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Table 1.  Characteristics of US Women Aged 40 to 74 Years Who Reported Having Natural Menopause, 1959-2018a
Characteristics of US Women Aged 40 to 74 Years Who Reported Having Natural Menopause, 1959-2018a
Table 2.  Odds Ratios for Factors Associated With Age at Menopause and Reproductive Life Span Among US Women, 1959-2018
Odds Ratios for Factors Associated With Age at Menopause and Reproductive Life Span Among US Women, 1959-2018
1.
Gold  EB.  The timing of the age at which natural menopause occurs.   Obstet Gynecol Clin North Am. 2011;38(3):425-440. doi:10.1016/j.ogc.2011.05.002PubMedGoogle ScholarCrossref
2.
Schoenaker  DA, Jackson  CA, Rowlands  JV, Mishra  GD.  Socioeconomic position, lifestyle factors and age at natural menopause.   Int J Epidemiol. 2014;43(5):1542-1562. doi:10.1093/ije/dyu094PubMedGoogle ScholarCrossref
3.
National Center for Health Statistics, Centers for Disease Control and Prevention. NHANES questionnaires, datasets, and related documentation. Accessed October 28, 2020. https://wwwn.cdc.gov/nchs/nhanes/default.aspx
4.
Costanian  C, McCague  H, Tamim  H.  Age at natural menopause and its associated factors in Canada.   Menopause. 2018;25(3):265-272. doi:10.1097/GME.0000000000000990PubMedGoogle ScholarCrossref
5.
Nichols  HB, Trentham-Dietz  A, Hampton  JM,  et al.  From menarche to menopause: trends among US women born from 1912 to 1969.   Am J Epidemiol. 2006;164(10):1003-1011. doi:10.1093/aje/kwj282PubMedGoogle ScholarCrossref
6.
Bjelland  EK, Hofvind  S, Byberg  L, Eskild  A.  The relation of age at menarche with age at natural menopause.   Hum Reprod. 2018;33(6):1149-1157. doi:10.1093/humrep/dey078PubMedGoogle ScholarCrossref
Research Letter
April 6, 2021

Trends in Age at Natural Menopause and Reproductive Life Span Among US Women, 1959-2018

Author Affiliations
  • 1Department of Public Health, Texas Tech University Health Sciences Center, Lubbock
  • 2Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
  • 3Division of Cardiovascular Sciences, University of California, Davis, Sacramento
  • 4Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University Medical Center, Nashville, Tennessee
  • 5Division of Endocrinology, Metabolism, and Diabetes, University of Louisville, Louisville, Kentucky
JAMA. 2021;325(13):1328-1330. doi:10.1001/jama.2021.0278

Menopause, the permanent cessation of menstruation for more than 12 consecutive months resulting from the loss of ovarian function, marks the end of a woman’s reproductive cycle.1 Trends of increasing age at natural menopause have been reported worldwide.2 Understanding changes in the timing of age at natural menopause and length of reproductive life span (age at menopause minus age at menarche) and their associated factors are important because they influence multiple health conditions.1 This study investigated 60-year trends in age at natural menopause and reproductive life span as well as associated factors among US women.

Methods

Data were from successive surveys spanning the National Health Examination Survey I (NHES I; 1959-1962) through the National Health and Nutrition Examination Survey (NHANES) for 2017-2018. Response rates ranged from 87% for the NHES I to 49% for NHANES 2017-2018. These surveys used similar standardized protocols to obtain nationally representative estimates for the US noninstitutionalized civilian population and were approved by the National Center for Health Statistics Research Ethics Review Board.3 All participants provided written informed consent. Ages at menarche and menopause were self-reported. All women aged 40 to 74 years with natural menopause and no missing age at menopause were included in this analysis. Women with the following characteristics were excluded: menopause due to medical treatment or other reasons, age at natural menopause before age 40 years or after age 62 years (because pathologic conditions may have influenced the occurrence of menopause at such ages),4 and reporting a race/ethnicity other than Black, White, or Hispanic. Trends in age at natural menopause and reproductive life span over time were examined using linear regression, while ordinal logistic regression was used to evaluate factors (Table 1) associated with higher age at menopause and longer reproductive life span. All models accounted for the complex design and sampling weights of the surveys using SAS version 9.4 (SAS Institute Inc). Consecutive 2-year surveys conducted after 1999 were grouped into 4-year intervals to produce statistically reliable estimates. A 2-tailed P < .05 indicates statistical significance.

Results

Of 9428 women aged 40 to 74 years at the time of the survey with natural menopause and without missing age at menopause, 1655 were excluded. Table 1 shows the characteristics of the 7773 included women. Overall, from 1959-1962 to 2015-2018, the mean age at natural menopause increased from 48.4 years to 49.9 years (P < .001 for trend). Over this interval, the mean reproductive life span increased from 35.0 years to 37.1 years (P < .001 for trend), while the mean age at menarche declined from 13.5 years to 12.7 years (P < .001 for trend). In adjusted models, Black or Hispanic race/ethnicity, poverty, current and former smoking status, and hormone therapy use were associated with earlier age at natural menopause and shorter reproductive life span, while greater years of education and oral contraceptive use were associated with later age at natural menopause and longer reproductive life span (Table 2).

Discussion

Over the past 6 decades, the mean age at natural menopause increased by 1.5 years and the mean reproductive life span by 2.1 years.

The increase in reproductive life span was driven both by increasing age at natural menopause and earlier age at menarche. Sociodemographic, lifestyle, and behavior factors were significantly associated with age at natural menopause and reproductive life span. Additional potential contributing factors may include improved access to health care, nutrition, and environmental factors.1,5

Limitations of this study include its repeated cross-sectional design, relatively small sample size, and potential recall bias in age at menarche and menopause, although moderate reliability in the recall of these events after several years has been reported.6

Available evidence links later age at natural menopause with reduced all-cause and cardiovascular mortality but increased risk of breast, endometrial, and ovarian cancers.1 Whether the 1.5-year increase in age at natural menopause over a 60-year time span has clinical significance for women’s health apart from reproduction is unknown.

Section Editor: Jody W. Zylke, MD, Deputy Editor.
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Article Information

Corresponding Author: Duke Appiah, PhD, MPH, Department of Public Health, Texas Tech University Health Sciences Center, 3601 Fourth St, Stop 9430, Lubbock, TX 79430 (duke.appiah@ttuhsc.edu).

Accepted for Publication: January 10, 2021.

Author Contributions: Dr Appiah had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Appiah, Nwabuo, Ebong, Wellons.

Acquisition, analysis, or interpretation of data: Appiah, Nwabuo, Ebong, Winters.

Drafting of the manuscript: Appiah.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Appiah, Nwabuo.

Administrative, technical, or material support: Wellons.

Supervision: Winters.

Conflict of Interest Disclosures: None reported.

Disclaimer: The National Health and Nutrition Examination Survey is conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention (CDC). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.

References
1.
Gold  EB.  The timing of the age at which natural menopause occurs.   Obstet Gynecol Clin North Am. 2011;38(3):425-440. doi:10.1016/j.ogc.2011.05.002PubMedGoogle ScholarCrossref
2.
Schoenaker  DA, Jackson  CA, Rowlands  JV, Mishra  GD.  Socioeconomic position, lifestyle factors and age at natural menopause.   Int J Epidemiol. 2014;43(5):1542-1562. doi:10.1093/ije/dyu094PubMedGoogle ScholarCrossref
3.
National Center for Health Statistics, Centers for Disease Control and Prevention. NHANES questionnaires, datasets, and related documentation. Accessed October 28, 2020. https://wwwn.cdc.gov/nchs/nhanes/default.aspx
4.
Costanian  C, McCague  H, Tamim  H.  Age at natural menopause and its associated factors in Canada.   Menopause. 2018;25(3):265-272. doi:10.1097/GME.0000000000000990PubMedGoogle ScholarCrossref
5.
Nichols  HB, Trentham-Dietz  A, Hampton  JM,  et al.  From menarche to menopause: trends among US women born from 1912 to 1969.   Am J Epidemiol. 2006;164(10):1003-1011. doi:10.1093/aje/kwj282PubMedGoogle ScholarCrossref
6.
Bjelland  EK, Hofvind  S, Byberg  L, Eskild  A.  The relation of age at menarche with age at natural menopause.   Hum Reprod. 2018;33(6):1149-1157. doi:10.1093/humrep/dey078PubMedGoogle ScholarCrossref
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