Recently, an increase in cases of premature menopause has been observed among Indian women, especially those from socioeconomically weaker sections.

A study published in the journal Scientific reports suggests that early onset of menopause may be related to surgical removal of the uterus.

Study: Increase in premature menopause and differences depending on educational level in India. Image credit: Pixel-Shot / Shutterstock

background

Menopause is a critical biological transition marked by the end of the menstrual cycle. Women typically experience a number of physical and psychological changes during this phase that can potentially cause them distress.

Premature menopause, or early onset of menopause before age 40, is associated with increased morbidity and mortality risk in women. Premature menopause can occur due to primary ovarian failure or surgical procedures such as surgical removal of the uterus (hysterectomy).

The incidence of premature menopause has increased sharply in Southeast Asia in recent times and represents a significant public health problem. Existing studies show that women from developing countries experience natural menopause several years earlier than their counterparts from developed countries.

In this study, scientists determined the prevalence of premature menopause among women in different Indian states. They also examined the factors that influence premature menopause.

Study design

The study analyzed reproductive health data from 180,743 women aged 30-39 years who participated in the latest Indian version of the Demography Health Survey (2019-2021), conducted in 29 Indian states and seven union territories.

The study considered various sociodemographic, nutritional and biological factors that might influence the incidence of premature menopause among Indian women.

Important observations

The study found that about 15% of Indian women are in menopause. The proportion of women in menopause was higher in rural areas than in urban areas. Similarly, the proportion of women experiencing premature menopause was higher in rural areas (5%) than in urban areas (3%).

Compared to other Indian states, the prevalence of premature menopause in Bihar among women aged 30 to 34 and 35 to 39 years is four and twice as high as the national average, respectively.

Factors that influence premature menopause

The analysis took into account various socio-demographic factors, including educational background, financial status, caste, religion and region of residence (rural vs. urban).

The results showed that women with the lowest educational background had a seven times higher prevalence of premature menopause than women with the highest educational background.

The analysis, taking into account nutritional and biological factors, found that increasing age, higher number of children and younger age of women at first and last birth are potential predictors of premature menopause.

The analysis also found that women who do not use contraception, have a normal or low body mass index (BMI), or do not suffer from anemia are more likely to experience premature menopause.

A significantly higher risk of premature menopause was observed in women with a history of hysterectomy or sterilization. A significantly higher risk was also observed in women with health insurance coverage. In contrast, a significantly lower risk of premature menopause was observed in women with higher financial status.

Decomposition analysis

The study conducted a decomposition analysis to obtain a more conclusive overview of the contribution of different factors to the largest differences observed in the incidence of premature menopause among women with different educational backgrounds.

The results showed that a history of hysterectomy accounted for about 84% of the difference in the incidence of premature menopause between women with the lowest and highest levels of education. Other important factors were age at first birth and financial situation.

Significance of the study

The study finds that a significantly high proportion of Indian women of childbearing age experience premature menopause. Women in rural areas are at higher risk of premature menopause than women in urban areas.

The study found an inverse association between educational background and the risk of premature menopause. A 7-fold higher prevalence of premature menopause was observed in women with the lowest educational background. Surgical menopause or hysterectomy was identified as the main factor for the observed differences in menopause frequency due to education.

These observations indicate that women who are not adequately informed about menopause and its consequences due to a lack of education are significantly more likely to undergo hysterectomy at a younger age, which in turn increases their risk of premature menopause.

It is generally believed that women with poor financial status have limited access to surgical care. However, the current study findings paint a different picture, suggesting a lack of awareness, lack of alternative treatment options and over-reliance on surgical care while neglecting conservative treatments.

Given the serious health consequences of premature menopause, future studies should investigate other factors that may lead women to choose hysterectomy at a younger age.