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Title:Age at natural menopause in a population-based screening cohort: the role of menarche, fecundity, and lifestyle factors
Author:P.A.H. van Noord et al.
Address:Utrecht, The Netherlands
Source:Fertility and Sterility 14: 95-102 (June)1997
Summary:A group of 3756 Dutch women born between 1911 and 1925 experiencing natural menopause were surveyed from the general population. No correlation could be made between the age at menarche and the age at menopause. The age at menopause (no menses for 12 months) was 50.16 ± 4.15 years. Increased parity, higher socioeconomic status, less smoking, having fewer siblings were independently associated with later age at menopause. There tended to be a slight trend toward menopause occurring at later age. There was also menopause at a later age in past pill users (51.49 years) , but relatively few women used the pill and they were in the younger portion of the study group that tended to have later menopause. The real significance may be obscured. The authors conclude that the greatest determinants are the genetics and the oocyte pool and that there are few (if any) lifestyle changes that may modify age at menopause with subsequent alteration
Comment:This study benefits from an open population, not clinically based, and sound statistical analysis. Frisch, presented the hypothesis of a critical weight necessary for menarche also stated that the later the onset of menses, the earlier the menopause. The former hypothesis has been severely criticized , if not disproven, and now it appears that the latter of her hypotheses may also be incorrect. The authors tend to favor the still, yet to be proven theory, that the suppression of ovarian function whether by oral contraceptives or pregnancy protects oocyte stores and prolongs reproductive function. A past study showed that Lupron given to rats suppressed ovulation function and extended their reproductive life by approximately the time the drug was administered. A caveat is that early follicle growth is supposed to be independent of gonadotropin stimulation and therefore, should not be effected by any hormonal manipulation. The mechanism of how the follicles are chosen to leave the resting pool represents an important piece of the puzzle.