Search:
Menopause Live - IMS Updates
InFocus

Date of release: 21 March, 2016

Does menopause start earlier in smokers?

Paula and colleagues in 2013 conducted a cross-sectional study to investigate the association between smoking and early onset of menopause [1]. The study included 1222 female employees on the campuses of Rio de Janeiro university. All participants were aged over 35 years. Smoking status was determined by questioning whether the participant had smoked at least 100 cigarettes during her lifetime, and whether she currently smoked. Women were classified as current smokers, former smokers or women who had never smoked. The researchers used a Cox proportional hazards model to investigate the data and the correlations between smoking status and age at the onset of menopause.



Among current smokers, there was an increase of 56% (hazard ratio 1.56; 95% confidence interval 1.06-2.31) in the risk of menopause, when compared with those who had never smoked (p = 0.02), while former smoking was not associated with the outcome. The results obtained from the study revealed that women who smoke are 1.8 years younger at the onset of menopause when compared to non-smoking women. There was no significant difference between the survival curves for former smokers and women who had never smoked, adding a very interesting conclusion: once a woman gives up smoking, her age at onset of menopause may be roughly equivalent to that of women who have never smoked. The results obtained from the study emphasize the importance of efforts to control cigarette smoking.

Comment

Menopause is defined as a physical change experienced by women when going through the aging process [2]. A harmful association between younger age at menopause and overall mortality has been recently documented, despite the results of Bernard, who investigated the correlation between smoking and early menopause among American women in 1949, and revealed a negative correlation [3].

Many authors have claimed that there are many factors on which the age at natural menopause (ANM) depends, such as genetic, socioeconomic, environmental, reproductive, dietary, and lifestyle factors. Some of these factors are have been proven to accelerate the ANM, like smoking, high fat intake, cholesterol, and caffeine, while other factors delay the ANM, such as parity, prior use of oral contraceptive pills and Japanese ethnicity. ANM is an important risk factor for mortality and long-term morbidity, and hence, we need to identify the modifiable risk factors and lifestyle changes [4].

In 2007, a substudy of 2123 postmenopausal women, who were born in 1940–41 and who had participated in the cross-sectional Oslo Health Study, was made to examine the association between early menopause and selected lifestyle factors. The authors defined early menopause as menopause occurring at an age less than 45 years. The researchers applied logistic regression analyses to examine the association between early menopause and selected lifestyle factors. The study showed an association between current smoking and early menopause. The data also suggested that the earlier a woman gives up smoking, the further she is from early menopause [5].

A recent study investigating the relationship between smoking and menopause followed a large population of Swedish women over 16 years; the authors investigated the difference in median age at death between women with menopause at 40 years and women with menopause at 60 years. The results showed that the difference was 1.3 years. In the same study, the researchers stated that, compared with current smokers, former smokers and never smokers had an older median age at death of 2.5 years [6].

Hee and colleagues in 2015 performed a study using data from the Korea National Health and Nutrition Examination Survey from 2007 to 2012. They analyzed the menopausal age in relation to smoking as a Kaplan-Meier survival curve for 11,510 women whose age was between 30 and 65 years. They found that the menopausal age among smokers was significantly lower than that among non-smokers [7].

The above-mentioned data and the results obtained from researches support the messages of the health educators and physicians: smoking is associated with early menopause; it can be prevented by quitting smoking; results for former smokers are similar to those who have never smoked.

A very interesting fact is that cigarette smoking, which decreases the age at menopause, has been identified as the only lifestyle factor modifying this association. This fact is really promising for those who want to prevent the health problems related with early menopause.

Comentario

Nermine Nosseir


Assistant Professor, Basic Medical Sciences, University of Sharjah



    References

  1. Mendes P de Holanda, Faerstein E, Junger WL. Does menopause start earlier in smokers? Evidence from the Pro-Saude Study. Rev Bras Saude Mater Infant 2013;13:359-63


    http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1519-38292013000400359&lng=en

  2. Schoenaker DA, Jackson CA, Rowlands JV, Mishra GD. Socioeconomic position, lifestyle factors and age at natural menopause: a systematic review and meta-analyses of studies across six continents. Int J Epidemiol 2014;43:1542–62


    http://www.ncbi.nlm.nih.gov/pubmed/24771324

  3. Bernhard P. Certain injurious effects of cigarette smoking on women. Med Monatsschr 1949;3:58-60


    --

  4. Jacobsen BK, Heuch I, Kvile G. Age at natural menopause and all-cause mortality: a 37-year follow-up of 19,731 Norwegian women. Am J Epidemiol 2003;157:923-9


    http://www.ncbi.nlm.nih.gov/pubmed/12746245

  5. Sapre S, Thakur R. Lifestyle and dietary factors determine age at natural menopause. J Midlife Health 2014;5:3–5


    http://www.ncbi.nlm.nih.gov/pubmed/24672198

  6. Bellavia A, Wolk A, Orsini N. Differences in age at death according to smoking and age at menopause. Menopause 2016;23:108-10


    http://www.ncbi.nlm.nih.gov/pubmed/26240946

  7. Yang HJ, Suh PS, Kim SJ, Lee SY. Effects of smoking on menopausal age: Results from the Korea National Health and Nutrition Examination Survey. J Prev Med Public Health 2015;48:216-24


    http://www.ncbi.nlm.nih.gov/pubmed/26265667


El siguiente comentario es una traducción de una contribución original en Inglés enviada a los miembros el Diciembre 16, 2013. La traducción ha sido gentilmente efectuada por el

Dr Priscila Parra

¿Las mujeres realmente toman su tratamiento para la osteoporosis?

Este fue un estudio observacional de cohorte retrospectivo que utilizó datos del 2005-2009 a partir de una gran población, debidamente asegurada [1]. Los criterios de inclusión fueron mujeres con una edad >55 años al iniciar el tratamiento para la osteoporosis, que tenían un período > 12 meses (al basal) sin haberse expuesto a terapia para la osteoporosis, y > 24 meses de seguimiento después de haber iniciado la terapia. La interrupción se definió como un lapso de 60 días sin haber tomado la prescripción. Se definió a la re-iniciación como el comienzo de una misma prescripción o una diferente terapia para la osteoporosis después del periodo de suspensión. De los 92,839 pacientes, el 45%, el 58%, y el 70% descontinuaron la terapia a los 6, 12 y 24 meses, respectivamente, después de la iniciación. De los que abandonaron, el 46% reinició la terapia, la mayoría haciéndolo dentro de los 6 meses de haberla suspendido. Las mujeres tuvieron menor probabilidad de volver a iniciar el tratamiento si es que éstas eran mayores (p = 0,0001) o si estaban hospitalizadas durante la línea basal (p = 0.0007). Las mujeres que suspendieron el tratamiento tempranamente (< 6 meses) después de la iniciación fueron las menos probables de re-iniciarlo (p = 0.0001) y se mantuvieron en la terapia por períodos más cortos luego de la re-iniciación. Dependiendo del tiempo de observación disponible, la mediana del tiempo en el que reiniciaron el tratamiento fue de 58-193 días.

Comentario

Los resultados del estudio son muy frustrantes ya que señalan una mala adherencia a la terapia. Debe señalarse que alrededor del 26% de las mujeres tenían de 55-60 años de edad, y alrededor del 22% tenían de 60-65 años; sólo el 30% tenían un diagnóstico de osteoporosis, y sólo el 4% tenía antecedentes de fractura osteoporótica. Los medicamentos principalmente incluidos fueron los bisfosfonatos (64% una vez por semana, el 21% una vez al mes), pero también otros como raloxifeno (9%), la calcitonina y la teriparatida. No pude encontrar datos por separado para cada tipo de medicación, pero se asume que las mejores conclusiones resultaron de los bisfosfonatos. Si estos resultados pueden ser generalizados permanece abierto, ya que se basa en una población con seguro privado, y con datos tomados de las prescripciones en lugar de un recuentro de pastillas, o algún otro método más preciso. Sin embargo, este estudio concuerda con otros estudios que llegaron a conclusiones similares sobre la falta de cumplimiento a la terapia para la osteoporosis [2, 3]. Más aún, parece que las bajas tasas de cumplimiento y de persistencia para las terapias para la osteoporosis en escenarios de la vida real resultan en un aumento de las tasas de fracturas por fragilidad [2]. El estudio actual no ofrece motivos para la interrupción o la re-iniciación del tratamiento (¿se olvida de tomar la medicación?, ¿efectos adversos?, ¿Tiene la sensación de que el tratamiento no es necesario o existe falta de información adecuada?, ¿toma demasiados medicamentos y las pastillas para la osteoporosis no son la prioridad?, ¿recibió consejos de otro médico o de otras personas, medios de comunicación, etc.). Aquellas mujeres tienen un mayor riesgo de fracturas y por lo tanto, el sistema médico debe esforzarse y seguirlas más de cerca para que no desistan. Un tratamiento exitoso de la osteoporosis significa tener al menos varios años de terapia. Si la tasa de abandono asciende hacia aproximadamente 50% en el primer año, esto debe convertirse en el objetivo principal para las organizaciones de servicios de salud para así, mejorar la persistencia de la terapia con el fin de lograr mejores cifras y reducir la incidencia de fracturas.

Amos Pines

Department of Medicine T, Ichilov Hospital, Tel-Aviv, Israel

References

  1. Balasubramanian A, Brookhart MA, Goli V, Critchlow CW. Discontinuation and reinitiation patterns of osteoporosis treatment among commercially insured postmenopausal women. Int J Gen Med 2013;6:839-48.
    http://www.ncbi.nlm.nih.gov/pubmed/24235846

  2. Siris ES, Selby PL, Saag KG, et al. Impact of osteoporosis treatment adherence on fracture rates in North America and Europe. Am J Med 2009;122(Suppl 2):S3S13.
    http://www.ncbi.nlm.nih.gov/pubmed/19187810

  3. Cramer JA, Gold DT, Silverman SL, Lewiecki EM. A systematic review of persistence and compliance with bisphosphonates for osteoporosis. Osteoporos Int 2007;18:10231031.
    http://www.ncbi.nlm.nih.gov/pubmed/17308956

  4. Brookhart MA, Avorn J, Katz JN, et al. Gaps in treatment among users of osteoporosis medications: the dynamics of noncompliance. Am J Med 2007;120:251256.
    http://www.ncbi.nlm.nih.gov/pubmed/17349448

  5. Ver comentario completo »