Socioeconomic position, lifestyle factors and age at natural menopause: a systematic review and meta-analyses of studies across six continents
Open accessAbstract
BACKGROUND: Age at natural menopause (ANM) is considered a marker of biological ageing and is increasingly recognized as a sentinel for chronic disease risk in later life. Socioeconomic position (SEP) and lifestyle factors are thought to be associated with ANM. METHODS: We performed a systematic review and meta-analyses to determine the overall mean ANM, and the effect of SEP and lifestyle factors on ANM by calculating the weighted mean difference (WMD) and pooling adjusted hazard ratios. We explored heterogeneity using meta-regression and also included unpublished findings from the Australian Longitudinal Study on Women's Health. RESULTS: We identified 46 studies across 24 countries. Mean ANM was 48.8 years [95% confidence interval (CI): 48.3, 49.2], with between-study heterogeneity partly explained by geographical region. ANM was lowest among African, Latin American, Asian and Middle Eastern countries and highest in Europe and Australia, followed by the USA. Education was associated with later ANM (WMD middle vs low education 0.30, 95% CI: 0.10, 0.51; high vs low education 0.64, 95% CI 0.26, 1.02). A similar dose-response relationship was also observed for occupation. Smoking was associated with a 1-year reduction of ANM (WMD: -0.91, 95% CI: -1.34, -0.48). Being overweight and moderate/high physical activity were modestly associated with later ANM, but findings were less conclusive. CONCLUSIONS: ANM varies across populations, partly due to differences across geographical regions. SEP and some lifestyle factors are associated with ANM, but further research is needed to examine the impact of the associations between risk factors and ANM on future health outcomes.
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Maintenance HRT after pubertal induction is continued until the expected age of natural menopause, about 50-55 years, but lower in some populations, aiming for at least 42 years of exogenous estrogen exposure.
“After completing pubertal induction, maintenance HRT is continued until the expected age of natural menopause, about 50-55 years, but lower in some populations,324,325 aiming for a period of at least 42 years of exogenous estrogen exposure mimicking normal physiology of endogenous estrogen exposure.”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [325]
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Gravholt, C. H., Andersen, N. H., Christin-Maitre, S., Davis, S. M., Duijnhouwer, A., Gawlik, A., Maciel-Guerra, A. T., Gutmark-Little, I., Fleischer, K., Hong, D., et al. (2024) · European Journal of Endocrinology · doi:10.1093/ejendo/lvae050 · Cited by 224 · see citing works
Metabolic characterization of menopause: cross-sectional and longitudinal evidence
Wang, Q., Ferreira, D. L. S., Nelson, S. M., Sattar, N., Ala-Korpela, M., & Lawlor, D. A. (2018) · BMC Medicine · doi:10.1186/s12916-018-1008-8 · Cited by 134 · see citing works
- Authors
- Schoenaker, D. A., Jackson, C. A., Rowlands, J. V., & Mishra, G. D.
- Affiliations
- The University of Queensland (AU)
- Corresponding author
- Schoenaker, Danielle AJM
- Venue
- International Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-04-26
- Volume
- 43
- Issue
- 5
- Pages
- 1542-1562
- ISSN
- 0300-5771 (ISSN-L)
- 1464-3685
- PMC
- PMC4190515
- OpenAlex
- W2111905047
- Cited by
- 550
- References
- 91
- Citations by year
- 2026: 66 · 2025: 86 · 2024: 60 · 2023: 64 · 2022: 55 · 2021: 45 · 2020: 51 · 2019: 32 · 2018: 30 · 2017: 28 · 2016: 19 · 2015: 13 · 2014: 1
- FWCI
- 3.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Epidemiology (publishedVersion)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by-nc)
- Research Online (University of Wollongong) (submittedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by-nc)
- ePrints Soton (University of Southampton) (submittedVersion)
- Figshare (submittedVersion)
- Funders
- Australian Government
- Medical Research Council
- Australian Research Council (FT120100812)
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- age at natural menopause, socioeconomic position, lifestyle factors, occupation, smoking, overweight, physical activity, biological aging, cross-national variation, women's health
- MeSH terms
- Age Factors, Female, Humans, Life Style, Menopause, Risk Factors, Smoking, Socioeconomic Factors, Body Mass Index, Women's Health
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