Variation in the Menopausal Transition: Hawaii, Mexico, and Bangladesh

Ages at menopause and symptom experiences at midlife differ within and across populations.  These differences may explain some of the global variation in chronic health concerns.  In this talk, three studies are detailed in which median ages at menopause were computed for diverse populations.  Menstrual histories were collected in the same way, and identical methods of analyses resulted in median ages at menopause that span five years: 48.1 years among Bangladeshis living in Sylhet, Bangladesh; 49.2 years among Bangladeshi immigrants living in London; 49.6 years in Puebla, Mexico; 52.8 years among British women of European descent living in London; and 53.0 years in Hilo, Hawaii, regardless of ethnicity.  Within populations, determinants of an earlier age at menopause included smoking, lower levels of education, fewer children, rural birthplace, more infectious diseases during childhood, and being unmarried.  Some determinants were common across studies (e.g., level of education), others were specific to a particular context (e.g., infectious diseases during childhood).  A comparative approach is also applied to examine symptom frequencies at midlife in relation to diverse climates, diets, reproductive histories, health-related behaviors, and cultures that influence the degree to which symptoms are noticed, labeled, and appropriate to report.  For example, in Hilo, Hawaii, Japanese-American women reported fewer hot flashes but objectively demonstrated the same number of hot flashes as their European-American neighbors.  This presentation addresses variation in age at menopause, the measurement and interpretation of variation in symptom experience among women at midlife, and potential health consequences.
Funding:  NSF No. BCS-1156368 (with L. Huicochea and DE. Brown), No. 0548393 (with G.R. Bentley and S. Muttukrishna), No. 9805299, NIH No. S06-GM08073-35 (D.E. Brown, PI).