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Factors associated with age at natural menopause in Iranian women living in Tehran
BRIEF COMMUNICATIONS
175
Factors associated with age at natural menopause in Iranian women living in Tehran Mahnaz Ashrafi a,b,⁎, Saeed Kazemi Ashtiani c , Farideh Malekzadeh a , Elham Amirchaghmaghi a , Fahimeh Kashfi d , Babak Eshrati d a
Endocrinology and Female Infertility Department, Royan Institute, Tehran, Iran Faculty of Medicine, Iran University of Medical Sciences and Health Services, Tehran, Iran c Stem Cells Department, Royan Institute, Tehran, Iran d Epidemiology Department, Royan Institute, Tehran, Iran b
Received 17 November 2007; received in revised form 20 February 2008; accepted 3 March 2008
KEYWORDS Age; Natural menopause; Reproductive factors
Following approval from the Royan Institute Ethics Committee, we conducted a study in 2004 and 2005 to determine the factors associated with age at natural menopause in Tehran, capital of Iran. In this cross-sectional study, women aged 35 years or older and living in Tehran were selected by multistage randomized cluster sampling. Clusters for each of the 22 metropolitan districts of Tehran were randomly selected from clusters used in the health and disease study Iran in 2000 [1]. In each cluster, 50 questionnaires were filled out by female student midwives during a face-to-face interview with the selected participants. The interviews took place in the afternoon to prevent selection bias as many younger women are at work in the morning. If a woman did not fully participate, she was replaced by another woman. The questionnaire consisted of a series of questions concerning age, age at menarche, age at menopause, regularity of menstrual cycles, parity, total breast-feeding duration, smoking habits, mother's age at menopause, occupation, and marital status. Data analysis was performed by means of the Mann—Whitney test, the t test, and linear regression using SPSS software (SPSS, Chicago, IL, USA). A total of 7711 questionnaires were completed. Of the 3261 women who were postmenopausal, 2462 were naturally so. Their mean ± SE age at natural onset of menopause was 47.71 ± 0.11 years, and 7% of them had experienced irregular menstruation.
⁎ Corresponding author. Endocrinology and Female Infertility Department, Royan Institute, P.O. Box: 19395-4644, Tehran, Iran. Tel./fax: +98 21 22510895. E-mail address: [email protected] (M. Ashrafi). doi:10.1016/j.ijgo.2008.03.010
The linear regression analysis showed significant associations between age at menopause and parity, mother's age at menopause, and irregular menstruation. The mean age at menopause for women with regular and irregular menses was 47.83 ± 0.1 years and 46.13 ± 0.4 years, respectively (P b 0.001). There was a reverse correlation between age at menopause and irregular menstruation (r = −2.04, P= 0.001). Age at menopause was also directly associated with parity (r = 0.17, P= 0.001). Age at menopause was 48.5 ±4.87 years and 48.13 ±4.82 years, respectively, for the participants' mothers and sisters, and there was an association between age at menopause and mother's age at menopause (r =0.32, P= 0.001). The relations between age at menopause and age at menarche, marital status, age at marriage, total duration of breast feeding, and smoking history were not significant (P N 0.05) (Table 1). Other studies determined that mean age at menopause was 48.3 ± 5.3 years in Shiraz [2] and 50.4 years for the whole of Iran [1]. Although sampling methods and studied populations differed between studies, the mean reported ages at menopause were similar. Reports of several studies have shown age at menopause to be influenced by menstrual and reproductive factors [2,3]. The present study showed that the mean age at natural menopause increased with increasing parity which was similar to Ayatollahi et al [2] while Ozdemir and Col [4] found no effect of parity on age at menopause in Ankara, Turkey. In the present study there was a significant reverse correlation between age at menopause and regularity of the menstrual cycle, but Meschia et al. [3] in Italy and Ozdemir and Col in Turkey [4] did not find significant a correlation. We also found a significant correlation between age at menopause and mother's age at menopause, as did Ozdemir and Col in Turkey [4].
Acknowledgments This work was supported by the Royan Institute and the Paknam Company. This work is dedicated to the memory of Dr. Saeed Kazemi Ashtiani.
176
BRIEF COMMUNICATIONS
Table 1 Demographic characteristics of women with natural menopause
References
Variable
[1] Mohammad K, Sadat Hashemi SM, Khalaj Abadi Farahani F. Age at menopause in Iran. Maturitas 2004;49(4):321–6. [2] Ayatollahi SM, Ghaem H, Ayatollahi SA. Menstrual-reproductive factors and age at natural menopause in Iran. Int J Gynecol Obstet 2003;80(3):311–3. [3] Meschia M, Pansini F, Modena AB, de Aloysio D, Gambacciani M, Parazzini F, et al. Determinants of age at menopause in Italy: results from a large cross-sectional study. ICARUS Study Group, Italian Climacteric Research Study Group. Maturitas 2000;34 (2):119–25. [4] Ozdemir O, Col M. The age at menopause and associated factors at the health center area in Ankara, Turkey. Maturitas 2004;49:211–9.
No. of participants (%)
Mean age at menopause, mean ± SD, y
P value
Occupation Housewife Employed Missing
2215 (89.97) 222 (9.02) 25 (1.01)
47.69 ± 4.72 48.07 ± 4.38 –
0.32 a
Smoking Yes No Missing
133 (5.4) 2147 (87.2) 182 (7.4)
47.74 ± 4.54 47.72 ± 4.72 –
0.53 a
49 ± 3.45 47.71 ± 4.68 47.63 ± 4.19 47.71 ± 5.11 –
0.09 b
Marital status Single 21 (0.85) Married 1623 (65.93) Divorced 38 (1.54) Widowed 778 (31.60) Missing 2 (0.08) a b
By the Mann–Whitney test. By the Kruskal–Wallis test.
Association between lethal fetal anomalies and lower risk for incomplete medical termination of pregnancy Tsz Kin Lo ⁎, Wai Lam Lau, Wing Cheong Leung Prenatal Diagnosis and Counseling Centre, Department of Obstetrics and Gynecology, Kwong Wah Hospital, Hong Kong
Received 2 January 2008; received in revised form 28 February 2008; accepted 3 March 2008
KEYWORDS Lethal fetal anomaly; Medical termination of pregnancy
Second- and third-trimester termination of pregnancy (TOP) following intrauterine death is associated with a need for lower doses of misoprostol and a shorter induction to birth interval
⁎ Corresponding author. Tel.: +852 23322311; fax: +852 35175291. E-mail address: [email protected] (T.K. Lo). doi:10.1016/j.ijgo.2008.03.009
[1]. However, it is not known whether the same phenomenon occurs when TOP is performed for lethal compared with nonlethal fetal anomalies. A retrospective study was performed for 223 women whose pregnancies were medically terminated owing to fetal anomalies in the second-trimester (between 13 and 24 gestational weeks) between 1999 and 2006. The lethal fetal anomalies categorized in the study (Table 1) were the same as those described in the consensus-based study by Leuthner [2]. In addition, alpha-thalassemia major was included because it is a lethal condition prevalent in our location. Vaginal misoprostol 400 µg (Cytotec; Pfizer, NY, USA) was inserted into the posterior fornix every 3 hours, up to a maximum of 5 doses in 24 hours. The regimen was repeated the next day if the fetus was not aborted within 24 hours. If
175
Factors associated with age at natural menopause in Iranian women living in Tehran Mahnaz Ashrafi a,b,⁎, Saeed Kazemi Ashtiani c , Farideh Malekzadeh a , Elham Amirchaghmaghi a , Fahimeh Kashfi d , Babak Eshrati d a
Endocrinology and Female Infertility Department, Royan Institute, Tehran, Iran Faculty of Medicine, Iran University of Medical Sciences and Health Services, Tehran, Iran c Stem Cells Department, Royan Institute, Tehran, Iran d Epidemiology Department, Royan Institute, Tehran, Iran b
Received 17 November 2007; received in revised form 20 February 2008; accepted 3 March 2008
KEYWORDS Age; Natural menopause; Reproductive factors
Following approval from the Royan Institute Ethics Committee, we conducted a study in 2004 and 2005 to determine the factors associated with age at natural menopause in Tehran, capital of Iran. In this cross-sectional study, women aged 35 years or older and living in Tehran were selected by multistage randomized cluster sampling. Clusters for each of the 22 metropolitan districts of Tehran were randomly selected from clusters used in the health and disease study Iran in 2000 [1]. In each cluster, 50 questionnaires were filled out by female student midwives during a face-to-face interview with the selected participants. The interviews took place in the afternoon to prevent selection bias as many younger women are at work in the morning. If a woman did not fully participate, she was replaced by another woman. The questionnaire consisted of a series of questions concerning age, age at menarche, age at menopause, regularity of menstrual cycles, parity, total breast-feeding duration, smoking habits, mother's age at menopause, occupation, and marital status. Data analysis was performed by means of the Mann—Whitney test, the t test, and linear regression using SPSS software (SPSS, Chicago, IL, USA). A total of 7711 questionnaires were completed. Of the 3261 women who were postmenopausal, 2462 were naturally so. Their mean ± SE age at natural onset of menopause was 47.71 ± 0.11 years, and 7% of them had experienced irregular menstruation.
⁎ Corresponding author. Endocrinology and Female Infertility Department, Royan Institute, P.O. Box: 19395-4644, Tehran, Iran. Tel./fax: +98 21 22510895. E-mail address: [email protected] (M. Ashrafi). doi:10.1016/j.ijgo.2008.03.010
The linear regression analysis showed significant associations between age at menopause and parity, mother's age at menopause, and irregular menstruation. The mean age at menopause for women with regular and irregular menses was 47.83 ± 0.1 years and 46.13 ± 0.4 years, respectively (P b 0.001). There was a reverse correlation between age at menopause and irregular menstruation (r = −2.04, P= 0.001). Age at menopause was also directly associated with parity (r = 0.17, P= 0.001). Age at menopause was 48.5 ±4.87 years and 48.13 ±4.82 years, respectively, for the participants' mothers and sisters, and there was an association between age at menopause and mother's age at menopause (r =0.32, P= 0.001). The relations between age at menopause and age at menarche, marital status, age at marriage, total duration of breast feeding, and smoking history were not significant (P N 0.05) (Table 1). Other studies determined that mean age at menopause was 48.3 ± 5.3 years in Shiraz [2] and 50.4 years for the whole of Iran [1]. Although sampling methods and studied populations differed between studies, the mean reported ages at menopause were similar. Reports of several studies have shown age at menopause to be influenced by menstrual and reproductive factors [2,3]. The present study showed that the mean age at natural menopause increased with increasing parity which was similar to Ayatollahi et al [2] while Ozdemir and Col [4] found no effect of parity on age at menopause in Ankara, Turkey. In the present study there was a significant reverse correlation between age at menopause and regularity of the menstrual cycle, but Meschia et al. [3] in Italy and Ozdemir and Col in Turkey [4] did not find significant a correlation. We also found a significant correlation between age at menopause and mother's age at menopause, as did Ozdemir and Col in Turkey [4].
Acknowledgments This work was supported by the Royan Institute and the Paknam Company. This work is dedicated to the memory of Dr. Saeed Kazemi Ashtiani.
176
BRIEF COMMUNICATIONS
Table 1 Demographic characteristics of women with natural menopause
References
Variable
[1] Mohammad K, Sadat Hashemi SM, Khalaj Abadi Farahani F. Age at menopause in Iran. Maturitas 2004;49(4):321–6. [2] Ayatollahi SM, Ghaem H, Ayatollahi SA. Menstrual-reproductive factors and age at natural menopause in Iran. Int J Gynecol Obstet 2003;80(3):311–3. [3] Meschia M, Pansini F, Modena AB, de Aloysio D, Gambacciani M, Parazzini F, et al. Determinants of age at menopause in Italy: results from a large cross-sectional study. ICARUS Study Group, Italian Climacteric Research Study Group. Maturitas 2000;34 (2):119–25. [4] Ozdemir O, Col M. The age at menopause and associated factors at the health center area in Ankara, Turkey. Maturitas 2004;49:211–9.
No. of participants (%)
Mean age at menopause, mean ± SD, y
P value
Occupation Housewife Employed Missing
2215 (89.97) 222 (9.02) 25 (1.01)
47.69 ± 4.72 48.07 ± 4.38 –
0.32 a
Smoking Yes No Missing
133 (5.4) 2147 (87.2) 182 (7.4)
47.74 ± 4.54 47.72 ± 4.72 –
0.53 a
49 ± 3.45 47.71 ± 4.68 47.63 ± 4.19 47.71 ± 5.11 –
0.09 b
Marital status Single 21 (0.85) Married 1623 (65.93) Divorced 38 (1.54) Widowed 778 (31.60) Missing 2 (0.08) a b
By the Mann–Whitney test. By the Kruskal–Wallis test.
Association between lethal fetal anomalies and lower risk for incomplete medical termination of pregnancy Tsz Kin Lo ⁎, Wai Lam Lau, Wing Cheong Leung Prenatal Diagnosis and Counseling Centre, Department of Obstetrics and Gynecology, Kwong Wah Hospital, Hong Kong
Received 2 January 2008; received in revised form 28 February 2008; accepted 3 March 2008
KEYWORDS Lethal fetal anomaly; Medical termination of pregnancy
Second- and third-trimester termination of pregnancy (TOP) following intrauterine death is associated with a need for lower doses of misoprostol and a shorter induction to birth interval
⁎ Corresponding author. Tel.: +852 23322311; fax: +852 35175291. E-mail address: [email protected] (T.K. Lo). doi:10.1016/j.ijgo.2008.03.009
[1]. However, it is not known whether the same phenomenon occurs when TOP is performed for lethal compared with nonlethal fetal anomalies. A retrospective study was performed for 223 women whose pregnancies were medically terminated owing to fetal anomalies in the second-trimester (between 13 and 24 gestational weeks) between 1999 and 2006. The lethal fetal anomalies categorized in the study (Table 1) were the same as those described in the consensus-based study by Leuthner [2]. In addition, alpha-thalassemia major was included because it is a lethal condition prevalent in our location. Vaginal misoprostol 400 µg (Cytotec; Pfizer, NY, USA) was inserted into the posterior fornix every 3 hours, up to a maximum of 5 doses in 24 hours. The regimen was repeated the next day if the fetus was not aborted within 24 hours. If