Age at natural menopause and its associated factors in Canada: cross-sectional analyses from the Canadian Longitudinal Study on Aging

The prevalent trajectory of early menopause associated with PM2.5 exposure across 1956-2018 extrapolated from LightGBM algorithm

BACKGROUND

Fine particulate matter (PM2.5) is noxious to female reproductive development and facilitates the occurrence of subsequent diseases. Early menopause is initiative factor of female aging. But due to the lack of historical exposure of PM2.5, we could not gain insight into the linkage between ambient PM2.5 exposure and early menopause.

METHODS

We conducted a community-based retrospective cross-sectional study and pooled 1173 postmenopausal women. The machine learning algorithm of LightGBM was processed to derive the historical concentrations of PM2.5 based on aerography of 1956-2022. The quantile g-computation and binary logistic regression were employed to estimate the mixed and single associations between PM2.5 and early menopause.

RESULTS

The visibility topped the most important feature for derivations of historical PM2.5 concentrations. The R2 of 10-fold cross-validation and predictive capability during processing were all above 0.8. The prevalence of early menopause was 7.3 %. Each 10 µg/m3 PM2.5 increased the prevalence of early menopause during prior 2 years exposure (OR: 1.49, 95 %CI: 1.03-2.16) and spring and autumn (OR: 1.28, 95 %CI: 1.07-1.54). After adjusting the reverse effects of temperature, the prior 2 years exposure of PM2.5 remained positively associated with early menopause in the fourth quantile vs the first quantile (OR: 3.36, 95 %CI: 1.53-7.36) in the spring and autumn. The higher BMI (OR: 1.40, 95 %CI: 1.14-1.72), waistline (OR: 1.42, 95 %CI: 1.09-1.85) and unfavourable dietary habits of less meat (OR: 1.72, 95 %CI: 1.11-2.68), more fried food (OR: 2.39, 95 %CI: 1.15-4.99) elevated the prevalence of early menopause.

CONCLUSIONS

The accurate environmental exposure assessment of historical PM2.5 vigorously promoted the researches on the relationship between PM2.5 and early menopause. It sounds the alarm on female infertility menace associated with particulate matter especially during the turbulent 2 years before menopause.

Greater TIMP-1 protein levels and neointimal formation represent sex-dependent cellular events limiting aortic vessel expansion in female rats

Fragmentation/loss of the structural protein elastin represents the precipitating event translating to aortic expansion and subsequent aneurysm formation. The present study tested the hypothesis that greater protein expression of tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) and neointimal growth secondary to a reduction of medial elastin content represent sex-dependent events limiting aortic vessel expansion in females. TIMP-1 protein levels were higher in the ascending aorta of female versus male patients diagnosed with a bicuspid aortic valve (BAV). The latter paradigm was recapitulated in the aorta of adult male and female rats complemented by greater TIMP-2 expression in females. CaCl2 (0.5 M) treatment of the infrarenal aorta of adult male and female rats increased the in situ vessel diameter and expansion was significantly smaller in females despite a comparable reduction of medial elastin content. The preferential appearance of a neointimal region of the CaCl2-treated infrarenal aorta of female rats may explain in part the smaller in situ expansion and neointimal growth correlated positively with the % change of the in situ diameter. Neointimal formation was secondary to a significant increase in the density of medial/neointimal vascular smooth muscle cells (VSMCs) that re-entered the G2-M phase whereas VSMC cell cycle re-entry was attenuated in the CaCl2-treated infrarenal aorta of male rats. Thus, greater TIMP-1 expression in the aorta of female BAV patients may prevent excessive elastin fragmentation and preferential neointimal growth following CaCl2-treatment of the infrarenal aorta of female rats represents a sex-dependent biological event limiting vessel expansion secondary to a significant loss of the structural protein.

Economic Evaluation of Population-Based BRCA1 and BRCA2 Testing in Canada

Importance

Population-based BRCA testing can identify many more BRCA carriers who will be missed by the current practice of BRCA testing based on family history (FH) and clinical criteria. These carriers can benefit from screening and prevention, potentially preventing many more breast and ovarian cancers and deaths than the current practice.

Objective

To estimate the incremental lifetime health outcomes, costs, and cost-effectiveness associated with population-based BRCA testing compared with FH-based testing in Canada.

Design, Setting, and Participants

For this economic evaluation, a Markov model was developed to compare the lifetime costs and outcomes of BRCA1/BRCA2 testing for all general population women aged 30 years compared with FH-based testing. BRCA carriers are offered risk-reducing salpingo-oophorectomy to reduce their ovarian cancer risk and magnetic resonance imaging (MRI) and mammography screening, medical prevention, and risk-reducing mastectomy to reduce their breast cancer risk. The analyses were conducted from both payer and societal perspectives. This study was conducted from October 1, 2022, to February 20, 2024.

Main Outcomes and Measures

Outcomes of interest were ovarian cancer, breast cancer, additional heart disease deaths, and incremental cost-effectiveness ratio ICER per quality-adjusted life-year (QALY). One-way and probabilistic-sensitivity-analyses (PSA) were undertaken to explore the uncertainty.

Results

In the simulated cohort of 1 000 000 women aged 30 years in Canada, the base case ICERs of population-based BRCA testing were CAD $32 276 (US $23 402.84) per QALY from the payer perspective or CAD $16 416 (US $11 903.00) per QALY from the societal perspective compared with FH-based testing, well below the established Canadian cost-effectiveness thresholds. Population testing remained cost-effective for ages 40 to 60 years but not at age 70 years. The results were robust for multiple scenarios, 1-way sensitivity, and PSA. More than 99% of simulations from payer and societal perspectives were cost-effective on PSA (5000 simulations) at the CAD $50 000 (US $36 254.25) per QALY willingness-to-pay threshold. Population-based BRCA testing could potentially prevent an additional 2555 breast cancers and 485 ovarian cancers in the Canadian population, corresponding to averting 196 breast cancer deaths and 163 ovarian cancer deaths per 1 000 000 population.

Conclusions and Relevance

In this economic evaluation, population-based BRCA testing was cost-effective compared with FH-based testing in Canada from payer and societal perspectives. These findings suggest that changing the genetic testing paradigm to population-based testing could prevent thousands of breast and ovarian cancers.

Sexual Activity, Function, and Satisfaction in Reproductive-Aged Females Living with Chronic Kidney Disease

Up to 80% of women living with chronic kidney disease (CKD) experience sexual dysfunction, though its link with sexual activity and sexual satisfaction is not well understood. Among older women with CKD treated with hemodialysis, the majority report sexual inactivity, though few describe sexual difficulty and most report high sexual satisfaction. Whether this applies to reproductive-aged females living with CKD is yet unknown. This study aimed to assess the sexual activity, function, and satisfaction of reproductive-aged females living with CKD. Self-identified females aged 18-51 years with CKD were recruited from nephrology clinics in Calgary, Canada. Sexual activity, function, and satisfaction were assessed with a modified version of the Female Sexual Function Index. Fifty-seven participants were recruited (35% CKD without kidney replacement therapy, 44% CKD treated with hemodialysis, 9% CKD treated with peritoneal dialysis, 12% CKD treated with kidney transplant) and nearly half (47%) reported sexual activity. Among sexually active participants, there was a high prevalence of sexual dysfunction (67%) and only 25% of participants reported sexual satisfaction. A strong relationship between sexual function and satisfaction was identified. Reproductive-aged females living with CKD are sexually active, though experience high rates of sexual dysfunction and dissatisfaction. These findings emphasize the importance of recognition and management of sexual dysfunction in this important population.

Hang up your cleats and hope for the best? A cross-sectional study of five health domains in retired elite female rugby players

ABSTRACT

Objectives

To investigate retired elite female rugby players' health outcomes (and their relationships) in five key areas (musculoskeletal, cognitive, mental, reproductive/endocrinological and cardiovascular) and how those compare with the general population.

Methods

Female rugby players aged ≥18 years old and retired from elite competition ≥2 years were recruited via email or social media to complete a 179-item online questionnaire and neurocognitive assessment. Data from general population controls (matched for age and sex) were obtained where available.

Results

159 participants responded (average age 43 (±5) years). 156 (98%) reported a hip/groin, knee, foot/ankle or lower back injury during their career, of which 104 (67%) reported ongoing pain. Participants reported worse hip and knee outcomes compared with the general population (p<0.0001). 146 (92%) reported sustaining one or more concussions. History of concussion was associated with lower-than-average scores on neurocognitive assessment. Compared with general population data, retired female rugby players reported less anxiety (OR=0.079 (95% CI 0.03 to 0.19)), depression (OR=0.67 (95% CI 0.57 to 0.78)) and distress (OR=0.17 (95% CI 0.15 to 0.19)). Amenorrhoea rates were higher compared with matched controls, and the age at menopause was younger. The prevalence of hypertension was higher. The rugby players perceived that their health decreased in retirement and cited a lack of physical activity as a main contributor.

Conclusion

Our findings point to the potential value of screening and monitoring, and identifying preventative measures during sporting careers to promote health and long-term quality of life for athletes.

High prevalence of iron deficiency and socioeconomic disparities in laboratory screening of non-pregnant females of reproductive age: A retrospective cohort study

Iron deficiency anemia (IDA) and non-anemic iron deficiency (NAID) are highly prevalent among non-pregnant females of reproductive age. Canada has no national screening guidelines for this population. Screening, when performed, is often with a complete blood count alone without ferritin or iron indices. The primary objective was to determine the prevalence of screening for NAID and IDA over a 3-year period in non-pregnant females of reproductive age who had tests performed at outpatient laboratories in Ontario, Canada. Retrospective cohort study of non-pregnant females ages 15-54 in Ontario, from 2017 to 2019. NAID was defined as ferritin <30 μg/L, anemia as hemoglobin <120 g/L, and IDA as ferritin <30 μg/L and hemoglobin <120 g/L. Annual household income was estimated using patient postal codes. A total of 784 132 non-pregnant females were included. The 82.1% were screened for iron deficiency, 38.3% had NAID and 13.1% had IDA; 55.6% with IDA had normal mean corpuscular volumes. The median household income was $89454.80 compared with a provincial median of $65285.00. Patients in the lowest income quintile had the highest odds of being anemic, and the lowest odds of having a ferritin checked. A large proportion of non-pregnant females of reproductive age in this cohort were screened for iron deficiency. In this relatively privileged cohort, NAID affected nearly 40%, and IDA 13%. Most patients with IDA did not have microcytosis. Low household income was associated with the greatest odds of anemia and the lowest odds of being screened, highlighting inequitable access to screening for IDA in Ontario, Canada.

Age at natural menopause and its associated characteristics among Brazilian women: cross-sectional results from ELSI-Brazil

OBJECTIVES

This study aimed to determine the median age at natural menopause and analyze lifestyle, anthropometric, and dietary characteristics associated with the age at natural menopause among Brazilian women.

METHODS

This cross-sectional study involved 2,731 women 50 years and over, drawn from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2015/16). Nonparametric Kaplan-Meier cumulative survivorship estimates were used to assess the median timing of natural menopause. Cox proportional hazards regression models were employed to estimate the associations between age at natural menopause and exposure variables.

RESULTS

The overall median age at natural menopause was 50 years. In the adjusted Cox model, current smoking (hazard ratio [HR], 1.11; 95% CI, 1.01-1.23) and underweight (HR, 1.34; 95% CI, 1.12-1.61) were associated with earlier natural menopause. Conversely, performing recommended levels of physical activity in the last week (HR, 0.88; 95% CI, 0.80-0.97), being overweight (HR 0.86; 95% CI, 0.74-0.99), and adhering to two or three healthy eating markers (HR, 0.80; 95% CI, 0.66-0.97; HR, 0.76; 95% CI, 0.61-0.94, respectively) were associated with later age at natural menopause. Binge drinking and waist circumference were not associated with age at natural menopause.

CONCLUSIONS

Lifestyle, anthropometric, and dietary characteristics are significant factors that affect the age at natural menopause. Our findings can contribute to public policies targeted at Brazilian women's health.

Age at natural menopause and associated factors with early and late menopause among Chinese women in Zhejiang province: A cross-sectional study

OBJECTIVES

Menopause is a significant life transition for women, impacting their physical and psychological health. The age at natural menopause (ANM) and its associated factors have differed by race and region. This study aimed to investigate ANM and associated factors of early and late menopause among Chinese women in Zhejiang province.

METHODS

A cross-sectional study was conducted using a multi-stage stratified cluster sampling method to recruit 8,006 women aged 40-69 years who had resided in Zhejiang province for over 6 months between July 2019 and December 2021. Self-reported ANM and sociodemographics, lifestyle behaviors, reproductive history, and health-related factors were collected using questionnaires in face-to-face surveys. ANM were categorized into three groups: early menopause (<45 years), normal menopause (45-54 years), and late menopause (≥55 years). Kaplan-Meier survival analysis was utilized to calculate the median ANM. Multivariable multinomial logistic regression was employed to explore the associated factors of early menopause and late menopause.

RESULTS

A total of 6,047 women aged 40-69 years were included for survival analysis, with 3,176 of them for the regression analysis. The overall median ANM was 51 years (Inter-quartile range [IQR]: 51-52). Women who were smokers (odds ratio [OR]:4.54, 95% confidence interval [CI]:1.6-12.84), had irregular menstrual cycles (OR:1.78, 95% CI:1.12-2.83) and hypertension (OR:1.55, 95% CI:1.09-2.21) had a higher odds ratio of early menopause, while central obesity (OR:1.33, 95% CI:1.03-1.73) and hyperlipidemia (OR:1.51, 95% CI:1.04-2.18) were factors associated with late menopause.

CONCLUSIONS

This study revealed the associations between ANM and various factors among Chinese women. These factors included socio-demographic factors such as age; life behavior factors like current or prior smoking status; reproductive history factors such as irregular menstrual cycles, miscarriages, and breastfeeding; and health-related factors like central adiposity, hypertension, and hyperlipidemia. These findings provided a basis for understanding factors associated with ANM.

Body weight in childhood, adolescence, and young adulthood in relation to later risk of disabilities and early retirement among Danish female nurses

BACKGROUND

Obesity is now the most common health problem in the younger population in Western societies and obesity rates are higher in lower socioeconomic status (SES) groups. We investigated whether overweight in childhood, independently of overweight in adulthood, influenced adult employment status and later risk of having disabilities. Using data from the Danish Female Nurse Cohort study, we examined associations between overweight in childhood/adolescence, and young adulthood and disabilities and early retirement in later adulthood (>44 years) and whether it was influenced by menopausal age (

RESULTS

Our results showed that overweight in childhood, adolescence and young adulthood was associated with an increased risk of disabilities and early retirement. Especially childhood overweight that did not persist into adulthood was associated with an increased risk of disabilities (OR = 1.82, 95% CI = 1.26-2.63) and early retirement (OR = 2.05, 95% CI = 1.38-3.03) in the postmenopausal group. A similar increased risk for disabilities (OR = 1.76, 95% CI = 1.26-2.47) was seen for adolescent overweight that did not persist into adulthood.

CONCLUSION

The results show that in a well-educated population of women, overweight in childhood and/or adolescence had adverse socioeconomic consequences for later risk of disabilities and early retirement irrespective of weight status in adulthood.

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MESH Headings

• Humans
• Female
• Denmark/epidemiology
• Adolescent
• Retirement/statistics & numerical data
• Adult
• Risk Factors
• Disabled Persons/statistics & numerical data
• Child
• Nurses/statistics & numerical data
• Young Adult
• Body Mass Index
• Middle Aged
• Pediatric Obesity/epidemiology
• Overweight/epidemiology
• Socioeconomic Factors
• Employment/statistics & numerical data
• Body Weight/physiology
• Cohort Studies

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Grants Collapse

Affiliation(s)

Hanna Kruse Reiband The Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark.
Rikke Tannenberg Klemmensen The Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
Susanne Rosthøj The Danish Cancer Institute, Research Centre, Copenhagen, Denmark Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
Thorkild I A Sørensen Center for Childhood Health, Copenhagen, Denmark Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark NNF Centre for Basic Metabolic Health, University of Copenhagen, Copenhagen, Denmark
Berit Lilienthal Heitmann The Research Unit for Dietary Studies, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark Department of Public Health, Section for general Practise, Faculty of Health and Medical Sciences University of Copenhagen, Copenhagen, Denmark

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Sex Differences in Depressive Symptoms in 1308 Patients Post-Stroke at Entry to Cardiac Rehabilitation

PURPOSE

The objective of this study was to determine whether a sex difference exists in the prevalence of post-stroke depressive symptoms (PSDS) at entry to cardiac rehabilitation (CR) and to determine the correlates of PSDS in all patients, and in women and men separately.

METHODS

People post-stroke at entry to CR from database records (2006-2017) were included. Bivariate analyses identified PSDS correlates (≥16 on the Center for Epidemiologic Studies Depression Scale) in all patients and women and men separately.

RESULTS

Patients (n = 1308, 28.9% women), mean age of 63.9 ± 12.9 yr, were 24.2 ± 9.9 mo post-stroke at CR entry. Among all patients, 30.0% had PSDS. A greater proportion of women than men had PSDS (38.6 vs 26.6%; P < .001). Correlates of PSDS in all patients were sex (women) (OR = 1.6: 95% CI, 1.14-2.12), being unemployed, ≤60 yr old, prescribed antidepressant medication, having lower cardiorespiratory fitness (peak oxygen uptake [V̇ o2peak ]), chronic obstructive pulmonary disease (COPD), higher body mass index (BMI), no transient ischemic attack, and longer time from stroke to CR entry (>12 mo). Correlates in women were being obese (BMI ≥ 30), 51-70 yr old, prescribed antidepressant medication, and not married. Correlates in men were being ≤60 yr old, unemployed, prescribed antidepressant medication, having lower V̇ o2peak , sleep apnea, COPD, and no hypertension.

CONCLUSION

Women were disproportionately affected by PSDS at entry to CR in bivariate and multivariable analyses. Women and men had mostly unique correlates of PSDS, indicating tailored strategies to address PSDS are required. PSDS disproportionately affected patients with longer delay to CR entry, suggesting efforts should target timely referral to facilitate earlier and repeated assessments and management.

Risk of Breast Cancer After Diabetes in Pregnancy: A Population-based Cohort Study

OBJECTIVES

Diabetes is associated with an increased risk of several cancers, including postmenopausal breast cancer. The evidence for higher breast cancer risk after diabetes in pregnancy is conflicting. We compared the incidence of breast and other cancers between pregnant women with and without diabetes.

METHODS

This work was a propensity-matched, retrospective cohort study using population-based health-care databases from Ontario, Canada. Those deliveries with gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (pregestational DM) were identified and matched to deliveries without diabetes mellitus (non-DM). Deliveries from each diabetes cohort were matched 1:2 on age, parity, year of delivery, and propensity score to non-DM deliveries. Matched subjects were followed from delivery for incidence of breast cancer as a primary outcome, and other site-specific cancers as secondary outcomes. We performed Cox proportional hazards regression to compare rates of breast cancer between matched groups.

RESULTS

Over a median of 8 (interquartile range 4 to 13) years of follow-up, compared with non-DM deliveries, the incidence of breast cancer was significantly lower for GDM but similar for pregestational DM deliveries (hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.82 to 0.98; and HR 0.92, 95% CI 0.80 to 1.07, respectively). GDM was associated with a significantly higher incidence of pancreatic and hepatocellular cancer, and pregestational DM was associated with a higher incidence of thyroid, hepatocellular, and endometrial cancers.

CONCLUSIONS

Diabetes in pregnancy does not have a higher short-term risk of subsequent breast cancer, but there may be a higher incidence of other cancers.

The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 7: Sex, Gender, and the Social Determinants of Health

Women vs men have major differences in terms of risk-factor profiles, social and environmental factors, clinical presentation, diagnosis, and treatment of cardiovascular disease. Women are more likely than men to experience health issues that are complex and multifactorial, often relating to disparities in access to care, risk-factor prevalence, sex-based biological differences, gender-related factors, and sociocultural factors. Furthermore, awareness of the intersectional nature and relationship of sociocultural determinants of health, including sex and gender factors, that influence access to care and health outcomes for women with cardiovascular disease remains elusive. This review summarizes literature that reports on under-recognized sex- and gender-related risk factors that intersect with psychosocial, economic, and cultural factors in the diagnosis, treatment, and outcomes of women's cardiovascular health.

The dose-response relationship of pre-menopausal alcohol consumption with age at menopause: a population study of 280 497 women in Norway

BACKGROUND

Previous research suggests that alcohol consumption is associated with high age at menopause. Yet, knowledge about the dose-response relationship is inconsistent. Thus, we studied the pattern of the association of pre-menopausal alcohol consumption with age at natural menopause.

METHODS

We performed a retrospective population-based study using self-reported data from 280 497 women aged 50-69 years attending the Norwegian breast cancer screening programme (BreastScreen Norway) during 2006-15. Associations of weekly alcohol consumption between the age of 20 and 49 years with age at menopause were estimated as hazard ratios (HRs) using Cox proportional hazard models with restricted cubic splines to allow for non-linear associations. We adjusted for year and place of birth, number of childbirths, educational level, body mass index and smoking habits.

RESULTS

Mean age at natural menopause was 51.20 years (interquartile range: 49-54 years). The adjusted HR of reaching menopause was highest for women with no alcohol consumption (reference) and the HR decreased by alcohol consumption up to 50 grams per week (adjusted HR 0.87; 95% CI: 0.86-0.88). Above 50 grams, there was no further decrease in the HR of reaching menopause (P for non-linearity of <0.001).

CONCLUSIONS

Women who did not consume alcohol were youngest at menopause. The lack of a dose-response association among alcohol consumers implies virtually no relation of alcohol consumption with age at menopause. Our findings may suggest that characteristics of the women who did not consume alcohol, not accounted for in the data analyses, explain their younger age at menopause.

Exploring sex differences for acute ischemic stroke clinical, imaging and thrombus characteristics in the INTERRSeCT study

Women, especially following menopause, are known to have worse outcomes following acute ischemic stroke. One primary postulated biological mechanism for worse outcomes in older women is a reduction in the vasculoprotective effects of estrogen. Using the INTERRseCT cohort, a multicentre international observational cohort studying recanalization in acute ischemic stroke, we explored the effects of sex, and modifying effects of age, on neuroradiological predictors of recanalization including robustness of leptomeningeal collaterals, thrombus burden and thrombus permeability. Ordinal regression analyses were used to examine the relationship between sex and each of the neuroradiological markers. Further, we explored both multiplicative and additive interactions between age and sex. All patients (n = 575) from INTERRseCT were included. Mean age was 70.2 years (SD: 13.1) and 48.5% were women. In the unadjusted model, female sex was associated with better collaterals (OR 1.37, 95% CIs: 1.01-1.85), however this relationship was not significant after adjusting for age and relevant comorbidities. There were no significant interactions between age and sex. In a large prospective international cohort, we found no association between sex and radiological predictors of recanalization including leptomeningeal collaterals, thrombus permeability and thrombus burden.

A Study to Assess the Prevalence and Factors Affecting Menopausal Symptoms among Middle-Aged Females in the Garhwal Region of Uttarakhand

Background

Middle age is a link between adulthood and old age, which requires special attention. During middle age among females, changes like menopause occur, which is responsible for causing various physical, vasomotor, psychological, and social changes, which may affect overall well-being and positive mental health status. Hence, the present study has been planned to assess the prevalence of menopausal symptoms among middle-aged females.

Materials and Methods

The present study was a cross-sectional study carried out in rural and urban areas of district Dehradun among 400 females. A stratified systematic random sampling technique method was used. All the females fulfilling the inclusion criteria and aged 40-60 years were included in the study. The Menopause-Specific Quality of Life (MENQOL) questionnaire was used to assess the prevalence of menopausal symptoms.

Results

A total of 400 women were recruited in the study, 200 from rural and urban areas each. The mean age of the total study participants was 50.00 ± 0.32 years. Among 400 middle-aged women, 189 were premenopausal and 211 were postmenopausal. The frequencies of occurrence of menopausal symptoms were explored in 189 premenopausal and 211 postmenopausal women. The mean age of premenopausal women was 44.21 ± 2.35 and postmenopausal was 54.39 ± 4.21. Females experienced varying grades of MENQOL symptoms.

Conclusions

It was found that majority of the females' quality of life were found to be affected with different grades of menopausal symptoms. With increasing age, symptoms also increase and are significantly high among postmenopausal women.

CA125 Levels in BRCA mutation carriers - a retrospective single center cohort study

BACKGROUND

Ovarian cancer screening in BRCA1/2 mutation carriers utilizes assessment of carbohydrate antigen 125 (CA125) and transvaginal ultrasound (TVU), despite low sensitivity and specificity. We evaluated the association between CA125 levels, BRCA1/2 mutation status and menopausal status to provide more information on clinical conditions that may influence CA125 levels.

METHODS

We retrospectively analyzed repeated measurements of CA125 levels and clinical data of 466 women at high risk for ovarian cancer. CA125 levels were compared between women with and without deleterious mutations in BRCA1/2. Pearson's correlation was used to determine the association between age and CA125 serum level. Differences in CA125 levels were assessed with the Mann-Whitney U test. The effect of BRCA1/2 mutation status and menopausal status on the change in CA125 levels was determined by Two-factor analysis of variance (ANOVA).

RESULTS

The CA125 serum levels of premenopausal women (median, 13.8 kU/mL; range, 9.4 - 19.5 kU/mL) were significantly higher than in postmenopausal women (median, 10.4 kU/mL; range, 7.7 - 14.0 kU/mL; p < .001). There was no significant difference in the CA125 levels of BRCA mutation carriers and non-mutation carriers across all age groups (p = .612). When investigating the combined effect of BRCA1/2 mutation and menopausal status, variance analysis revealed a significant interaction between BRCA1/2 mutation status and menopausal status on CA125 levels (p < .001). There was a significant difference between the CA125 levels of premenopausal and postmenopausal women, with a large effect in BRCA mutation carriers (p < .001, d = 1.05), whereas in non-mutation carriers there was only a small effect (p < .001, d = 0.32).

CONCLUSION

Our findings suggest that hereditary mutations in BRCA1/2 affect the decline of CA125 levels with increasing age. To prove a definite effect of this mutation on the CA125 level, prospective trials need to be conducted to define new cut-off levels of CA 125 in mutation carriers and optimize ovarian cancer screening.

Age at Natural Menopause in Women Living with HIV: A Cross-Sectional Study Comparing Self-Reported and Biochemical Data

Early menopause (<45 years) has significant impacts on bone, cardiovascular, and cognitive health. Several studies have suggested earlier menopause for women living with HIV; however, the current literature is limited by reliance on self-report data. We determined age at menopause in women living with HIV and socio-demographically similar HIV-negative women based on both self-report of menopause status (no menses for ≥12 months) and biochemical confirmation (defined as above plus follicle-stimulating hormone level ≥ 25 IU/mL). Multivariable median regression models assessed factors associated with menopause age, controlling for relevant confounders. Overall, 91 women living with HIV and 98 HIV-negative women were categorized as menopausal by self-report, compared to 83 and 92 by biochemical confirmation. Age at menopause did not differ significantly between groups, whether based on self-report (median [IQR]: 49.0 [45.3 to 53.0] vs. 50.0 [46.0 to 53.0] years; p = 0.28) or biochemical confirmation (50.0 [46.0 to 53.0] vs. 51.0 [46.0 to 53.0] years; p = 0.54). In the multivariable model, no HIV-related or psychosocial variables were associated with earlier age at menopause (all p > 0.05). Overall, HIV status per se was not statistically associated with an earlier age at menopause, emphasizing the importance of comparing socio-demographically similar women in reproductive health and HIV research.

Aerobic exercise improves executive functions in females, but not males, without the BDNF Val66Met polymorphism

BACKGROUND

Aerobic exercise promotes cognitive function in older adults; however, variability exists in the degree of benefit. The brain-derived neurotropic factor (BDNF) Val66Met polymorphism and biological sex are biological factors that have been proposed as important modifiers of exercise efficacy. Therefore, we assessed whether the effect of aerobic exercise on executive functions was dependent on the BDNFval66met genotype and biological sex.

METHODS

We used data from a single-blind randomized controlled trial in older adults with subcortical ischemic vascular cognitive impairment (NCT01027858). Fifty-eight older adults were randomly assigned to either the 6 months, three times per week progressive aerobic training (AT) group or the usual care plus education control (CON) group. The secondary aim of the parent study included executive functions which were assessed with the Trail Making Test (B-A) and the Digit Symbol Substitution Test at baseline and trial completion at 6 months.

RESULTS

Analysis of covariance, controlling for baseline global cognition and baseline executive functions performance (Trail Making Test or Digit Symbol Substitution Test), tested the three-way interaction between experimental group (AT, CON), BDNFval66met genotype (Val/Val carrier, Met carrier), and biological sex (female, male). Significant three-way interactions were found for the Trail Making Test (F(1,48) = 4.412, p < 0.04) and Digit Symbol Substitution Test (F(1,47) = 10.833, p < 0.002). Posthoc analyses showed female Val/Val carriers benefited the most from 6 months of AT compared with CON for Trail Making Test and Digit Symbol Substitution Test performance. Compared with CON, AT did not improve Trail Making Test performance in male Val/Val carriers or Digit Symbol Substitution Test performance in female Met carriers.

CONCLUSIONS

These results suggest that future randomized controlled trials should take into consideration BDNF genotype and biological sex to better understand the beneficial effects of AT on cognitive function in vascular cognitive impairment to maximize the beneficial effects of exercise and help establish exercise as medicine for cognitive health.

Alcohol intake and the risk of epithelial ovarian cancer

PURPOSE

To investigate the association between alcohol intake over the lifetime and the risk of overall, borderline, and invasive ovarian cancer.

METHODS

In a population-based case-control study of 495 cases and 902 controls, conducted in Montreal, Canada, average alcohol intake over the lifetime and during specific age periods were computed from a detailed assessment of the intake of beer, red wine, white wine and spirits. Multivariable logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for the association between alcohol intake and ovarian cancer risk.

RESULTS

For each one drink/week increment in average alcohol intake over the lifetime, the adjusted OR (95% CI) was 1.06 (1.01-1.10) for ovarian cancer overall, 1.13 (1.06-1.20) for borderline ovarian cancers and 1.02 (0.97-1.08) for invasive ovarian cancers. This pattern of association was similarly observed for alcohol intake in early (15- < 25 years), mid (25- < 40 years) and late adulthood (≥ 40 years), as well as for the intake of specific alcohol beverages over the lifetime.

CONCLUSIONS

Our results support the hypothesis that a higher alcohol intake modestly increases the risk of overall ovarian cancer, and more specifically, borderline tumours.

Iron Status and Associated Factors among Canadian Women: Results from the Canadian Health Measures Survey

BACKGROUND

Iron deficiency and overload may negatively impact women's health. There has been limited assessment of iron status and its associated factors among Canadian women.

OBJECTIVES

This study investigated associations of various sociodemographic, lifestyle, medication, and dietary factors with body iron stores among pre- and postmenopausal women in Canada.

METHODS

Analyses were conducted using cross-sectional, nationally representative survey and biomarker data from women aged 20-79 y (n = 6362) in the Canadian Health Measures Survey (2009-2017). Body iron stores were assessed by measuring serum concentrations of ferritin (SF). Information on potential correlates was collected during an in-home interview. Multivariable linear regression analyses were performed to evaluate associations with SF concentration, and logistic regression was used to estimate associations with iron deficiency (SF <15 μg/L) or elevated iron stores (SF >150 μg/L).

RESULTS

Geometric mean SF concentrations were significantly higher in postmenopausal than in premenopausal women (73.2 versus 33.8 μg/L; P < 0.001). The prevalence of iron deficiency among pre- and postmenopausal women was 16.0% and 4.0%, respectively, whereas that of elevated iron stores was 2.7% and 21.0%, respectively. After simultaneous adjustment for multiple factors, including high-sensitivity CRP (inflammation marker), we found that age, East/Southeast Asian (versus White) race/ethnicity, alcohol, and red meat consumption were positively associated with SF concentration among pre- and postmenopausal women. In addition, aspirin use and dairy consumption were inversely associated with SF concentration among postmenopausal women only. Similar patterns were observed for associations with elevated iron stores among postmenopausal women, whereas higher grain consumption was associated with an increased prevalence of iron deficiency among premenopausal women.

CONCLUSIONS

Sociodemographic, lifestyle, medication, and dietary factors are correlated with iron status determined by SF concentration among Canadian women. The findings may have implications for intervention strategies aimed at optimizing body iron stores in pre- and postmenopausal women.

Beyond the medals: a cross-sectional study exploring retired elite female athletes' health

Objectives

Little is known about the impact of elite sport participation on long-term athlete health. We aimed to: (1) describe musculoskeletal, mental health, reproductive/endocrine and cardiovascular characteristics in retired elite female athletes and compare to the general population and (2) explore athletes' perceptions of their elite sport participation and its impact on health.

Methods

A 136-item online questionnaire was disseminated to Canadian elite female rowing and rugby athletes >18 years old, >2 years retired from elite competition. Matched general population data were obtained from Statistics Canada when available.

Results

Seventy-four (24% response rate) athletes (average age 45 (±9) years; retired 15 (±9) years) completed the questionnaire (30 rowing, 44 rugby athletes). During their career, 63 athletes (85%) experienced a hip/groin, knee, foot/ankle injury, or low back pain, with 42 (67%) reporting ongoing symptoms. Athletes 35-54 years reported worse knee symptoms and quality of life compared with the general population (symptom: p=0.197; d=1.15 [0.66, 1.63]; quality of life: p=0.312 d=1.03 [0.54, 1.51]) while other hip, knee and foot/ankle outcome scores were similar. Retired athletes had lower odds of anxiety (OR=0.155 [95% CI0.062 to 0.384]), greater lifetime/ever odds of amenorrhea (OR=6.10 [95%CI 2.67 to 13.96]) and gave birth when older (p<0.05). Fifty-nine (79%) recalled witnessing or experiencing at least one form of harassment/abuse during their career. Sixty athletes (81%) rated their current health as above average or excellent and 61 (82%) would compete at the same level again if given the choice.

Conclusion

These novel insights can inform future preventative efforts to promote positive elite sport-related outcomes for current, former and future female athletes.

The association between diabetes type, age of onset, and age at natural menopause: a retrospective cohort study using the Canadian Longitudinal Study on Aging

OBJECTIVES

With growing incidence of type 1 diabetes (T1D), type 2 diabetes (T2D), and gestational diabetes, more women are expected to spend a larger proportion of their reproductive years living with a diabetes diagnosis. It is important to understand the long-term implications of premenopausal diabetes type on women's reproductive health including their age at natural menopause (ANM).

METHODS

Baseline data from the Comprehensive Cohort of Canadian Longitudinal Study on Aging were used. Females who reported premenopausal diagnosis of diabetes were considered exposed. Kaplan-Meier cumulative survivorship estimates and multivariable Cox regression models were used to assess the association between diabetes types and ANM. Sociodemographic, lifestyle, and premenopausal clinical factors were adjusted in the final model as covariates.

RESULTS

The sample comprised 11,436 participants, weighted to represent 1,474,412Canadian females aged 45 to 85 years. The median ANM was 52 years. After adjusting for ethnicity, education, smoking, and premenopausal clinical factors, early age of diagnosis of both T1D (<30 years) and T2D (30-39 years) were associated with earlier menopause (T1D, <30: hazard ratio [HR], 1.55; 95% confidence interval [CI], 1.05-2.28; T2D, 30-39: HR, 1.82; 95% CI, 1.12-2.94), as compared with nondiabetics. In addition, later age of diagnosis of T2D (≥40 years) was associated with later ANM (T2D: HR, 0.63; 95% CI, 0.50-0.80). No significant association between gestational diabetes and ANM was noted.

CONCLUSIONS

Our results point to early menopause among young women living with a diabetes diagnosis. These findings should allow for more focused research geared toward understanding the long-term health implications of diabetes on women's reproductive health and aging.

Pattern and Predictors of Sexual Activity among Postmenopausal Women Attending a Family Medicine Clinic in Ilorin, North-Central Nigeria

OBJECTIVES

Sexual activity tends to decline with age and is greatly impacted in postmenopausal women. This study aimed to describe the sexual activity pattern among postmenopausal Nigerian women and also detect socio-demographic and menopause-related predictors of their sexual activity.

METHODS

In this hospital-based cross-sectional study, 357 postmenopausal women between 45-60 years participated. Data was collected using the sexual activity questionnaire and a socio-demographic questionnaire developed by the authors.

RESULTS

The prevalence of sexual inactivity among the participants was 60%. This was attributed mainly to the unavailability of male partners (50.5%) and negative menopause-related sociocultural beliefs (23.8%). Among sexually active participants, 83.2% of them reported having pleasurable experiences and 53.8% of them reported no associated sexual discomfort. Only being in a marital relationship was found to be a statistically significant predictor of sexual activity among the participants (regression coefficient = 3.125, degree of freedom = 1, P < 0.0001).

CONCLUSIONS

We reported a high prevalence of sexual inactivity among the participants; the most important reasons given were the unavailability of their husbands and the belief that sexual intercourse was taboo during the postmenopausal period. The study also provided positive evidence for the importance of marriage for sexual activity among the participants.

Birth Cohort Effects in Breast Cancer Incidence: Global Patterns and Trends

Breast cancer is the most common neoplasm in the world among women. The age-specific incidences and onset ages vary widely between Asian and Western countries/regions. Invasive breast cancer cases among women from 1997 to 2011 were abstracted from the International Agency for Research on Cancer and the Taiwan Cancer Registry. Age-period-cohort analysis was performed to examine the trends. The cohort effect was prominent in South Korea, Taiwan, Japan, and Thailand, possibly related to the timing of westernization. The risk of breast cancer initially rose with the birth cohorts in Hong Kong and India (both former British colonies), peaked, and then declined in recent birth cohorts. Unlike other Asian countries/regions, virtually no birth cohort effect was identified in the Philippines (a Spanish colony in 1565 and the first Asian country to adopt Western cultural aspects). Moreover, an at-most negligible birth cohort effect was identified for all ethnic groups (including Asian immigrants) in the United States. This global study identified birth cohort effects in most Asian countries/regions but virtually no impact in Western countries/regions. The timing of westernization was associated with the birth cohort effect.

Association of lifetime lactation and age at natural menopause: a prospective cohort study

OBJECTIVE

The aim of this study was to examine the association between duration of lifetime lactation and age at natural menopause.

METHODS

In this prospective cohort study, we analyzed parous premenopausal women in the multiethnic Study of Women's Health Across the Nation who were followed approximately annually for 10 years (1995-2008). Lifetime lactation was defined as the duration of breastfeeding across all births in months. Age at natural menopause was defined as age in years after 12 consecutive months of amenorrhea after the final menstrual period for no other reported cause. We used Cox proportional hazard models to analyze time to natural menopause with age as the underlying time scale. Multivariable models controlled for education, race/ethnicity, parity, smoking, body mass index, and oral contraceptive use.

RESULTS

Among 2,377 women, 52.6% experienced natural menopause during follow-up and reported a valid final menstrual period date. The small, crude association between lifetime lactation up to 24 months and later age at natural menopause attenuated to nonsignificance in adjusted models (6 months: adjusted hazard ratio [AHR], 0.96; 95% confidence interval (CI), 0.87-1.06; 12 months: AHR, 0.95; 95% CI, 0.82-1.11; 18 months: AHR, 0.96; 95% CI, 0.82-1.13; 24 months: AHR, 0.99; 95% CI, 0.84-1.16).

CONCLUSIONS

Duration of lifetime lactation was not associated with age at natural menopause after controlling for sociodemographic characteristics.

Using machine learning to predict individual patient toxicities from cancer treatments

PURPOSE

Machine learning (ML) is a powerful tool for interrogating datasets and learning relationships between multiple variables. We utilized a ML model to identify those early breast cancer (EBC) patients at highest risk of developing severe vasomotor symptoms (VMS).

METHODS

A gradient boosted decision model utilizing cross-sectional survey data from 360 EBC patients was created. Seventeen patient- and treatment-specific variables were considered in the model. The outcome variable was based on the Hot Flush Night Sweats (HFNS) Problem Rating Score, and individual scores were dichotomized around the median to indicate individuals with high and low problem scores. Model accuracy was assessed using the area under the receiver operating curve, and conditional partial dependence plots were constructed to illustrate relationships between variables and the outcome of interest.

RESULTS

The model area under the ROC curve was 0.731 (SD 0.074). The most important variables in the model were as follows: the number of hot flashes per week, age, the prescription, or use of drug interventions to manage VMS, whether patients were asked about VMS in routine follow-up visits, and the presence or absence of changes to breast cancer treatments due to VMS. A threshold of 17 hot flashes per week was identified as being more predictive of severe VMS. Patients between the ages of 49 and 63 were more likely to report severe symptoms.

CONCLUSION

Machine learning is a unique tool for predicting severe VMS. The use of ML to assess other treatment-related toxicities and their management requires further study.

Orgasm Rating Scale and Bodily Sensations of Orgasm Scale: Validation for Use With Pre, Peri, and Post-Menopausal Women

BACKGROUND

Orgasm, particularly in older women, remains a poorly understood aspect of female sexual response partly because of a lack of validated self-report measures.

AIM

To evaluate the Orgasm Rating Scale (ORS) and Bodily Sensations of Orgasm Scale (BSOS) for use with pre, peri, and post-menopausal women and between solitary and partnered orgasm contexts.

METHODS

Participants (solitary context, 252 pre, 139 peri, 190 post; partnered context, 229 pre, 136 peri, and 194 post-menopausal women, aged 18-82 years) were asked to complete an online questionnaire based on most recent solitary and partnered orgasm. Principal components analysis with Varimax rotation summarized the data into interpretable baseline models for all groups. Multi-Group Confirmatory Factor Analysis tested for multi-group measurement invariance. Adjustments to the models were made, and final model structures were presented.

MAIN OUTCOME MEASURES

ORS and BSOS measuring solitary and/or masturbation and partnered orgasm.

RESULTS

For the ORS, 10 factor solutions were preferred, explaining 81% (pre), 80% (peri), and 81% (post) of the variance for the solitary and 83% (pre), 86% (peri), and 84% (post) of the variance for the partnered context. Factors included pleasurable satisfaction, ecstasy, emotional intimacy, relaxation, building sensations, flooding sensations, flushing sensations, shooting sensations, throbbing sensations, and general spasms. For the BSOS, 3 factor solutions were preferred, explaining 55% (pre), 60% (peri), and 56% (post) of the variance for the solitary and 56% (pre), 61% (peri), and 60% (post) of the variance for the partnered context. Factors included extragenital sensations, genital sensations and spasms, and nociceptive sensations and sweating responses. Divergent validity was observed (solitary r = -.04; partnered r = -.11) and configural, metric and scalar invariance for the solitary and partnered versions of the ORS and BSOS were found, suggesting the measures were interpreted similarly by all women.

CLINICAL IMPLICATIONS

With valid measurement tools, women's varying orgasm experiences can be investigated more systematically and compared to address gaps and conflicts in the existing literature. Ultimately, these additions may assist with improved interventions for women who are unsatisfied with their orgasm experiences.

STRENGTHS AND LIMITATIONS

Strengths include gaining the ability to compare age and menopausal status groups using empirically validated measures of orgasm experience. Limitations include cross-sectional design and lack of test-retest reliability measurement.

CONCLUSION

The ORS and BSOS are supported for use with women across adulthood in solitary and partnered orgasm contexts and can be used concurrently to provide a comprehensive assessment. Webb AE, Reissing ED, Huta V. Orgasm Rating Scale and Bodily Sensations of Orgasm Scale: Validation for Use With Pre, Peri, and Post-Menopausal Women. J Sex Med 2022;19:1156-1172.

Age at natural menopause and factors affecting its onset: A cross-sectional study among postmenopausal females in District Dehradun

Background: Menopause has become a popular topic of study as life expectancy rises around the world. The average age at menopause in both developed and developing countries ranges from 45 to 53 years. Factors influencing the extent of ovarian follicle reserve dwindling, such as sociodemographic, menstrual, reproductive, and dietary factors. Aim and Objective: The present study aimed to determine the mean age of menopause and to find out the various factors affecting menopause onset. Methods: A community based cross-sectional study conducted in rural and urban areas of District Dehradun for a period of 1 year starting 1st August 2020 to 31st July 2021. Data were collected using multistage stratified random sampling from 211 cases of natural menopause. Chi-square was applied as statistical test of significance and p < 0.05 was considered statistically significant. Results: According to current study, average age menopausal age is 46 years. Variables like sociodemographic characteristics, lifestyle habits, reproductive and menstrual factors were found to have a significant relationship with onset of menopause. Conclusion: Menopause, whether it occurs early or late in life, several factors are responsible for deciding its onset. As a result, it is critical to identify the factors influencing the onset of menopause.

Incidence and familial risk of premature ovarian insufficiency in the Finnish female population

STUDY QUESTION

What is the incidence of premature ovarian insufficiency (POI), has the incidence of POI changed over time, and what is the risk of POI among relatives of POI women?

SUMMARY ANSWER

The incidence of POI increased among females aged 15-19 years from 2007 onwards and decreased in older age groups, and among relatives of women with POI the risk of POI is significantly increased.

WHAT IS KNOWN ALREADY

So far, there has been no good quality, nationwide studies of the incidence of POI. Early menopause has been associated with the elevated risk of early menopause among relatives, but the knowledge of the familial risk of POI is scarce. Lower socioeconomic status has been associated with lower age at natural menopause.

STUDY DESIGN, SIZE, DURATION

Population-based study with 5011 women diagnosed with POI in 1988-2017. The data were collected from national registries and covers POI subjects in entire Finland.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Women with hormone replacement therapy reimbursement for POI were identified from Social Insurance Institution (SII). We calculated POI incidence in different age groups and studied the changes in the incidence rate over time in 5-year segments. Four population-based controls were selected from the Digital and Population Data Services Agency (DVV) for each POI woman. Family members of the POI cases and controls were identified from the DVV and linked to SII reimbursement data to identify POI diagnoses among them. The familial risk of POI was estimated with a logistical regression model.

MAIN RESULTS AND THE ROLE OF CHANCE

The incidence was highest in the 35-39 age group, ranging from 73.8/100 000 women-years in 1993-1997 to 39.9/100 000 women-years in 2013-2017. From 2007, the incidence among 15- to 19-year-olds rose from 7.0 to 10.0/100 000 women-years in 2015-2017. Cumulative incidence of POI for women under 40 years in 1988-2017 was 478/100 000 women. The relative risk of POI among relatives of women with POI was 4.6 (95% CI 3.3-6.5) compared to relatives of women without POI. POI women tended to have slightly lower socioeconomic status and level of education compared to controls.

LIMITATIONS, REASONS FOR CAUTION

For some women with POI, diagnosis or reimbursement may be lacking. However, we presume that these women represent a minority due to the nature of the disease and the economic benefits of reimbursement. Some changes in the incidence of POI can reflect changes in clinical practice and changing treatments and reimbursement criteria.

WIDER IMPLICATIONS OF THE FINDINGS

The risk of developing POI is significantly higher in women who have first-degree relatives diagnosed with POI. Raising awareness of the increased risk might lead to earlier diagnosis and initiation of hormonal replacement therapy, possibly preventing adverse effects of low oestrogen levels, such as osteoporosis.

STUDY FUNDING/COMPETING INTEREST(S)

This work was financially supported by the Oulu University Hospital. H.S. received a grant from Finnish Menopause Society. S.M.S. received a grant from the Finnish Menopause Society, the Finnish Medical Foundation and the Juho Vainio Foundation. The authors do not have any competing interests to declare.

TRIAL REGISTRATION NUMBER

N/A.

The ascending aorta of male hypertensive bicuspid aortic valve patients preferentially associated with a cellular aneurysmal phenotype

Male sex and hypertension represent risk factors in the progression of an aortic aneurysm. The present study examined the morphological/cellular phenotype of the ascending aorta (AA) of male and female patients diagnosed with a bicuspid aortic valve (BAV) to test the hypothesis that hypertension-induced remodeling of male BAV patients preferentially recapitulated the expression of a panel of proteins favoring aneurysm formation. The diameter of the AA of hypertensive male (35 ± 6 mm) and female (39 ± 5 mm) BAV patients was comparable to normotensive patients reflecting an early phase of vessel expansion. Morphological/structural remodeling of the medial region of the AA of male normotensive and hypertensive BAV patients were comparable. Protein levels of non-muscle myosin IIB, the cell cycle inhibitor p27kip1, tumor suppressor p53 and matrix metalloproteinase-2 and -9 were significantly upregulated in the AA of male hypertensive BAV patients. In female hypertensive BAV patients, collagen content was significantly increased whereas elastin content and medial width of the AA were similar to normotensive BAV patients. In the AA of female hypertensive BAV patients, matrix metalloproteinase-9 and p27kip1 protein levels were unchanged whereas p53 and matrix metalloproteinase-2 protein expression was significantly reduced. Nestin protein levels were diminished in the AA of male and female hypertensive BAV patients. Thus, sexual dimorphic remodeling of the AA was prevalent in hypertensive BAV patients. Moreover, during the early phase of vessel expansion, the AA of male hypertensive BAV patients was preferentially associated with the upregulation of a panel of proteins linked to progressive dilatation and potential aneurysm formation.

Age at natural menopause in women with a history of chronic diseases-A population-based cohort study

OBJECTIVE

This study was carried out to determine whether chronic diseases can influence age at natural menopause (ANM).

STUDY DESIGN AND MAIN OUTCOME MEASURES

This population-based prospective study recruited all eligible women from participants in the Tehran Lipid and Glucose Study (TLGS). The Cox proportional-hazards model (unadjusted and adjusted) was used to assess associations of ANM with chronic diseases, including diabetes mellitus (DM), hypertension (HTN), dyslipidemia, metabolic syndrome (MetS), cardiovascular disease (CVD), chronic kidney disease (CKD), and thyroid disorders, which were not included simultaneously in the model because there were correlations between chronic diseases.

RESULTS

A total of 4662 women, aged 15-50 years, who had not reached menopause at initiation of the TLGS were included. Of these women, 1220 (26.2%) experienced menopause during the study follow-up. In the multivariable Cox regression model adjusted for potential confounders, women with DM [HR:1.75; 95%CI: (1.32, 2.32)], HTN [HR: 2.11; 95%CI: (1.64, 2.72)], MetS [HR: 2.01; 95%CI: (1.57, 2.58)], CVD [HR: 3.02; 95%CI: (1.93, 4.73)], CKD [HR: 2.64; 95%CI: (2.16, 3.22)], and thyroid disorders [HR: 1.41; 95%CI: (1.06, 1.88)] reached menopause earlier, while dyslipidemia was not associated with ANM.

CONCLUSION

This study demonstrates that women with a history of chronic diseases, such as metabolic disorders, cardiovascular events, and CKD, experience menopause earlier than their counterparts without such a history.

The association between shift work exposure and the variations in age at natural menopause among adult Canadian workers: results from the Canadian Longitudinal Study on Aging (CLSA)

OBJECTIVE

A wide range of negative health outcomes have been associated with shift work (SW) particularly night and rotating SW. However, little is known about effects of SW exposure on reproductive health outcomes. The objective of our study is to prospectively investigate the association between SW exposure and the variations in age at natural menopause among adult Canadian workers.

METHODS

Secondary data analyses were performed using the Canadian Longitudinal Study on Aging database. Premenopausal women (N = 3,688) at baseline were followed prospectively for 3 years. Three derived variables were used to measure SW primary exposure: 1) ever exposed to SW, 2) SW exposure in current job, and 3) SW exposure in the longest job. Cox proportional hazard regression models were used to evaluate risk of variations in age at natural menopause after adjusting for potential confounders.

RESULT

One out of five women (20%) reported to be ever exposed to SW during their jobs. Overall, women who were ever exposed to SW were significantly associated with a delayed onset of menopause compared with daytime workers (hazard ratios [HR] = 0.77, 95% CI, 0.61-0.98). Particularly, when compared with daytime workers, rotating shift worker in the current and longest job were significantly related to delayed onset of menopause (HR = 0.64, 95% CI, 0.46-0.89 and HR = 0.65, 95% CI, 0.49-0.86), respectively.

CONCLUSION

Our results suggest a relationship between rotating shift and delayed onset of menopause. We speculate that disruptive circadian stimuli may play a role in menopausal onset and this warrants further investigation.

VIDEO SUMMARY

http://links.lww.com/MENO/A940.

Association of weight, smoking, and alcohol consumption with age at natural menopause

In South Korea, rapid economic growth and modernization have led to changes in lifestyle factors that may affect age at natural menopause. Data from 4,793 women aged ≥55 years, who had a natural menopause, were analyzed from the Korea National Health and Nutrition Examination Survey (2013-2017). Multinomial logistic regression was used to examine the association between lifestyle factors and age at natural menopause after adjusting for birth cohort (Model 1) and sociodemographic and reproductive factors (Model 2). Overall, 3.1% of women experienced premature menopause (<40 years), 7.6% early menopause (40-44 years), and 12.8% late menopause (≥55 years). Women born in the 1940s or earlier among the birth cohorts had the highest prevalence of premature (70.0%), early (58.5%), and late (43.1%) menopause. In Model 2, current smoking (odds ratio = 3.99 and 95% confidence interval = 1.35-11.81) was associated with premature menopause. Low (<18.5 kg/m²) and high (≥25 kg/m²) body mass index were associated with early (odds ratio = 2.30 and 95% confidence interval = 1.01-5.22) and late (odds ratio = 1.38 and 95% confidence interval = 1.10-1.72) menopause respectively. Conversely, there was no association between age at natural menopause and alcohol consumption. The results suggest that healthy lifestyle factors, such as not smoking and proper weight maintenance, are significant factors affecting age at natural menopause. Our findings may help develop health policies and provide targeted care to improve women's health after midlife.

Is Alcohol Consumption Associated With Risk of Early Menopause?

Earlier age at menopause is associated with increased long-term health risks. Moderate alcohol intake has been suggested to delay menopause onset, but it is unknown whether alcohol subtypes are associated with early menopause onset at age 45 years. Therefore, we aimed to evaluate risk of early natural menopause among 107,817 members of the Nurses' Health Study II who were followed from 1989 to 2011. Alcohol consumption overall and by subtypes, including beer, red wine, white wine, and liquor, was assessed throughout follow-up. We estimated hazard ratios in multivariable models that were adjusted for age, body mass index, parity, smoking, and other potential confounders. Women who reported moderate current alcohol consumption had lower risks of early menopause than did nondrinkers. Those who reported consuming 10.0-14.9 g/day had a lower risk of early menopause than did nondrinkers (hazard ratio = 0.81, 95% confidence interval: 0.68, 0.97). Among specific beverages, evidence of lower early menopause risk was confined to consumption of white wine and potentially red wine and liquor, but not to beer. Data from this large prospective study suggest a weak association of moderate alcohol intake with lower risk of early menopause, which was most pronounced for consumption of white and red wine and liquor. High consumption was not related to lower risk of early menopause.

The association between chronic diseases and the age at natural menopause: a systematic review

Despite several existing studies on the age at natural menopause (ANM) and its related factors, epidemiologic data on the associations between chronic diseases and ANM are scarce with conflicting and inconclusive results. The aim of this systematic review was to summarize the results of the studies investigating the association between chronic disease and ANM. PubMed, Scopus, and Web of Science were searched for retrieving and summarizing studies published up to October 2020 investigating the association between chronic medical conditions and ANM. All types of observational studies published in the English language were eligible to be included in the systematic review. Studies needed to report the effect of at least one chronic disease on ANM. Studies with other designs, studies with unreliable and incomplete results, and those that assessed none of the chronic diseases as outcomes of interest were excluded. Of the 6294 records retrieved by searching the databases, a total of 28 observational studies were included for this review. According to the Newcastle-Ottawa scale, nine studies were classified as high-quality, fifteen studies as moderate, and four as low-quality. Among the five studies investigating the association between polycystic ovary syndrome (PCOS) and ANM, three studies reported that PCOS was associated with a later ANM, whereas others found no such association. Eight studies showed that diabetes was associated with an earlier ANM, whereas eight other studies found no such association. While only one study showed a younger age at the onset of menopause in patients with a history of hypertension, five studies did not report such an effect. Only one study assessed the effect of dyslipidemia on ANM and showed no association between these variables. While three studies documented the effects of cardiovascular diseases (CVD) and heart disease on earlier ANM, one study found no association between these diseases and ANM. Most included studies showed the association of mood disorders with earlier ANM. There were no sufficient data for assessing the effects of thyroid, skin, and autoimmune diseases on ANM. Chronic diseases particularly cardio-metabolic disturbances, cardiovascular events, and psycho-emotional disorders are associated with earlier menopause, whereas other diseases such as PCOS may lead to later menopause. Accordingly, early diagnosis and managing chronic medical conditions in women can potentially prevent early or late menopause.

Menopausal symptoms in the Southwest United States: A cross-sectional survey of women from areas with different socioeconomic resources

OBJECTIVE

Menopausal symptoms may differ by geography and ethnicity, but the impact of socioeconomic factors is less clear. The purpose of this study was to compare menopausal symptoms in women from areas of Arizona with different socioeconomic resources.

STUDY DESIGN

Women aged 40-65 years in two cohorts were surveyed: (1) Phoenix women attending either a clinic for patients who are uninsured or a clinic for people experiencing homelessness; and (2) Scottsdale women living in zip codes with higher average income and neighborhood advantage (surveyed by mail). Surveys included the Greene Climacteric Scale (GCS) and demographic questions.

MAIN OUTCOME MEASURES

GCS score by domain and subdomain, corrected for age, race, menopause stage and menopausal hormone therapy (HT).

RESULTS

Phoenix participants (N = 104) were 51.2 years old (SD 6.45), Hispanic (54.4%), White (28.2%) or African American (8.7%), and uninsured (53.0%). Scottsdale participants (N = 151) were 52.6 years old (SD 5.52), mostly White (94.7%) and insured (100%). Three percent of Phoenix women were on HT vs. 23.3% in Scottsdale (p < 0.001). Multivariate analysis revealed higher total GCS scores in the Phoenix vs. Scottsdale cohort (39.13 vs 30.14, p < 0.001), which was also seen in the psychological and somatic domains, as well as the anxiety and depression subdomains. No statistically significant differences were seen in the vasomotor or sexual dysfunction domains.

CONCLUSION

In a group of women living in Arizona from distinct socioeconomic areas, significant differences were demonstrated in menopausal symptom bother specifically with higher psychological and somatic symptoms in women who were uninsured or experiencing homelessness independent of age, race, menopause stage and HT use. Future studies controlling for co-morbidities associated with lower socioeconomic status such as depression would provide further insight into this population of midlife women.

Age at menopause among rural and urban women in the state of Campeche, Mexico

OBJECTIVE

The purpose of this study was to examine age at natural menopause among women of Maya and non-Maya ancestry living in urban and rural communities in the state of Campeche, Mexico.

METHODS

Women ages 40 to 60 (n = 543) participated in semi-structured interviews and anthropometric measures. The last names, languages spoken, and the birthplace of the woman, her parents, and her grandparents were used to determine Maya or non-Maya ethnicity. Recalled age at natural menopause was compared across four communities; analysis of variance was used to compare means and Kaplan-Meier analyses were used to compare medians. Probit analysis was also used to estimate median ages at menopause. Cox regression analyses were applied to identify variables associated with age at menopause.

RESULTS

Mean recalled age at natural menopause across all sites was 46.7 years, ranging from 47.8 years in the city of Campeche to 43.9 years in the rural Maya communities in the municipality of Hopelchén. Median ages at menopause across all sites were 50.55 years by probit analysis and 50.5 years by Kaplan-Meier. Variables associated with a later age at menopause included higher socioeconomic status, higher parity, and a later age at menarche.

CONCLUSIONS

The early mean recalled age at menopause in southern Hopelchén was consistent with previous studies in the Yucatán peninsula. As expected, probit and Kaplan-Meier analyses demonstrated later ages at menopause. Contrary to our expectations, Maya/non-Maya ethnicity was not associated with age at menopause. Demographic and reproductive factors were more important than ethnicity in explaining variation in age at menopause within the state of Campeche, Mexico.

Determinants of Leptomeningeal Collateral Status Variability in Ischemic Stroke Patients

BACKGROUND

Collateral status is an indicator of a favorable outcome in stroke. Leptomeningeal collaterals provide alternative routes for brain perfusion following an arterial occlusion or flow-limiting stenosis. Using a large cohort of ischemic stroke patients, we examined the relative contribution of various demographic, laboratory, and clinical variables in explaining variability in collateral status.

METHODS

Patients with acute ischemic stroke in the anterior circulation were enrolled in a multi-center hospital-based observational study. Intracranial occlusions and collateral status were identified and graded using multiphase computed tomography angiography. Based on the percentage of affected territory filled by collateral supply, collaterals were graded as either poor (0-49%), good (50-99%), or optimal (100%). Between-group differences in demographic, laboratory, and clinical factors were explored using ordinal regression models. Further, we explored the contribution of measured variables in explaining variance in collateral status.

RESULTS

386 patients with collateral status classified as poor (n = 64), good (n = 125), and optimal (n = 197) were included. Median time from symptom onset to CT was 120 (IQR: 78-246) minutes. In final multivariable model, male sex (OR 1.9, 95% CIs [1.2, 2.9], p = 0.005) and leukocytosis (OR 1.1, 95% CIs [1.1, 1.2], p = 0.001) were associated with poor collaterals. Measured variables only explained 44.8-53.0% of the observed between-patient variance in collaterals.

CONCLUSION

Male sex and leukocytosis are associated with poorer collaterals. Nearly half of the variance in collateral flow remains unexplained and could be in part due to genetic differences.

Carbohydrate quality index: Its relationship to menopausal symptoms in postmenopausal women

OBJECTIVE

The aim of this study was to determine the relationship between carbohydrate quality intake and menopausal symptoms.

STUDY DESIGN

This is a cross-sectional study of 393 postmenopausal women attending municipality health houses and health centers in the south of Tehran, Iran, from September 2016 to January 2017.

MAIN OUTCOME MEASURES

The dietary intake and menopausal symptoms of the participants were assessed with a validated food frequency questionnaire and a menopause rating scale (MRS) carbohydrate quality index (CQI) was calculated using three indices: dietary fiber, glycemic index, and the ratio of solid carbohydrates to total carbohydrates. Linear and logistic regressions were used to assess the relationship between CQI and menopausal symptoms.

RESULTS

After adjustment for age, education, time passed since menopause, body mass index, physical activity and energy intake, an inverse association was found between CQI and total MRS score (TMRSS) (β -0.61; p <0.001), somatic score (SS) (β -0.27; p <0.001) and psychological score (PS) (β -0.37; p <0.001) in multivariable linear regression. In addition, logistic regression analysis revealed that compared with the lowest quartile of CQI, participants in the highest quartile of CQI had a lower TMRSS (odds ratio (OR) 0.36, 95% confidence interval (CI) 0.19-0.68). Moreover, CQI was inversely related to SS (OR 0.34; 95% CI 0.17-0.68) and PS (OR 0.32; 95% CI 0.16-0.61). However, there was no significant association between CQI and urogenital score (US).

CONCLUSIONS

Higher-quality carbohydrate intake was found to be associated with lower somatic and psychological symptoms of menopause. These findings suggest that CQI may be an important basis for developing an effective dietary modification for reducing menopausal symptoms.

Associations of long-term exposure to environmental noise and outdoor light at night with age at natural menopause in a US women cohort

Previous studies have suggested noise, especially at night time, and light at night (LAN) could cause neuroendocrine disturbance and circadian disruption, which may lead to ovarian follicle atresia and earlier onset of menopause. However, no study to date has directly investigated the associations of exposure to these factors and menopausal age.

Methods

Premenopausal women from the Nurses' Health Study II (NHS II) were followed from age 40 through 2015. Median daytime and nighttime anthropogenic noise and outdoor LAN exposure were measured from a geospatial prediction model and satellite images, respectively, at residential addresses throughout the follow-up. Time-varying Cox proportional hazard models were used to calculate the hazard ratios and 95% confidence intervals, adjusting for individual lifestyle, reproductive history, and neighborhood socioeconomic factors. Possible effect modification by region, smoking status, body mass index, race/ethnicity, history of rotating shift work, and census tract population density and median income was examined.

Results

A total of 63,380 of 105,326 women self-reported natural menopause during 1,043,298 person-years of follow-up. No associations were found for noise (both daytime and nighttime) and outdoor LAN exposure with age at natural menopause (hazard ratios = 0.99-1.00) in the fully adjusted models. Sensitivity analyses showed similar null associations. No meaningful effect modification was found for region, smoking status, body mass index, race/ethnicity, history of rotating shift work, and census tract socioeconomic measures in stratified analyses.

Conclusion

No associations were found between environmental noise and outdoor LAN exposure in mid-adulthood and menopausal age in this cohort of US women.

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

This national survey study uses the National Health and Nutrition Examination Survey (NHANES) to describe trends in age at natural menopause, age at menarche, and reproductive life span, and variables associated with shorter and longer spans, among US women between 1959-1962 and 2015-2018.

Intravenous ketamine for postmenopausal women with treatment-resistant depression: Results from the Canadian Rapid Treatment Center of Excellence

Women are disproportionately represented amongst samples of adults with treatment-resistant depression (TRD). Ketamine has demonstrated rapid and robust efficacy in adults with TRD. Herein, we sought to determine whether the effectiveness of intravenous (IV) ketamine was influenced by menopausal status in women with TRD. We defined premenopausal women as those under the age of 45 (n = 52), while postmenopausal women (n = 54) were those over the age of 51. Participants received four IV ketamine infusions over one-to-two weeks at a community-based center for adults with TRD. The primary outcome of interest was the change in depressive symptom severity as measured by the Quick Inventory of Depressive Symptomatology Self-Report 16 (QIDS-SR₁₆) following four infusions, compared to pretreatment. The secondary outcomes were improvements in suicidal ideation (SI; i.e., QIDS-SR₁₆ SI item), anxiety (i.e., Generalized Anxiety Disorder-7 scale), anhedonic severity (i.e., Snaith-Hamilton Pleasure Scale), and workplace and psychosocial function (i.e., Sheehan Disability Scale). Menopausal status did not influence overall treatment response, F (4, 280) = 1.83, p = .123, η_p² = 0.025. Both premenopausal and postmenopausal participants demonstrated similar response rates (30% and 26%, respectively) and remission rates (both 13%) to IV ketamine treatment following four infusions. Premenopausal women experienced improvements in social function more rapidly than postmenopausal women, F (2, 174) = 1.65, p = .047, η_p² = 0.019. Postmenopausal women experienced reduction in SI more rapidly than premenopausal women, F (4, 280) = 2.72, p = .030, η_p² = 0.037. These preliminary post-hoc findings provide the impetus for future studies to investigate the moderational role of menopausal status, as defined by hormone levels, on response to IV ketamine for TRD.

The association between primary ovarian insufficiency and osteoporosis in the Canadian Longitudinal Study on Aging

OBJECTIVE

The objective of this study is to describe the association of premature ovarian insufficiency (POI) and early menopause on bone mineral density (BMD) and osteoporosis in a large cohort of women living in Canada.

METHODS

Cross-sectional baseline data from a deeply characterized cohort (female participants) of the Canadian Longitudinal Study on Aging was used. Additional bio-psycho-social characteristics that may influence bone health and the development of osteoporosis were explored.

RESULTS

The mean age of women at the time of baseline assessment was 65 years (N = 12,339). When comparing women with POI to those with early and normal age of menopause, there was no difference in hip BMD between groups, but women in the POI group were more likely to have a higher rate of self-reported osteoporosis (21.9% vs 16.7%) and have used osteoporosis drugs (11.39% vs 7.63%). After adjustment, POI was found to increase the odds of osteoporosis, as diagnosed using BMD. Current cigarette smoking was found to influence this association. Protective factors included obesity and current hormone therapy use, but not the duration of hormone therapy use. Women in the POI group were more likely to be obese, have decreased physical activity, and were more likely to be current smokers.

CONCLUSION

These results confirm findings from smaller cohorts illustrating that POI is associated with osteoporosis. Increasing understanding of the sequelae associated with an earlier loss of ovarian function will aid in targeting earlier screening and intervention strategies for women in Canada and abroad.

Prevalence and correlates of early-onset menopause among women living with HIV in Canada

OBJECTIVE

Menopause is a pivotal transition for women. Previous studies have suggested increased risk of early menopause (40-45 years) and premature menopause (<40 years) for women with HIV. We aimed to determine age of menopause, prevalence of early menopause and premature menopause, and risk factors for menopause <45 years in Canadian women with HIV.

METHODS

This was a cross-sectional analysis from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study. Analyses were restricted to biologically female participants reporting being postmenopausal (regardless of etiology). Primary outcome was median age at menopause. Predetermined variables, and those with P < 0.10 in univariable analyses were considered for inclusion into multivariable logistic regression model, to determine independent correlates of menopause <45 years.

RESULTS

229 women were included. Median age of menopause was 48 years (interquartile range 43, 51); 29.7% of women experienced menopause <45 years: 16.6% with early menopause and 13.1% with premature menopause. In univariable analyses, menopause <45 years was more likely (P < 0.05) with birth in Canada, white ethnicity, less than high-school education, smoking, recreational drug use, and hepatitis C co-infection. In multivariable modeling, less than high-school education (adjusted odds ratio [aOR] 2.45, 95% confidence interval [CI] 1.22-4.93) and hepatitis C co-infection (aOR 1.90, 95% CI 1.04-3.50) were independently associated with menopause <45 years.

CONCLUSIONS

In Canadian women with HIV, median age of menopause was 48 years; 3 years younger than the general population. Only lower education and hepatitis C co-infection were independently associated with menopause <45 years, highlighting importance of socioeconomic factors and comorbidities. These findings have implications for counseling and management of women with HIV.

Early and surgical menopause associated with higher Framingham Risk Scores for cardiovascular disease in the Canadian Longitudinal Study on Aging

OBJECTIVE

In women, the risk of cardiovascular disease (CVD) is higher in the postmenopausal period. The effect that menopausal type, natural versus surgical, or the age at natural menopause has on CVD needs further investigation. To this end, we assessed the association between menopausal type and timing and the 10-year office-based Framingham Risk Score (FRS) in women from the Canadian Longitudinal Study on Aging.

METHODS

We included women aged 45 to 85 years from the Canadian Longitudinal Study on Aging Comprehensive cohort of seven Canadian provinces who were menopausal at the time of recruitment and had no prior CVD. Poisson regressions were used to evaluate the association between menopausal characteristics and the FRS. Natural menopause was defined as the cessation of menstrual periods for at least 1 year in women with no history of hysterectomy. Surgical menopause was defined as hysterectomy with or without oophorectomy prior to natural menopause. As main covariates, we examined age, education, province of residency, and hormone therapy.

RESULTS

A total of 10,090 women (8,200 natural menopausal and 1,890 surgical menopausal) were eligible for the study. In the multivariable model, surgical menopause was associated with a higher mean FRS compared with natural menopause (CVD risk 12.4% vs 10.8%, P < 0.001). Compared with women with age at natural menopause from 50 to 54 years (CVD risk 10.2%), natural menopause before age 40, 40 to 44, or 45 to 49 had a higher CVD risk (12.2%, 11.4%, and 10.6%, respectively, P < 0.001).

CONCLUSIONS

Our study supports an association between menopausal type and timing on CVD risk prediction and highlights the need to be judicious about surgical menopause. Preventative interventions for CVD should be considered in surgical menopausal women and women with an age at natural menopause less than 45 years.

Effects of Environment and Lifestyle Factors on Premature Ovarian Failure

Premature ovarian insufficiency (POI) or primary ovarian failure is defined as a cessation of the menstrual cycle in women younger than 40 years old. It is strictly defined as more than 4 months of oligomenorrhea or amenorrhea in a woman <40 years old, associated with at least two follicle-stimulating hormone (FSH) levels >25 U/L in the menopausal range, detected more than 4 weeks apart. It is estimated that POI was affected 1 and 2% of women. Although 80% of POI cases are of unknown etiology, it is suggested that genetic disorder, autoimmune origin, toxins, and environmental factors, as well as personal lifestyles, may be risk factors of developing POI. In this section, we will discuss the influences of environmental and lifestyle factors on POI. Moreover updated basic research findings regarding how these environmental factors affect female ovarian function via epigenetic regulations will also be discussed.

The incidence of breast cancer in Canada 1971-2015: trends in screening-eligible and young-onset age groups

OBJECTIVES

Breast cancer incidence has fluctuated considerably in Canada, with recent reductions in rates among screening-eligible women. However, incidence of early-onset and pre-menopausal breast cancer is understudied. We examined age-specific trends in breast cancer incidence between 1971 and 2015, as well as possible trends by birth cohort.

METHODS

Incidence data were collected from the National Cancer Incidence Reporting System and the Canadian Cancer Registry, and annual percent changes were estimated using the Joinpoint Regression Program. Five-year birth cohort models were fit using the National Cancer Institute's web tool.

RESULTS

Breast cancer incidence among women under age 40 has increased since 2000, while incidence under 50 has remained stable. Rates of post-menopausal breast cancer declined sharply and have recently plateaued. More recent birth cohorts are at a non-significantly increased risk of breast cancer compared with the reference, with an increasing upward trend.

CONCLUSIONS

Rates of breast cancer may be increasing among younger women, and there is suggestive evidence that more recent birth cohorts are at increased risk of the disease. More research is needed into the risk factors for pre-menopausal breast cancer to support primary prevention efforts in this area.

Frailty Is Inversely Related to Age at Menopause and Elevated in Women Who Have Had a Hysterectomy: An Analysis of the Canadian Longitudinal Study on Aging

BACKGROUND

Frailty is a complex pathophysiological phenomenon that will impact a significant proportion of adults over the age of 65 and contributes to the risk of several adverse health outcomes. Although women have a disproportionately higher risk of frailty, the sex-specific factors related to this syndrome are not well described. Hence, we sought to examine the relationship of age at menopause, hysterectomy status, and hormone replacement therapy use with prevalent frailty in older women.

METHODS

We performed a cross-sectional analysis of the Canadian Longitudinal Study on Aging (CLSA) Baseline Comprehensive Cohort (n = 30,097, 45-85 years old). Frailty was operationalized using both the deficit accumulation (frailty index) and frailty phenotype (Fried) models. Postmenopausal women were categorized as follows: premature (30-39 years), early (40-45 years), normal (46-54 years), and late (55+ years) menopause, or hysterectomy. Associations were determined using multivariate analysis, adjusting for sociodemographics, lifestyle factors, social support, and hormone replacement therapy use.

RESULTS

Age at menopause was inversely related to frailty in older Canadian women. The frailty index decreased 1.2% of the mean (p < .001) with every year of menopause onset and was significantly higher for women in the premature (24%; p < .001) and early (7%; p < .01) menopause and hysterectomy (21%; p < .001) groups, compared to the normal menopause group. The odds for being classified as frail using Fried's criteria was higher for the premature menopause (OR = 1.33, 95% CI = 0.72-2.27) and hysterectomy (OR = 1.59, 95% CI = 1.25-2.02) groups.

CONCLUSIONS

Our study supports a role for age at menopause and hysterectomy in the risk of frailty in older women and warrants further investigation.