Scime Natalie V, Huang Beili, Brown Hilary K, Brennand Erin A
Department of Health and Society, University of Toronto Scarborough, Toronto, ON, Canada.
Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada.
Am J Epidemiol. 2025 Jun 3;194(6):1726-1734. doi: 10.1093/aje/kwae320.
We investigated the time-varying association between parity and timing of natural menopause, surgical menopause, and premenopausal hysterectomy among 23 728 women aged 40-65 years at enrollment in the Alberta's Tomorrow Project cohort study (2000-2022), using flexible parametric survival analysis. Overall, natural menopause was most common by study end (57.2%), followed by premenopausal hysterectomy (11.4%) and surgical menopause (5.3%). Risks of natural menopause before age 50 years were elevated for 0 births (adjusted hazard ratio [aHR] at age 45, 1.33; 95% CI, 1.18-1.49) and 1 birth (aHR age 45, 1.21; 95% CI, 1.07-1.38), but similar for ≥3 births (aHR age 45, 0.95; 95% CI, 0.85-1.06) compared to 2 births (reference). Elevated risks of surgical menopause before age 45 years for 0 births (aHR age 40, 1.37; 95% CI, 1.09-1.69) and 1 birth (aHR age 40, 1.11; 95% CI, 0.85-1.45) attenuated when excluding women with past infertility or recurrent pregnancy loss, and reduced risks were observed over time for ≥3 births (aHR age 50, 0.84; 95% CI, 0.75-0.94). Risks of premenopausal hysterectomy were lower before age 50 years for 0 births (aHR age 45, 0.82; 95% CI, 0.76-0.88) but elevated after age 40 years for ≥3 births (aHR age 50, 1.25; 95% CI, 1.08-1.45). These complex associations necessitate additional research on the sociobiological impacts of childbearing on gynecologic health.
在阿尔伯塔明日项目队列研究（2000 - 2022年）中，我们纳入了23728名年龄在40 - 65岁之间的女性，采用灵活的参数生存分析方法，研究了生育次数与自然绝经、手术绝经以及绝经前子宫切除术时间之间的时变关联。总体而言，到研究结束时，自然绝经最为常见（57.2%），其次是绝经前子宫切除术（11.4%）和手术绝经（5.3%）。未生育（45岁时调整后风险比[aHR]为1.33；95%置信区间[CI]，1.18 - 1.49）和生育1次（45岁时aHR为1.21；95% CI，1.07 - 1.38）的女性在50岁之前自然绝经的风险升高，但与生育2次（参照组）相比，生育≥3次的女性风险相似（45岁时aHR为0.95；95% CI，0.85 - 1.06）。未生育（40岁时aHR为1.37；95% CI，1.09 - 1.69）和生育1次（40岁时aHR为1.11；95% CI，0.85 - 1.45）的女性在45岁之前手术绝经的风险升高，排除有既往不孕或反复流产史的女性后，风险减弱，并且随着时间推移，生育≥3次的女性风险降低（50岁时aHR为0.84；95% CI，0.75 - 0.94）。生育0次的女性在50岁之前绝经前子宫切除术的风险较低（45岁时aHR为0.82；95% CI，0.76 - 0.88），但生育≥3次的女性在40岁之后风险升高（50岁时aHR为1.25；95% CI，1.08 - 1.45）。这些复杂的关联需要对生育对妇科健康的社会生物学影响进行更多研究。
