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      Age of menopause and determinants of menopause age: A PAN India survey by IMS

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          Abstract

          Introduction:

          Age of menopause is a very important biomarker of not only the loss of fertility but also an increased risk for various mid-life diseases and problems. Many of these diseases can be prevented by timely intervention of lifestyle modification, menopausal hormone therapy, or other supplementations such as calcium, Vitamin D, and micronutrients. In India age of menopause is less than our counterparts in the Western world. This means that the fertility potential of Indian women starts compromising early, so we need to start with the preventive measures much early. Earlier studies in India have been done on a limited population, and small sample size and not all the determinants of menopause age were considered.

          Materials and Methods:

          Survey was conducted in 21 chapters of Indian Menopause Society and all regions South, West, East and North were covered. There were 23 Medical practitioners who participated. Consent was taken and inclusion and exclusion criteria was set. Set questions were asked The questionnaire comprised of identification of the participants’ religion, education, and various socioeconomic parameters. They were also inquired about their marital and parity status, abortion, or contraceptive use. The menopausal women were asked their menopause age and whether it was natural or surgical. The perimenopausal women were asked to enlist the date of their last period. All women with <1 year to menopause were classified as perimenopausal. The height, weight, and waist circumference were noted for all the women, and body mass index (BMI) was calculated. The women were also inquired about their food habits and social habits including alcohol consumption or smoking. Hence, this study was planned as a PAN India study.

          Results:

          Average age of menopause of an Indian woman is 46.2 years much less than their Western counter parts (51 years). A definite rural and urban division was also seen. There was a correlation between the age of menopause and social and economic status, married status, and parity status.

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          Most cited references23

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          Reproductive factors and breast cancer.

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            Menopause and the risk of coronary heart disease in women.

            To determine the relation of menopause to the risk of coronary heart disease, we analyzed data on a prospective cohort of 121,700 U.S. women 30 to 55 years old who were followed from 1976 to 1982. Information on menopausal status, the type of menopause, and other risk factors was obtained in 1976 and updated every two years by mailing questionnaires. Through 1982, the follow-up rate was 98.3 percent for mortality and 95.4 percent for nonfatal events. After we controlled for age and cigarette smoking, women who had had a natural menopause and who had never taken replacement estrogen had no appreciable increase in the risk of coronary heart disease, as compared with premenopausal women (adjusted rate ratio, 1.2; 95 percent confidence limits, 0.8 and 1.8). Again compared with premenopausal women, the occurrence of a natural menopause together with the use of estrogens did not affect the risk (rate ratio, 0.8, 95 percent confidence limits, 0.4 and 1.3). Women who had undergone bilateral oophorectomy and who had never taken estrogens after menopause had an increased risk (rate ratio, 2.2; 95 percent confidence limits, 1.2 and 4.2). However, the use of estrogens in the postmenopausal period appeared to eliminate this increased risk among these women as compared with premenopausal women (rate ratio, 0.9; 95 percent confidence limits, 0.6 and 1.6). These data suggest that, in contrast to a natural menopause, bilateral oophorectomy increases the risk of coronary heart disease. This increase appears to be prevented by estrogen-replacement therapy.
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              Age at menopause, cause-specific mortality and total life expectancy.

              A later menopause has been associated with a decreased cardiovascular risk but with an increased risk for breast and endometrial cancer. The net effect on mortality is unclear. We determined the association of age at menopause with longevity and with the balance between cardiovascular and cancer mortality. We analyzed data from a breast cancer screening cohort comprising 12,134 postmenopausal women followed for an average of 17 years. We used Cox proportional hazards models and life tables to calculate the life expectancy of an average Dutch woman at age 50. During 204,024 person-years, there were 2607 deaths, of which 963 were due to cardiovascular diseases and 812 due to cancer. Ischemic heart disease risk decreased with a later menopause (hazard ratio [HR] = 0.98 per year; 95% confidence interval = 0.96-0.99), but the risk of fatal uterine or ovarian cancer increased (1.07 per year; 1.01-1.12). A later menopause was associated with longer overall survival; HR for total mortality was 0.98 per year (0.97-0.99). Life expectancy in women with menopause after age 55 was 2.0 years longer than those with menopause before age 40. Adjustment for potential confounders did not materially change the results. Age-adjusted mortality is reduced 2% with each increasing year of age at menopause. In particular, ischemic heart disease mortality is 2% lower. Although the risk of death from uterine or ovarian cancer is increased by 5%, the net effect of a later menopause is an increased lifespan.
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                Author and article information

                Journal
                J Midlife Health
                J Midlife Health
                JMH
                Journal of Mid-Life Health
                Medknow Publications & Media Pvt Ltd (India )
                0976-7800
                0976-7819
                Jul-Sep 2016
                : 7
                : 3
                : 126-131
                Affiliations
                [1]Director Ahuja Hospital and Infertility Centre, Faridabad, Haryana, India
                Author notes
                Address for Correspondence: Dr. Maninder Ahuja, Ahuja Hospital and Infertility Centre, 526, Sector 17, Faridabad, Haryana, India. E-mail: ahuja.maninder@ 123456gmail.com

                Participating Doctors

                Dr. Maninder Ahuja (Faridabad), Dr. Sudha Sharma (Jammu), Dr. Jyoti Jaiswal (Raipur), Dr. Susheela Rani (Bengaluru),

                Dr. Laxmi Maru (Indore), Dr. Ujjwala Deshmukh (Nagpur), Dr. Meeta (Hyderabad), Dr. Sonal Bathla, Dr. Charut Taneja (New Delhi),

                Dr. Bipasa Sen (Kolkata), Dr. Yashodhara Pradeep (Lucknow), Dr. Naini Tondon, Dr. Asha Ashfaq (Lucknow), Dr. Shuchita Meherishi (Jaipur),

                Dr. Suneela Khandelwal (Jaipur), Dr. Jyoti Hak (Jammu), Dr. Surjit Kaur (Jalandhar), Dr. Jignesh Shah (Ahmedabad),

                Dr. NP Kumar (Guwahati), Dr. Laxmi Ratna (Hyderabad), Dr. Iqbal Ahuja (Ludhiana), Dr. Valsan MK (Calicut),

                Dr. Vijaylakshmi Seshadri (Chennai), Dr. Jyoti M Shah (Rajkot), Dr. Beena Trivedi (Rajkot), Dr. Meeta Agarwal (Bhopal),

                Dr. Jaideep Malhotra (Agra), Dr. Jyotsana Poddar (Pune)

                Biostatistics: Dr. Perumal Vanamail, (Department of Obstetrics and Gynecology, AIIMS, New Delhi)

                Collaborators: Dr. Deepika Chhabra, Dr. Anu Chopra (Department of Scientific Services, Jagsonpal Pharmaceuticals, New Delhi)

                Article
                JMH-7-126
                10.4103/0976-7800.191012
                5051232
                27721640
                f005fe5b-90c7-4c0e-8d8e-e46bdfaac226
                Copyright: © 2016 Journal of Mid-life Health

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Categories
                Original Article

                Medicine
                determinants of age of menopause,ethnicity and menopause,menopause,smoking and menopause

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