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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (3): 502-510. doi: 10.19723/j.issn.1671-167X.2023.03.017

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Secular trends of age at menarche and age at menopause in women born since 1951 from a county of Shandong Province, China

Xiao-wei WANG1,2,Ying-chao MU3,*(),Zhen-yu GUO1,2,Yu-bo ZHOU1,2,Yong ZHANG3,Hong-tian LI1,2,4,*(),Jian-meng LIU1,2,4   

  1. 1. Institute of Reproductive and Child Health, Peking University; National Health Commission Key Laboratory of Reproductive Health, Beijing 100191, China
    2. Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
    3. Women & Children's Health Care Hospital of Huantai, Zibo 256400, Shandong, China
    4. Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing 100191, China
  • Received:2023-02-14 Online:2023-06-18 Published:2023-06-12
  • Contact: Ying-chao MU,Hong-tian LI E-mail:1319094858@qq.com;lihongtian@pku.edu.cn
  • Supported by:
    the Fundamental Research Funds for the Central Universities(BMU2021RCZX029)

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Abstract:

Objective: To describe the secular trends of age at menarche and age at natural menopause of women from a county of Shandong Province. Methods: Based on the data of the Premarital Medical Examination and the Cervical Cancer and Breast Cancer Screening of the county, the secular trends of age at menarche in women born in 1951 to 1998 and age at menopause in women born in 1951 to 1975 were studied. Joinpoint regression was used to identify potential inflection points regarding the trend of age at menarche. Average hazard ratios (AHR) of early menopause among women born in different generations were estimated by performing multivariate weighted Cox regression. Results: The average age at menarche was (16.43±1.89) years for women born in 1951 and (13.99±1.22) years for women born in 1998. The average age at menarche was lower for urban women than that for rural women, and the higher the education level, the lower the average age at menarche. Joinpoint regression analysis identified three inflection points: 1959, 1973 and 1993. The average age at menarche decreased annually by 0.03 (P < 0.001), 0.08 (P < 0.001), and 0.03 (P < 0.001) years respectively for women born during 1951-1959, 1960-1973, and 1974-1993, while it remained stable for those born during 1994-1998 (P=0.968). As for age at menopause, compared with women born during 1951-1960, those born during 1961-1965, 1966-1970 and 1971-1975 showed a gradual decrease in the risk of early menopause and a tendency to delay the age at menopause. The stratified analysis presented that the risk of early menopause gradually decreased and the age of menopause showed a significant delay among those with education level of junior high school and below, but this trend was not obvious among those with education level of senior high school and above, where the risk of early menopause decreased and then increased among those with education level of college and above, and the corresponding AHRs were 0.90 (0.66-1.22), 1.07 (0.79-1.44) and 1.14 (0.79-1.66). Conclusion: The age at menarche for women born since 1951 gradually declined until 1994 and leveled off, with a decrease of nearly 2.5 years in these years. The age at menopause for women born between 1951 and 1975 was generally delayed over time, but the trend of first increase and then decrease was observed among those with relatively higher education levels. In the context of the increasing delay in age at marriage and childbearing and the decline of fertility, this study highlights the necessity of the assessment and monitoring of women' s basic reproductive health status, especially the risk of early menopause.

Key words: Menarche, Menopause, Age, Women' s health, Reproductive health

CLC Number: 

  • R173

Figure 1

The flow chart of subjects' inclusion on the analyses of secular trends of age at menarche and age at menopause"

Table 1

Distribution of age at menarche in different population groups (n=58 114)"

Characteristic Total, n(%)Age at menarcheP value
Mean±SD M (P25, P75)
Birth cohort < 0.001
   1951-1959 7 247 (12.47) 16.23±1.93 16.00 (15.00, 18.00)
   1960-1969 20 766 (35.73) 15.56±1.55 15.00 (15.00, 16.00)
   1970-1979 17 365 (29.88) 14.89±1.34 15.00 (14.00, 16.00)
   1980-1989 8 245 (14.19) 14.43±1.28 15.00 (14.00, 15.00)
   1990-1998 4 491 (7.73) 14.05±1.25 14.00 (13.00, 15.00)
Region < 0.001
   Urban 40 598 (69.86) 15.10±1.57 15.00 (14.00, 16.00)
   Rural 17 516 (30.14) 15.34±1.70 15.00 (14.00, 16.00)
Educational level < 0.001
   Primary school or below 17 559 (30.21) 15.75±1.72 15.00 (15.00, 17.00)
   Junior high school 24 094 (41.46) 15.18±1.49 15.00 (14.00, 16.00)
   Senior high school 8 432 (14.51) 14.80±1.47 15.00 (14.00, 16.00)
   College or above 7 973 (13.72) 14.24±1.31 14.00 (13.00, 15.00)
   Unknown 56 (0.10) 14.68±1.16 15.00 (14.00, 15.00)

Figure 2

Secular trend of age at menarche A, total (${\bar x}$±s); B, by region."

Table 2

Segmented general linear model regression analysis of age at menarche"

Birth cohort β SE t P value
1951-1959 -0.03 0.008 -4.38 < 0.001
1960-1973 -0.08 0.002 -47.55 < 0.001
1974-1993 -0.03 0.002 -17.55 < 0.001
1994-1998 0.00 0.014 0.04 0.97

Table 3

Distribution of age at menopause in different population groups (n=38 483)"

Characteristic Total, n(%) Postmenopausal, n(%)Age at menopauseχ2 P value
Mean±SEa M (P25, P75)b
Birth cohort 42.969 < 0.001
   1951-1960 7 853 (20.41) 7 845 (99.90) 50.24±0.05 50.00 (48.00, 53.00)
   1961-1965 10 275 (26.70) 10 015 (97.47) 50.71±0.04 51.00 (49.00, 53.00)
   1966-1970 11 815 (30.70) 8 046 (68.10) 50.95±0.04 51.00 (49.00, 53.00)
   1971-1975 8 540 (22.19) 1 670 (19.56) 50.10±0.19 51.00 (49.00, 52.00)
Region 7.605 0.006
   Urban 26 083 (67.78) 18 302 (70.17) 50.81±0.03 51.00 (49.00, 53.00)
   Rural 12 400 (32.22) 9 274 (74.79) 50.60±0.04 51.00 (49.00, 53.00)
Educational level 29.068 < 0.001
   Primary school or below 16 092 (41.82) 13 280 (82.53) 50.49±0.03 51.00 (48.00, 53.00)
   Junior high school 17 335 (45.05) 11 281 (65.08) 50.89±0.03 51.00 (49.00, 53.00)
   Senior high school 3 613 (9.39) 2 335 (64.63) 50.96±0.07 51.00 (49.00, 53.00)
   College or above 1 443 (3.75) 680 (47.12) 51.13±0.11 51.00 (50.00, 53.00)

Figure 3

Kaplan-Meier curve of age at menopause among women in different birth cohorts"

Figure 4

Kaplan-Meier curve of age at menopause among women in different birth cohorts (by region)"

Figure 5

Kaplan-Meier curve of age at menopause among women in different birth cohorts (by educational level)"

Table 4

Association between birth cohorts and early menopause"

Birth cohortAdjusted AHR (95%CI)
1951-1960 1961-1965 1966-1970 1971-1975
Total Reference 0.91 (0.88-0.94) 0.89 (0.86-0.91) 0.80 (0.75-0.84)
Region
   Rural Reference 0.90 (0.86-0.95) 0.84 (0.80-0.89) 0.71 (0.64-0.78)
   Urban Reference 0.92 (0.89-0.96) 0.91 (0.88-0.95) 0.85 (0.79-0.91)
Educational level
   Primary school or below Reference 0.96 (0.92-1.00) 0.87 (0.83-0.91) 0.81 (0.73-0.89)
   Junior high school Reference 0.92 (0.86-0.98) 0.94 (0.88-1.00) 0.86 (0.79-0.94)
   Senior high school Reference 0.81 (0.72-0.90) 0.86 (0.77-0.97) 0.87 (0.72-1.06)
   College or above Reference 0.90 (0.66-1.22) 1.07 (0.79-1.44) 1.14 (0.79-1.66)
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