Factors Affecting Age of Onset of Menopause

Background: Menopause is a menopause. Chi-square test was applied to check the association between the different factors and age of menopause. Results: The mean age of the participants was found to be 43.23 ± 4.11 SD years, while the mean age of onset of menopause was recorded to be 49.21 ± 3.83 SD years. The associations between the marital status, body mass index, use of OCP and socio-economic factors with age of onset of menopause, were found to be statistically significant. Conclusion: Menopausal age not only reflects the end of fertility era but also of aging as well. Age of menopause significantly effects physical and psychological health of women and is considered as a very important event in women’s lives. Controllable factors like obesity, tobacco use, use of OCP plays a significant role in age of onset of natural menopause.


INTRODUCTION
Menopause is a vital phase in a women's life which marks the end of her fertility period [1]. It is described as the natural phenomenon in which cessation of menses occurs which is longer than a year. The cause of this normal aging process is decrease ovarian functioning and decline in hormones that occur in midlives of all women [2][3][4]. The termination of active menstruation cycles is not an illness nor is it due to any pathological reason [5]. This end of fertility phase in woman's life gradually passes through a prodromal stage which is termed as menopausal transition [4].
The decline in ovarian functioning accompanied by hormonal depletion results in number of bodily problems like vaginal dryness, mood swings and hot flashes. Menopause not only causes somatic problems but also cause sexual and psychological problems which collectively significantly lessens women's quality of life [5][6][7]. sometimes, unnatural menopause can also be induced either by removal of uterus along with bilateral ovaries, known as surgical menopause and via treatment with cytotoxic drugs [8].
With the improvement of health care facilities, nutritional advancements and widely accessible modern treatment lead to the more postmenopausal women and the subject of menopause has gained much importance [9]. 45 to 53 year age bracket is now considered to be the age natural menopause worldwide [10 -16].
Menopause influences not only on physical health but on other domains of health as well like psychological health and socio-cultural aspects [17]. Onset age of natural menopause is demonstrative of depletion in ovarian follicles reserves, which further depend upon different environmental and genetic factors [18]. The environmental factors can be controlled and they include use of nicotine, socioeconomic status, occupation and parity of women [19].

Objectives
To explore the factors affecting onset age of menopause among a Pakistani women.

METHODOLOGY
This cross-sectional-observation study was conducted on 139 women (aged at or above 40 years) presenting to the Outpatient Department of Obstetrics -Gynecology at Jinnah Medical College Hospital, Karachi -Pakistan from Nov 2020 to May 2021. Data was collected using a structured interview-based proforma which contained questions regarding biodata, sociodemographic details, menstrual history, and probable factors affecting age of onset of menopause. Anthropometric parameters like height, weight, BMI, body fat and visceral fat was recroded via OMRON BF 508 body composition monitor.
Aged above 40 years
"Women with artificial/induced menopause"

Statistical Analysis
Data was analyzed using SPSS v. 21.0. Chisquare test was applied to check the association between the different factors and age of menopause.

RESULTS
The mean age of the participants was found to be 43.23 ± 4.11 SD years, while the mean onset age of menopause was recorded as 49.21 ± 3.83 SD years. Most of the women resided in urban areas and fell within the middle socioeconomic bracket. The associations between the marital status, body mass index, use of OCP and socioeconomic factors with age of onset of menopause, were found to be statistically significant.

DISCUSSION
The present study did not find any significant correlation between residential status of participants and the onset age menopause. This result is very much different from the findings of Dasgupta and Ray [20]. who found out that the average onset age of natural menopause of females residing in rural setting was 49.3 ± 5.29 years while those living in urban areas was at 54.23 ± 6.7 years and this variance was reported as statistically significant.
Our study found out that the women with BMI more than 30 reach menopause sooner than those having lower BMI. This finding is proved to be statistically significant. This is in agreement with that of Bromberger et al, [12]. who reported that average age of onset of natural menopause as 50.9 years for females with high BMI while average onset age of natural menopause was found to be 52.6 years in females with low BMI. Gold et al., [21]. stated a non-existent relation between natural menopause and BMI. [22] The current study found out that married women have later age of menopause than those of single women. The parallel outcomes were reported by Gold et al [21]. that single women (who were either divorced or widowed or separated) achieved menopause way more sooner than those married females. Same is reported by Reynolds and Obermeyer [23] as well.
The study reported that with the use of OCP, women achieved menopause sooner than those who never used any contraceptives. This key finding was "in line with that of Gold et al. [21]. who also reported that the use of OCPs during fertility period was associated with younger age of onset of menopause. Findings contrary to this, were reported Palmer et al [22] and Reynolds and Obermeyer [23], who reported an inverse and no association between use of OCP and onset age of menopause", respectively.

CONCLUSION
Menopausal age not only reflects the end of fertility era but also of aging as well. Age of menopause significantly effects physical and psychological health of women and is considered as a very important event in women's lives. Controllable factors like obesity, tobacco use, use of OCP plays a significant role in age of onset of natural menopause.

CONSENT
As per international standard or university standard, Participants' written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
It is not applicable.