Adolescent childbirth associated with early menopause and hysterectomy

A new study has shown that women who gave birth as adolescents tend to have a greater chance of an early menopause or a hysterectomy. The study, which looked at reproductive histories of women from several countries and income groups, is presented at the World Congress of Menopause in Vancouver.

There is increasing evidence that early life experiences can impact what happens in later life. It is also known that reaching menopause at a later age is associated with lower rates of cardiovascular disease and increased lifespan. However, little has been known about which associations are culture specific, and which are more generally applicable to women worldwide.

To test this, a group of researchers led by Dr. Catherine Pirkle (Office of Public Health Studies, University of Hawaii at Manoa) and Dr. Maria Velez (Department of Obstetrics and Gynecology, Queen’s University, Kingston, Ontario) looked at data from the International Mobility in Aging Study, a Canadian-led study, which looked at women’s health in Albania, Colombia and Brazil, as well as Ontario and Quebec, Canada.

The study looked at the health histories of 1047 women, and found significant variation: just 29 percent had reached an early menopause (menopause by 45 years old) in Albania, as opposed to 41 percent in Colombia. Most of these women had had a hysterectomy (around half of women reporting an early age at menopause also had a hysterectomy, compared to less than a quarter of women with later ages at menopause ). Women from the poorer countries of Brazil and Colombia also reported high rates of early natural menopause (>30 percent) compared to the other wealthier sites (around 20 percent or less), which suggests faster reproductive aging at these poorer study sites.

However, those women who reported social adversity in childhood were around 56 percent more likely to have had an early reported menopause (OR=1.56, p=0.04), and this was true across the countries studied. In addition, women who gave birth under the age of 20 were around 64 percent more likely to have had a hysterectomy than women who gave birth later (OR=1.64, p=0.01). The result was identical when they looked at hysterectomy plus oophorectomy (e.g. hysterectomy plus removal of the ovaries). These findings took into account many other factors that might also explain a relationship between these variables and early menopause.

In women who did not have a hysterectomy, these associations disappeared. See below for results.

Lead researcher, Catherine Pirkle said:

“This work shows that things that happen to you when you are young can affect your health many years later, including when you commence menopause. It shows that giving birth early is linked with an increased rate of hysterectomy. It also shows that having a difficult childhood increases the chance of an early menopause, across a range of cultural and financial settings.

This is important for health in later life. We know that reaching menopause at a later age is associated with better quality of life, and better health outcomes in women. This work implies that early birth or a difficult childhood may be storing up problems which only come out half a lifetime later”.

Commenting, World Congress on Menopause Scientific Programme Committee Chair, Professor Nick Panay (Imperial College, London) said:

“This study demonstrates possible associations between early childbirth and hysterectomyandbetween difficult childhood andearlymenopause. If these associations are confirmed these are of great importance because this has implications for future fertilityaspirations, but also for health implications, if early menopause is notadequately treatedwith hormone therapy.”

“In women with early menopause, quality of life, metabolic, bone, cardiovascular,cognitive health and life expectancy can be adversely affectedif adequate hormone therapy is not used at least until the average age of menopause.”

“The information from this study canbe used to counsel women withearly childbirth anddifficult childhood about their potential risks. This will empower themto optimise theirgeneral and reproductivehealth.”

Professor Panay was not involved in this research.

Results

• 348 of the 1047 women in the study reported reaching the menopause before the age of 46.
• 112 women in the sample also reported experiencing social adversity (which was defined as experiencing two or more of the following: parental drug/alcohol abuse, witnessing family violence, or being physically abused), and 47 of these women (42 percent) had an early menopause. This compares with just 34 percent of the women who had not experienced social adversity who reported an early menopause (unadjusted p-value = 0.078).

The situation was also reflected in women who had a child early. 43 percent of women who had a child while under the age of 20 also had an early menopause (92 women in the total study). This compares with just 33 percent of women who had a child later and then went on to have an early menopause (unadjusted p-value 0.012)

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