Social Research Institute, University College London, London, UK.
Great Ormond Street Institute Of Child Health, University College London, London, UK.
BMC Womens Health. 2022 Nov 8;22(1):438. doi: 10.1186/s12905-022-02021-4.
Menopause that occurs before the age of 45 and is not medically induced (referred to here as 'early natural menopause') affects around one in 10 women and has serious health consequences. These consequences include increased risk of all-cause mortality, cardiovascular disease, osteoporosis, and type 2 diabetes.
We investigate risk factors for the onset of natural menopause before the age of 45 in two population-based prospective cohort studies in Britain: the 1958 cohort following 8959 women and the 1970 cohort following 8655 women. These studies follow women from birth to adulthood, and we use harmonized data on birth and early life characteristics, reproductive health, health behaviour, and socioeconomic characteristics for 6805 women who were pre-menopausal, peri-menopausal or had undergone natural menopause. Of these 6805 women, 3614 participated in the 1958 cohort (of which 368 had early menopause) and 3191 participated in the 1970 cohort (of which 206 had early menopause). Taking a life course approach, we focus on three distinct life stages - birth/early life, childhood, and early adulthood - to understand when risk factors are most harmful. Respecting the temporal sequence of exposures, we use a series of multivariable logistic regression models to estimate associations between early menopause and each potential risk factor adjusted for confounders.
We find that early menopause is influenced by circumstances at birth. Women born in lower social class families, whose mother smoked during the pregnancy or who were breastfed 1 month or less were more likely to undergo early menopause. Early menopause is also associated with poorer cognitive ability and smoking in childhood. Adult health behaviour also matters. Smoking is positively correlated with early menopause, while regular exercise and moderate frequency of alcohol drinking in women's early thirties are associated with reduced risk of early menopause. The occurrence of gynaecological problems by women's early thirties is also linked to early menopause.
We demonstrate that characteristics at different periods of life are associated with early menopause. Some of these associations relate to modifiable behaviours and thus the risks of early menopause and the adverse health outcomes associated with it may be preventable.
45 岁之前发生且非医学诱导的（以下简称“早发性自然绝经”）绝经会影响十分之一左右的女性，且会带来严重的健康后果。这些后果包括全因死亡率、心血管疾病、骨质疏松症和 2 型糖尿病风险增加。
我们在英国两项基于人群的前瞻性队列研究中，调查了 45 岁前发生自然绝经的风险因素：第一项研究是对 1958 年出生的 8959 名女性进行的随访，第二项研究是对 1970 年出生的 8655 名女性进行的随访。这些研究从女性出生到成年进行随访，我们使用经过协调的、关于出生和生命早期特征、生殖健康、健康行为和社会经济特征的数据，对 6805 名处于绝经前、围绝经期或自然绝经后的女性进行分析。这 6805 名女性中，有 3614 名参加了 1958 年的队列研究（其中 368 名发生早发性绝经），3191 名参加了 1970 年的队列研究（其中 206 名发生早发性绝经）。我们采取生命历程方法，重点关注三个不同的生命阶段——出生/生命早期、儿童期和成年早期，以了解风险因素何时危害最大。我们尊重暴露的时间顺序，使用一系列多变量逻辑回归模型，在调整混杂因素后，估计早发性绝经与每个潜在风险因素之间的关联。
我们发现，早发性绝经受到出生时情况的影响。出生于社会经济地位较低家庭的女性、母亲在怀孕期间吸烟或仅母乳喂养 1 个月或更短时间的女性，更有可能早发性绝经。早发性绝经也与儿童期认知能力差和吸烟有关。成年后的健康行为也很重要。吸烟与早发性绝经呈正相关，而女性三十出头时经常锻炼和适度饮酒则与降低早发性绝经风险相关。女性三十出头时出现妇科问题也与早发性绝经有关。
我们证明了生命不同时期的特征与早发性绝经有关。其中一些关联与可改变的行为有关，因此，早发性绝经及其相关的不良健康后果可能是可以预防的。
