A study published in Scientific Reports explored the triggers of premature and early menopause in India based on the National Family Health Survey 2019–2021. There were 96 million women over the age of 45 in India in 2011, a number expected to rise to more than 400 million by 2026.
Record
Biologists have hypothesized that the natural age for women to experience menopause, defined as ovarian failure, is between 45 and 50 years of age, when individuals transition into a post-reproductive stage of life. Menopause before age 40 is considered premature, while menopause before age 45 is considered early menopause.
Estimating the prevalence of premature and early menopause and identifying risk factors associated with them can enable public health professionals and policy makers to design appropriate policy interventions and ensure the readiness of health systems to meet the needs of this population.
About the study
In addition to calculating prevalence, the researchers in this study hypothesized that lifestyle behaviors, medical history, and demographic and socioeconomic factors would modify the risk of premature and early menopause. The data used for the analysis came from the fifth round of the Indian National Family Health Survey (NFHS), which included 724,115 female respondents.
After excluding women who were pregnant or breastfeeding at the time of the study, as well as those who had undergone surgical menopause, the final sample included 429,446 women who had experienced early menopause and 79,643 women who had early menopause. Women were categorized as postmenopausal if they had not had a menstrual cycle for a year or more.
Socioeconomic and demographic factors included education, status, religion, place of residence, household wealth index, employment status, marital status, and geographic region. Lifestyle behaviors included tobacco and alcohol consumption as well as unhealthy dietary patterns (specifically high intake of fizzy drinks and fried foods). Anthropometric data were used to assess body mass index (BMI) and anemia status.
Hazard ratios were calculated from these data to estimate how the risk of early or premature menopause changed for women in different demographic, socioeconomic, and other categories.
Foundings
Prevalence analysis showed that 2.23% of women between 15 and 39 years experienced early menopause, while 16.2% of women between 40 and 44 years experienced early menopause. The majority of women experiencing early and premature menopause resided in rural areas (66%), and 15 to 40% of these women had received no education. Almost 40% were poor, most were married, and more than 60% had given birth to their first child when they were between 18 and 24 years old.
Time trends showed that the prevalence of early menopause showed a gradual decrease over time. Early menopause peaked in 1998-1999 (3.4%) before declining or remaining stable in subsequent waves. In contrast, early menopause, which had a prevalence of 21% in the 1990s, fluctuated over time.
Bivariate analyzes showed that rural women, working women, women with low education, those with low household wealth and those belonging to the ‘other backward classes’ (OBC) category were significantly more likely to experience early menopause. Women in North and West India were also at higher risk. Other risk factors included regular intake of fried foods, alcohol use and tobacco consumption. For early menopause, bivariate analysis identified similar risk factors.
Survival models suggested that higher educational levels were protective against early menopause, as were unemployment and high wealth. Women who reported never marrying were less likely to have an early menopause, while those who had terminated a pregnancy faced a greater risk. Other risk factors included smoking and using unsanitary menstrual methods. Women whose age at menarche was 12 years or younger had an increased risk of early menopause compared with those whose age at menarche was 15 years or older.
conclusions
In summary, the study used a large-scale, nationally representative population survey to assess the prevalence and drivers of premature and early menopause. The authors hypothesized the existence of links related to nutrition and poverty. Specifically, educational, economic, and household vulnerabilities could intersect and lead to compound effects on age at menopause.
Strengths of the study include its methodological robustness and the use of a nationally representative survey, which collected detailed data to assess the relative importance of various factors in early and premature menopause. The comprehensive medical history made it easy to exclude women who had a hysterectomy or low estrogen levels. However, the self-reported nature of the menstrual data could lead to recall bias, and the cross-sectional design does not allow for causal inference.
Further study on this topic, particularly through detailed micro-studies, will strengthen the public health system and enable public health initiatives to target health and nutrition interventions for underprivileged women to address menopause-related problems such as osteoporosis.
