Age at Menopause

1 ,1960-62, (HSM)73-1268 Washington, ,DEPARTMENTOFHEALTH,EDUCATION, , , ,&~uty~h?c~ , ,~~s; , , , ,J4cdical~doho~ , ,Dental~drirorLOUISR,STOLCIS, ,ExecutiveOjj? ,ChtifTAVIAGORDON,AristantChiefSTATISTIC SCOOPERATIONOFTHEBUREAUOFTHECENSUSI naccordancewithspecificationsestablished bytheNa-tionalHealthSurvey,theBureauofth eCensus,underacon-tractualagreement,part icipatedinthedesignandselectionofthesamp le, ,noninstitutionalpopu-lationoftheconterm inousUnitedStates,ages18-79years, , ,noninstitu-tionalpopulationofdistributi onsofphysicalandphysiologicalcharacteris tics,prevalence,andrelationshipsamongdem ographic,socioeconom-ic, ,structurallyunbiased,alongwithsamplingv ari-ancesappropriatetothedesign, ,theNationalCenterforHealthSta-tistics.

2 Recognizingthevalueofwiderexploita-tiono fthedatabeingaccumulatedbytheHealthExami nationSurvey(HES) ~ ,HarvardUniversity, ,andthedecisionsconcerninganalyticaltech niquesweremadebyhimandhisassociateintheS choolofPublicHealth, , ~sarepresentedonthemenopausalstatwsofwom enpavttm stedofa&- , ; ,mam taZstatus,pan ty,famiZyincome,geo-graphicregion,height , ~timofwomeninindividualyearsofogeveporti ~thattheyhadhadanaturalmenopausegaveagoo dfittoalogisticcurvewith50-percentendpm @equentZythanmarm ththedemographicandphysiologicvartablese xamined., *CONTENTSPageForeword------------------- ----------------------. , ,andJaneWorcester, ,DepartmentsofEpidemiologyandBiostatisti cs,SchoolofPublicHealth, ,reproductive, ~2 Thesample,selectedtorepresentthecivilian ,non-institutionalpopulationoftheUnitedS tatesbe-tween18and79yearsofage,contained 4,211femalesofwhom3,581( ) l% (notcountingpreg-nancy~~) [~ ]~~ I% ,211women.

3 Thisgroupconsistedof2,206womenwhoanswere d no toquestionb, ,onewaspregnantatthetimeofresponse,three wereseenbytheiranswerstootherpartsofques tion74tostillbemenstruating, Thisgroupconsistedof471womenwhoanswered yes tobothbandd,and2womenwhodidnotanswerbbut answered yes Thisgrouplconsistedofwomenwhowerepost-me nopausalandwhodidnotanswer yes yes no tod, ,butthequestionsweresimple,thequestionna ireswerecompletedinamedicalenvironmentin privacy,andthemotiva-tionoftherespondent s,asjudgedbyresponserate, ,sincetheywereaskedtorespondasthoughthey werestillmenstruatingwhen,infact, , ,totheexistenceofpathologicalprocesses, sinterview(quitedistantfromthemenopauseq uestion) , ; ~ , ,thestatisticalvaluestobepresentedherear evirtuallyidenticalwhethercomputedfromth esampleitselforfromtbepop-ulationestimat es,andunlessotherwisespecified, reportedageatwhichmenopauseoc-curred , (table3).

4 ,someuseismadeofitem74e ,theprogressionisnotconsistentlyup-wards incetheobservationsweretakenoninde-pende ntsamplesateachage, , , ,20percentbyage43,50percentbyage49,90per centbyage54, ,sinceitisacompoundoftheagetrendfornatur almeno-pause(whichmightbeexpectedtoshows omenaturalsymmetry)withthatforfrequencyo foperativemenopausebyage(forwhichthereis noreasontoexpectsymmetry). l% (table4).Forwomenover65yearsthepercentag ewasconsiderablylower(17percent)andforth ose70yearsandoveritwasonly13percent(tabl e1).Thisdeclinewithageafterage 65maybetheresultofdiminishingrecall, , ,itisevidentthatoperationsarefrequentcon tributorstothemeno-pauseofwomenwhoarenow menopausal,andhaveinthepast15years, (table4).

5 , , , ,parity,familyincome, ,re-gardlessoftheirageatthetimeofrespons e(exceptthatallwerebetween18and64years). Thepopulationatriskinthatagegroupisas-su medtobeallthewomeninthesamplelessthan65y earsofagewhohavepassedthroughthatageinte rval, (1percentperannum)ineach5-year-ageperiod between35and49, ,mentsastowhenmenopauseoccurred:Agewhenm enopauseoccurredUnder25-2930-3435-3940 -4445-4950-5455-5960-6425years---------- years-------------years-------------year s-------------years-------------years--- ----------years-------------years------- ------years-------------byageHealthasder ivedfromrespondents state-ExaminationSurvey,1960-62 Popula-tionatrisk(a)l2,9442,4852,1121,72 11, ~ (b)l2,9442,4732,0061,5661.

6 (a)thenumberofrespondentsinallagegroupsh igherthantheparticularagegroupconsidered ,plushalftherespondentsinthatagegroupatt hetimeofresponse.(b]thenumberin(a)reduce dbvthem?o~ ;f~ , ,amongmenstruatingwomen, , , ,theninewomenwhowerelessthan35yearsofage andreportedhavinghadanaturalmenopausewer eexcludedasheingeitherinerrororahnormal, , i%eline,illustratedinfigure2, ,and4l* ,. ,1,1,1,1$37394143484749515355s? ,byageattimeofresDonse.(WomenwhoreDorted havinghadanoperdtivemenoau$eareexcludedf romthedenominators.!( ) * ,n=22,p> ,asderivedfromthiscurve, ,asjudgedbystand-arderrorscomputedfromth esample,fortheSO-percentpoint( )andslope( ) (tablel). l% ,amongwomenEnothavinghdoperativemenopaus e:HealthExaminationSurvey, , ,incontrasttotheearlierestimatewhichwast heagebywhich50percentofthewomenrecognize dthattheirmenopausehadoccurred.))

7 L%issecondestimateshould,ofcourse, , ,andthedataarerestrictedtoages38-59, ,forthetotalsample, ,usingthefive5-year-agegroupsbe-tween35a nd59, ,n=3,p> ,inmanyofwhichnumbersarequitesmall, ,maritalstatus,familyincome, , ,amongthewhitegroups,womenwithfamilyinco mesoflessthan$2,000,andruralresidents,al sohadlowmenopausalages, ,however, ,height,skinfoldthick-ness, , showsignificantdevia-tionsfromfit, , , ,becauseofdifferencesinmethodsofelicitin gdataandofanalysis, ,inallbutafewstudies, l% , ,andindeedhasbeensuggestedfordiseasesasv ariedascarcinomaofthebodyoftheuterus3-5a ndofthebreast,Gfibroids,6diabetes,4!5car diovasculardisease, ! ,butitisassertedthattheyrepresentednorma lwomeninavarietyofsocialstatuses,geograp hicregions, ,ofcourse,commonlyencounteredinthereview ofstudiesof6human normality, ,themethodhasbeentoaskpostmenopausalwome ntheageatwhichtheirmenopauseoccurred, (table3), sFederationalreadyreferredto8thenumberso fwomenreportingmenopauseatspec-ifiedages were.

8 AgeNumber39,40,4114,92,3544,45,4628,96,6 749,50,5179,167, ,amongwomenaged,say,50years,thosewhoarep ostmenopausalwillbeincluded, , ,when,asinsomestudies, ,someinvestigatorshaveincludedonlywomenw hoarewithinacertainperiod( ,5years) ,sincethefemalepopu-lationdeclinessubsta ntiallybetween40and60yearsofage,andthenu mber atrisk ,asreportedbywomenpostmenopausalatthetim eofSurvey:HealthExaminationSurvey,1960-6 2 :Excludes74womenwhodidnotstatetheageatwh ichmenopauseoccurred, ,inadditiontothetheoreticalreasonsforsup posingthatmostoftheerrorswouldleadtounde restimation, , , 4 sSecond, ; ,ratherthantheiractualage, Ibis,however, , , ,inaddition,theeffectoftheothertypesofer rorsishighlydependentontheagedistributio nofthegroupsurveyed , ,estimateswithinarangeoflessthan3yearsha vebeenreportedMeanmenopausalPlaceandyeav ageinyearsIsrael(1963) (1961~ ,Switzerland(1961) (1960) white(1960) (1942) (1933) ,Pa.)

9 (1918) ,themedianageatmenopauseinFrommer sdataisthemedianageatwhichthelastmenstru alperiodoccurred, ,asFrommerdid, ,ayearearlierthanthatofFrommer ~ ,andintwostudies5 (table7),butinthepresentdatatheeffectiss mallandstatisticallynotsignificant,unipa rouswomensharethelowmeanofthenulliparae, ,s~ > ,usuallyinthecourseofassemblingcontrolgr oupsforepidemiologicstudiesofdiseases,su chascancerofthebreast, , ,asseemslikely,thecertainlythemostcommon formofprocedureincidenceofoperativemenop auseisincreasing,involved,andthefrequenc yobservedinthisthisfactormustbeconsidere dintheinterpre-sampleissufficientlyhight ohaveasubstantialtationoftrendsininciden ceof{ ,* , , :CycleIoftheHealthExaminationSurvey, , ,S.}

10 :46, , :Associationbetweenclimactericbaemor-rha ge, , ,. ~tican# *316, ,VonG,A.,Mtiller,T.,Valaer,M.,Erb,H., ,Remen, !hen,P. :270, , :356, :106, Fmmmer, , ; ,H.:Undersg$ :3,677, , ,Gampel,B.,Slome, ,N. , , ,Obiri, ,Valaer,M.,Erb,H.,M~l-Ier,T.,Remen, ~&en,P. , , ,Remen,U.,Valaer,M.,Erb,H.,M;l-ler, ,J. :39, ]ienfeld, :927, , , , , , (1):28-38, ,byageattimeofresponseandmenopausalstatu s:HealthExaminationSurvey,l96O-62------- ---------------------------------------- --------112.~um~e;20fwomen,byageattimeof reaponaeandmenopausalstatus:UnitedStates , ,bytypeofmenopauseandreportedagewhenperi odsstopped:HealthExaminationSurvey,1960- 62-------------134*Prevalenceofhavinghad operativemenopauae,byageattimeofresponse andrace:HealthExaminationSurvey, ~byracqmsritalstatus,parity,familyincome ,andgeographicregion:HealthExaminationSu rvey, ,byracqmsritalstatus,familyincome,geogra phicregion,andpopulation-sizegroup:Healt hExaminationSurvey, ,byparity,height,skinfoldthickness,andag eatmenarche:HealthExaminationSurvey, , ,19~0-62 Percentageofwomenhavinghad.