Women in low- and middle-income countries face a significantly higher risk of premature menopause, with South Asian women showing an elevated likelihood compared with other ethnicities, according to an analysis of data from 26 countries published in 'The Lancet Obstetrics, Gynaecology, and Women's Health' journal.
The findings also link earlier menopause with increased risk of cardiovascular events such as heart attack and stroke.
Higher risk in low and middle-income countries
The study found that women in low- and middle-income countries could face a 53 per cent increased risk of premature menopause, with half reaching menopause by age 47.5 years, compared with 50.6 years in high-income countries.
Across the 26 countries analysed, data from 1,11,619 women showed that 9.5 per cent had experienced premature menopause, while 15.3 per cent had undergone early menopause.
South Asian women at greater risk
When compared with European women, South Asian women were found to have a 34 per cent increased risk of premature menopause, with half reaching menopause by 47.4 years, compared with 50.7 years for European women.
Menopause is classified as premature when it occurs before age 40 and early when it occurs between ages 40 and 44.
Link to cardiovascular risk
The researchers found that earlier menopause was associated with a higher risk of major cardiovascular events.
Reaching menopause at a younger age increased risk of such events by 14 per cent in early menopause and 27 per cent in premature menopause, the team said.
The association remained consistent across regions and ethnicities, according to the 'Prospective Urban Rural Epidemiologic (PURE)' study.
The authors said, "The findings highlight the importance of the management of cardiovascular risk for women with premature and early menopause globally."
Global study insights
The study is described as the largest of its kind examining menopause using consistent questions across countries, asking participants: "Do you still have periods?" and "How many years since you stopped menstruating?"
Researchers noted that higher cardiovascular event rates were observed in low- and middle-income countries despite lower prevalence of traditional risk factors such as hypertension, obesity and diabetes.
They also pointed to additional contributors such as air pollution, poor diet, low education levels and reduced grip strength.
Importantly, the study identified early and premature menopause as a women-specific risk factor contributing to cardiovascular disease burden in lower-income settings.
The authors said, "This study confirms the association of premature menopause and major cardiovascular events among women in one large internally consistent global study, and has found no heterogeneity in this association across country-income groups and major ethnic groups."