Early Menopause and POI Associated with Higher Rates of Multimorbidity, New Findings Reveal

"Women with primary ovarian insufficiency and early menopause exhibited a notably higher prevalence of multimorbidity (64.8%) and severe multimorbidity (39.2%) compared to those who experienced menopause at the average age (43.9% and 21.1%, respectively)," the researchers reported. Multimorbidity, which refers to the presence of two or more chronic diseases or conditions simultaneously, poses significant challenges for patient management and quality of life.

Alison K. Shea, McMaster Institute for Research on Aging, Hamilton, Ontario, Canada, Hamilton, Ontario, Canada, and colleagues aimed to describe the prevalence of multimorbidity among individuals with premature ovarian insufficiency and early menopause compared to the average age of menopause.

The research, conducted as part of a large prospective cohort study, involved female postmenopausal individuals from the Canadian Longitudinal Study on Aging (CLSA). This study gathered cross-sectional data from 50,000 community-dwelling Canadians aged 45 to 85 between 2010 and 2015.

The primary exposure of interest was primary ovarian insufficiency, defined as the onset of menopause before age 40. The study compared this group to those experiencing menopause at average age (46 to 55 years), early menopause (40 to 45 years), late-onset menopause (56 to 65 years), and individuals who had undergone a hysterectomy.

The main outcome measures included multimorbidity, defined as having two or more chronic conditions, and severe multimorbidity, which was defined as having three or more chronic conditions. The study also evaluated the frequency of specific chronic conditions from 15 individual conditions.

The association between multimorbidity and age at menopause was assessed using logistic regression and odds ratios, with confidence intervals set at 95%. These odds ratios were adjusted for various known predictors of multimorbidity, such as age, menopause hormone therapy (MHT), education, ethnicity, self-reported loneliness, living alone, BMI, smoking habits, nutritional risk, social participation, and physical activity.

The study revealed the following findings:

• The study included 12,339 postmenopausal participants, of which 3.0% experienced POI and 11.3% experienced early menopause.
• The prevalence of multimorbidity was 64.8% and 51.1% among those with POI and early menopause, respectively. In contrast, only 43.9% of individuals with average age of menopause (age 46 to 55 years) had multimorbidity.
• The OR for multimorbidity in the POI population was 2.5 in comparison to those who underwent the average age of menopause. This relationship was maintained after adjustment for confounders (aOR 2.0).
• The prevalence of severe multimorbidity was also double in the POI group than the average age group (39.2% versus 21.1%).
• There was a significantly increased risk of ischemic heart disease (aOR 2.8), gastric ulcers (aOR 1.6), and osteoporosis (aOR 1.6) in the POI group.

The study highlights that individuals with premature menopause experience higher rates of multimorbidity compared to those who undergo menopause at the average age of 46 to 55 years. This pattern remains evident even after accounting for significant risk factors for multimorbidity. Additionally, about half of those with POI did not receive adequate MHT, despite evidence suggesting that MHT could potentially reduce multimorbidity risk in this group. Healthcare providers must offer targeted counseling to these patients and conduct thorough assessments.

"The findings emphasize the need for comprehensive, patient-centered care involving family physicians, dietitians, and specialists to effectively manage the complex health needs of individuals with premature menopause," the researchers concluded.

Reference:

Kirubarajan A, Sohel N, Mayhew A, Griffith LE, Raina P, Shea AK, The association between primary ovarian insufficiency and increased multimorbidity in a large prospective cohort, Fertility and Sterility (2024), doi: https://doi.org/10.1016/j.fertnstert.2024.08.345.