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Type: Journal article
Title: Socioeconomic position, lifestyle factors and age at natural menopause: a systematic review and meta-analyses of studies across six continents
Author: Schoenaker, D.
Jackson, C.
Rowlands, J.
Mishra, G.
Citation: International Journal of Epidemiology, 2014; 43(5):1542-1562
Publisher: Oxford University Press
Issue Date: 2014
ISSN: 0300-5771
Statement of
Danielle AJM Schoenaker, Caroline A Jackson, Jemma V Rowlands and Gita D Mishra
Abstract: BACKGROUND: Age at natural menopause (ANM) is considered a marker of biological ageing and is increasingly recognized as a sentinel for chronic disease risk in later life. Socioeconomic position (SEP) and lifestyle factors are thought to be associated with ANM. METHODS: We performed a systematic review and meta-analyses to determine the overall mean ANM, and the effect of SEP and lifestyle factors on ANM by calculating the weighted mean difference (WMD) and pooling adjusted hazard ratios. We explored heterogeneity using meta-regression and also included unpublished findings from the Australian Longitudinal Study on Women's Health. RESULTS: We identified 46 studies across 24 countries. Mean ANM was 48.8 years [95% confidence interval (CI): 48.3, 49.2], with between-study heterogeneity partly explained by geographical region. ANM was lowest among African, Latin American, Asian and Middle Eastern countries and highest in Europe and Australia, followed by the USA. Education was associated with later ANM (WMD middle vs low education 0.30, 95% CI: 0.10, 0.51; high vs low education 0.64, 95% CI 0.26, 1.02). A similar dose-response relationship was also observed for occupation. Smoking was associated with a 1-year reduction of ANM (WMD: -0.91, 95% CI: -1.34, -0.48). Being overweight and moderate/high physical activity were modestly associated with later ANM, but findings were less conclusive. CONCLUSIONS: ANM varies across populations, partly due to differences across geographical regions. SEP and some lifestyle factors are associated with ANM, but further research is needed to examine the impact of the associations between risk factors and ANM on future health outcomes.
Keywords: Menopause; smoking; body mass index; physical activity; socioeconomic factors; systematic review; meta-analysis
Description: Advance Access Publication Date: 26 April 2014
Rights: © The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact
RMID: 0030069284
DOI: 10.1093/ije/dyu094
Grant ID:
Appears in Collections:Medical Sciences publications

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