Natural menopause among women below 50 years in India: a population based study

Background and objectives - The age at which menopause naturally occurs may reflect nutritional and environmental circumstances as well as genetic factors. We examined natural menopause as a marker of women’s health at the population level.

Material and Methods - Data from the Indian District Level Household Survey carried out during 2007-2008 covering 643,944 ever-married women aged 15-49 yr were used; women of older ages were not included in this survey. As not all women in this age group had achieved natural menopause at the time of survey, Cox proportional hazard regression models were employed to obtain the median age of women reporting a natural menopause, excluding those who underwent hysterectomy. We estimated hazard ratios for key socio-economic and reproductive variables that could potentially affect the age at natural menopause <40 yr.

Results - Overall, menopause prior to age 40 was reported by approximately 1.5 per cent of women. In the national data set, statistically significant associations with age at natural menopause were identified with marriage breakdown or widowhood, poverty, Muslim religious affiliation, ‘scheduled caste’ status, not having received schooling, rural residence, having never used contraceptive pills, not been sterilized or had an abortion, low parity and residence in the western region. Within data from five selected states examined separately, the strength of these associations varied.

Interpretation and conclusion - We have identified associations of natural menopause with sociocultural and geographical factors, but most importantly of poverty that require further investigation as to causality. The proportion of women experiencing early menopause may represent a useful overall indicator of women’s health. The data are reassuring with regard to possible late effects of sterilization on ovarian function.