Age at natural menopause and associated factors in adult women: Findings from the China Kadoorie Biobank study in Zhejiang rural area

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.

Previous cancers in women diagnosed with premature ovarian insufficiency: A nationwide population-based case-control study

INTRODUCTION

To investigate the occurrence of previous cancer diagnoses in women suffering from premature ovarian insufficiency (POI) and compare it with the general population, shedding light on the association between cancer, cancer treatments, and POI.

MATERIAL AND METHODS

We conducted a nationwide case-control study based on registry data from various sources, including the Social Insurance Institution, Finnish Population Information System, and Finnish Cancer Registry spanning from 1953 to 2018. Our participants comprised all women in Finland who, between 1988 and 2017, received hormone replacement therapy reimbursement for ovarian insufficiency before the age of 40 years (n = 5221). Controls, matched in terms of age and municipality of residence, were selected from the Finnish Population Information System (n = 20 822). Our main exposure variable was a history of cancer diagnosis preceding the diagnosis of POI. We analyzed odds ratios (OR) to compare the prevalence of previous cancers in women with POI with that in controls, stratifying results based on cancer type, age at cancer diagnosis, and the time interval between cancer diagnosis and POI. We also assessed changes in OR for previous cancer diagnoses over the follow-up period.

RESULTS

Out of the women diagnosed with POI, 21.9% had previously been diagnosed with cancer, resulting in an elevated OR of 36.5 (95% confidence interval [CI] 30.9 to 43.3) compared with 0.8% of the controls. The risk of developing POI was most pronounced during the first 2 years following a cancer diagnosis, with an OR of 103 (95% CI 74.1 to 144). Importantly, this risk remained elevated even when the time interval between cancer and POI exceeded 10 years, with an OR of 5.40 (95% CI 3.54 to 8.23).

CONCLUSIONS

This study reveals that 21.9% of women with POI have a history of cancer, making the prevalence of cancer among these women 27.5 times higher than age-matched controls in the Finnish population. The risk of developing POI is most substantial in the first 2 years following a cancer diagnosis. These findings underscore the role of cancer treatments as an etiological factor for POI and emphasize the importance of recognizing the risk of POI in cancer survivors for early diagnosis and intervention.

Age at natural menopause and its determinants in female population of Kharameh cohort study: Comparison of regression, conditional tree and forests

BACKGROUND

Natural menopause is defined as the permanent cessation of menstruation that occurs after 12 consecutive months of amenorrhea without any obvious pathological or physiological cause. The age of this phenomenon has been reported to be associated with several health outcomes.

OBJECTIVES

This study aimed to estimate the Age at Natural Menopause (ANM) and to identify reproductive and demographic factors affecting ANM.

METHODS

This cross-sectional, population-based study was conducted on 2517 post-menopausal women aged 40-70 years participating in the first phase of the PERSIAN cohort study of Kharameh, Iran, during 2014-2017. To more accurately detect the determinants of ANM, we applied multiple linear regression beside some machine learning algorithms including conditional tree, conditional forest, and random forest. Then, the fitness of these methods was compared using Mean Squared Error (MSE) and Pearson correlation coefficient.

RESULTS

The mean±SD of ANM was 48.95±6.13. Both applied forests provided more accurate results and identified more predictors. However, according to the final comparison, the conditional forest was the most accurate method which recognized that more pregnancies, longer breastfeeding, Fars ethnicity, and urbanization have the greatest impact on later ANM.

CONCLUSIONS

This study found a wide range of reproductive and demographic factors affecting ANM. Considering our findings in decision-making can reduce the complications related to this phenomenon and, consequently, improve the quality of life of post-menopausal women.

Micronutrients intake and genetic variants associated with premature ovarian insufficiency; MASHAD cohort study

BACKGROUND AND AIM

premature ovarian insufficiency (POI) is defined as the menopause before 40 years of age, and its prevalence is reported to be two-fold higher in Iranian women than the average for woman globally. POI is associated with several cardio/cerebrovascular complications as well as an increased overall mortality. Genetic factors, and serum levels of minerals and vitamin D, have been reported to be related to the prevalence of POI. We have investigated the association between some POI -related genotypes with the serum levels of some important micronutrients.

METHODS

One hundred and seventeen women with POI and 183 controls without any renal, hepatic, and thyroid abnormalities were recruited as part of the MASHAD study. Demographic and anthropometric features were recorded and blood samples were collected and processed. DNA was extracted from the buffy coat of blood samples from all participants and 8 POI-related single nucleotide polymorphisms (SNPs) were determined using ASO-PCR or Tetra ARMS-PCR. Serum minerals and vitamin D concentrations were measured using routine methods.

RESULTS

In women with POI, serum copper, phosphate, and calcium were significantly different for those with rs244715, rs16991615, and rs4806660 genotypes, respectively. In our control population, significant differences were also found in serum copper concentrations between different genotypes of rs4806660, rs7246479, rs1046089, and rs2303369. After adjusting for all confounding factors, the women with POI carrying TC genotype (rs4806660) had a lower risk to have serum copper levels < 80 (µg/dL) than those carrying a TT genotype. Furthermore, women with POI carrying GG genotype (rs244715) had a 6-fold higher risk to have serum copper levels > 155 than those carrying AA genotype.

CONCLUSION

The C and G alleles of the rs4806660 and rs244715 polymorphisms respectively are independently associated with serum copper in women with POI. Further studies are necessary to investigate the association of serum copper and other micronutrients in women and other POI -related polymorphisms.

Age at Natural Menopause and Influencing Factors in Women Attending the Gynecological Outpatient Clinic at a Tertiary Care Hospital

Background

Menopause is the irreversible cessation of menstruation that results from the lack of ovarian follicular function and is diagnosed after 12 consecutive months of amenorrhea without reasonable cause. This study aims to determine the average age at natural menopause and identify its associated factors among Somali women.

Methods

This is a cross-sectional study conducted at the Mogadishu Somalia Türkiye Recep Tayyip Erdogan research and training hospital's Obstetrics and Gynecology outpatient clinic between June 1 and July 1, 2023. Data was collected from subjects during the data collection period using face-to-face interviews with structured questionnaires consisting of sociodemographic, lifestyle, dietary, and reproductive characteristics. A multivariate logistic regression analysis was conducted to find the association between menopause age and target variables.

Results

Out of the 188 participants recruited for the study, the median age of menopause was 45.00 (95% CI = 44.50-45.62), and 48.9% had either premature or early menopause. The majority (53.7%) of the participants had a minimum of eight children. In Spearman's rank correlation analysis, we found a significantly positive correlation between menopausal age and age at first (p<0.01), last childbirth (p<0.01), number of parities (p<0.05), and age at marriage (p<0.05). In multivariate logistic regression, we found that the odds of developing premature or early menopause among unemployed women were 59% lower than those of employed women (AOR = 0.41, 95% CI = 0.18-0.93).

Conclusion

In this study, we established that the age of natural menopause was lower than the findings reported by previous authors. We also found that employment status, education, history of contraceptive use, BMI, age at first and last childbirth, and parity were associated with age at natural menopause, suggesting that social, lifestyle, and reproductive factors may have an impact on menopausal age.

Review of mendelian randomization studies on age at natural menopause

Menopause marks the end of the reproductive phase of life. Based on epidemiological studies, abnormal age at natural menopause (ANM) is thought to contribute to a number of adverse outcomes, such as osteoporosis, cardiovascular disease, and cancer. However, the causality of these associations remains unclear. A powerful epidemiological method known as Mendelian randomization (MR) can be used to clarify the causality between ANM and other diseases or traits. The present review describes MR studies that included ANM as an exposure, outcome and mediator. The findings of MR analyses on ANM have revealed that higher body mass index, poor educational level, early age at menarche, early age at first live birth, early age at first sexual intercourse, and autoimmune thyroid disease appear to be involved in early ANM etiology. The etiology of late ANM appears to be influenced by higher free thyroxine 4 and methylene tetrahydrofolate reductase gene mutations. Furthermore, early ANM has been found to be causally associated with an increased risk of osteoporosis, fracture, type 2 diabetes mellitus, glycosylated hemoglobin, and the homeostasis model of insulin resistance level. In addition, late ANM has been found to be causally associated with an increased systolic blood pressure, higher risk of breast cancer, endometrial cancer, endometrioid ovarian carcinoma, lung cancer, longevity, airflow obstruction, and lower risk of Parkinson's disease. ANM is also a mediator for breast cancer caused by birth weight and childhood body size. However, due to the different instrumental variables used, some results of studies are inconsistent. Future studies with more valid genetic variants are needed for traits with discrepancies between MRs or between MR and other types of epidemiological studies.

Urban-rural differences in epidemiology and risk factors of menopause syndrome in middle-aged Chinese women

OBJECTIVE

To compare the prevalence and severity of menopausal symptoms and investigate their associated factors among rural and urban middle-aged Chinese women.

METHODS

A descriptive, cross-sectional study of 4,580 urban and 2,729 rural randomly sampled participants aged 40 to 55 years in Gansu Province, China, was conducted. Questionnaires assessing the sociodemographic information and menstrual and reproductive histories of the participants were administered. The modified Kupperman scale was used to assess the presence and severity of menopausal symptoms. Binary and ordinal logistic regression analyses were performed to identify factors associated with the occurrence and severity of menopausal syndrome, respectively, according to the modified Kupperman Menopausal Index score rank.

RESULTS

The natural menopausal age of the rural women was significantly lower than that of the urban women (rural: 47.22, urban: 47.98; P < 0.05). Furthermore, rural women had a higher prevalence (rural: 56.35%, urban: 43.47%) and severity (rural: 11.40%, urban: 6.61%) of menopausal syndrome than the urban women ( P < 0.05). For both the urban and rural women, the prevalence and severity of most menopausal symptoms increased as menopause progressed. The three most prevalent symptoms in both the urban and rural women were fatigue (rural: 70.43%, urban: 68.19%), muscle/joint pain (rural: 62.84%, urban: 59.32%), and vertigo (rural: 57.42%, urban: 47.44%). Positive associations between menopausal symptoms and age, residence, body mass index, level of education, time of pregnancy, menstrual cycle, and presence of chronic diseases were observed.

CONCLUSIONS

Rural women experience more frequent and severe menopausal syndrome than do urban women.

Depressive symptoms and physical activity among community-dwelling perimenopausal women: a prospective longitudinal study

BACKGROUND

Women in perimenopause are vulnerable to depressive symptoms, and physical activity was reported to be a potential protective factor. The trajectories of physical activity and depressive symptoms over time and their longitudinal relationships in Chinese perimenopausal women have not been explored yet, leaving a research gap hindering us from better understanding and managing perimenopause depressive symptoms.

METHODS

A multi-center prospective longitudinal study was conducted in four cities in Sichuan Province, China. Depressive symptoms and physical activity in perimenopausal women were collected in March 2019, June 2019, September 2019, and December 2019, respectively. Multivariable linear regression by generalized estimation equation was used to identify the relevant factors associated with depressive symptoms and physical activity. A four-wave autoregressive and cross-lagged panel model was performed to explore their longitudinal relationships.

RESULTS

A total of 1875 women who completed the four-wave data collection were included in the data analysis. Depressive symptoms exacerbated over time and were associated with women's age, monthly income, marital status, chronic disease, and negative life events. Physical activity decreased over time and was associated with educational background and monthly income. According to the cross-lagged panel model, perimenopausal women with more severe depressive symptoms tended to be less physically active, and similarly, perimenopausal women with less physical activity were more prone to report more severe depressive symptoms.

CONCLUSION

The cross-lagged panel model disclosed longitudinal bidirectional relationships between depressive symptoms and physical activity in perimenopausal women. Appropriate physical activity should be recommended for perimenopausal women to improve their mental well-being. Tailored physical activity duration and maintenance measures should be proposed based on different sociodemographic statuses.

Prevalence of early and late menopause and its determinants in Rafsanjan cohort study

Our investigation aimed to evaluate the prevalence of early and late menopause and its determinants in adult women of Rafsanjan cohort study. We used data obtained from the Rafsanjan Cohort Study, as a part of the prospective epidemiological research studies in Iran. In this cross-sectional research, 2002 postmenopausal women were included in the present study. Menopause age were divided into three groups (≤ 41 years, 42-54 years, and ≥ 55 years) based on the 10th and 90th percentile. The association between age at menopause with demographic and reproductive characteristics and some clinical risk factors of women was evaluated by logistic regressions. The mean age at menopause among the study participants was 48.63 ± 5.37 years. In this study, 11.49% and 11.39% of the women experienced early and late menopause respectively. After adjusting for all potential confounders, the results showed that taller and smoker women had higher odds of early menopause (OR 1.03, 95% CI 1.00-1.06) and OR 1.85, 95% CI 1.01-3.41) respectively) and women with history of using hormonal contraceptive more than median had lower odds of early menopause (OR 0.61, 95% CI 0.41-0.91). Also older women (OR 8.65, 95% CI 5.31-14.08) and women with a history of diabetes (OR 2.42, 95% CI 1.63-3.60), hypertension (OR 2.06, 95% CI 1.42-2.97), thyroid disease (OR 1.85, 95% CI 1.07-3.20) and depression (OR 2.00, 95% CI 1.35-2.97) had higher odds of late menopause. The results showed that the year of birth, height, smoking, history of diabetes, hypertension, thyroid disease and depression and using hormonal contraceptive were significantly associated with the menopausal age. Since age at menopause can affect subsequent health in women, understanding the determinants of menopausal age is important and should be pursued.

Relationship between DMFT index and reproductive history- a cross-sectional study on enrollment phase of Azar cohort study

Background

Hormonal changes in women throughout life might affect the oral health. The aim of this study is to investigate the relationship between the Decayed, Missing, and Filled Teeth (DMFT) index and reproductive history.

Methods

The present cross-sectional study was performed using data of Azar Cohort Study conducted in 2014, in Shabestar city, East Azerbaijan Province, Iran. In the present study, the data of all 8294 women from the enrollment phase of the Azar cohort were included. All available data related on the variables of reproductive history (including age at the onset of menstruation, age of onset of menopause, age of first pregnancy, and frequency of pregnancy), age at interview, educational level, socioeconomic status, frequency of tooth brushing, chronic diseases, body mass index and DMFT were extracted. Negative binomial regression with loglink was used to analyze the relationship between variables. Three regression models have been applied to adjust the effect of confounding variables. Model 1 adjusted for education, socio-economic status, age, chronic diseases, body mass index and frequency of tooth brushing. Model 2 adjusted for education, socioeconomic status, age, chronic diseases and body mass index. Model 3 adjusted for education, socio-economic status and age.

Results

The mean DMFT of 8294 women was 20.99 ± 8.95. In model 1, there was no significant relationship between DMFT and frequency of pregnancy. However, model 2 and 3 showed that in women who had four or more pregnancies, the DMFT rate was significantly higher than those who did not have a history of pregnancy (P = 0.02, P = 0.04). Age at the onset of menopause, age at the onset of menstruation and age of first pregnancy had no significant relationship with DMFT in the models. Brushing less than once a day and increasing age at interview had significant relationship with DMFT in the models (P < 0.001).

Conclusion

Despite hormonal changes through the life, the history of reproductive showed no significant relationship with women’s DMFT. Oral health education for women is an important step in promoting oral health and it is necessary to pay special attention to preventive programs in oral health policy for women specially with increasing the age.

Dietary supplementation for female infertility: Recent advances in the nutritional therapy for premature ovarian insufficiency

Premature ovarian insufficiency (POI) ranks top in the reproductive disorders that may impair multiple functioning systems, reduce the quality of life and ultimately deprive patients of their fertility among women. Symptoms can be partially alleviated by present hormone replacement therapy that cannot improve conception or decrease occurrence rates of systemic complication. Nutritional dietary supplements are attracting more and more attention because of their safety, bioavailability, and efficacy for well-being. Nutrients in the daily food are composed of carbohydrates, fat and lipoprotein, protein and polypeptide, vitamins, and vegetable or fruits containing phytoestrogens. These are functional nutrients due to the proliferative, anti-inflammatory, anti-oxidant, and mitochondria-protective potential during the course of menopause. Apart from dietary nutrients, microbe-related nutritional substances, including probiotics, prebiotics and the combination-synbiotics, display high potential as well in supporting estrous cycle, ovarian viability and modulating other vital reproductive functions. The present review will discuss dietary and microbial nutrients and their roles and applications in the living body based upon animal or human research, evaluate possible effect mechanisms from molecular, cellular and tissue levels, and provide insights into nutritional therapy for prolonging reproductive lifespan in female patients.

Hemodynamic differences between women and men with elevated blood pressure in China: A non-invasive assessment of 45,082 adults using impedance cardiography

Background

Whether there are sex differences in hemodynamic profiles among people with elevated blood pressure is not well understood and could guide personalization of treatment.

Methods and results

We described the clinical and hemodynamic characteristics of adults with elevated blood pressure in China using impedance cardiography. We included 45,082 individuals with elevated blood pressure (defined as systolic blood pressure of ≥130 mmHg or a diastolic blood pressure of ≥80 mmHg), of which 35.2% were women. Overall, women had a higher mean systolic blood pressure than men (139.0 [±15.7] mmHg vs 136.8 [±13.8] mmHg, P<0.001), but a lower mean diastolic blood pressure (82.6 [±9.0] mmHg vs 85.6 [±8.9] mmHg, P<0.001). After adjusting for age, region, and body mass index, women <50 years old had lower systemic vascular resistance index (beta-coefficient [β] -31.7; 95% CI: -51.2, -12.2) and higher cardiac index (β 0.07; 95% CI: 0.04, 0.09) than men of their same age group, whereas among those ≥50 years old women had higher systemic vascular resistance index (β 120.4; 95% CI: 102.4, 138.5) but lower cardiac index (β -0.15; 95% CI: -0.16, -0.13). Results were consistent with a propensity score matching sensitivity analysis, although the magnitude of the SVRI difference was lower and non-significant. However, there was substantial overlap between women and men in the distribution plots of these variables, with overlapping areas ranging from 78% to 88%.

Conclusions

Our findings indicate that there are sex differences in hypertension phenotype, but that sex alone is insufficient to infer an individual’s profile.

Menopause status and climacteric symptoms in a birth cohort of mid-life New Zealand women

BACKGROUND

There is little current research on the transition to natural menopause among contemporary groups of mid-life women at age 40 years.

OBJECTIVE

This study reports on female members of the Christchurch Health and Development Study cohort. This research aimed to: document the menopause status, reproductive outcomes and climacteric symptoms of the women at age 40 years; examine the associations between menopause status and concurrent measures of psychosocial and economic well-being; and document the associations between menopause status and potential predictors of menopause reflecting childhood, family and individual factors prior to age 40 years.

METHODS

The Christchurch Health and Development Study is a longitudinal, representative, prospective cohort of 1265 babies (630 females) born in New Zealand in 1977. At age 40 years, 470 women (who had not experienced surgical menopause) were interviewed on their menopause status, climacteric symptoms and associated factors.

RESULTS

The majority of women were premenopausal, around 20% were perimenopausal and 2% were postmenopausal. Statistically significant associations were found reflecting higher rates of diagnosed reproductive disorder, climacteric symptoms, low occupational status, non-heterosexual sexuality and exposure to childhood sexual abuse amongst both perimenopausal and postmenopausal women at age 40 years.

CONCLUSION

These data will inform directions for future data collection and analyses.

Combined Low Plant and High Animal Dietary Pattern Is Associated with a Lower Risk of Anemia among Dyslipidemic Adult Women in Taiwan: A Retrospective Study from 2001 to 2015

Anemia and dyslipidemia often occurs in premenopausal women. This study investigated the association between dietary patterns and anemia among dyslipidemic women in Taiwan. This study recruited 22,631 dyslipidemic women aged 20-45 years between 2001 and 2015. The dietary assessment was collected by a validated food frequency questionnaire. The biochemical data including blood lipids, red blood cells, hemoglobin, hematocrit, and C-reactive protein (CRP) were retrieved from the database. Women with a combined high plant diet (HP) and low animal diet (LA) were associated with a lower prevalence of obesity (11.7%), central obesity (16.0%), high total cholesterol (16.4%), and high low-density lipoprotein cholesterol (11.9%), and had lower hemoglobin (12.9 ± 1.4 g/dL), hematocrit (38.8 ± 3.6%), and CRP levels (20.6 ± 31.4 nmol/L). The low plant diet (LP) + high animal diet (HA) pattern was negatively associated with moderate to severe anemia (OR: 0.76, 95% CI: 0.64-0.92, p = 0.004) compared to the low plant diet (LP) + low animal diet (LA) pattern. However, the HP + LA pattern was positively correlated with moderate to severe anemia (OR: 1.22, 95% CI: 1.04-1.43, p = 0.015). In conclusion, a low plant and high animal diet plays a role in preventing anemia development among dyslipidemic women.

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.

The effect of self-care education program on the severity of menopause symptoms and marital satisfaction in postmenopausal women: a randomized controlled clinical trial

Background

Physiological and psychological changes during menopause can affect the quality of marital satisfaction. The aim of this study was to evaluate the effect of self-care education program on the severity of menopause symptoms and marital satisfaction in postmenopausal women.

Methods

In this randomized controlled clinical trial, 70 postmenopausal women who referred to the gynecology clinic of Baqiyatallah and 502 Artesh hospitals in Tehran, Iran, and met the all inclusion criteria were randomly allocated into two equal groups (intervention and control groups) using block randomization. The intervention group received self-care training program in physical, psychological, social and sexual dimensions in 5 sessions during a week. The control group also had 5 sessions exactly the same as the intervention group, except that they received only routine care and training. Data were collected pre- and post-intervention using Menopause Symptoms' Severity Inventory (MSSI-38) questionnaire and the Revised Dyadic Adjustment Scale (RDAS) questionnaire.

Results

In the control and intervention groups before the intervention, socio-demographic characteristics (P > 0.05), the mean scores of MSSI-38 (P = 0.388) and RADS (P = 0.476) were not statistically significant. However, in the intervention group the mean scores of MSSI-38 (49.88 ± 3.3 vs. 39.33 ± 3.7, P < 0.001) and RADS (35.15 ± 4.3 vs. 49.48 ± 3.2, P < 0.001) after the intervention changed significantly and this change were statistically significant compared to the control group. Significant inverse correlation between severity of menopausal symptoms and marital satisfaction was observed with r = -0.461, P < 0.001.

Conclusion

Our findings indicate that self-care training has a positive effect on the severity of menopause symptoms and also improves marital satisfaction in postmenopausal women. Therefore, we recommend that more attention be paid to providing self-care educational content to improve the marital satisfaction in postmenopausal women.

Clinical trial registration Iranian Registry of Clinical Trials; https://www.irct.ir/trial/49225 (IRCT20200624047910N1), registered (10/11/2020).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01653-w.

Association between dairy consumption and ischemic heart disease among Chinese adults: a prospective study in Qingdao

BACKGROUND

Previous studies linking dairy consumption with ischemic heart disease (IHD) are almost from western countries, with little from China. The present study was to explore the relationship between dairy consumption and IHD among Chinese adults.

METHODS

The data for the present study was from the prospective cohort study of China Kadoorie Biobank in Qingdao, a total of 33,355 participants in the present study. An interviewer-administered laptop-based questionnaire was used to collect information on the consumption frequency of dairy, incident IHD cases were identified through Disease Surveillance Point System and the new national health insurance databases. Cox regression analyses were performed to estimate adjusted hazard ratios (HRs) and confidence interval for the relationship between the incidence of IHD and dairy consumption.

RESULTS

The baseline survey reported that 32.4% of males and 34.6% of females consumed dairy regularly (i.e. ≥ 4 days/week). Over an average of 9.2 years follow-up, 2712 new-onset IHD were documented. Compared with participants who never or rarely consume dairy, the HR of consumed dairy regularly was 0.85(0.73-0.98) for males (P < 0.05), while no significant benefits were identified for females.

CONCLUSIONS

Regular dairy consumption had an inverse association to the onset of IHD among males, with no similar findings for females.

The relation of number of childbirths with age at natural menopause: a population study of 310 147 women in Norway

STUDY QUESTION

Does age at natural menopause increase with increasing of number of childbirths?

SUMMARY ANSWER

Age at menopause increased with increasing number of childbirths up to three childbirths; however, we found no further increase in age at menopause beyond three childbirths.

WHAT IS KNOWN ALREADY

Pregnancies interrupt ovulation, and a high number of pregnancies have therefore been assumed to delay menopause. Previous studies have had insufficient statistical power to study women with a high number of childbirths. Thus, the shape of the association of number of childbirths with age at menopause remains unknown.

STUDY DESIGN, SIZE, DURATION

A retrospective population study of 310 147 women in Norway who were 50-69 years old at data collection.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The data were obtained by two self-administered questionnaires completed by women attending BreastScreen Norway, a population-based screening program for breast cancer. The associations of number of childbirths with age at menopause were estimated as hazard ratios by applying Cox proportional hazard models, adjusting for the woman's year of birth, cigarette smoking, educational level, country of birth, oral contraceptive use and body mass index.

MAIN RESULTS AND THE ROLE OF CHANCE

Women with three childbirths had the highest mean age at menopause (51.36 years; 95% CI: 51.33-51.40 years), and women with no childbirths had the lowest (50.55 years; 95% CI: 50.48-50.62 years). Thus, women with no childbirths had higher hazard ratio of reaching menopause compared to women with three childbirths (reference group) (adjusted hazard ratio, 1.24; 95% CI: 1.22-1.27). Beyond three childbirths, we estimated no further increase in age at menopause. These findings were confirmed in sub-analyses among (i) women who had never used hormonal intrauterine device and/or systemic menopausal hormonal therapy; (ii) women who were born before 1950 and (iii) women who were born in 1950 or after.

LIMITATIONS, REASONS FOR CAUTION

Information about age at menopause was based on self-reports.

WIDER IMPLICATIONS OF THE FINDINGS

If pregnancies truly delay menopause, one would expect that women with the highest number of childbirths had the highest age at menopause. Our results question the assumption that interrupted ovulation during pregnancy delays menopause.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by the South-Eastern Norway Regional Health Authority [2016112 to M.S.G.] and by the Norwegian Cancer Society [6863294-2015 to E.K.B.]. The authors declare no conflicts of interest.

TRIAL REGISTRATION NUMBER

N/A.

Severity and factors of menopausal symptoms in middle-aged women in Gansu Province of China: a cross-sectional study

OBJECTIVE

To investigate the severity and risk factors of menopausal symptoms in the middle-aged women in Gansu Province of China.

METHODS

In this cross-sectional study, a total of 7319 women (aged 40-55 years) attended the health survey in Gansu Province in China were enrolled. Information on demographics, menopausal status, reproductive history, and history of chronic diseases was collected via a structured questionnaire. Severity of menopausal symptom was evaluated by the Modified Kupperman Menopausal Index. Ordinal logistic regression model was applied to explore its risk factors.

RESULTS

A total of 7319 participants were included in present study, among them, 3606 (49.27%) had moderate or severe menopausal symptom. Compared with premenopausal women, perimenopausal and postmenopausal women have a higher mKMI score. We observed that older age, higher BMI, non-married status, longer duration of menstruation (≥ 7 days), number of pregnancy (> 3 times), longer duration of breastfeeding (> 12 months), peri- or post-menopausal status, and menopause hormone therapy was positively associated with menopausal symptom score, while higher level of family income, educational and physical activity, and history of gynecological, breast or chronic disease were negatively associated with the score.

CONCLUSIONS

Numerous factors were associated with the severity of menopausal symptom among the Chinese women. Because it was gradually increased with aging, more attention is warranted to manage the menopausal symptom.

Menopausal symptoms among Chinese and Japanese women: differences and similarities

OBJECTIVES

This study aimed to identify the characteristics of menopausal symptoms among Japanese and Chinese women and to determine the correlation between menopausal symptoms and self-efficacy.

METHODS

We surveyed 40- to 59-year-old women, 329 of whom were from an urban area in Northwest China (Xi'an) and 310 were from an urban area in Western Japan (Ehime), using a menopausal symptoms inventory and a self-efficacy scale. Comparison analysis was conducted among pre-, peri-, and postmenopausal status, within and between the two cultural groups. Following a two-way ANOVA, multiple comparisons were performed using the Tukey-Kramer test. The correlation between severity of menopause symptoms and self-efficacy scores was evaluated using canonical correlation analysis.

RESULTS

The most frequently reported symptoms were fatigue (93.6%) among Japanese women and memory loss (76.6%) among Chinese women. Japanese women showed significantly higher severity scores across all factors than Chinese, sexual function: 19.58 (SE = 0.73) versus 15.04 (SE = 0.67); mental health condition: 35.44 (SE = 1.15) versus 27.12 (SE = 0.95); interpersonal anxiety: 27.45 (SE = 0.95) versus 21.92 (SE = 0.86); autonomic balance: 42.76 (SE = 1.27) versus 35.75 (SE = 1.17); other subjective symptoms: 39.68 (SE = 1.20) versus 33.07 (SE = 1.12) in the premenopausal group (P < 0.01); and mental health conditions 35.14 (SE = 1.41) versus 29.60 (SE = 1.25), interpersonal anxiety: 27.34 (SE = 1.18) versus 20.79 (SE = 1.02), autonomic balance factors: 45.81 (SE = 1.79) versus 38.05 (SE = 1.67) in the postmenopausal group (P < 0.01). No significant differences of the factors among menopausal stages within Japanese women were found. Among Chinese women, peri- and postmenopausal women showed significantly higher severity scores on sexual function, while perimenopausal women scored higher on mental health conditions and autonomic balance factors (P < 0.01). A negative correlation was found between menopausal symptoms and self-efficacy among both Japanese and Chinese women (P < 0.01).

CONCLUSIONS

Japanese women reported more severe symptoms compared with their Chinese counterparts, and for Chinese women, symptoms might be specifically associated with menopausal status. Menopausal experience is associated with self-efficacy and vice versa.

Shared Genetics Between Age at Menopause, Early Menopause, POI and Other Traits

Reproductive ageing leading to menopause is characterized by depletion of follicles and its regulating mechanisms are only partly understood. Early age at menopause and premature ovarian insufficiency (POI) are associated with several other traits such as cardiovascular disease, dyslipidemia, osteoporosis and diabetes. In large cohorts of Northern European women hundreds of Single Nucleotide Polymorphisms (SNPs) have been identified to be associated with age at menopause. These SNPs are located in genes enriched for immune and mitochondrial function as well as DNA repair and maintenance processes. Genetic predisposition to earlier menopause might also increase the risk of other associated traits. Increased risk for cardiovascular disease in women has been associated with age at menopause lowering SNPs. Pleiotropy between early age at menopause and increased mortality from coronary artery disease has been observed, implicating that genetic variants affecting age at menopause also affect the risk for coronary deaths. This review will discuss the shared genetics of age at menopause with other traits. Mendelian Randomization studies implicate causal genetic association between age at menopause and age at menarche, breast cancer, ovarian cancer, BMD and type 2 diabetes. Although the shared biological pathways remain to be determined, mechanisms that regulate duration of estrogen exposure remain an important focus.

A case-control study of thallium exposure with the risk of premature ovarian insufficiency in women

Thallium exposure has been associated with female reproductive health, but little is known about its potential association with premature ovarian insufficiency (POI). In this study, a total of 169 patients with POI and 209 healthy women were recruited from Zhejiang province, China. Urinary thallium concentrations were significantly positively associated with the risk of POI [adjusted odds ratio (OR) = 1.63, 95% CI: 1.25-2.13, p < 0.001], geometric mean values of which were significantly higher in POI cases (0.213 μg/L, 0.302 μg/g for creatinine adjustment) than those of controls (0.153 μg/L, 0.233 μg/g for creatinine adjustment). Furthermore, the serum levels of follicle-stimulating hormone and luteinizing hormone were positively associated with urinary thallium concentrations, whereas anti-Mullerian hormone and estradiol were negatively correlated with thallium. To the best of our knowledge, this is the first study to provide evidence that thallium exposure at currently environmental levels is the potential risk factor for POI in women.

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.

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.

Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association

Cardiovascular disease (CVD) is the leading cause of death in women, who have a notable increase in the risk for this disease after menopause and typically develop coronary heart disease several years later than men. This observation led to the hypothesis that the menopause transition (MT) contributes to the increase in coronary heart disease risk. Over the past 20 years, longitudinal studies of women traversing menopause have contributed significantly to our understanding of the relationship between the MT and CVD risk. By following women over this period, researchers have been able to disentangle chronological and ovarian aging with respect to CVD risk. These studies have documented distinct patterns of sex hormone changes, as well as adverse alterations in body composition, lipids and lipoproteins, and measures of vascular health over the MT, which can increase a woman's risk of developing CVD postmenopausally. The reported findings underline the significance of the MT as a time of accelerating CVD risk, thereby emphasizing the importance of monitoring women's health during midlife, a critical window for implementing early intervention strategies to reduce CVD risk. Notably, the 2011 American Heart Association guidelines for CVD prevention in women (the latest sex-specific guidelines to date) did not include information now available about the contribution of the MT to increased CVD in women. Therefore, there is a crucial need to discuss the contemporary literature on menopause and CVD risk with the intent of increasing awareness of the significant adverse cardiometabolic health-related changes accompanying midlife and the MT. This scientific statement provides an up-to-date synthesis of the existing data on the MT and how it relates to CVD.

Menopausal Symptoms and Associated Social and Environmental Factors in Midlife Chinese Women

Objective

To investigate the dependency of menopausal symptoms on age and/or menopausal status and association with social and environmental factors.

Methods

The cross-sectional study was conducted on 4595 women (40–83 years) coming from 31 provinces during two years to our “Menopause Clinic”, the first official center in China. Menopausal symptoms were assessed: negative mood, cognitive symptoms, sleep disorder, vasomotor symptoms (VMS), urogenital symptoms, autonomic nervous disorder, limb pain/paresthesia. Social and environmental factors were collected; simple and unconditional logistic regression with adjustments by all analyzed factors were used to assess associations.

Results

Urogenital symptoms were the most common and VMS the least common complaints. All symptoms, except cognitive and urogenital symptoms, worsened age-dependently up to 60 years but improved beyond this age. Most symptoms also were associated with menopause, except negative mood and autonomic nervous disorders. Soya-rich diet decreased all symptoms, but only if consumed daily. Exercise was beneficial for some symptoms. Hormone replacement therapy (HRT) was most effective but only with regular use. Increased alcohol consumption aggravated VMS. Higher education was associated with less symptoms; no relationship was found for smoking, gravidity, parity, and menarche.

Conclusion

All symptoms, except cognitive and urogenital symptoms, worsened age-dependently up to 60 years but improved beyond this age; most were also associated with menopause. For the first time in a large study population, it was observed that soy-rich diet is protective but only with daily consumption. Exercising can protect against some of the symptoms. HRT decreased all symptoms, but regular use is necessary. Women with higher education reported less symptoms, but after adjustments no other relationships were observed (ChiCTR2000035047).

Effect of health education on knowledge and attitude of menopause among middle-age teachers

BACKGROUND

Adequate knowledge and positive attitude toward menopause are important for women to tackle changes related to menopause. Even though all women experience menopause at some stage in their life, teachers face more difficulties more than other female employees due to the nature of their roles do. In Eritrea, menopause has been given little attention hence gaps exist concerning women's knowledge, attitude, and the effects of health education on the same subject. This study aimed at assessing the effect of health education on knowledge and attitude of menopause among middle-aged teachers in elementary, junior, and secondary schools of Asmara, Eritrea.

METHOD

A semi-experimental design with pre-intervention, immediate post-intervention, and three-month follow up test was used in this study. The data was collected from 99 middle age teachers using stratified random sampling. The intervention was done using lectures, group discussions, brochures, and handouts. Data on socio-demographics, knowledge, and attitude was collected using a pre-designed questionnaire. The effect of educational training at the three-time points was evaluated by repeated measure ANOVA using SPSS version 22.

RESULTS

The mean scores of correct knowledge at pre-intervention, immediate post-intervention, and 3-months follow-up were 12.3/22 (SD = 3.06), 17.3/22 (SD = 3.21), and 16.5/22 (SD = 2.52) respectively. A significant difference in scores of knowledge at the three-time points was observed due to the educational intervention with a statistical significance of (p <  0.0001). Post-hoc analysis revealed that knowledge score immediately after intervention was significantly greater than that of pre-intervention (p <  0.0001), and 3-months follow-up (p = 0.004). The mean scores of attitude at the three-time points were 27.9/45 (SD = 5.14), 28.3/45(SD = 5.25), 28.32/45(SD = 5.12). The educational intervention had brought a change in the mean scores of attitude at the three-time point with a statistical significance of (p < 0.0001). Post-hoc analysis revealed that attitude scores at immediate post-intervention were also significant (p = 0.001) with the 3-months follow up at (p < 0.0001) were higher than that of pre-intervention.

CONCLUSION

The structured educational intervention was beneficial to the studied women in intensifying their knowledge and tuning them toward a positive attitude. Hence, proper health education programs regarding menopause are strongly recommended.

Effect of Health Education on Healthy Nutrition and Physical Activity among Female Teachers Aged 40-60 Years in Asmara, Eritrea: A Quasiexperimental Study

BACKGROUND

Middle age is a period in women's life where many changes occur in their bodies due to the decline of gonadotropins. As a result, they face various vasomotor, psychological, and somatic symptoms. Moreover, chronic illness such as diabetes, hypertension, heart diseases, and osteoporosis are prevalent at this time. Healthy nutrition and physical activity are effective factors to reduce the problems of menopause faced during middle age.

OBJECTIVE

This study aimed at assessing the effect of health education on healthy nutrition and physical activity among 40-60-year-old female teachers in elementary, junior, and secondary schools of Asmara.

METHOD

A quasiexperimental design was used in this study. The data were collected from 99 middle-age female teachers who were selected by stratified random sampling. The intervention was conducted using lecture, brochure, and group discussion for a total of 3 hours. Data on physical activity and healthy nutrition were collecting using HPLP- II subscales physical activity and nutrition. Sociodemographic data were collected using a predesigned questionnaire. The effect of educational training at preintervention and postintervention was evaluated by the paired t-test and factorial mixed ANOVA using SPSS (version 22).

RESULTS

The mean score of practicing healthy diet and physical activity at preintervention and postintervention was 27/44 (SD = 4.20) and 31/44 (SD = 5.36), respectively. A significant difference in the scores of practicing healthy diet and physical activity was observed after the educational intervention (MD = 4.06, 95% CI 2.95-5.17, p < 0.0001). The effectiveness of health education was seen across the categories of age, educational level, and occupational level where none of them showed significant interaction, displaying similar effect of educational intervention across all categories of the demographic variables.

CONCLUSION

The structured educational intervention was beneficial for the studied women in changing their practice on healthy nutrition and physical activity.

A case-control study of arsenic exposure with the risk of primary ovarian insufficiency in women

Arsenic, a well-known toxic metalloid, is ubiquitously existed in environment. Arsenic exposure has been associated with female reproductive health. However, a potential association between arsenic exposure and primary ovarian insufficiency (POI) in women has not been recognized yet. In this case-control study, a total of 169 POI cases and 209 healthy controls were recruited to determine urinary concentrations of arsenic and serum levels of reproductive hormones (follicle-stimulating hormone (FSH), luteinizing hormone (LH), anti-Mullerian hormone (AMH) and estradiol). The median concentration of urinary arsenic in cases (21.5 μg/L, 28.0 μg/g for creatinine adjustment) was significantly higher than that of controls (13.8 μg/L, 19.3 μg/g for creatinine adjustment). Urinary arsenic concentrations were significantly positively associated with the risk of POI (adjusted odds ratio (OR) = 2.66, 95% CI: 1.43-4.95 for the highest vs lowest tertile of arsenic, p = 0.002; p for trend = 0.004). We also assessed the associations between arsenic exposure and reproductive hormones that are important for ovarian functions. FSH and LH levels were positively associated with urinary arsenic, whereas AMH and estradiol levels were negatively correlated with this element. This study provided evidence that arsenic exposure could be the potential risk factor for POI in women.

Relationship between BRSK1 rs12611091 variant and age at natural menopause based on physical activity

Objectives:

The rs12611091 variant in the BR serine/threonine kinase 1 gene is one of the variants previously associated with age at natural menopause. So far, this variant has not been replicated in Taiwanese women. The purpose of this study was to determine the association between rs12611091 and age at natural menopause based on physical activity.

Methods:

A total of 1,758 women were eligible for analysis whose information about menopause was collected from the Taiwan Biobank. Multiple linear regression analysis was used for analysis.

Results:

The mean age (standard deviation) at natural menopause was 50.82 (3.59) years. Of the eligible participants, 56.94% were rs12611091 CC carriers, 36.69% were TC carriers, and 6.37% were TT carriers. Compared to CC carriers, TC and TT carriers were associated with early menopause (β = −0.42, P = 0.02 and −0.87, P = 0.01, respectively). There was a significant interaction between rs12611091 and physical activity (P for interaction = 0.02). Compared to rs12611091 CC carriers, TC and TT carriers who were physically inactive were significantly associated with earlier menopause (β = −0.88, P < 0.01 and −1.25, P = 0.02, respectively).

Conclusion:

We demonstrated that rs12611091 variant was associated with age at natural menopause especially among inactive women in Taiwan. That is, women with TC and TT genotypes who were physically inactive were significantly associated with earlier natural menopause compared to those with CC genotype.

Sexual frequency is associated with age of natural menopause: results from the Study of Women's Health Across the Nation

It is often observed that married women have a later age of natural menopause (ANM) than unmarried women; however, the reason for this association is unknown. We test an original hypothesis that sexual frequency acts as a bio-behavioural mediator between marital status and ANM. We hypothesize that there is a trade-off between continued ovulation and menopause based on the woman's chances of becoming pregnant. If a woman is sexually inactive, then pregnancy is impossible, and continued investment in ovulation would not be adaptive. In addition, we test an existing hypothesis that the observed relationship is because of the exposure to male pheromones. Data from 2936 women were drawn from 11 waves of the Study of Women's Health Across the Nation, which is a longitudinal study conducted in the United States. Using time-varying Cox regression, we found no evidence for the pheromone hypothesis. However, we did observe that women who reported to have sex weekly during the study period were 28% less likely to experience menopause than women who had sex less than monthly. This is an indication that ANM may be somewhat facultative in response to the likelihood of pregnancy.

Current ecology, not ancestral dispersal patterns, influences menopause symptom severity

All human females who reach midlife experience menopause, however, it is currently unclear why women experience this period of infertility, and why it is accompanied by many unpleasant symptoms. Using primary data from four ethnic groups in China, we test an existing theory that age of menopause and its symptoms are the result of intragenomic conflict between maternally and paternally inherited genes, with the outcome of such conflict predicted to be contingent on the ancestral postmarital residence pattern of the female (Úbeda, Ohtsuki, & Gardner, Ecology Letters, 17, 2014, 165). The model predicts that being ancestrally patrilocal results in less intragenomic conflict, causing a shorter, less symptomatic perimenopause that terminates in a later menopause. Our findings show no support for this hypothesis and suggest current, rather than ancestral, residence patterns better predict aspects of the menopausal transition. Furthermore, current patrilocality when compared to duolocality is associated with more severe menopause symptoms, which may be due to sexual, rather than intragenomic, conflict.

OPEN RESEARCH BADGES

This article has earned an Open Data Badge for making publicly available the digitally-shareable data necessary to reproduce the reported results. The data is available at https://doi.org/10.5061/dryad.27s8k0p.

Diet, menopause and the risk of ovarian, endometrial and breast cancer

Menopause, the permanent cessation of the menstrual cycle, marks the end of a woman's reproductive lifespan. In addition to changes in sex hormone levels associated with menopause, its timing is another predictor of future health outcomes such as duration of the presence of vasomotor symptoms (VMS) and the risk of hormone-related cancers. With ageing of the population, it is estimated that worldwide 1·2 billion women will be menopausal by the year 2030. Previously the effects of reproductive factors (e.g. parity, age at menarche, pregnancy) and socio-demographic factors on intermediate and long-term health outcomes of menopause have been widely documented. However, little is known about whether diet could have an impact on these. Therefore, we review current evidence on the associations of diet with menopause, presence of VMS and the risk of hormone-related cancers such as ovarian, endometrial and breast cancer. Dietary factors could influence the lifespan of the ovaries and sex-hormones levels, hence the timing of natural menopause. Few studies reported an association between diet, in particular soya consumption, and a reduced risk of VMS. Sustained oestrogen exposure has been associated with a higher risk of hormone-related cancers and thus high-fat and meat diets have been linked with an increased risk of these cancers. However, to better understand the mechanistic pathways involved and to make stronger conclusions for these relationships, further studies investigating the associations of dietary intakes and dietary patterns with menopause, presence of VMS and the risk of hormone-related cancers are required.