Factors associated with early menopause

Objective: An understanding of why certain factors contribute to a more rap id decline in ovarian function may, for some women, help prevent premature loss of fecundity and the subsequent impact of health problems secondary to long-term estrogen deficiency such as osteoporosis, cardiovascular disease , and possibly Alzheimer's disease. Methods: A summary of the evidence rega rding factors that have been proposed to contribute to an early onset of na tural menopause is presented. These factors include cigarette smoking, race , education. parity, menstrual cycle length, the use of oral contraceptives , age at menarche, major depression anthropometry, and handedness. Results: Cigarette smoking has been found to hasten the onset of menopause by as mu ch as one year. Lifetime number of ovulatory cycles (indicative of oocyte d epletion) is also predictive of the age at natural menopause (ANP). This is consistent with the many studies that have reported early ANP among women with shorter menstrual cycles, and a later ANP among multigravid women or t hose who used oral contraceptives. The relationship between depressive diso rder and ovarian failure is complex, involving consideration of the pharmac ological effects of treatment, and is currently unclear. The findings regar ding an effect of body mass index on ANP are also mixed. At this time, ther e is little persuasive evidence that handedness or demographic characterist ics (independent of their relationship with behavioral factors like smoking ) influence the ANP to any substantial degree. Conclusions: Some factors th at could potentially influence ANP have been identified, but these and othe r avenues of investigation warrant further study. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.