Early Menopause Tied to More Health Problems Later on

By Megan Brooks

January 24, 2020

NEW YORK (Reuters Health) - Women who suffer premature menopause at age 40 or younger have an increased risk of experiencing multiple health problems in their 60s, according to new research from Australia.

"Our findings could inform health professionals to consider comprehensive screening and assessment of risk factors for increased risk of multimorbidity when treating women who experienced natural premature menopause," first author Dr Xiaolin Xu told Reuters Health by email.

"Our findings also highlighted that multimorbidity should be considered as a clinical and public health priority for chronic conditions control and prevention in women's health," said Dr. Xu, who conducted the research as part of his PhD thesis at the University of Queensland and is now a research professor at Zhejiang University, China.

The findings are based on data collected as part of the prospective Australian Longitudinal Study on Women's Health on 5,107 women aged 45 to 50 years in 1996 and who were followed until 2016.

Periodically, the women provided information about age at natural menopause and whether they had been diagnosed with any of 11 chronic conditions in the past three years (diabetes, high blood pressure, heart disease, stroke, arthritis, osteoporosis, asthma, chronic obstructive pulmonary disease, depression, anxiety, or breast cancer).

During the 20-year follow-up period, 2.3% of the women experienced premature menopause and 55.1% developed two or more chronic conditions, the researchers report in Human Reproduction.

In the fully adjusted model, compared with women who experienced menopause at age 50 to 51, women with premature menopause had twice the odds of developing two or more conditions by the age of 60 (odds ratio, 1.98; 95% confidence interval, 1.31 to 2.98) and three times the odds of developing multimorbidity from the age of 60 onward (OR, 3.03; 95% CI 1.62 to 5.64).

In email to Reuters Health, senior author Dr. Gita Mishra, director of the Centre for Longitudinal and Life Course Research at The University of Queensland, Brisbane, noted that while previous research has shown that women with premature menopause are at increased risk of developing chronic conditions such as cardiovascular disease and diabetes, "this is the first study to show that they (are) more likely to develop not just one chronic condition but rather multiple chronic conditions, compared with women who reached menopause at the average age of 50-51 years."

Women with premature menopause also had higher rates of most of the 11 individual conditions.

Dr. Xu said there are several plausible explanations for the associations between premature menopause and the development of multiple chronic conditions.

"Firstly, our study suggested that women who experienced natural premature menopause and women who developed multimorbidity shared most of the reproductive, socioeconomic and health behavioral risk factors. These risk factors and others (e.g. genetic and environmental factors) may drive the earlier onset of both menopausal transition and chronic conditions," he explained.

"Secondly, some chronic conditions (e.g. depression) or pre-conditions (e.g.insulin resistance, high level of cholesterol) in premenopausal women were positively associated the onset of menopause, further leading to the onset of other related chronic conditions. Thirdly, the genetic predisposition to earlier age at menopause itself may play an important role; for example, a recent study suggested that genetic variants associated with earlier age at menopause are associated with increased cardiovascular risk," Dr. Xu said.

"Finally, premature estrogen loss itself, either naturally occurring or induced by surgery, causes an alteration of several fundamental aging processes at the cellular, organ and system level, finally leading to the onset of chronic conditions and multimorbidity," Dr Xu added.

The researchers caution that the study does not show that premature menopause causes the development of multiple chronic conditions, only that there is an association. The fact that the study relied on self-reported information from the women is a limitation.

The researchers are now evaluating what risk factors could be targeted to prevent or slow the development of these chronic conditions in women who experience premature menopause. These include improving diet and exercise, not smoking, controlling body weight, engaging in mentally stimulating activity and regular screening for cancer and other medical problems related to the reproductive system.

SOURCE: http://bit.ly/3ayBI9E Human Reproduction, online January 20, 2020.