Department of International Development, London School of Economics and Political Science, London, UK
Institute for Global Health, University College London, London, UK.
BMJ Glob Health. 2023 Jun;8(6). doi: 10.1136/bmjgh-2023-012312.
While secular trends in high-income countries show an increase in the mean age at menopause, it is unclear if there is a similar pattern in low-income and middle-income countries (LMICs), where women's exposure to biological, environmental and lifestyle determinants of menopause may differ. Premature (before age 40 years) and early (ages 40-44 years) menopause could have negative repercussions on later life health outcomes which in ageing societies could mean further stress on low-resource health systems. An evaluation of such trends in LMICs has been hampered by the suitability, quality and comparability of data from these countries.
Using 302 standardised household surveys from 1986 to 2019, we estimate trends and CIs using bootstrapping in the prevalence of premature and early menopause in 76 LMICs. We also developed a summary measure of age at menopause for women who experience menopause before the age of 50 years based on demographic estimation methods that can be used to measure menopausal status in surveys with truncated data.
Trends indicate an increasing prevalence of early and premature menopause in LMICs, in particular in sub-Saharan Africa and South/Southeast Asia. These regions also see a suggested decline of the mean age at menopause with greater variation across continents.
This study enables the analysis of menopause timing by exploiting data generally used for the study of fertility by methodologically allowing the use of truncated data. Findings show a clear increase in prevalence of premature and early menopause in the regions with the highest fertility with possible consequences for later life health. They also show a different trend compared with high-income regions, confirming a lack of generalisability and the importance of accounting for nutritional and health transitions at the local level. This study calls for further data and research on menopause on a global scale.
在高收入国家，绝经年龄呈上升趋势，但在中低收入国家（LMICs）是否存在类似趋势尚不清楚，这些国家女性面临的绝经生物学、环境和生活方式决定因素可能不同。过早（40 岁之前）和早期（40-44 岁）绝经可能对以后的生活健康结果产生负面影响，在老龄化社会中，这可能意味着对资源匮乏的卫生系统造成进一步的压力。由于这些国家的数据适宜性、质量和可比性，对这些趋势进行评估受到了阻碍。
使用 1986 年至 2019 年的 302 项标准化家庭调查，我们使用.bootstrap 法估计了 76 个 LMICs 中过早和早期绝经的流行率趋势和置信区间。我们还根据人口估计方法开发了一个汇总指标，用于衡量 50 岁之前经历绝经的女性的绝经年龄，该指标可用于衡量具有截断数据的调查中的绝经状况。
趋势表明，LMICs 中早期和过早绝经的流行率呈上升趋势，特别是在撒哈拉以南非洲和南亚/东南亚。这些地区的绝经年龄平均值也有所下降，各大陆之间的差异更大。
本研究通过在方法上允许使用截断数据，利用通常用于生育研究的数据来分析绝经时间，从而能够进行分析。研究结果表明，在生育率最高的地区，过早和早期绝经的流行率明显增加，这可能对以后的生活健康产生影响。与高收入地区的趋势不同，这一发现证实了缺乏普遍性，并且必须在当地考虑营养和健康转型。本研究呼吁在全球范围内进一步开展关于绝经的研究。
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