Grand Rounds

Has Age at Menopause Increased Over the Last 60 years?

BACKGROUND AND PURPOSE:

Age at natural menopause appears to be on an upward trend worldwide, which has the potential to influence a variety of health conditions
Later age at natural menopause is associated with
- Reduced all-cause and cardiovascular mortality
- Increased risk for breast, endometrial, and ovarian cancer
Appiah et al. (JAMA, 2021) investigated 60-year trends in age at natural menopause and reproductive life span among US women

Data sources
- Survey data: National Health Examination Survey I (NHES I; 1959 to 1962) | National Health through to the Nutrition Examination Survey (NHANES; 2017 to 2018)
Population
- All women, 40 to 74 years
- Natural menopause
- Exclusion: Menopause due to medical treatment or other reasons | Age at natural menopause <40 years or >62 years | Reported race/ethnicity other than Black, White, or Hispanic
Study design
- Ages at menarche and menopause were self-reported
- Linear regression was used to assess trends in age at natural menopause and reproductive life span over time
- Logistic regression was used to evaluate factors associated with higher age at menopause and longer reproductive life span

7773 women
Between the periods of 1959 to 1962 and 2015 to 2018, the mean age at natural menopause increased (P < 0.001 for trend)
- 1959 to 1962: mean age 48.4 years
- 2015 to 2018: mean age 49.9 years
Mean reproductive life span also increased over this interval (P < 0.001 for trend)
- 1959 to 1962: mean length 35.0 years
- 2015 to 2018: mean length 37.1 years
Mean age at menarche declined over this time period (P < 0.001 for trend)
- 1959 to 1962: mean age 13.5 years
- 2015 to 2018: mean age 12.7 years
The following were associated with earlier age at natural menopause and a shorter reproductive life span
- Black or Hispanic race/ethnicity
- Poverty
- Current and former smoking status
- Hormone therapy use
The following were associated with later age at natural menopause and a longer reproductive life span
- Greater years of education
- Oral contraceptive use

In the past 60 years, age at natural menopause and mean reproductive life span has increased
- Mean age at natural menopause has increased by 1.5 years
- Mean reproductive life span has increased by 2.1 years
Reproductive life span increase attributable to both later age at natural menopause and earlier age at menarche
Socioeconomic and lifestyle factors were associated with age at menopause and overall reproductive lifespan

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