The age at and cause of period cessation were not found to be associated with conventional cardiovascular risk factors across middle age and later life, according to the results of a prospective longitudinal study published in Heart.
Studies have shown that period cessation before 45 years of age is associated with increased mortality and cardiovascular risk, but few have examined the association between age of period cessation and intermediate risk factors for cardiovascular disease.
To evaluate this, data from the UK Medical Research Council National Survey of Health and Development were used to assess the association between age at period cessation by type of cessation (natural or surgical) and trajectories for various risk factors for cardiovascular disease. Women with a known date of period cessation, ≥1 measure of the risk factor in the analysis, and complete data on all confounders were included. Women whose periods stopped for reasons other than natural causes or hysterectomy were excluded. Women using hormone replacement therapy (HRT) before menopause who did not stop HRT use for at least 1 year before giving responses on period regularity were also excluded.
Physiologic measurements to account for cardiovascular risk included blood pressure, body mass index (BMI), and waist circumference, which were collected 5 times between 36 and 69 years of age. Blood lipid levels and glycated hemoglobin (HbA1c) were measured 3 times between 53 and 69 years of age.
Of the 787 women who provided data on lipid and HbA1c measures, 94% who underwent a hysterectomy had the surgery before 53 years of age and 61% who underwent natural menopause were postmenopausal by 53 years of age. Of the 908 women who provided blood pressure data and the 915 who provided BMI and waist circumference data, 99.6% who had a natural menopause and 89.6% who had a hysterectomy were premenopausal at baseline (age 36 years).
Women who had a hysterectomy were more likely to be in a lower social class and have higher parity, higher prevalence of smoking at 36 years of age, higher prevalence of physical inactivity at 36 years of age, higher prevalence of HRT use across all time points, and lower mean age at menarche (12.9 vs 13.1 years) and at period cessation (44.1 vs 51.5 years) compared with women who had natural menopause.
Any association of age at period cessation or type of period cessation with trajectories of any cardiovascular disease risk factor were either insignificant on adjustment for confounders or had confidence intervals that spanned the null value.
This was the first study to examine the association of type and timing of period cessation with cardiovascular disease risk factors into the seventh decade of life in a cohort that included women who had taken HRT, experienced early or late menopause, and undergone hysterectomy, whom many previous analyses have excluded.
Further studies with larger cohorts and additional cardiovascular disease intermediates are necessary to examine the mechanisms underlying age at period cessation and cardiovascular disease risk.
O’Keeffe LM, Kuh D, Fraser A, Howe LD, Lawlor D, Hardy R. Age at period cessation and trajectories of cardiovascular risk factors across mid and later life [published online February 25, 2020]. Heart. doi:10.1136/heartjnl-2019-315754