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Susan E Hankinson - One of the best experts on this subject based on the ideXlab platform.
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is alcohol consumption associated with Early Menopause risk
American Journal of Epidemiology, 2021Co-Authors: Joshua R Freeman, Brian W Whitcomb, Alexandra C Purduesmithe, Joann E Manson, Christine R Langton, Susan E Hankinson, Bernard RosnerAbstract:Earlier age at Menopause is associated with increased long-term health risks. Moderate alcohol intake has been suggested to delay Menopause onset, but it is unknown whether alcohol subtypes are associated with Early Menopause onset at age 45. Therefore, we aimed to evaluate risk of Early natural Menopause among n=107,817 Nurses' Health Study II members followed from 1989-2011. Alcohol consumption overall, and by subtypes including beer, red wine, white wine, and liquor was assessed throughout follow-up. We estimated hazard ratios (HR) in multivariable models adjusting for age, body mass index, parity, smoking and other potential confounders. Women reporting moderate, current alcohol consumption had lower risks of Early Menopause than non-drinkers. Those reporting 10-14.9 g/day had lower risk of Early Menopause compared to non-drinkers (HR = 0.81, 95% confidence interval (CI): 0.68, 0.97). Among specific beverages, evidence of lower Early Menopause risk was confined to white wine, and potentially red wine and liquor, but not to beer. Data from this large prospective study suggest a weak association of moderate alcohol intake with lower risk of Early Menopause, which was most pronounced for consumption of white and red wine, and liquor. High consumption was not related to lower Early Menopause risk.
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association of oral contraceptives and tubal ligation with risk of Early natural Menopause
Human Reproduction, 2021Co-Authors: C R Langton, Brian W Whitcomb, Alexandra C Purduesmithe, Joann E Manson, Susan E Hankinson, Bernard Rosner, Lynnette Leidy SievertAbstract:Study question What is the association of oral contraceptives (OCs) and tubal ligation (TL) with Early natural Menopause? Summary answer We did not observe an association of OC use with risk of Early natural Menopause; however, TL was associated with a modestly higher risk. What is known already OCs manipulate hormone levels, prevent ovulation, and may modify the rate of follicular atresia, while TL may disrupt the blood supply to the ovaries. These mechanisms may be associated with risk of Early Menopause, a condition associated with increased risk of cardiovascular disease and other adverse health outcomes. Study design, size, duration We examined the association of OC use and TL with natural Menopause before the age of 45 years in a population-based study within the prospective Nurses' Health Study II (NHSII) cohort. Participants were followed from 1989 to 2017 and response rates were 85-90% for each cycle. Participants/materials, setting, methods Participants included 106 633 NHSII members who were premenopausal and aged 25-42 years at baseline. Use, duration and type of OC, and TL were measured at baseline and every 2 years. Menopause status and age were assessed every 2 years. Follow-up continued until Early Menopause, age 45 years, hysterectomy, oophorectomy, death, cancer diagnosis, or loss to follow-up. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% CIs adjusted for lifestyle, dietary, and reproductive factors. Main results and the role of chance Over 1.6 million person-years, 2579 members of the analytic cohort experienced Early natural Menopause. In multivariable models, the duration, timing, and type of OC use were not associated with risk of Early Menopause. For example, compared with women who never used OCs, those reporting 120+ months of OC use had an HR for Early Menopause of 1.01 (95% CI, 0.87-1.17; P for trend=0.71). TL was associated with increased risk of Early Menopause (HR = 1.17, 95% CI, 1.06-1.28). Limitations, reasons for caution Our study population is homogenous with respect to race and ethnicity. Additional evaluation of these relations in more diverse populations is important. Wider implications of the findings To our knowledge, this is the largest study examining the association of OC use and TL with Early natural Menopause to date. While TL was associated with a modest higher risk of Early Menopause, our findings do not support any material hazard or benefit for the use of OCs. Study funding/competing interest(s) The study was sponsored by UO1CA176726 and R01HD078517 from the National Institutes of Health and Department of Health and Human Services. The work was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The authors have no competing interests to report. Trial registration number N/A.
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association of parity and breastfeeding with risk of Early natural Menopause
JAMA Network Open, 2020Co-Authors: Christine R Langton, Brian W Whitcomb, Alexandra C Purduesmithe, Joann E Manson, Susan E Hankinson, Bernard Rosner, Lynnette Leidy SievertAbstract:Importance Pregnancy and breastfeeding prevent ovulation and may slow the depletion of the ovarian follicle pool. These factors may lower the risk of Early Menopause, a condition associated with increased risk of cardiovascular disease and other adverse health outcomes. Objective To examine the association of parity and breastfeeding with the risk of Early Menopause. Design, Setting, and Participants This population-based cohort study within the Nurses’ Health Study II cohort (1989-2015) included premenopausal participants who were aged 25 to 42 years at baseline. Response rates were 85% to 90% for each cycle, and follow-up continued until Menopause, age 45 years, hysterectomy, oophorectomy, death, cancer diagnosis, loss to follow-up, or end of follow-up in May 2015. Hypotheses were formulated after data collection. Data analysis took place from February to July 2019. Exposures Parity (ie, number of pregnancies lasting ≥6 months) was measured at baseline and every 2 years. History and duration of total and exclusive breastfeeding were assessed 3 times during follow-up. Menopause status and age were assessed every 2 years. Main Outcomes and Measures Risk of natural Menopause before age 45 years. Results At baseline, 108 887 premenopausal women aged 25 to 42 years (mean [SD] age, 34.1 [4.6] years; 102 246 [93.9%] non-Hispanic white) were included in the study. In multivariable models, higher parity was associated with lower risk of Early Menopause. Hazard ratios were attenuated with adjustment for breastfeeding but remained significant. Compared with nulliparous women, those reporting 1, 2, 3, and 4 or more pregnancies lasting at least 6 months had hazard ratios for Early Menopause of 0.92 (95% CI, 0.79-1.06), 0.84 (95% CI, 0.73-0.96), 0.78 (95% CI, 0.67-0.92), and 0.81 (95% CI, 0.66-1.01), respectively (P for trend = .006). In multivariable models also adjusted for parity, hazard ratios for duration of exclusive breastfeeding of 1 to 6, 7 to 12, 13 to 18, and 19 or more months were 0.95 (95% CI, 0.85-1.07), 0.72 (95% CI, 0.62-0.83), 0.80 (95% CI, 0.66-0.97), and 0.89 (95% CI, 0.69-1.16), respectively, compared with less than 1 month of exclusive breastfeeding (P for trend = .001). Despite the significant test for trend, estimates were not observed to be lower as duration of exclusive breastfeeding increased. In a stratified analysis of parous women, risk of Early Menopause was lowest among those reporting exclusive breastfeeding for 7 to 12 months in each level of parity (women with 2 pregnancies and 7-12 months of breastfeeding: HR, 0.79; 95% CI, 0.66-0.96; ≥3 pregnancies and 7-12 months of breastfeeding: HR, 0.68; 95% CI, 0.52-0.88; 2 pregnancies and ≥13 months of breastfeeding: HR, 0.87; 95% CI, 0.66-1.15; ≥3 pregnancies and 13-18 months of breastfeeding: HR, 0.86; 95% CI, 0.66-1.13; and ≥3 pregnancies and ≥19 months of breastfeeding: HR, 0.98; 95% CI, 0.72-1.32). Conclusions and Relevance In this study, an inverse association of parity with risk of Early Menopause was observed. Breastfeeding was associated with significantly lower risk, even after accounting for parity. Breastfeeding at levels consistent with current recommendations may confer an additional benefit of lower risk of Early Menopause.
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a prospective study of dairy food intake and Early Menopause
American Journal of Epidemiology, 2019Co-Authors: Alexandra C Purduesmithe, Brian W Whitcomb, Joann E Manson, Susan E Hankinson, Bernard Rosner, Lisa M Troy, Elizabeth R BertonejohnsonAbstract:Early natural Menopause, the cessation of ovarian function prior to age 45 years, affects approximately 10% of women and increases risk of cardiovascular disease and other adverse conditions. Laboratory evidence suggests a potential role of dairy foods in the ovarian aging process; however, no prior epidemiologic studies have evaluated how dairy-food intake is associated with risk of Early Menopause. We therefore evaluated how intakes of total, low-fat, high-fat, and individual dairy foods were associated with Early Menopause in Nurses' Health Study II. Women who were premenopausal at the start of follow-up in 1991 were followed until 2011 for Early Menopause. Food frequency questionnaires were used to assess dietary intake. In Cox proportional hazards models adjusting for age, smoking, and other factors, total baseline dairy-food intake of ≥4 servings/day versus <4 servings/week was associated with 23% lower risk of Early Menopause (hazard ratio = 0.77, 95% confidence interval: 0.64, 0.93; P for trend = 0.08). Associations appeared to be limited to low-fat dairy foods (for ≥2 servings/day vs. <3 servings/month, hazard ratio = 0.83, 95% confidence interval: 0.68, 1.01; P for trend = 0.02), whereas high-fat dairy-food intake was not associated with Early Menopause. Low-fat dairy foods may represent a modifiable risk factor for reducing risk of Early Menopause among premenopausal women.
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a prospective study of inflammatory biomarker levels and risk of Early Menopause
Menopause, 2019Co-Authors: Elizabeth R Bertonejohnson, Alexandra C Purduesmithe, Joann E Manson, Susan E Hankinson, Bernard Rosner, Brian W WhitcombAbstract:Objective Early Menopause, the cessation of ovarian function before age 45, has consequences for fertility and cardiovascular health. Evidence from studies of women with autoimmune conditions and genetic studies supports a role for inflammation in Early Menopause, but the association of inflammatory markers and risk has not been directly evaluated. Methods We assessed the relation of the soluble fraction of tumor necrosis factor alpha receptor 2 (sTNFR2), C-reactive protein, interleukin-6 (IL6) levels with incident Early Menopause among Nurses' Health Study II participants who provided a premenopausal blood sample in 1996 to 1999. Cases (n = 328) were women reporting natural Menopause between blood collection and age 45.Controls (n = 492) included (1) 328 women with Menopause after age 47, matched 1:1 with cases on age at blood collection and other factors; and (2) 164 additional women with Menopause after age 45. Results In multivariable models comparing cases and n = 492 controls, we observed a significant association of sTNFR2 levels and risk of Early Menopause (P = 0.002). Compared with women with the lowest sTNFR2 levels, odds ratios (95% CIs) for quartiles 2 to 4 were 0.60 (0.38-0.95), 0.93 (0.61-1.43), and 1.40 (0.93-2.11). Results further adjusting for antimullerian hormone levels were similar in magnitude, as were results from sensitivity analyses of matched cases and controls (n = 328 pairs), nonsmokers, and leaner women. C-reactive protein and IL6 levels were unrelated to risk. Conclusions The observation of lower risk of Early Menopause among women with moderate sTNFR2 levels compared with women with lower and higher levels warrants further prospective study.
Joann E Manson - One of the best experts on this subject based on the ideXlab platform.
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is alcohol consumption associated with Early Menopause risk
American Journal of Epidemiology, 2021Co-Authors: Joshua R Freeman, Brian W Whitcomb, Alexandra C Purduesmithe, Joann E Manson, Christine R Langton, Susan E Hankinson, Bernard RosnerAbstract:Earlier age at Menopause is associated with increased long-term health risks. Moderate alcohol intake has been suggested to delay Menopause onset, but it is unknown whether alcohol subtypes are associated with Early Menopause onset at age 45. Therefore, we aimed to evaluate risk of Early natural Menopause among n=107,817 Nurses' Health Study II members followed from 1989-2011. Alcohol consumption overall, and by subtypes including beer, red wine, white wine, and liquor was assessed throughout follow-up. We estimated hazard ratios (HR) in multivariable models adjusting for age, body mass index, parity, smoking and other potential confounders. Women reporting moderate, current alcohol consumption had lower risks of Early Menopause than non-drinkers. Those reporting 10-14.9 g/day had lower risk of Early Menopause compared to non-drinkers (HR = 0.81, 95% confidence interval (CI): 0.68, 0.97). Among specific beverages, evidence of lower Early Menopause risk was confined to white wine, and potentially red wine and liquor, but not to beer. Data from this large prospective study suggest a weak association of moderate alcohol intake with lower risk of Early Menopause, which was most pronounced for consumption of white and red wine, and liquor. High consumption was not related to lower Early Menopause risk.
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association of oral contraceptives and tubal ligation with risk of Early natural Menopause
Human Reproduction, 2021Co-Authors: C R Langton, Brian W Whitcomb, Alexandra C Purduesmithe, Joann E Manson, Susan E Hankinson, Bernard Rosner, Lynnette Leidy SievertAbstract:Study question What is the association of oral contraceptives (OCs) and tubal ligation (TL) with Early natural Menopause? Summary answer We did not observe an association of OC use with risk of Early natural Menopause; however, TL was associated with a modestly higher risk. What is known already OCs manipulate hormone levels, prevent ovulation, and may modify the rate of follicular atresia, while TL may disrupt the blood supply to the ovaries. These mechanisms may be associated with risk of Early Menopause, a condition associated with increased risk of cardiovascular disease and other adverse health outcomes. Study design, size, duration We examined the association of OC use and TL with natural Menopause before the age of 45 years in a population-based study within the prospective Nurses' Health Study II (NHSII) cohort. Participants were followed from 1989 to 2017 and response rates were 85-90% for each cycle. Participants/materials, setting, methods Participants included 106 633 NHSII members who were premenopausal and aged 25-42 years at baseline. Use, duration and type of OC, and TL were measured at baseline and every 2 years. Menopause status and age were assessed every 2 years. Follow-up continued until Early Menopause, age 45 years, hysterectomy, oophorectomy, death, cancer diagnosis, or loss to follow-up. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% CIs adjusted for lifestyle, dietary, and reproductive factors. Main results and the role of chance Over 1.6 million person-years, 2579 members of the analytic cohort experienced Early natural Menopause. In multivariable models, the duration, timing, and type of OC use were not associated with risk of Early Menopause. For example, compared with women who never used OCs, those reporting 120+ months of OC use had an HR for Early Menopause of 1.01 (95% CI, 0.87-1.17; P for trend=0.71). TL was associated with increased risk of Early Menopause (HR = 1.17, 95% CI, 1.06-1.28). Limitations, reasons for caution Our study population is homogenous with respect to race and ethnicity. Additional evaluation of these relations in more diverse populations is important. Wider implications of the findings To our knowledge, this is the largest study examining the association of OC use and TL with Early natural Menopause to date. While TL was associated with a modest higher risk of Early Menopause, our findings do not support any material hazard or benefit for the use of OCs. Study funding/competing interest(s) The study was sponsored by UO1CA176726 and R01HD078517 from the National Institutes of Health and Department of Health and Human Services. The work was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The authors have no competing interests to report. Trial registration number N/A.
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association of parity and breastfeeding with risk of Early natural Menopause
JAMA Network Open, 2020Co-Authors: Christine R Langton, Brian W Whitcomb, Alexandra C Purduesmithe, Joann E Manson, Susan E Hankinson, Bernard Rosner, Lynnette Leidy SievertAbstract:Importance Pregnancy and breastfeeding prevent ovulation and may slow the depletion of the ovarian follicle pool. These factors may lower the risk of Early Menopause, a condition associated with increased risk of cardiovascular disease and other adverse health outcomes. Objective To examine the association of parity and breastfeeding with the risk of Early Menopause. Design, Setting, and Participants This population-based cohort study within the Nurses’ Health Study II cohort (1989-2015) included premenopausal participants who were aged 25 to 42 years at baseline. Response rates were 85% to 90% for each cycle, and follow-up continued until Menopause, age 45 years, hysterectomy, oophorectomy, death, cancer diagnosis, loss to follow-up, or end of follow-up in May 2015. Hypotheses were formulated after data collection. Data analysis took place from February to July 2019. Exposures Parity (ie, number of pregnancies lasting ≥6 months) was measured at baseline and every 2 years. History and duration of total and exclusive breastfeeding were assessed 3 times during follow-up. Menopause status and age were assessed every 2 years. Main Outcomes and Measures Risk of natural Menopause before age 45 years. Results At baseline, 108 887 premenopausal women aged 25 to 42 years (mean [SD] age, 34.1 [4.6] years; 102 246 [93.9%] non-Hispanic white) were included in the study. In multivariable models, higher parity was associated with lower risk of Early Menopause. Hazard ratios were attenuated with adjustment for breastfeeding but remained significant. Compared with nulliparous women, those reporting 1, 2, 3, and 4 or more pregnancies lasting at least 6 months had hazard ratios for Early Menopause of 0.92 (95% CI, 0.79-1.06), 0.84 (95% CI, 0.73-0.96), 0.78 (95% CI, 0.67-0.92), and 0.81 (95% CI, 0.66-1.01), respectively (P for trend = .006). In multivariable models also adjusted for parity, hazard ratios for duration of exclusive breastfeeding of 1 to 6, 7 to 12, 13 to 18, and 19 or more months were 0.95 (95% CI, 0.85-1.07), 0.72 (95% CI, 0.62-0.83), 0.80 (95% CI, 0.66-0.97), and 0.89 (95% CI, 0.69-1.16), respectively, compared with less than 1 month of exclusive breastfeeding (P for trend = .001). Despite the significant test for trend, estimates were not observed to be lower as duration of exclusive breastfeeding increased. In a stratified analysis of parous women, risk of Early Menopause was lowest among those reporting exclusive breastfeeding for 7 to 12 months in each level of parity (women with 2 pregnancies and 7-12 months of breastfeeding: HR, 0.79; 95% CI, 0.66-0.96; ≥3 pregnancies and 7-12 months of breastfeeding: HR, 0.68; 95% CI, 0.52-0.88; 2 pregnancies and ≥13 months of breastfeeding: HR, 0.87; 95% CI, 0.66-1.15; ≥3 pregnancies and 13-18 months of breastfeeding: HR, 0.86; 95% CI, 0.66-1.13; and ≥3 pregnancies and ≥19 months of breastfeeding: HR, 0.98; 95% CI, 0.72-1.32). Conclusions and Relevance In this study, an inverse association of parity with risk of Early Menopause was observed. Breastfeeding was associated with significantly lower risk, even after accounting for parity. Breastfeeding at levels consistent with current recommendations may confer an additional benefit of lower risk of Early Menopause.
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a prospective study of dairy food intake and Early Menopause
American Journal of Epidemiology, 2019Co-Authors: Alexandra C Purduesmithe, Brian W Whitcomb, Joann E Manson, Susan E Hankinson, Bernard Rosner, Lisa M Troy, Elizabeth R BertonejohnsonAbstract:Early natural Menopause, the cessation of ovarian function prior to age 45 years, affects approximately 10% of women and increases risk of cardiovascular disease and other adverse conditions. Laboratory evidence suggests a potential role of dairy foods in the ovarian aging process; however, no prior epidemiologic studies have evaluated how dairy-food intake is associated with risk of Early Menopause. We therefore evaluated how intakes of total, low-fat, high-fat, and individual dairy foods were associated with Early Menopause in Nurses' Health Study II. Women who were premenopausal at the start of follow-up in 1991 were followed until 2011 for Early Menopause. Food frequency questionnaires were used to assess dietary intake. In Cox proportional hazards models adjusting for age, smoking, and other factors, total baseline dairy-food intake of ≥4 servings/day versus <4 servings/week was associated with 23% lower risk of Early Menopause (hazard ratio = 0.77, 95% confidence interval: 0.64, 0.93; P for trend = 0.08). Associations appeared to be limited to low-fat dairy foods (for ≥2 servings/day vs. <3 servings/month, hazard ratio = 0.83, 95% confidence interval: 0.68, 1.01; P for trend = 0.02), whereas high-fat dairy-food intake was not associated with Early Menopause. Low-fat dairy foods may represent a modifiable risk factor for reducing risk of Early Menopause among premenopausal women.
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a prospective study of inflammatory biomarker levels and risk of Early Menopause
Menopause, 2019Co-Authors: Elizabeth R Bertonejohnson, Alexandra C Purduesmithe, Joann E Manson, Susan E Hankinson, Bernard Rosner, Brian W WhitcombAbstract:Objective Early Menopause, the cessation of ovarian function before age 45, has consequences for fertility and cardiovascular health. Evidence from studies of women with autoimmune conditions and genetic studies supports a role for inflammation in Early Menopause, but the association of inflammatory markers and risk has not been directly evaluated. Methods We assessed the relation of the soluble fraction of tumor necrosis factor alpha receptor 2 (sTNFR2), C-reactive protein, interleukin-6 (IL6) levels with incident Early Menopause among Nurses' Health Study II participants who provided a premenopausal blood sample in 1996 to 1999. Cases (n = 328) were women reporting natural Menopause between blood collection and age 45.Controls (n = 492) included (1) 328 women with Menopause after age 47, matched 1:1 with cases on age at blood collection and other factors; and (2) 164 additional women with Menopause after age 45. Results In multivariable models comparing cases and n = 492 controls, we observed a significant association of sTNFR2 levels and risk of Early Menopause (P = 0.002). Compared with women with the lowest sTNFR2 levels, odds ratios (95% CIs) for quartiles 2 to 4 were 0.60 (0.38-0.95), 0.93 (0.61-1.43), and 1.40 (0.93-2.11). Results further adjusting for antimullerian hormone levels were similar in magnitude, as were results from sensitivity analyses of matched cases and controls (n = 328 pairs), nonsmokers, and leaner women. C-reactive protein and IL6 levels were unrelated to risk. Conclusions The observation of lower risk of Early Menopause among women with moderate sTNFR2 levels compared with women with lower and higher levels warrants further prospective study.
Gita D Mishra - One of the best experts on this subject based on the ideXlab platform.
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emas position statement predictors of premature and Early natural Menopause
Maturitas, 2019Co-Authors: Gita D Mishra, Hsinfang Chung, Dimitrios G Goulis, Antonio Cano, Peter Chedraui, Patrice Lopes, Alfred O Mueck, Margaret Rees, Levent M Senturk, Tommaso SimonciniAbstract:Abstract Introduction While the associations of genetic, reproductive and environmental factors with the timing of natural Menopause have been extensively investigated, few epidemiological studies have specifically examined their association with premature ( Aim The aim of this position statement is to provide evidence on the predictors of premature and Early natural Menopause, as well as recommendations for the management of premature and Early Menopause and future research. Materials and methods Literature review and consensus of expert opinion. Results and conclusions Strong genetic predictors of premature and Early Menopause include a family history of premature or Early Menopause, being a child of a multiple pregnancy and some specific genetic variants. Women with Early menarche and nulliparity or low parity are also at a higher risk of experiencing premature or Early Menopause. Cigarette smoking (with a strong dose–response effect) and being underweight have been consistently associated with premature and Early Menopause. Current guidelines for the management of premature and Early Menopause mainly focus on Early initiation of hormone therapy (HT) and continued treatment until the woman reaches the average age at Menopause (50–52 years). We suggest that clinicians and health professionals consider the age at Menopause of the relevant region or ethnic group as part of the assessment for the timing of HT cessation. In addition, there should be Early monitoring of women with a family history of Early Menopause, who are a child of a multiple pregnancy, or who have had Early menarche (especially those who have had no children). As part of preventive health strategies, women should be encouraged to quit smoking (preferably before the age of 30 years) and maintain optimal weight in order to reduce their risk of premature or Early Menopause.
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abstract mp28 Early Menopause is associated with Early onset cardiovascular disease before age of 60 years
Circulation, 2019Co-Authors: Dongshan Zhu, Hsinfang Chung, Nirmala Pandeya, Annette J Dobson, Gita D MishraAbstract:Introduction: Evidence has shown that Early Menopause is linked to higher risk of cardiovascular disease (CVD) in women. A prevailing view is that endogenous estrogen may confer protection against ...
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abstract 127 premenopausal cardiovascular disease is associated with Early natural Menopause
Stroke, 2019Co-Authors: Dongshan Zhu, Hsinfang Chung, Nirmala Pandeya, Annette J Dobson, Gita D MishraAbstract:Introduction: Early Menopause has been associated with an increased risk of cardiovascular disease (CVD), but few studies have examined the converse, i.e., whether CVD events that occurred before m...
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cigarette smoking and the risk for premature and Early natural Menopause results from pooled analysis of data from 51 450 women
Maturitas, 2017Co-Authors: Gita D Mishra, Hsinfang Chung, Nirmala Pandeya, Annette J DobsonAbstract:Introduction: Premature Menopause and Early Menopause are known risk factors for adverse health outcomes in later life. While cigarette smoking is an established risk factor for earlier age at Menopause, the overall size and strength of its relationship with premature or Early Menopause is yet to be fully elucidated.Objectives: To quantify the magnitude of the relationship between cigarette smoking status with the age at final menstrual period (FMP).Methods: The International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE) enables the use of pooled data on 51 450 women from nine longitudinal observational studies in the UK, Scandinavia, Australia and Japan. Age at FMP was confirmed by at least 12 months of cessation of menses and categorised as: premature Menopause (FMP before age 40), Early Menopause (FMP 40–44 years), 45–49 years, 50–51 years, 52–53 years, or 54 or more years. Cigarette smoking was categorised as current smoker, past smoker, or never smoker. Multinomial logistic regression was used to identify associations with age categories for FMP, after adjusting for birth year, age at menarche, education level, marital status, parity, and body mass index during midlife.Findings: Overall 18% of the women were smokers, with a mean age at FMP of 48.9 years (SD 4.2). The mean (SD) for never or past smokers was 50.1 (4.2) years. Current smokers were at a higher risk of having premature Menopause (RRR 1.48, 95% CI 1.17 to 1.88), Early Menopause (1.70, 1.43 to 2.03), FMP at 45–49 years (1.43, 1.31 to 1.56) compared with never smokers. Past smokers had similar risks as never smokers.Conclusions: This study identified robust evidence for the effect of cigarette smoking on the timing of Menopause before the age of 50, with the effect being highest for Early Menopause. Findings underscore support for smoking prevention and quitting programmes for women of reproductive age.
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Early menarche nulliparity and the risk for premature and Early natural Menopause
Human Reproduction, 2017Co-Authors: Gita D Mishra, Hsinfang Chung, Nirmala Pandeya, Annette J Dobson, Diana Kuh, Graham G Giles, Debra Anderson, Sven Sandin, Fiona BruinsmaAbstract:STUDY QUESTION: Are parity and the timing of menarche associated with premature and Early natural Menopause? SUMMARY ANSWER: Early menarche (≤11 years) is a risk factor for both premature Menopause (final menstrual period, FMP <40 years) and Early Menopause (FMP 40-44 years), a risk that is amplified for nulliparous women. WHAT IS KNOWN ALREADY: Women with either premature or Early Menopause face an increased risk of chronic conditions in later life and of Early death. Findings from some studies suggest that Early menarche and nulliparity are associated with Early Menopause, however overall the evidence is mixed. Much of the evidence for a direct relationship is hampered by a lack of comparability across studies, failure to adjust for confounding factors and inadequate statistical power. STUDY DESIGN, SIZE, DURATION: This pooled study comprises 51 450 postmenopausal women from nine observational studies in the UK, Scandinavia, Australia and Japan that contribute to the International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE). PARTICIPANTS/MATERIALS, SETTING, METHODS: Age at menarche (categorized as ≤11, 12, 13, 14 and 15 or more years) and parity (categorized as no children, one child and two or more children) were exposures of interest. Age at FMP was confirmed by at least 12 months of cessation of menses where this was not the result of an intervention (such as surgical Menopause due to bilateral oophorectomy or hysterectomy) and categorized as premature Menopause (FMP before age 40), Early Menopause (FMP 40-44 years), 45-49 years, 50-51 years, 52-53 years and 54 or more years. We used multivariate multinomial logistic regression models to estimate relative risk ratio (RRR) and 95% CI for associations between menarche, parity and age at FMP adjusting for within-study correlation. MAIN RESULTS AND THE ROLE OF CHANCE: The median age at FMP was 50 years (interquartile range 48-53 years), with 2% of the women experiencing premature Menopause and 7.6% Early Menopause. Women with Early menarche (≤11 years, compared with 12-13 years) were at higher risk of premature Menopause (RRR 1.80, 95% CI 1.53-2.12) and Early Menopause (1.31, 1.19-1.44). Nulliparity was associated with increased risk of premature Menopause (2.26, 1.84-2.77) and Early Menopause (1.32, 1.09-1.59). Women having Early menarche and nulliparity were at over 5-fold increased risk of premature Menopause (5.64, 4.04-7.87) and 2-fold increased risk of Early Menopause (2.16, 1.48-3.15) compared with women who had menarche at ≥12 years and two or more children. LIMITATIONS, REASONS FOR CAUTION: Most of the studies (except the birth cohorts) relied on retrospectively reported age at menarche, which may have led to some degree of recall bias. WIDER IMPLICATIONS OF THE FINDINGS: Our findings support Early monitoring of women with Early menarche, especially those who have no children, for preventive health interventions aimed at mitigating the risk of adverse health outcomes associated with Early Menopause.
Bernard Rosner - One of the best experts on this subject based on the ideXlab platform.
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is alcohol consumption associated with Early Menopause risk
American Journal of Epidemiology, 2021Co-Authors: Joshua R Freeman, Brian W Whitcomb, Alexandra C Purduesmithe, Joann E Manson, Christine R Langton, Susan E Hankinson, Bernard RosnerAbstract:Earlier age at Menopause is associated with increased long-term health risks. Moderate alcohol intake has been suggested to delay Menopause onset, but it is unknown whether alcohol subtypes are associated with Early Menopause onset at age 45. Therefore, we aimed to evaluate risk of Early natural Menopause among n=107,817 Nurses' Health Study II members followed from 1989-2011. Alcohol consumption overall, and by subtypes including beer, red wine, white wine, and liquor was assessed throughout follow-up. We estimated hazard ratios (HR) in multivariable models adjusting for age, body mass index, parity, smoking and other potential confounders. Women reporting moderate, current alcohol consumption had lower risks of Early Menopause than non-drinkers. Those reporting 10-14.9 g/day had lower risk of Early Menopause compared to non-drinkers (HR = 0.81, 95% confidence interval (CI): 0.68, 0.97). Among specific beverages, evidence of lower Early Menopause risk was confined to white wine, and potentially red wine and liquor, but not to beer. Data from this large prospective study suggest a weak association of moderate alcohol intake with lower risk of Early Menopause, which was most pronounced for consumption of white and red wine, and liquor. High consumption was not related to lower Early Menopause risk.
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association of oral contraceptives and tubal ligation with risk of Early natural Menopause
Human Reproduction, 2021Co-Authors: C R Langton, Brian W Whitcomb, Alexandra C Purduesmithe, Joann E Manson, Susan E Hankinson, Bernard Rosner, Lynnette Leidy SievertAbstract:Study question What is the association of oral contraceptives (OCs) and tubal ligation (TL) with Early natural Menopause? Summary answer We did not observe an association of OC use with risk of Early natural Menopause; however, TL was associated with a modestly higher risk. What is known already OCs manipulate hormone levels, prevent ovulation, and may modify the rate of follicular atresia, while TL may disrupt the blood supply to the ovaries. These mechanisms may be associated with risk of Early Menopause, a condition associated with increased risk of cardiovascular disease and other adverse health outcomes. Study design, size, duration We examined the association of OC use and TL with natural Menopause before the age of 45 years in a population-based study within the prospective Nurses' Health Study II (NHSII) cohort. Participants were followed from 1989 to 2017 and response rates were 85-90% for each cycle. Participants/materials, setting, methods Participants included 106 633 NHSII members who were premenopausal and aged 25-42 years at baseline. Use, duration and type of OC, and TL were measured at baseline and every 2 years. Menopause status and age were assessed every 2 years. Follow-up continued until Early Menopause, age 45 years, hysterectomy, oophorectomy, death, cancer diagnosis, or loss to follow-up. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% CIs adjusted for lifestyle, dietary, and reproductive factors. Main results and the role of chance Over 1.6 million person-years, 2579 members of the analytic cohort experienced Early natural Menopause. In multivariable models, the duration, timing, and type of OC use were not associated with risk of Early Menopause. For example, compared with women who never used OCs, those reporting 120+ months of OC use had an HR for Early Menopause of 1.01 (95% CI, 0.87-1.17; P for trend=0.71). TL was associated with increased risk of Early Menopause (HR = 1.17, 95% CI, 1.06-1.28). Limitations, reasons for caution Our study population is homogenous with respect to race and ethnicity. Additional evaluation of these relations in more diverse populations is important. Wider implications of the findings To our knowledge, this is the largest study examining the association of OC use and TL with Early natural Menopause to date. While TL was associated with a modest higher risk of Early Menopause, our findings do not support any material hazard or benefit for the use of OCs. Study funding/competing interest(s) The study was sponsored by UO1CA176726 and R01HD078517 from the National Institutes of Health and Department of Health and Human Services. The work was supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The authors have no competing interests to report. Trial registration number N/A.
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association of parity and breastfeeding with risk of Early natural Menopause
JAMA Network Open, 2020Co-Authors: Christine R Langton, Brian W Whitcomb, Alexandra C Purduesmithe, Joann E Manson, Susan E Hankinson, Bernard Rosner, Lynnette Leidy SievertAbstract:Importance Pregnancy and breastfeeding prevent ovulation and may slow the depletion of the ovarian follicle pool. These factors may lower the risk of Early Menopause, a condition associated with increased risk of cardiovascular disease and other adverse health outcomes. Objective To examine the association of parity and breastfeeding with the risk of Early Menopause. Design, Setting, and Participants This population-based cohort study within the Nurses’ Health Study II cohort (1989-2015) included premenopausal participants who were aged 25 to 42 years at baseline. Response rates were 85% to 90% for each cycle, and follow-up continued until Menopause, age 45 years, hysterectomy, oophorectomy, death, cancer diagnosis, loss to follow-up, or end of follow-up in May 2015. Hypotheses were formulated after data collection. Data analysis took place from February to July 2019. Exposures Parity (ie, number of pregnancies lasting ≥6 months) was measured at baseline and every 2 years. History and duration of total and exclusive breastfeeding were assessed 3 times during follow-up. Menopause status and age were assessed every 2 years. Main Outcomes and Measures Risk of natural Menopause before age 45 years. Results At baseline, 108 887 premenopausal women aged 25 to 42 years (mean [SD] age, 34.1 [4.6] years; 102 246 [93.9%] non-Hispanic white) were included in the study. In multivariable models, higher parity was associated with lower risk of Early Menopause. Hazard ratios were attenuated with adjustment for breastfeeding but remained significant. Compared with nulliparous women, those reporting 1, 2, 3, and 4 or more pregnancies lasting at least 6 months had hazard ratios for Early Menopause of 0.92 (95% CI, 0.79-1.06), 0.84 (95% CI, 0.73-0.96), 0.78 (95% CI, 0.67-0.92), and 0.81 (95% CI, 0.66-1.01), respectively (P for trend = .006). In multivariable models also adjusted for parity, hazard ratios for duration of exclusive breastfeeding of 1 to 6, 7 to 12, 13 to 18, and 19 or more months were 0.95 (95% CI, 0.85-1.07), 0.72 (95% CI, 0.62-0.83), 0.80 (95% CI, 0.66-0.97), and 0.89 (95% CI, 0.69-1.16), respectively, compared with less than 1 month of exclusive breastfeeding (P for trend = .001). Despite the significant test for trend, estimates were not observed to be lower as duration of exclusive breastfeeding increased. In a stratified analysis of parous women, risk of Early Menopause was lowest among those reporting exclusive breastfeeding for 7 to 12 months in each level of parity (women with 2 pregnancies and 7-12 months of breastfeeding: HR, 0.79; 95% CI, 0.66-0.96; ≥3 pregnancies and 7-12 months of breastfeeding: HR, 0.68; 95% CI, 0.52-0.88; 2 pregnancies and ≥13 months of breastfeeding: HR, 0.87; 95% CI, 0.66-1.15; ≥3 pregnancies and 13-18 months of breastfeeding: HR, 0.86; 95% CI, 0.66-1.13; and ≥3 pregnancies and ≥19 months of breastfeeding: HR, 0.98; 95% CI, 0.72-1.32). Conclusions and Relevance In this study, an inverse association of parity with risk of Early Menopause was observed. Breastfeeding was associated with significantly lower risk, even after accounting for parity. Breastfeeding at levels consistent with current recommendations may confer an additional benefit of lower risk of Early Menopause.
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a prospective study of dairy food intake and Early Menopause
American Journal of Epidemiology, 2019Co-Authors: Alexandra C Purduesmithe, Brian W Whitcomb, Joann E Manson, Susan E Hankinson, Bernard Rosner, Lisa M Troy, Elizabeth R BertonejohnsonAbstract:Early natural Menopause, the cessation of ovarian function prior to age 45 years, affects approximately 10% of women and increases risk of cardiovascular disease and other adverse conditions. Laboratory evidence suggests a potential role of dairy foods in the ovarian aging process; however, no prior epidemiologic studies have evaluated how dairy-food intake is associated with risk of Early Menopause. We therefore evaluated how intakes of total, low-fat, high-fat, and individual dairy foods were associated with Early Menopause in Nurses' Health Study II. Women who were premenopausal at the start of follow-up in 1991 were followed until 2011 for Early Menopause. Food frequency questionnaires were used to assess dietary intake. In Cox proportional hazards models adjusting for age, smoking, and other factors, total baseline dairy-food intake of ≥4 servings/day versus <4 servings/week was associated with 23% lower risk of Early Menopause (hazard ratio = 0.77, 95% confidence interval: 0.64, 0.93; P for trend = 0.08). Associations appeared to be limited to low-fat dairy foods (for ≥2 servings/day vs. <3 servings/month, hazard ratio = 0.83, 95% confidence interval: 0.68, 1.01; P for trend = 0.02), whereas high-fat dairy-food intake was not associated with Early Menopause. Low-fat dairy foods may represent a modifiable risk factor for reducing risk of Early Menopause among premenopausal women.
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a prospective study of inflammatory biomarker levels and risk of Early Menopause
Menopause, 2019Co-Authors: Elizabeth R Bertonejohnson, Alexandra C Purduesmithe, Joann E Manson, Susan E Hankinson, Bernard Rosner, Brian W WhitcombAbstract:Objective Early Menopause, the cessation of ovarian function before age 45, has consequences for fertility and cardiovascular health. Evidence from studies of women with autoimmune conditions and genetic studies supports a role for inflammation in Early Menopause, but the association of inflammatory markers and risk has not been directly evaluated. Methods We assessed the relation of the soluble fraction of tumor necrosis factor alpha receptor 2 (sTNFR2), C-reactive protein, interleukin-6 (IL6) levels with incident Early Menopause among Nurses' Health Study II participants who provided a premenopausal blood sample in 1996 to 1999. Cases (n = 328) were women reporting natural Menopause between blood collection and age 45.Controls (n = 492) included (1) 328 women with Menopause after age 47, matched 1:1 with cases on age at blood collection and other factors; and (2) 164 additional women with Menopause after age 45. Results In multivariable models comparing cases and n = 492 controls, we observed a significant association of sTNFR2 levels and risk of Early Menopause (P = 0.002). Compared with women with the lowest sTNFR2 levels, odds ratios (95% CIs) for quartiles 2 to 4 were 0.60 (0.38-0.95), 0.93 (0.61-1.43), and 1.40 (0.93-2.11). Results further adjusting for antimullerian hormone levels were similar in magnitude, as were results from sensitivity analyses of matched cases and controls (n = 328 pairs), nonsmokers, and leaner women. C-reactive protein and IL6 levels were unrelated to risk. Conclusions The observation of lower risk of Early Menopause among women with moderate sTNFR2 levels compared with women with lower and higher levels warrants further prospective study.
Hsinfang Chung - One of the best experts on this subject based on the ideXlab platform.
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emas position statement predictors of premature and Early natural Menopause
Maturitas, 2019Co-Authors: Gita D Mishra, Hsinfang Chung, Dimitrios G Goulis, Antonio Cano, Peter Chedraui, Patrice Lopes, Alfred O Mueck, Margaret Rees, Levent M Senturk, Tommaso SimonciniAbstract:Abstract Introduction While the associations of genetic, reproductive and environmental factors with the timing of natural Menopause have been extensively investigated, few epidemiological studies have specifically examined their association with premature ( Aim The aim of this position statement is to provide evidence on the predictors of premature and Early natural Menopause, as well as recommendations for the management of premature and Early Menopause and future research. Materials and methods Literature review and consensus of expert opinion. Results and conclusions Strong genetic predictors of premature and Early Menopause include a family history of premature or Early Menopause, being a child of a multiple pregnancy and some specific genetic variants. Women with Early menarche and nulliparity or low parity are also at a higher risk of experiencing premature or Early Menopause. Cigarette smoking (with a strong dose–response effect) and being underweight have been consistently associated with premature and Early Menopause. Current guidelines for the management of premature and Early Menopause mainly focus on Early initiation of hormone therapy (HT) and continued treatment until the woman reaches the average age at Menopause (50–52 years). We suggest that clinicians and health professionals consider the age at Menopause of the relevant region or ethnic group as part of the assessment for the timing of HT cessation. In addition, there should be Early monitoring of women with a family history of Early Menopause, who are a child of a multiple pregnancy, or who have had Early menarche (especially those who have had no children). As part of preventive health strategies, women should be encouraged to quit smoking (preferably before the age of 30 years) and maintain optimal weight in order to reduce their risk of premature or Early Menopause.
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abstract mp28 Early Menopause is associated with Early onset cardiovascular disease before age of 60 years
Circulation, 2019Co-Authors: Dongshan Zhu, Hsinfang Chung, Nirmala Pandeya, Annette J Dobson, Gita D MishraAbstract:Introduction: Evidence has shown that Early Menopause is linked to higher risk of cardiovascular disease (CVD) in women. A prevailing view is that endogenous estrogen may confer protection against ...
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abstract 127 premenopausal cardiovascular disease is associated with Early natural Menopause
Stroke, 2019Co-Authors: Dongshan Zhu, Hsinfang Chung, Nirmala Pandeya, Annette J Dobson, Gita D MishraAbstract:Introduction: Early Menopause has been associated with an increased risk of cardiovascular disease (CVD), but few studies have examined the converse, i.e., whether CVD events that occurred before m...
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relationships between intensity duration cumulative dose and timing of smoking with age at Menopause a pooled analysis of individual data from 17 observational studies
PLOS Medicine, 2018Co-Authors: Dongshan Zhu, Hsinfang Chung, Nirmala Pandeya, Annette J Dobson, Sybil L Crawford, Nancy E Avis, Janet E Cade, Darren C Greenwood, Ellen B GoldAbstract: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.
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body mass index and age at natural Menopause an international pooled analysis of 11 prospective studies
European Journal of Epidemiology, 2018Co-Authors: Dongshan Zhu, Hsinfang Chung, Nirmala Pandeya, Annette J Dobson, Diana Kuh, Sybil L Crawford, Ellen B Gold, Nancy E Avis, Graham G GilesAbstract:Current evidence on the association between body mass index (BMI) and age at Menopause remains unclear. We investigated the relationship between BMI and age at Menopause using data from 11 prospective studies. A total of 24,196 women who experienced Menopause after recruitment was included. Baseline BMI was categorised according to the WHO criteria. Age at Menopause, confirmed by natural cessation of menses for ≥ 12 months, was categorised as < 45 years (Early Menopause), 45–49, 50–51 (reference category), 52–53, 54–55, and ≥ 56 years (late age at Menopause). We used multinomial logistic regression models to estimate multivariable relative risk ratios (RRRs) and 95% confidence intervals (CI) for the associations between BMI and age at Menopause. The mean (standard deviation) age at Menopause was 51.4 (3.3) years, with 2.5% of the women having Early and 8.1% late Menopause. Compared with those with normal BMI (18.5–24.9 kg/m2), underweight women were at a higher risk of Early Menopause (RRR 2.15, 95% CI 1.50–3.06), while overweight (1.52, 1.31–1.77) and obese women (1.54, 1.18–2.01) were at increased risk of late Menopause. Overweight and obesity were also significantly associated with around 20% increased risk of Menopause at ages 52–53 and 54–55 years. We observed no association between underweight and late Menopause. The risk of Early Menopause was higher among obese women albeit not significant (1.23, 0.89–1.71). Underweight women had over twice the risk of experiencing Early Menopause, while overweight and obese women had over 50% higher risk of experiencing late Menopause.
