While doing some research on peri/meno I came across a study that proves out what many of us have been saying on this site regarding age and peri/meno. It contridicts what most drs tell us when they give us that "You are too young" look. Since we are limited on posting links I am cutting and pasting the most interesting details. Anyone who wants the link can pm me and I will be happy to supply. Hugs, Susan
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Numerous studies on the distribution of age at menopause have been published in the past 20 years . These efforts have been motivated partly by interest in the natural history of ageing and more recently by evidence that the incidences of chronic diseases, such as osteoporosis, cardiovascular disease and, possibly, certain cancers vary with menstrual status. Associations of disease incidence with menstrual status lead naturally to the idea that the lifetime risks of these diseases vary with age at menopause, which has further increased interest in identifying factors with which age at menopause varies.

One review of the data on natural menopause noted the prevailing view that menopause results from peripheral organ failure, namely of the ovaries, but that the mechanisms and the role of the pituitary gland remain unknown. The median age of menopause, 50 years, has not changed in the past century according to some reports. Although this would appear to support the notion that age at menopause is predetermined, a number of environmental factors have been shown to affect ovarian function.

There is considerable uncertainty as to what factors affect the timing of menopause. Genetic and racial factors have recently been proposed to be the most important determinants of age at natural menopause. In addition to genetic factors, several behavioural (smoking, nutrition, and sociodemographic factors), reproductive and anthropometric factors are also associated with age at menopause.

Factors that affect menopause timing may have important clinical implications because early menopause is associated with an increased risk of cardiovascular disease and osteoporosis, whereas delayed menopause has been associated with increased risk of breast cancer and endometrial cancer. These associations may result from the direct effect of menstrual function (or cessation of function) and the related hormone changes, or may be an indirect result of the other previously mentioned factors that are associated with age at menopause. The connection of menopausal age with risk factors for such medical conditions makes age at menopause an important epidemiological issue.

A retrospective, descriptive, epidemiological study was conducted. The target population was women with menopausal amenorrhoea for 1-5 years, who were aged 30 years and over and were living in Alexandria Governorate during the period from 1 November 1995 to 31 October 1996. Women who reported 12 continuous months of amenorrhoea (according to World Health Organization criteria), without a hysterectomy or other procedure that would have stopped their menses, were classified as naturally menopausal. Age at natural menopause (NM) was defined as the age at last menstrual period.

The majority (289, 96.33%) of the 300 menopausal women had reached their menopause spontaneously (i.e. natural menopause); only a minority (11, 3.67%) had experienced menopause after oophorectomy (i.e. surgical menopause) and were excluded from the study.

The age range of the women with NM was 30-59 years; the age range was 40-54 years in most of the cases (88.93%). Premature NM (at age 30-39 years) was experienced by 7.96%, while late NM (at age 55-59 years) was reported by 3.11% of the women. Distribution of the observed age at menopause was unimodal and a peak in the age group 45-49 years was noted. The median age at NM was 47.00 years, while the mean age was 46.70 ± 5.44 years.

Reproductive Characteristics

Age at menarche. Age at menarche among the women ranged from 9 years to 17 years with a mean age of 12.24 ± 1.32 years. Most of the women (83.04%) had menarche between 11 years and 13 years, while 12.46% had menarche at an older age (> 13-17 years) and 4.50% at a younger age (9-< 11 years). However, although age at menarche was positively associated with that of NM, the relationship was not statistically significant (r = 0.03, P = 0.581 and F = 1.15, P = 0.318).

Gravidity and parity. For the ever-married women, the number of conceptions ranged from 0 to 15 with a mean of 6.19 ± 3.29 pregnancies. The number of deliveries ranged from 0 to 10 with a mean of 5.09 ± 2.52 births. About two-thirds of these women (66.91%) had had five or more pregnancies and more than half of them (55.25%) had had five or more deliveries. Only a minority (2.80%) had never conceived or had a baby. The highest age at NM was found among those who had had 1-2 pregnancies or deliveries (47.94 ± 5.34 years and 47.64 ± 6.05 years respectively). There was a positive relationship between age at NM and both gravidity and parity (r = 0.03, P = 0.579 for each). However, all these relationships were not statistically significant.

Age at first and last live birth. The women who had had children had their first live birth at a mean age of 20.53 ± 4.41 years and their last one at a mean age of 33.37 ± 6.26 years. Less than half of them (48.92%) had had their first child before the age of 20 years (14-< 20 years), while more than half (51.08%) had had the first child at the age of 20 years and over (20-29 years). On the other hand, more than two-thirds (68.35%) had delivered their last child between the age of 20 years and 35 years and less than one-third (30.93%) did so above the age of 35 years (> 35-53 years); only two women (0.72%) had their last child before the age of 20 years. The age at NM was significantly positively associated with both age at first live birth (r = 0.19, P = 0.002 and t = 2.69, P = 0.008) and age at last live birth (r = 0.27, P = 0.001 and F = 4.92, P = 0.006).

Previous abortions. Less than half (44.76%) of the married women had not had any abortions. More than half of them (55.24%) had a history of abortion. Of these, 45.80% had suffered spontaneous abortions 1-7 times with a mean of 2.12 ± 1.51 abortions. On the other hand, 9.44% had 1-6 induced abortions with a mean of 2.31 ± 1.61 abortions. NM occurred earlier among those who had a history of abortion (46.46 ± 5.59 years) and those who had experienced spontaneous abortion (46.42 ± 6.06 years) although the differences were not significant. Correlation analysis revealed a positive but non-significant relationship between the number of spontaneous abortions and age at NM (r = 0.10, P = 0.243).

Menstrual Characteristics

Duration of menses. The duration of menstrual periods ranged from 3 days to 10 days with a mean of 5.15 ± 1.53 days. Correlation analysis revealed a negative but non-significant relationship between age at NM and duration of menses (r = -0.10, P = 0.10).

Regularity of menstrual periods. Menstrual periods were regular in 96.89% of the women before the age of 25 years and in 92.04% after that age. Having irregular periods before the age of 25 years was significantly associated with a higher age at NM (51.00 ± 3.12 years) compared with having regular ones (46.55 ± 5.45 years) (t = 2.44, P = 0.015). The same relationship was found after the age of 25 years, but it was not statistically significant (t = 0.33, P = 0.745).

Dysmenorrhoea. Half (50.17%) of the women had experienced their menstrual periods without pain, while 43.60% and 6.23% had suffered from spasmodic and congestive dysmenorrhoea respectively. It was found that both congestive and spasmodic dysmenorrhoea were significantly associated with a higher age at NM (48.67 ± 3.33 years and 47.30±5.71 years respectively) compared with painless periods (45.91 ± 5.31 years) (F = 3.53, P = 0.031).

Midcycle spotting. The few women who reported midcycle spotting (2.77%) reached NM significantly later (48.37 ± 1.68 years) than those who did not (97.23%) (46.64 ± 5.50 years) (t = 2.55, P = 0.026).

Pattern of menstrual cessation. Two-fifths (39.79%) of the women had entered their NM abruptly, while the rest (60.21%) experienced a gradual cessation of menstruation over a mean transitional period of 16.84 ± 16.71 months. Sudden cessation of menstruation was significantly associated with lower age at NM (43.94 ± 5.30 years) compared with those with gradual cessation (48.51 ± 4.73 years) (t =7.47, P < 0.001).

Exogenous Hormonal Use

The only form of hormones used by the women was contraceptive pills. Among the women, 59.44% had never used contraceptive pills, while 40.56% had used them at some time in their lives for a period that ranged from 0.25 years to 23 years with a mean of 7.43 ± 5.32 years. Although no significant difference could be detected among pill-users and non-users as regards age at NM, which was more or less similar in both groups, the duration of pill use was positively associated with the age at NM (F = 4.49, P = 0.013 and r = 0.23, P = 0.012).

Smoking

The majority (96.19%) of the women were non-smokers; only a minority (3.81%) were current cigarette smokers. The duration of smoking ranged from 10 years to 27 years with a mean of 18.86 ± 6.30 years. All the smokers smoked less than one packet a day. The mean age at NM was slightly lower among cigarette smokers (46.43 ± 3.23 years) than the non-smokers (46.70 ± 5.53 years). However, the difference was not significant (t = 0.16, P = 0.84).

Psychological Factors

The Middle Sex Test revealed that the most common neurotic traits were psychosomatism (psychosomatic symptoms) (53.63%), followed by depression (49.13%) and obsession (46.37%). Anxiety was less common (31.14%), while phobia and hysteria were the least common (17.65% and 8.30% respectively).

When neurotic traits were considered as a factor in menopausal timing, symptoms of anxiety, phobia, obsession and hysteria were found to be associated with early NM. The reverse was found with psychosomatism and depressive symptoms. However, the age differences were insignificant between those with and those without the traits as shown by t-values. On the other hand, correlation analysis revealed that obsessive symptoms were significantly negatively correlated with age at NM (r = -0.12, P = 0.035).

General Health Status

Findings revealed that 34.95% of the women had hypertension, 23.53% had diabetes mellitus and 9.69% had ischaemic heart disease. Hypertensive women experienced NM at a significantly higher age (48.36 ± 5.55 years) than normotensive women (45.79 ± 5.18 years) (t =3.91, P = < 0.001). Diabetics experienced NM at a higher age (47.74 ± 5.12 years) than the non-diabetics (46.37 ± 5.51 years), while women suffering from ischaemic heart disease experienced NM at an earlier age (44.89 ± 6.38 years) than the non-ischaemic women (46.88 ± 5.31 years). However, these differences were not significant (t = 1.82, P = 0.070 and t = 1.85, P = 0.066 respectively).

Anthropometric Measurements

The weights of the women ranged from 48 kg to 143 kg with a mean of 81.39 ± 16.78 kg. Their heights ranged from 146 cm to 176 cm with a mean of 160.10 ± 5.79 cm. BMI ranged from 22.80 kg/m2 to 68.00 kg/m2 with a mean of 38.59 ± 7.88 kg/m2.

The majority (96.87%) of the women were obese as indicated by the BMI values; 57.29% and 31.94% were grade II and III respectively and only 7.64% were grade I. Only a minority (3.13%) were not obese or were of a normal weight.

Both weight and BMI were significantly positively correlated with the age at NM (r = 0.21, P = < 0.001 and r = 0.20, P < 0.001 respectively). A positive but non-significant correlation was found between height and age at NM (r = 0.086, P = 0.086).

Analysis

When factors associated with age at NM were related to each other in multiple linear regression analysis (Table 1), only four factors were found to be significant predictors of age at NM. They were: age at last delivery (b = 0.449), residence (b = 0.306), pattern of menstrual cessation (b = 0.275) and duration of pill use (b = 0.261). Age differences found for other independent variables were not significant. Thus it was revealed that a women with early NM (i.e. short fertile span) was one who had her last baby at an early age, lived in a semiurban area, abruptly ended her periods and had used contraceptive pills for a short period.

Earlier menopause in thinner women may be due in part to the tendency of smokers to be thin. On the other hand, the association of obesity with later menopause may be due to the greater availability of endogenous estrogen produced in the adipose tissue from its androgenic precursor.

A wide range for the age of NM has been reported in different countries. In our study, the mean age at NM was 46.70 ± 5.44 years; the median was 47 years. In the USA (51.50 years in 1997), Finland (51.00 years in 1994), the UK (50.70 years in 1989) , Sweden (50.10 years in 1993) and Ghana (48.00 years in 1993).
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While this study isn't the do all and say all of peri/meno, it does point out some interesting data. Susan

Hi Susan,

Interesting results. I thought the mean number of children per woman seemed pretty high, and the mean number of smokers pretty low. I looked it up, and this study was preformed in Alexandria, Egypt. Interesting, the difference in a woman's life, on the other side of the globe.

Hi Duch,

It sure would be nice if someone in the US did a similar study, wouldn't it? Be at the very least most of the info still validates what we have all been saying here on PS. I do wonder why there is the small difference in mean age in other countries. Since this study provided basic similarities such as age of menarche, number of births, smokers, weight etc. it wouldn't explain the four or so year difference.

Oh well, I think I have spent too much time trying to figure this all out.

Hugs,
Susan

Wow, look at how heavy these women are ! Mean BMI is 38+ ?

Interesting that the median age of NM is 47 and mean (average) is 46. That average is way lower than what is claimed in the U.S. I've been wondering if that U.S. average is correct. Was it calculated from actual study data ? Or is it lore from an unknown source, that we're all repeating thinking it's true ?

Here's one way, with a group of 5 ages, to get a median of 47 and a a mean of 46: 40, 41, 47, 49, 53. Lows that are farther from the median point than the highs will cause the mean to be lower than the median.

I'm guessing the Egyptian women do not eat as much hormone injected meat and dairy as we do. I wonder if that has impact.

MamaMia, thank you so much for posting that article ! It's REALLY interesting ! I'm going to be obsessively dissecting it over and over during the next few days. :-)