Premature and early menopause in India: what are the triggers?

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A study has been published Scientific report Triggers of premature and early menopause in India are explored based on the National Family Health Survey 2019-2021. In 2011 there were 96 million women over the age of 45 in India, a number that is expected to increase to over 400 million by 2026.

Study: Exploring the triggers of premature and early menopause in India: a comprehensive analysis based on the National Family Health Survey, 2019-2021.  Image credit: AJP/Shutterstock.com
Study: Exploring the triggers of premature and early menopause in India: a comprehensive analysis based on the National Family Health Survey, 2019-2021. Image credit: AJP/Shutterstock.com

Background

Biologists estimate that the normal age for women to experience menopause, defined as ovarian failure, is between the ages of 45 and 50, when individuals transition into a post-reproductive phase of their lives. Reaching menopause before age 40 is considered premature, while menopause before age 45 is considered early menopause.

Estimating the prevalence of premature and early menopause and identifying their associated risk factors can enable public health professionals and policymakers to design appropriate policy interventions and ensure health system readiness to meet the needs of this population.

About the study

In addition to calculating prevalence, researchers in this study hypothesized that lifestyle behaviors, medical history, and demographic and socioeconomic factors would modify the risk of premature and early menopause. The data used for analysis came from the fifth round of the Indian National Family Health Survey (NFHS), which included 724,115 female respondents.

After excluding women who were pregnant or lactating at the time of the study, as well as those who experienced surgical menopause, the final sample included 429,446 women who experienced premature menopause and 79,643 women who experienced early menopause. Women were classified as menopausal if they had no menstrual cycles for a year or more.

Socioeconomic and demographic factors include education, race, religion, place of residence, household wealth index, work status, marital status, and geographic region. Lifestyle behaviors included tobacco and alcohol consumption as well as unhealthy diets (especially high intake of aerated drinks and fried foods). Demographic data were used to assess body mass index (BMI) and anemia status.

Hazard ratios were calculated from these data to assess how the risk of early or premature menopause varied for women in different demographic, socioeconomic, and other categories.

Findings

Conventional analysis suggested that 2.23% of women between the ages of 15 and 39 experienced premature menopause, while 16.2% of women between the ages of 40 and 44 experienced early menopause. The majority of women experiencing early and premature menopause lived in rural areas (66%), and 15 to 40% of these women had no education. About 40% were poor, most were married, and more than 60% had their first child between the ages of 18 and 24.

Time trends indicate that the incidence of premature menopause has gradually decreased over time; Premature menopause peaked in 1998–1999 (3.4%) before declining or remaining stable in subsequent waves. Conversely, early menopause, which showed a prevalence of 21% in the 1990s, fluctuated over time.

Bivariate analysis showed that rural, working women, those with low education, those with low family wealth and those belonging to the ‘Other Backward Classes’ (OBC) category were significantly more likely to experience premature menopause. Women in North and West India were also at higher risk. Other risk factors include regular fried foods, alcohol consumption and tobacco use. For early menopause, bivariate analysis identified similar risk factors.

Survival models have suggested that higher education levels are protective against premature menopause, as are unemployment and higher wealth. Women who reported never having married were less likely to experience premature menopause, while those who had stopped conceiving had a higher risk. Other risk factors include smoking and using unsanitary menstrual methods. Women who had menarche at age 12 or younger had a higher risk of premature menopause than women who had age 15 or older.

Conclusion

In summary, the study used a large-scale, nationally representative population survey to assess the prevalence and drivers of premature and early menopause. The authors hypothesize the existence of links between nutrition and poverty. Specifically, educational, economic, and residential vulnerabilities may intersect and have compounding effects on age at menopause.

Strengths of the study include its methodological robustness and the use of a nationally representative survey, which collected detailed data to assess the relative importance of different causes of early and premature menopause. Extensive medical histories make it easy to exclude women who have had a hysterectomy or low estrogen levels. However, the self-reported nature of menstrual data may lead to recall bias, and the cross-sectional design does not allow for causal inference.

Further study on this topic, particularly through detailed micro-studies, will strengthen public health systems and allow public health initiatives to target health and nutrition interventions for disadvantaged women to address menopause-related concerns such as osteoporosis.



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