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Body mass index and age at natural menopause: an international pooled analysis of 11 prospective studies

European Journal of Epidemiology volume 33, pages 699–710 (2018)Cite this article

Abstract

Current evidence on the association between body mass index (BMI) and age at menopause remains unclear. We investigated the relationship between BMI and age at menopause using data from 11 prospective studies. A total of 24,196 women who experienced menopause after recruitment was included. Baseline BMI was categorised according to the WHO criteria. Age at menopause, confirmed by natural cessation of menses for ≥ 12 months, was categorised as < 45 years (early menopause), 45–49, 50–51 (reference category), 52–53, 54–55, and ≥ 56 years (late age at menopause). We used multinomial logistic regression models to estimate multivariable relative risk ratios (RRRs) and 95% confidence intervals (CI) for the associations between BMI and age at menopause. The mean (standard deviation) age at menopause was 51.4 (3.3) years, with 2.5% of the women having early and 8.1% late menopause. Compared with those with normal BMI (18.5–24.9 kg/m2), underweight women were at a higher risk of early menopause (RRR 2.15, 95% CI 1.50–3.06), while overweight (1.52, 1.31–1.77) and obese women (1.54, 1.18–2.01) were at increased risk of late menopause. Overweight and obesity were also significantly associated with around 20% increased risk of menopause at ages 52–53 and 54–55 years. We observed no association between underweight and late menopause. The risk of early menopause was higher among obese women albeit not significant (1.23, 0.89–1.71). Underweight women had over twice the risk of experiencing early menopause, while overweight and obese women had over 50% higher risk of experiencing late menopause.

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Acknowledgements

The data on which this research is based were drawn from 11 observational studies. The research included data from the ALSWH, the University of Newcastle, Australia, and the University of Queensland, Australia. We are grateful to the Australian Government Department of Health for funding and to the women who provided the survey data. MCCS was supported by VicHealth and the Cancer Council, Victoria, Australia. DNCS was supported by the National Institute of Public Health, Copenhagen, Denmark. WLHS was funded by a grant from the Swedish Research Council (Grant Number 521-2011-2955). NSHD has core funding from the UK Medical Research Council (MC UU 12019/1). NCDS is funded by the Economic and Social Research Council. ELSA is funded by the National Institute on Aging (Grants 2RO1AG7644 and 2RO1AG017644-01A1) and a consortium of UK government departments. UKWCS was funded by the World Cancer Research Fund. The Whitehall II study has been supported by grants from the Medical Research Council. SMWHS was supported by grants from the National Institute for Nursing Research.

SWAN has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR) and the NIH Office of Research on Women’s Health (ORWH) (Grants U01NR004061; U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, U01AG012495). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH or the NIH. Clinical Centers: University of Michigan, Ann Arbor – Siobán Harlow, PI 2011 – present, MaryFran Sowers, PI 1994-2011; Massachusetts General Hospital, Boston, MA – Joel Finkelstein, PI 1999 – present; Robert Neer, PI 1994 – 1999; Rush University, Rush University Medical Center, Chicago, IL – Howard Kravitz, PI 2009 – present; Lynda Powell, PI 1994 – 2009; University of California, Davis/Kaiser – Ellen Gold, PI; University of California, Los Angeles – Gail Greendale, PI; Albert Einstein College of Medicine, Bronx, NY – Carol Derby, PI 2011 – present, Rachel Wildman, PI 2010 – 2011; Nanette Santoro, PI 2004 – 2010; University of Medicine and Dentistry – New Jersey Medical School, Newark – Gerson Weiss, PI 1994 – 2004; and the University of Pittsburgh, Pittsburgh, PA – Karen Matthews, PI.

NIH Program Office: National Institute on Aging, Bethesda, MD – Chhanda Dutta 2016 – present; Winifred Rossi 2012 – 2016; Sherry Sherman 1994 – 2012; Marcia Ory 1994 – 2001; National Institute of Nursing Research, Bethesda, MD – Program Officers.

Central Laboratory: University of Michigan, Ann Arbor – Daniel McConnell (Central Ligand Assay Satellite Services).

Coordinating Center: University of Pittsburgh, Pittsburgh, PA – Maria Mori Brooks, PI 2012 - present; Kim Sutton-Tyrrell, PI 2001 – 2012; New England Research Institutes, Watertown, MA - Sonja McKinlay, PI 1995 – 2001.

Steering Committee: Susan Johnson, Current Chair; Chris Gallagher, Former Chair

All studies would like to thank the participants for volunteering their time to be involved in the respective studies. The findings and views in this paper are not necessarily those of the original studies or their respective funding agencies.

Author’s contribution

DZ performed statistical analyses and drafted the manuscript. HFC and NP harmonised the data and contributed to critical revision of the manuscript. AJD, DK, SLC, EBG, NEA, GGG, FB, HOA, EW, DCG, JEC, ESM, NFW, EJB, and MKS provided study data and contributed to critical revision of the manuscript. GDM conceptualized the study and provided critical revision of the manuscript for intellectual content.

Funding

InterLACE project is funded by the Australian National Health and Medical Research Council Project Grant (APP1027196). GDM is supported by Australian National Health and Medical Research Council Principal Research Fellowship (APP1121844). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. School of Public Health, University of Queensland, Brisbane, QLD, 4006, Australia

    Dongshan Zhu, Hsin-Fang Chung, Nirmala Pandeya, Annette J. Dobson & Gita D. Mishra

  2. Medical Research Council Unit for Lifelong Health and Ageing at UCL, London, UK

    Diana Kuh

  3. Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA

    Sybil L. Crawford

  4. Department of Public Health Sciences, University of California, Davis, Davis, CA, USA

    Ellen B. Gold

  5. Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Nancy E. Avis

  6. Cancer Epidemiology and Intelligence Division Centre, Cancer Council Victoria, Melbourne, VIC, Australia

    Graham G. Giles & Fiona Bruinsma

  7. Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia

    Graham G. Giles

  8. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Hans-Olov Adami & Elisabete Weiderpass

  9. Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway

    Hans-Olov Adami

  10. Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland

    Elisabete Weiderpass

  11. Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway

    Elisabete Weiderpass

  12. Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway

    Elisabete Weiderpass

  13. Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK

    Darren C. Greenwood & Janet E. Cade

  14. Family and Child Nursing, School of Nursing, University of Washington, Seattle, WA, USA

    Ellen S. Mitchell

  15. Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA, USA

    Nancy F. Woods

  16. Department of Epidemiology and Public Health, University College London, London, UK

    Eric J. Brunner

  17. UcDiakonissen and Parker Institute, Frederiksberg, Denmark

    Mette Kildevæld Simonsen

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  1. Dongshan Zhu
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  2. Hsin-Fang Chung
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  18. Mette Kildevæld Simonsen
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  19. Gita D. Mishra
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Correspondence to Gita D. Mishra.

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Zhu, D., Chung, HF., Pandeya, N. et al. Body mass index and age at natural menopause: an international pooled analysis of 11 prospective studies. Eur J Epidemiol 33, 699–710 (2018). https://doi.org/10.1007/s10654-018-0367-y

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