Effects of Smoking on Menopausal Age: Results From the Korea National Health and Nutrition Examination Survey, 2007 to 2012

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.

Potential Disruption of Systemic Hormone Transport by Tobacco Alkaloids Using Computational Approaches

Tobacco/nicotine is one of the most toxic and addictive substances and continues to pose a significant threat to global public health. The harmful effects of smoking/nicotine affect every system in the human body. Nicotine has been associated with effects on endocrine homeostasis in humans such as the imbalance of gonadal steroid hormones, adrenal corticosteroid hormones, and thyroid hormones. The present study was conducted to characterize the structural binding interactions of nicotine and its three important metabolites, cotinine, trans-3'-hydroxycotinine, and 5'-hydroxycotinine, against circulatory hormone carrier proteins, i.e., sex-hormone-binding globulin (SHBG), corticosteroid-binding globulin (CBG), and thyroxine-binding globulin (TBG). Nicotine and its metabolites formed nonbonded contacts and/or hydrogen bonds with amino acid residues of the carrier proteins. For SHBG, Phe-67 and Met-139 were the most important amino acid residues for nicotine ligand binding showing the maximum number of interactions and maximum loss in ASA. For CBG, Trp-371 and Asn-264 were the most important amino acid residues, and for TBG, Ser-23, Leu-269, Lys-270, Asn-273, and Arg-381 were the most important amino acid residues. Most of the amino acid residues of carrier proteins interacting with nicotine ligands showed a commonality with the interacting residues for the native ligands of the proteins. Taken together, the results suggested that nicotine and its three metabolites competed with native ligands for binding to their carrier proteins. Thus, nicotine and its three metabolites may potentially interfere with the binding of testosterone, estradiol, cortisol, progesterone, thyroxine, and triiodothyronine to their carrier proteins and result in the disbalance of their transport and homeostasis in the blood circulation.

Thermotherapy as an alternative to exercise for metabolic health in obese postmenopausal women: focus on circulating irisin level

Irisin is a myokine caused by exercise that improves insulin resistance and weight loss. However, under unfavorable conditions such as air pollution, and during the pandemic, outdoor activities are uncomfortable. Therefore, in this study, the effect of heat therapy (half bath 42 ± 0.5°C for 30 min) on irisin circulation levels as an exercise alternative for middle-aged obese women after menopause was investigated. Subjects were 33 women aged 49.54 ± 6.04 years, with parameters of height, 160.12 ± 4.33 cm, weight, 69.71 ± 7.52 kg, body surface area 1.73 ± 0.13 m², body mass index, 27.19 ± 3.40 kg/m². The results suggest that circulating irisin levels showed a significant increase after one-time thermotherapy (TH-1). However, the increase in circulating irisin levels after 15 treatments (TH-15, 5 days/week, 3 weeks) was significantly varied. The level of adiponectin, which increases fatty oxidation to reduce fatty deposition, increased significantly at TH-1, but further increased at TH-15, which was significantly different from the level of TH-1. In addition, the basic serum free fatty acid (FFA) level was significantly increased at TH-15 compared to TH-1. Significant differences were also found in the lipid profile (body mass index, waist circumference, and % body fat). Thermotherapy can significantly increase the tympanic temperature and induce changes in circulating irisin and adiponectin levels. Thus, it resulted in positive changes in FFA and lipid profiles. Therefore, repeated thermotherapy is effective in increasing circulating irisin levels in postmenopausal obese women.

Association between body mass index, waist circumference, and age at natural menopause: a population-based cohort study in Chinese women

The purpose of the study was to investigate whether premenopausal body mass index (BMI) and waist circumference (WC) influence age at menopause. A total of 2116 women aged 35-64 years from two communities of the CMCS Beijing cohort were recruited in 1992 and followed up to 2018. Of 1439 premenopausal women at baseline, 6 women data were missing. Finally, 1433 women were included for analysis. Overweight was defined as BMI 24-27.99 kg/m². Central obesity was defined as WC ≥80 cm. Age at menopause was categorized as <45 years, 45-49 years, 50-51 years (reference), and >51 years. Multinomial logistic regression models were used to estimate relative odds ratios (RORs) and 95% confidence intervals (CIs). Compared to women with normal weight and normal WC, overweight women with normal WC had higher risk of menopause at >51 years (ROR 1.64, 95% CI 1.10-2.45; P = .01); and overweight women with central obesity had higher risk of menopause at not only >51 years (ROR 1.82, 95% CI 1.13-2.93; P = .01) but also <45 years (ROR 3.13, 95% CI 1.20-8.43; P = .02) and 45-49 years (ROR 2.76, 95% CI 1.71-4.46; P < .001). When overweight women combine with central obesity, the risk of early menopause will increase in some of them.

Premature menopause among women in India: Evidence from National Family Health Survey-IV

AIM

Women who experience premature menopause either due to biological or induced reasons have a longer duration of exposure to severe symptoms and adverse health consequences when compared to those who undergo menopause at later age. Despite the fact that premature menopause has a profound effect on the health of women, there has been limited study on this issue. Therefore, this study attempted to determine the prevalence and factors associated with premature menopause among 302 557 women aged 25-39 years in India.

METHODS

This study utilized secondary data from the fourth round of the National Family Health Survey-IV (NFHS-4), conducted during 2015-2016 in India. Descriptive statistics and multinomial logistic regression were used for statistical analyses of the data.

RESULTS

The results revealed that the prevalence of premature menopause in this sample of Indian women was 3.7%, out of which 2.1% of women had experienced natural premature menopause, whereas 1.7% had surgical premature menopause. The prevalence of premature menopause was highest in the southern region of India. Factors like age, education, wealth index, place of residence, smoking status, children ever born, age at first birth, use of hormonal contraception, sterilization, and body mass index were found to be associated with premature menopause in India.

CONCLUSION

A sizeable proportion of women in India are attaining menopause prematurely. Furthermore, the percentage and likelihood of experiencing premature menopause are relatively high among rural women, women with higher parity, early age at childbearing, and women who smoke.

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.

Mapping premature ovarian insufficiency and potential environmental factors: A tool for triggering in-depth research of the problem in Slovenia

Aiming at triggering in-depth research of the problem of Premature Ovarian Insufficiency (POI) in Slovenia, we assessed the regional differences in POI incidence emphasising the relationship with social and physical environmental factors at the population level using a mapping approach. The differences in POI incidence between regions were tested by goodness-of-fit chi-square test, while Pearson correlation coefficient was used to assess the ecological relationship between POI incidence and selected environmental indicators. Significant indicators were mapped. The results showed highly significant interregional differences in POI incidence (p<0.001). Statistically significant ecological relationships were observed between POI incidence and prevalence of active smoking (p=0.001), passive smoking (p=0.017) and consumption of vitamins (p=0.008). The results could be used in diminishing interregional differences in POI. It was concluded that mapping is an effective tool in public health research, especially in triggering new activities.

Factors associated with age at natural menopause among elderly women in São Paulo, Brazil

OBJECTIVES

To analyze factors associated with age at natural menopause in elderly women who are part of the Health, Well-Being and Aging Study- which is a representative sample of elderly residents of the municipality of São Paulo, Brazil.

METHODS

Multivariate Cox proportional-hazards analysis using data from a total of 1,415 women with natural menopause. We included 163 women with hysterectomy, oophorectomy, and estrogen therapy as censored data.

RESULTS

The median age of natural menopause was 50 years. In the multivariate Cox proportional hazards, smoking was associated with earlier age at natural menopause for the three cohorts (2000, 2006, and 2010). Current smokers had a 35% higher risk of earlier natural menopause (hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.12, 1.62) and former smokers had a 27% higher risk of earlier natural menopause (HR 1.27, 95% CI 1.09, 1.50), in comparison with never-smokers. Women with 8 years or more of formal education had a 33% lower risk of earlier natural menopause (HR 0.67, 95% CI 0.50, 0.89) than women with no education, and women who were separated, widowed, or divorced had a 15% higher risk of earlier natural menopause (HR 1.15, 95% CI 1.00, 1.31) in comparison with married women. Marital status and parity were associated with later age at natural menopause only in 2006.

CONCLUSIONS

We found significant associations of age at natural menopause with reproductive and lifestyle factors similar to some studies of women from developed countries.

Clinical management of vaginal bleeding in postmenopausal women

Menopause is characterized by permanent cessation of menstrual periods and is clinically diagnosed after 12 months of complete amenorrhea. It occurs at a median age of 51 years alongside the physiological process of aging, although it can happen at an earlier age for other medical conditions or after surgery (surgical menopause). Due to reduced circulating estrogens and progesterone, the reproductive organs undergo progressive atrophy. This physiologic process of aging is also present at an endometrial level; without the cyclic hormonal actions of the menstrual cycle, the endometrium during menopause becomes atrophic. Postmenopausal bleeding (PMB) is a common gynecologic complaint encountered by the clinician. Endometrial cancer is present in about 10% of patients with PMB. Nevertheless, many other conditions, such as endometrial or cervical polyps, genital atrophy, or non-gynecologic conditions, may also be present. Historically, dilation and curettage (D&C) was the main diagnostic procedure in patients with PMB; however, newer methods of investigation have replaced D&C. The aim of this review is to present an up-to-date analysis of the current evidence for the clinical management of vaginal bleeding in postmenopausal women.

Relationships between intensity, duration, cumulative dose, and timing of smoking with age at menopause: A pooled analysis of individual data from 17 observational studies

BACKGROUND

Cigarette smoking is associated with earlier menopause, but the impact of being a former smoker and any dose-response relationships on the degree of smoking and age at menopause have been less clear. If the toxic impact of cigarette smoking on ovarian function is irreversible, we hypothesized that even former smokers might experience earlier menopause, and variations in intensity, duration, cumulative dose, and age at start/quit of smoking might have varying impacts on the risk of experiencing earlier menopause.

METHODS AND FINDINGS

A total of 207,231 and 27,580 postmenopausal women were included in the cross-sectional and prospective analyses, respectively. They were from 17 studies in 7 countries (Australia, Denmark, France, Japan, Sweden, United Kingdom, United States) that contributed data to the International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE). Information on smoking status, cigarettes smoked per day (intensity), smoking duration, pack-years (cumulative dose), age started, and years since quitting smoking was collected at baseline. We used multinomial logistic regression models to estimate multivariable relative risk ratios (RRRs) and 95% confidence intervals (CIs) for the associations between each smoking measure and categorised age at menopause (<40 (premature), 40-44 (early), 45-49, 50-51 (reference), and ≥52 years). The association with current and former smokers was analysed separately. Sensitivity analyses and two-step meta-analyses were also conducted to test the results. The Bayesian information criterion (BIC) was used to compare the fit of the models of smoking measures. Overall, 1.9% and 7.3% of women experienced premature and early menopause, respectively. Compared with never smokers, current smokers had around twice the risk of experiencing premature (RRR 2.05; 95% CI 1.73-2.44) (p < 0.001) and early menopause (1.80; 1.66-1.95) (p < 0.001). The corresponding RRRs in former smokers were attenuated to 1.13 (1.04-1.23; p = 0.006) and 1.15 (1.05-1.27; p = 0.005). In both current and former smokers, dose-response relationships were observed, i.e., higher intensity, longer duration, higher cumulative dose, earlier age at start smoking, and shorter time since quitting smoking were significantly associated with higher risk of premature and early menopause, as well as earlier menopause at 45-49 years. Duration of smoking was a strong predictor of age at natural menopause. Among current smokers with duration of 15-20 years, the risk was markedly higher for premature (15.58; 11.29-19.86; p < 0.001) and early (6.55; 5.04-8.52; p < 0.001) menopause. Also, current smokers with 11-15 pack-years had over 4-fold (4.35; 2.78-5.92; p < 0.001) and 3-fold (3.01; 2.15-4.21; p < 0.001) risk of premature and early menopause, respectively. Smokers who had quit smoking for more than 10 years had similar risk as never smokers (1.04; 0.98-1.10; p = 0.176). A limitation of the study is the measurement errors that may have arisen due to recall bias.

CONCLUSIONS

The probability of earlier menopause is positively associated with intensity, duration, cumulative dose, and earlier initiation of smoking. Smoking duration is a much stronger predictor of premature and early menopause than others. Our findings highlight the clear benefits for women of early smoking cessation to lower their excess risk of earlier menopause.

Nonalcoholic Fatty Liver Disease Associates With Increased Overall Mortality and Death From Cancer, Cardiovascular Disease, and Liver Disease in Women but Not Men

BACKGROUND & AIMS

It is not clear whether women vs men have increased mortality from nonalcoholic fatty liver disease (NAFLD). We investigated whether NAFLD is associated with increased overall and cause-specific deaths in a Korean population using a large health study database.

METHODS

We collected data on 318,224 subjects in Korea (165,131 men and 153,093 women) age 20 to 94 years (mean age, 39.3 y), enrolled in the Kangbuk Samsung Health Study cohort. All subjects underwent a comprehensive annual or biennial health examination in Seoul or Suwon, South Korea, from 2002 through 2012. The presence of NAFLD was ascertained by ultrasonography in the absence of other known liver diseases. Mortality (from 2002 through 2012) was determined by the nationwide death certificate data from the Korea National Statistical Office.

RESULTS

During a median 5.7-year follow-up period, cumulative overall mortality was 0.51% (1613 deaths)-cancer was the leading cause of death. In men, NAFLD was not associated with increased mortality from any cause, except lower rate of death from cancer (hazard ratio, 0.79; 95% CI, 0.66-0.93; P = .005), after adjusting for age, body mass index, smoking status, daily alcohol consumption, and physical activity. In women, NAFLD was independently associated with death from all causes (hazard ratio, 1.79; 95% CI, 1.50-2.14; P < .0001), death from cancer (hazard ratio, 1.83; 95% CI, 1.42-2.35; P < .0001), death from cardiovascular disease (hazard ratio, 1.63; 95% CI, 1.00-2.66; P = .0498), and death from liver disease (hazard ratio, 5.58; 95% CI, 1.79-17.39; P = .003). In obese men, NAFLD was associated with a reduced risk of death from cancer. However, NAFLD was associated with increased risk of death from cardiovascular disease in nonobese men. In obese women, NAFLD did not increase risk of death compared with obesity alone. However, NAFLD was associated with increased overall risk of death and risk of death from cancer in nonobese women.

CONCLUSIONS

Associations between NAFLD and mortality differ between men and women in Koreans. NAFLD was associated with increased overall mortality and death from cancer, cardiovascular disease, and liver disease in women, but these associations were not observed in men.

Evaluation of sex differences in the relationship between diastolic dysfunction and thromboembolism using propensity score analysis

BACKGROUND

Female sex is a risk factor for thromboembolism (TE) in atrial fibrillation (AF); however, the underlying mechanisms are unclear. We postulated that left ventricular (LV) diastolic dysfunction (LVDD) could be associated with increased thromboembolic risk in women.

METHODS

From a retrospective cohort, 158 patients (female : male = 79:79) with nonvalvular AF were propensity score-matched for age, presence of diabetes, hypertension, coronary artery disease, congestive heart failure, embolic history, AF type, and AF duration. Cardiac size and function and central aortic stiffness parameters were evaluated. Diastolic function was classified as normal, indeterminate, and LVDD according to recent guidelines. Surrogate markers for thromboembolism (dense spontaneous echo contrast and thrombus) were evaluated using transesophageal echocardiography.

RESULTS

Surrogate markers for TE showed a trend to be more frequent in women than in men (21.5% vs 11.4%, P = .086). LVDD was more prevalent in women than in men (22.8% vs 2.5%, P < .001); however, the prevalence of indeterminate diastolic function was not different between sexes (26.6% vs 20.3%, P = .453). Surrogate markers for TE were detected mostly in women with LVDD. LV diastolic parameters showed a restrictive pattern, and aortic stiffness parameters were worse in women than in men. Women with LVDD had increased aortic stiffness compared to women with indeterminate and normal function, whereas aortic stiffness did not differ among men in all groups. Significant relations between LV diastolic function and aortic stiffness parameters were observed only in women.

CONCLUSION

LVDD due to increased aortic stiffness could be related to a higher thromboembolic risk in women with AF.

Prevalence and severity of menopause symptoms among perimenopausal and postmenopausal women aged 30-49 years in Gulele sub-city of Addis Ababa, Ethiopia

Background

Menopause is a natural phenomenon occurring as women approach middle-age. It is characterized by declining of ovarian function and onset of the last menstrual period and subsequent 12-month cessation of menstruation. Due to a growing aging population and longer life expectancies, sub-Saharan African women will spend a significant portion of their lives in postmenopause. Menopausal symptom research has been primarily conducted on Caucasian women from high-income countries. Understanding menopause symptom prevalence and perceptions among diverse women in Ethiopia will better inform reproductive health care.

Methods

We conducted a multi-stage, cross-sectional study on 226 perimenopausal and postmenopausal women aged 30-49 years in Gulele sub-city of Addis Ababa, Ethiopia. Data on socio-demographic characteristics, menopausal status and an 11-item Menopause Rating Scale (MRS) were collected using interviewer-administered questionnaire. Statistical analyses consisted of descriptive data and chi-squared analyses.

Results

Study participants were 40.4 ± 5.9 years, on average, with the majority married, educated at secondary school level, and comprised different ethnicities and wealth tertiles. The most prevalent types of menopausal symptoms reported from the MRS were from somatic subscale (65.9%) while psychological (46.0%) and urogenital subscale symptoms (30.5%) were also prevalent. The most commonly reported individual symptoms were: hot flushes (65.9% (95% CI: 59.4%–72.1%)), difficulty falling asleep (49.6% (95% CI: 42.9%-56.3%)), depressive mood (46.0% (95% CI: 39.4%-52.8%)), irritability (45.1% (95% CI: 38.5%-51.9%)), and anxiety (39.8% (95% CI: 33.4%-46.5%)). Each of the somatic, psychological, and urogenital MRS subscale scores were higher among postmenopausal women compared to perimenopausal women. Women self-reported differing severity levels of symptoms with high severity reported in 8.4% of total MRS, 1.3% of somatic, 10.6% of psychological, and 8.4% of urogenital scales.

Conclusions

Our study provides the first presentation of menopausal symptoms among perimenopausal and postmenopausal women in the Gulele sub-city of Addis Ababa, Ethiopia. We capture the prevalence of menopausal symptoms experienced as well as self-rated severity through the MRS. Our findings reflect menopausal symptoms in our specific study population and have been found to be consistent with previous international research.

Electronic supplementary material

The online version of this article (10.1186/s12905-017-0484-x) contains supplementary material, which is available to authorized users.

Correlation of age at natural menopause with occupational status and other epidemiologic factors in women from Prefecture of Kavala, Greece

AIM

Aim of this study was to explore possible associations between the timing of natural menopause and occupational status and other determinant epidemiologic factors among women living in the Prefecture of Kavala, a region of North-East Greece.

METHODS

The sample of the study comprised of 827 naturally menopausal women, who consented to participate in this questionnaire-based interview study between 2011 and 2016. The study population was recruited from women who were hospitalized or visited the outpatient clinics of the General Hospital of Kavala and women working in the public sector services and private companies in the Prefecture of Kavala.

RESULTS

The mean age of the sample at natural menopause was 49.1 years; 12.2 % had early menopause, and 4.5 % were diagnosed with premature ovarian failure. For the majority of enrolled women (80.5 %) menopause occurred between 45-54 years, and for the rest (2.8 %) after 54 years of age. In univariate analysis, a statistically significant correlation was found between age at menopause and occupational status, year of birth, mother's age at menopause, age at menarche, and high levels of chronic stress. Multiple regression analysis revealed that occupational status, year of birth and mother's natural menopausal age could predict age at menopause.

CONCLUSION

Socioeconomic, demographic and familial variables appear to be associated with age at natural menopause in a representative sample of women in the Prefecture of Kavala, Greece. HIPPOKRATIA 2017, 21(1): 32-37.