Elsevier

Maturitas

Volume 57, Issue 2, 20 June 2007, Pages 139-153
Maturitas

The timing of natural menopause in Poland and associated factors

https://doi.org/10.1016/j.maturitas.2006.12.001Get rights and content

Abstract

Objectives

The outcome of interest was the assessment of age at natural menopause and the variables hypothesized as covariates of age at menopause were indicators of demographic and social status, characteristics of the reproductive history and lifestyle behaviour.

Methodology

Seven thousand one hundred and eighty-three women from all social strata of non-clinical population, and aged between 35 and 65 years were investigated in cross-sectional survey across Poland in 2000–2004. The demographic, social, lifestyle behaviour and reproductive history aspects of the menopause-specific questionnaire were examined. The non-parametric Kaplan–Meier cumulative survivorship estimates were used to assess the timing of natural menopause. Univariate and multivariate Cox proportional hazards regression models were used to assess the association of age at natural menopause with factors of interest and to estimate relevant relative risk (the hazard ratio) for earlier age at menopause.

Results

The overall median age at natural menopause was 51.25 years; 25th percentile 49; 75th percentile 54 years. Temporal changes in age at menopause were not demonstrated in the sample (p = 0.9 for differences among age cohorts). Univariate Cox models were first fitted to the age at natural menopause for all covariates singly. The findings revealed that marital status, living environment, employment, BMI, age at first live birth delivered by a woman, breastfeeding, physical activity, smoking amount, and consumption of alcohol were not associated with age at menopause (p > 0.05). The multiple Cox model revealed that early menarche, short menstrual cycle length, smoking cigarettes, a low level of education, and a negative health perception were associated with younger age at menopause (p < 0.01). Use of oral contraceptives and parity were associated with later menopause (p < 0.01).

Conclusion

The present study provides an estimate of median age at natural menopause in Poland that may be used as a measure of health for the growing number of Polish women whose survival is calculated at 30 years after menopause. This study has revealed that the pattern of relationship between age at menopause and the study factors reflects its population-specific character for its social and cultural backgrounds, socio-economic status, and social behaviours.

Introduction

The long-term pattern of demographic change in Poland, the decrease in mortality and gain in life expectancy, has resulted in an increased number of women in middle and later life [1]. By the year 2030 a projected 10.3 million women 45 years and older will be living in Poland, nearly double the current number. Women's life expectancy this year will be 83.3 years [2]. The dramatic increase in life expectancy has led to women expecting to live more than a third of their lives after menopause.

Natural menopause is defined as a complex biosocial and biocultural phenomenon, which occurs spontaneously in a women's midlife. It refers to the permanent cessation of menses resulting from the loss of ovarian follicular function [3]. The timing of natural menopause may serve as a marker for the process of reproductive ageing, with earlier age at menopause indicating premature ageing [4]. It may also serve as an indicator of population health as the occurrence of menopause indicates the increased risk for the onset of several chronic diseases [5], [6], [7], [8]. Women with an earlier menopause are at an increased risk of cardiovascular disease and osteoporosis, whereas women with later menopause are at an increased risk of breast and endometrial cancer.

Numerous studies have examined the menopause transition to date, yet there have been few in Central and Eastern Europe [9], [10], [11], [12], [13], [14]. Their findings have revealed a considerable variability in age at menopause among populations in a large variety of geographic, social and cultural settings [15], [16]. They have also shown that variation in age at menopause is associated with several factors, such as genetic, reproductive, demographic, socio-economic, and lifestyle behaviours, though various studies have produced inconsistent results [17], [18], [19].

In Poland, the investigation of the age at menopause goes back to the research in the late 1930s [20]. However, the problem of ageing women has recently come to the fore. In a few studies carried out to date, the average age at menopause has been estimated at 48, 50 and 51 years. The findings have shown urban–rural differences and temporal changes within the population [21], [22], [23]. Comparison of the findings is, however, made difficult by the different methodologies applied across studies.

A search for up-dated records of menopause in Polish women has stimulated our interest in this issue. The aim of the present study is two-fold: (1) to estimate the average age at natural menopause among Polish women using an approach designed to avoid the problems that might account for the inconsistent results of the prior studies and (2) to assess the association of age at menopause with biological, demographic, social and lifestyle factors.

Section snippets

Study design and the sample

During 2000–2004 a cross-sectional survey of middle-aged women's health and well-being (WOMID) was conducted across Poland. The Local Bioethics Committee approved the project. Women were enrolled in the study from randomly selected sites of all residence categories. First, the written information regarding the objectives of the study and the invitation to participate in it were sent to the local media, health and fitness centres, places of employment, and universities of the third age situated

Sample characteristics

Socio-demographic, reproductive history, health and lifestyle behaviour characteristics by menopausal status of the study women are presented in Table 1.

The mean age of women was 49.5; 95% CI: 49.3–49.6; S.D. 7 years with a skewness of 0.13 and a kurtosis of −0.51, indicating a fairly symmetric distribution of age. Overall, a large proportion of the study women were still menstruating (43.9%). Women with experience of taking hormones prior to menopause consisted of 6.6% of the sample, and those

Discussion

The present study is the first comprehensive estimation of age at natural menopause and underlying biological and social factors in a representative sample of Polish women. Much of the data, however, notably age at menopause, age at menarche, menstrual cycle characteristics, breastfeeding habits, were obtained through self-reports of earlier life events, and were thus subject to retrospective recall errors [26], [27], [28], [29], [30], [31], [32]. Do et al. [33] in a follow-up study of

Conclusion

In summary, this study has provided an estimate of median age at natural menopause in Poland that may be used as a measure of health for the growing number of Polish women whose survival is calculated at 30 years after menopause.

This study has revealed that a set of biological and socio-demographic factors had been associated with the timing of menopause in Poland. Early menarche, short menstrual cycle length, smoking cigarettes, a low level of education and a negative health perception were

Acknowledgements

My thanks are due to my graduate students for their contribution to data collection. I am grateful to Dr. M. Sitek for statistical advice. Most of all, I thank the study participants, Polish women, whose generosity made this research possible. I also thank anonymous reviewers for their stimulating comments and suggestions.

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