Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 50, Office NA29-14, PO Box 2040, 3000 CA Rotterdam, the Netherlands Department of Public Health, Uludag University School of Medicine, Bursa, Turkey.
Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 50, Office NA29-14, PO Box 2040, 3000 CA Rotterdam, the Netherlands Leiden University College, The Hague, the Netherlands.
Hum Reprod Update. 2016 Jun;22(4):516-28. doi: 10.1093/humupd/dmw013. Epub 2016 Jun 8.
Early onset of menopause is associated with long-term health risks, including cardiovascular disease and premature death. Although alcohol intake has been suggested to affect the age at which natural menopause occurs, results from observational studies are not consistent.
In the view of the differing risks to the health of early menopause and the increasing trends in alcohol consumption in women, in this systematic review, we aimed to quantify the association between all levels of alcohol consumption and menopause onset.
Six electronic databases (Medline, Embase, Cochrane, PubMed, Google Scholar and Web of Science) were systematically searched until 4 November 2015 to identify relevant studies assessing the association between alcohol consumption and onset of menopause. Two independent reviewers screened the titles and abstracts of all initially identified studies according to the selection criteria. Studies were sought if they (i) were observational cross-sectional, prospective and interventional studies, (ii) had reported on natural onset of menopause, (iii) had reported on alcohol consumption, (iv) had assessed the association between alcohol consumption and menopause onset, (v) were conducted in humans and (vi) were not conducted in patients with cancer. Data were extracted by two independent reviewers using a predesigned data-collection form. The primary exposure variable was the presence of active alcohol drinking at baseline compared with a reference group of non-drinkers. Pooled relative risks (RRs) were calculated.
Of the 1193 references (all in English language) reviewed for eligibility, 22 articles based on 20 unique studies were included in the final analysis. A total of 41 339 and 63 868 non-overlapping women were included in the meta-analysis of cross-sectional and observational cohort studies, respectively. In cross-sectional studies, the pooled RR for earlier onset of menopause was 0.86 (95% confidence interval (CI): 0.78-0.96) between drinkers versus non-drinkers. Analysis of the levels of alcohol consumed showed that low and moderate alcohol consumption (more than one drink per week (RR = 0.60; 95% CI: 0.49-0.75) and three or fewer drinks per week (RR = 0.75; 95% CI: 0.60-0.94)) were associated with later menopause onset, compared to non-drinkers. In prospective studies, RR for earlier menopause onset was 0.95 (95% CI: 0.91-0.98) when comparing women who reported drinking alcohol versus women who did not. Analysis of the dose of alcohol consumed showed that low-to-moderate alcohol intake (0-8 g/day (RR = 0.95; 95% CI: 0.93-0.98), and 16 g/day (RR = 0.89, 95%CI: 0.86-0.92)) was associated with later menopause onset, compared to non-drinking.
The findings of this review indicate that alcohol consumption, particularly low and moderate alcohol intake, might be associated with later onset of menopause although the magnitude of the association is low. Further studies are needed to corroborate these findings, clarify the level of alcohol intake at which menopause is delayed and identify the potential mechanisms behind this association.
绝经前期与长期健康风险相关，包括心血管疾病和早逝。尽管有研究表明饮酒会影响自然绝经的年龄，但观察性研究的结果并不一致。
鉴于绝经前期和女性饮酒量增加对健康的不同风险，在本系统评价中，我们旨在量化所有饮酒水平与绝经前期发生的相关性。
系统检索了 6 个电子数据库（Medline、Embase、Cochrane、PubMed、Google Scholar 和 Web of Science），以确定评估饮酒与绝经前期发生相关性的相关研究。两名独立的审查员根据选择标准筛选了所有最初确定的研究的标题和摘要。如果研究符合以下标准，则纳入研究：（i）为观察性的横断面、前瞻性和干预性研究；（ii）报告自然发生的绝经前期；（iii）报告饮酒情况；（iv）评估饮酒与绝经前期发生的相关性；（v）在人类中进行；（vi）不在癌症患者中进行。两名独立的审查员使用预先设计的数据收集表提取数据。主要暴露变量为与非饮酒者相比，基线时存在主动饮酒的情况。计算了合并的相对风险（RR）。
在审查的 1193 篇参考文献（均为英文）中，有 22 篇文章基于 20 项独特的研究符合最终分析的入选标准。共有 41339 名和 63868 名非重叠的女性分别纳入横断面研究和前瞻性队列研究的荟萃分析。在横断面研究中，与非饮酒者相比，饮酒者发生绝经前期的合并 RR 为 0.86（95%置信区间（CI）：0.78-0.96）。对饮酒量的分析表明，低至中度饮酒（每周饮酒 1 次以上（RR=0.60；95%CI：0.49-0.75）和每周饮酒 3 次以下（RR=0.75；95%CI：0.60-0.94））与绝经后期发生相关，与非饮酒者相比。在前瞻性研究中，与不饮酒的女性相比，报告饮酒的女性发生绝经前期的 RR 为 0.95（95%CI：0.91-0.98）。对饮酒量的分析表明，低至中度饮酒（0-8 g/天（RR=0.95；95%CI：0.93-0.98）和 16 g/天（RR=0.89，95%CI：0.86-0.92））与绝经后期发生相关，与非饮酒者相比。
本综述的结果表明，饮酒，特别是低至中度饮酒，可能与绝经后期发生有关，尽管关联的幅度较小。需要进一步的研究来证实这些发现，阐明延迟绝经发生的饮酒量水平，并确定这种关联背后的潜在机制。
