality ratio (SMR) of 1.18 (95% confidence limits (CI) 0.87-1.60). SMR was significantly increased in women (1.97, CI 1.20-3.21) but not in men (0.83, CI 0.55-1.26). SMR in patients with normal pituitary function, panhypopituitarism and partial insufficiency were not different from that in the general population. SMR in hypopituitary women was substantially higher than in men with pituitary insufficiency. Treatment with growth hormone in GH-deficient patients did not influence survival.

CONCLUSION

Pituitary surgery for nonfunctioning adenoma and subsequent pituitary insufficiency had no effect on mortality in men, but was associated with significantly increased mortality in women. Suboptimal hormonal substitution in women may play a role.

A reassessment of sexual dimorphism in human senescence: theory, evidence, and causation

Age-specific mortality rates of men are higher than those of women, and men have shorter average life spans than women. This has been interpreted as evidence of sexual dimorphism in rates of senescence. However, because mortality can be caused by numerous factors in addition to senescence, higher mortality rates do not necessarily indicate more rapid senescence. In this paper, we (1) emphasize the necessity of decoupling mortality and senescence when considering sexual dimorphism in senescence, (2) present a theoretical framework for the hypothesis that selection affects senescence in human males and females differently due to different life history characteristics, (3) consider phenotypic evidence from the literature that human males show a later onset of senescence than human females, despite exhibiting higher mortality rates, and (4) discuss the potential roles of mutation accumulation and antagonistic pleiotropy in the evolution of sexual dimorphism in senescence.

Increased longevity in older users of postmenopausal estrogen therapy: the Leisure World Cohort Study

OBJECTIVE

To examine the effect of postmenopausal estrogen therapy (ET), including duration and recency of use, on all-cause mortality in older women.

DESIGN

As part of a prospective cohort study of residents of a California retirement community begun in the early 1980s, Leisure World Cohort women (median age, 73 y) completed a postal health survey including details on ET use and were followed up for 22 years (1981-2003). Age- and multivariate-adjusted risk ratios (RR) and 95% CIs were calculated using proportional hazard regression.

RESULTS

Of the 8,801 women, 6,626 died during follow-up (median age, 88 y). ET users had an age-adjusted mortality rate of 52.9 per 1,000 person-years compared with 56.5 among lifetime nonusers (RR = 0.91; 95% CI, 0.87-0.96). Risk of death decreased with both increasing duration of ET and decreasing years since last use (P for trend <0.001). The risk was lowest among long-term (> or =15 y) users (RR = 0.83; 95% CI, 0.74-0.93 for 15-19 y and RR = 0.87; 95% CI, 0.80-0.94 for 20+ y). For long-term users, the age-adjusted mortality rate was 50.4 per 1,000 person-years. Lower-dose users (< or =0.625 mg) had a slightly better survival rate than higher-dose users (RR = 0.84; 95% CI, 0.78-0.91 vs RR = 0.91; 95% CI, 0.83-0.97). Risk did not differ by route of administration (P = 0.56). Further adjustment for potential confounders had little effect on the observed RRs for ET.

CONCLUSION

Long-term ET is associated with lower all-cause mortality in older women.

Pesticide exposure and timing of menopause: the Agricultural Health Study

Age at menopause has implications for fertility and risk of hormonally related chronic diseases. Some pesticides disrupt reproductive hormones or are toxic to the ovary, but little is known about the association between pesticide exposure and timing of menopause. Cox proportional hazards modeling was used to examine the association between use of pesticides and age at menopause among 8,038 women living and working on farms in Iowa and North Carolina. Premenopausal women aged 35-55 years were followed from enrollment (1993-1997) to the date of their last menstrual period, or their follow-up interview (1999-2003) if still premenopausal. Women who experienced surgical menopause were censored at the date of surgery. Approximately 62% of the women reported ever mixing or applying pesticides; women who had never used pesticides were the comparison group for all analyses. After control for age, smoking status, and past use of oral contraceptives, the median time to menopause increased by approximately 3 months for women who used pesticides (hazard ratio = 0.87, 95% confidence interval: 0.78, 0.97) and by approximately 5 months for women who used hormonally active pesticides (hazard ratio = 0.77, 95% confidence interval: 0.65, 0.92). Pesticide use may be associated with a later age at menopause.

Premature ovarian failure, endothelial dysfunction and estrogen-progestogen replacement

Cardiovascular disease, including coronary artery disease, stroke and peripheral vascular disease, is the leading cause of death among women. Vascular endothelial dysfunction is an early marker of atherosclerosis. Women with premature ovarian failure (or premature menopause) present an increased risk for cardiovascular disease, which might be attributed to the early onset of vascular endothelial dysfunction, associated with sex steroid deficiency. Cyclical estrogen and progestogen therapy has been shown to restore endothelial function in these young women. Further research is required to assess primarily the long-term effects of hormone replacement therapy on cardiovascular and overall prognosis in young women with premature ovarian failure, as well as the effects of different doses, duration and routes of hormone administration in these women.

Age at natural menopause and factors associated with menopause state among Puerto Rican women aged 40-59 years, living in Puerto Rico

OBJECTIVE

The timing of menopause is associated with multiple health outcomes in female populations including all-cause mortality, heart disease, breast cancer, and osteoporosis. Although research suggests that age at menopause varies in different ethnic groups, data on age at menopause among Hispanic women are limited.

DESIGN

The present cross-sectional study estimates age at natural menopause among a sample of 1,272 Puerto Rican women aged 40 to 59 years who participated in health fairs held in 22 municipalities of Puerto Rico between May 2000 and November 2001. Cox proportional hazard regression analysis was used to characterize age at natural menopause and its association with relevant covariates.

RESULTS

The overall adjusted median age at natural menopause was 51.3 years. Current employment (hazard ratio = 0.75, 95% CI: 0.59-0.95) and parity of two or three children as compared with having no children or one child (hazard ratio = 0.73, 95% CI: 0.54-0.98) were associated with a later menopause.

CONCLUSIONS

This study provides a robust estimate of age at menopause for Puerto Rican women, which is similar to overall estimates previously reported for US populations, but higher than estimates for other Hispanic populations. Our results confirm attributes associated with age at menopause and provide information relevant to understanding the potential chronic disease burden of Puerto Rican women as they age.

The association between early menopause and risk of ischaemic heart disease: Influence of Hormone Therapy

Randomised clinical trials find no protection against development of ischaemic heart disease by use of Hormone Therapy (HT) after the age of 50 years. Observational studies suggest that early menopause is a risk factor for ischaemic heart disease. Yet, a clinical very relevant question is whether HT reduces this risk associated with early menopause.

OBJECTIVE

To analyse whether early menopause based on various causes are independent risk factors for ischaemic heart disease, and to investigate whether the risks are modified by use of HT.

METHODS

In a prospective cohort study questionnaires were mailed to Danish female nurses above 44 years of age in 1993. Information on menopause, use of HT and lifestyle was obtained. In total 19,898 (86%) nurses fulfilled the questionnaire, among them 10.533 were postmenopausal with definable menopausal age, free of previous ischaemic heart disease, stroke or cancer. Through individual linkage to national register incident cases of ischaemic heart disease were identified until end of 1998.

RESULTS

Menopause below both age 40 and 45 was associated with an increased risk of ischaemic heart disease, seeming most pronounced for women who had an early ovariectomy but also among spontaneous menopausal women. Generally HT did not reduce the risk except for the early-ovariectomised women, where no increased risk of ischaemic heart disease for HT users was found.

CONCLUSION

We found an increased risk of ischaemic heart disease associated with early removal of the ovaries that might be reduced with HT. The present study need confirmation from other studies but suggests that early ovariectomised women could benefit from HT.

Bone status of Indian women from a low-income group and its relationship to the nutritional status

Indian women from low-income groups consume diets that have inadequate calcium coupled with too few calories, proteins and micronutrients. Hospital-based data suggest that these women have osteoporotic hip fractures at a much earlier age than Western women. Studies reporting bone parameters of the Indian population involving large sample sizes are not available. This study was therefore carried out with 289 women in the 30-60-year age group to estimate the prevalence of osteoporosis and measure the bone parameters by dual energy X-ray absorptiometry (DXA). Their mean (+/- SD) age was 41.0+/-8.60 years. Their mean (+/- SD) height, weight and body mass index (BMI) were 149.1+/-5.49 cm, 49.2+/-9.85 kg and 22.1+/-3.99, respectively. Dietary intake of calcium was estimated to be 270+/-57 mg/day. The prevalence of osteoporosis at the femoral neck was around 29%. Bone mineral density (BMD) and T scores at all the skeletal sites were much lower than the values reported from the developed countries and were indicative of a high prevalence of osteopenia and osteoporosis. BMD showed a decline after the age of 35 years in cases of the lumbar spine and femoral neck. This was largely due to a decrease of bone mineral content (BMC). The nutritional status of women appears to be an important determinant of bone parameters. BMD and BMC at all the skeletal sites and whole body increased significantly with increasing body weight and BMI of women (P<0.05). However, bone area (BA) did not change with an increase in BMI. In the multiple regression analysis, apart from body weight, age, menopause and calcium intake were the other important determinants of BMD (P<0.05). In addition to these, height was also an important determinant of WB-BMC. This study highlights the urgent need for measures to improve the nutritional status, dietary calcium intake and thus the bone health of this population.

Natural menopause and risk of stroke in elderly women

Although early natural menopause has been postulated to increase stroke risk, studies have not produced convincing results. We examined the associations between stroke risks and age at natural menopause or time since natural menopause. 5,731 naturally postmenopausal women more than 65 yr of age were followed from 1993 to 1998. Information on age at menopause and risk factors were obtained using mailed questionnaires. 186 cases of stroke occurred over a total 27,936 person-years. After adjusting for age, hypertension, and physical activity, age at menopause was not found to be significantly associated with stroke or cerebral infarction. However, adjusted relative risks (aRRs) showed a significant increasing tendency of hemorrhagic stroke versus age at menopause (aRRs, 0.66, 0.48, 1.00 and 2.33 for the following age groups at menopause; 40-44, 45-49, 50-54 [reference group], and > or =55 yr). Time since menopause (11-20, 21-30, and > or =31 yr) was not found to be significantly associated with cerebral infarction, or hemorrhagic stroke. Late menopause (menopause age > or =55 yr) showed a tendency of a lower risk of cerebral infarction (aRR, 0.79) and a higher risk of hemorrhagic stroke (aRR, 2.33). Further study is warranted to determine stroke risk in women during the decade following menopause.

Age at natural menopause and cause-specific mortality

Several studies have suggested that a young age at menopause may be associated with increased risk of all-cause mortality. Few studies have examined the influence of age at menopause on specific causes of death other than coronary heart disease. Data from a prospective cohort study of US adults were used to examine the relation between age at natural menopause and all-cause and cause-specific mortality among women who never used hormone replacement therapy, who never smoked, and who experienced natural menopause between the ages of 40 and 54 years. After 20 years of follow-up between 1982 and 2002, 23,067 deaths had occurred among 68,154 women. Results from Cox proportional hazards models showed that all-cause mortality rates were higher among women who reported that menopause occurred at age 40-44 years compared with women who reported that menopause occurred at age 50-54 years (rate ratio (RR) = 1.04, 95% confidence interval (CI): 1.00, 1.08). This increased risk was largely due to higher mortality rates from coronary heart disease (RR = 1.09, 95% CI: 1.00, 1.18), respiratory disease (RR = 1.19, 95% CI: 1.02, 1.39), genitourinary disease (RR = 1.39, 95% CI: 1.07, 1.82), and external causes (RR = 1.56, 95% CI: 1.21, 2.02). These findings suggest that mortality from other diseases, as well as coronary heart disease, may contribute to the increased mortality associated with a younger age at menopause.

Age of menopause and menopausal symptoms in HIV-infected women

The objective of this study was to examine the median age of menopause, factors associated with postmenopausal status, and the prevalence of menopausal symptoms in HIV-infected women. We surveyed 120 HIV-infected women between 40 and 57 years old who attended an inner city infectious diseases clinic. Ninety-five percent of the women surveyed were African American and almost half of the women (44%) had used methadone, heroin, cocaine, marijuana, or a combination of these drugs within the past 6 months. Eighty-seven percent had smoked cigarettes at least some time during their life and 45% drank alcohol between the ages of 40 and 49 years old. Thirty women were postmenopausal (having no menstrual periods in the previous 12 consecutive months), 31 were perimenopausal (having 1-11 periods within the previous 12 months), and 59 were premenopausal (having 12 or more periods within the previous 12 months). The median age of menopause was 50 years old (95% confidence interval = 49, 53). In a multivariate model, methadone use within the past 6 months was associated with postmenopausal status. We did not find an association between postmenopausal status and body mass index, number of pregnancies, CD4 cell counts, HIV viral load, individual and grouped antiretroviral therapies, cigarette smoking, and current or past oral contraceptive use. In multivariate analysis, postmenopausal status was associated with hot flashes and cocaine use was associated with vaginal dryness.

Sun exposure and age at natural menopause: A cross-sectional study in Turkish women

OBJECTIVES

In a cross-sectional study of 157 Turkish women attending outpatient clinics of a university hospital during April-May 2003, association between various subject characteristics and menopause timing was investigated.

METHODS

Characteristics were self-reported by women aged 45-60. Of the lifestyle factors, sun exposure, physical activity, food intake and dressing with headscarf were obtained as recalled average lifelong practices up to time of menopause. Cox proportional hazard modeling was used, censoring for hysterectomy, oopherectomy and HRT use.

RESULTS

Median age at natural menopause was 52 years. In multivariate analysis, earlier natural menopause was associated with low level of lifelong sun exposure (HR=6.381, 95% CI: 2.996-13.588, p< or =0.0001), heavy physical activity (HR=2.335, 95% CI: 1.305-4.177, p=0.0043), current calcium supplement use (HR=3.191, 95% CI: 1.361-7.485, p=0.0076), diagnosis of hypertension (HR=2.002, 95% CI: 1.186-3.378, p=0.0093), not owning a house (HR=3.002, 95% CI: 1.148-7.852, p=0.0250) and longer years on oral contraceptives (HR=1.085, 95% CI: 1.000-1.176, p=0.0487). Engagement in farming (HR=2.043, 95% CI: 1.056-3.952, p=0.0339), height (cm) (HR=0.953, 95% CI: 0.907-0.994, p=0.0279) and fish consumption (servings/week) (HR=0.600, 95% CI: 0.375-0.960, p=0.0331) were associated with age at menopause in univariate analysis only. For n=109 women who recalled whether maternal menopausal age was <50 or > or =50, sun exposure (HR=7.221, 95% CI: 2.971-17.547, p<0.0001) was a stronger predictor of age at natural menopause than maternal menopausal age (HR=2.882, 95% CI: 1.477-5.621, p=0.0019).

CONCLUSIONS

We identify some previously unrecognized correlates of age at natural menopause, namely self-reported lifelong sun exposure, lifelong physical activity, house-ownership, current use of calcium supplements, and lifelong fish consumption. These findings should be confirmed in larger studies.

HIV infection, drug use, and onset of natural menopause

OBJECTIVE

To study the relationship of HIV infection and drug use with the onset of natural menopause.

METHODS

Our analyses used the World Health Organization's definition of menopause (i.e., the date of the last menstrual period is confirmed after 12 months of amenorrhea) and baseline data from a prospective study. Semiannual interviews were conducted. Levels of HIV antibody and CD4+ cell counts were obtained. Menopause was identified at baseline or during 12 months of follow-up. Women ingesting reproductive hormones were excluded. Logistic regression analyses were used to assess factors associated with menopause.

RESULTS

Of 571 women, 53% were HIV infected, and 52% had used heroin or cocaine in the previous 5 years. The median age was 43 years (interquartile range [IQR], 40-46 years); 48.9% of the women were black, 40.4% were Hispanic, and 10.7% were white. The median body mass index was 29.1 kg/m2, and 90.4% of participants were current or former cigarette smokers. Menopause was identified in 102 women: 62 HIV-infected women (median age, 46 years; interquartile range [IQR], 39-49 years) and 40 uninfected women (median age, 47 years; IQR, 44.5-48 years). Factors independently associated with menopause included HIV infection (adjusted odds ratio [OR], 1.73; 95% confidence interval [CI], 1.075-2.795), drug use (adjusted OR, 2.633; 95% CI, 1.610-4.308), and physical activity (adjusted OR, 0.895; 95% CI, 0.844-0.950). Among HIV-infected women, factors independently associated with menopause included CD4+ cell counts of >500 cells/mm3 (adjusted OR, 0.191; 95% CI, 0.076-0.4848) and 200-500 cells/mm3 (adjusted OR, 0.356; 95% CI, 0.147-0.813).

CONCLUSION

Our study shows that HIV infection and immunosuppression are associated with an earlier age at the onset of menopause. Whether early onset of menopause in HIV-infected women increases their risk of osteoporosis and heart disease requires further study.