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Frequency and type of premature or early menopause in a geographically defined American population

OBJECTIVE

There is limited information on the prevalence of premature and early menopause. Therefore, we studied the frequency and type of premature (age < 40 years) or early (age 40-44 years) menopause in a geographically-defined American population.

METHODS

We studied a random sample of women aged 18 to 50 years who resided in Olmsted County, MN between 1988 and 2007. Women were followed through December 2021, and age at cessation of menses was assessed via review of the medical records included in a medical records-linkage system. Menopause was defined as cessation of menses due to spontaneous or induced ovarian insufficiency.

RESULTS

1015 women (71.3 %) underwent spontaneous menopause, 138 (9.7 %) underwent bilateral oophorectomy, 17 (1.2 %) had antecedent chemotherapy or radiation therapy, and 254 (17.8 %) underwent hysterectomy or endometrial ablation. The median age at cessation of menses was 51.0 years (IQR, 49.0-52.0) for spontaneous menopause, 46.0 years (IQR, 41.0-49.0) for menopause induced by oophorectomy, chemotherapy, or radiation therapy, and 38.0 years (IQR, 33.0-44.0) for hysterectomy. Considering both spontaneous and induced menopause, the frequency was 3.1 % (95 % CI, 2.2-4.2) for premature and 6.2 % (95 % CI, 5.0-7.8) for early menopause. Considering only spontaneous menopause, the frequency reduced to 0.4 % (95 % CI, 0.2-1.0) for premature and 5.2 % (95 % CI, 4.0-6.8) for early menopause. However, considering all types of cessations of menses, the frequency was 12.2 % (95 % CI, 10.6-14.0) for premature and 9.7 % (95 % CI, 8.3-11.3) for early cessation of menses.

DISCUSSION

Approximately 3 % of women in the general population experienced either spontaneous or induced premature menopause. The most common cause of premature menopause was bilateral oophorectomy.

Long-term risk of de novo mental health conditions after hysterectomy with ovarian conservation: a cohort study

OBJECTIVE

The aim of this research was to study the long-term risk of de novo mental health conditions in women who underwent hysterectomy with bilateral ovarian conservation compared with age-matched referent women.

METHODS

Using the Rochester Epidemiology Project records-linkage system, we identified a historical cohort of 2,094 women who underwent hysterectomy with ovarian conservation for benign indications at age ≥18 years and with an index date between 1980 and 2002 in Olmsted County, Minnesota. Each woman was age-matched (±1 y) to a referent woman residing in the same county who had not undergone hysterectomy or any oophorectomy before the index date. These two cohorts were followed historically to identify de novo mental health conditions. We estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs) using Cox proportional hazards models adjusted for 20 preexisting chronic conditions and other potential confounders. We also calculated absolute risk increases (ARIs) and reductions (ARRs) at 30 years of follow-up.

RESULTS

Over a median follow-up of 21.9 years, women who underwent hysterectomy at any age experienced increased risks of de novo depression (adjusted HR 1.26; 95% CI, 1.12-1.41; ARI 6.6%) and anxiety (adjusted HR 1.22; 95% CI, 1.08-1.38; ARI 4.7%). The association for depression increased significantly with younger age at hysterectomy, but did not vary significantly by indication. Interactions were not significant for anxiety.

CONCLUSIONS

Hysterectomy, even with ovarian conservation, is associated with an increased long-term risk of de novo depression and anxiety, especially when performed in women who are younger. : Video Summary:http://links.lww.com/MENO/A465.