Fatores associados à idade da menopausa natural na coorte Elsa-Brasil

Abstract

Introduction: In Brazil, the average age of menopause is between 50 and 51.2 years. When early, menopause is associated with a higher risk for cardiovascular diseases, type 2 diabetes mellitus and osteoporosis, among others. Sociodemographic characteristics, life habits and reproductive factors can interfere with the age of natural menopause, but there are few studies on these relationships in the Brazilian context. Objective: To analyze factors associated with age at natural menopause in women participating in the ELSA Adult Health Longitudinal Study – Brazil, at the first (2008 – 2010) and second visit (2012 – 2014). Methodology: Cross-sectional study, with data from the first (2008-2010) and second (2012-2014) visit in Elsa-Brasil. A total of 3,538 women were studied, considering the age of natural menopause as outcome. Explanatory variables: sociodemographic characteristics (age, income, education, race/color), reproductive characteristics (age at menarche, history of pregnancy - number of deliveries and abortions, duration of the menstrual cycle, use of contraceptives), life habits (smoking, use alcohol consumption, daily consumption of fruits and vegetables, physical activity), health variables (obesity, diabetes, hypertension, symptoms of depression). The association between these variables and the outcome was analyzed by multiple linear regression. Results: The mean age of natural menopause was 49.07 years. The following variables were associated with menopause age: low schooling (High school: β-0.81; 95%CI-1.16;-0.47, Elementary school: β-1.19; 95%CI-1.79;-0.60, Incomplete elementary school: β -1.26;95%CI -1.93, -0.59) in relation to higher education; brown and indigenous skin color in relation to white skin color (β: -0.43; 95%CI-0.80;-0.06 and β:-1.71; 95%CI -3.12;-0.30); smoking (β:-0.84;CI95%-1.29;- 0.39) in relation to never having smoked; number of pregnancies (2 pregnancies β:0.46; 95%CI 0.01; 0.93, 3 pregnancies β:1.01; 0.53;1.50, 4 or more β:0.93; 95%CI 0.45;1.41); in relation to no pregnancy; and menstrual cycle <25 days and >35 days (β -0.58; 95%CI -1.15; -0.02, β: 2.24; 95%CI 1.43; 3.04), compared to 25-35 days. Conclusion: Lower schooling, smoking, brown and indigenous skin color and shorter menstrual cycle were associated with lower mean age at natural menopause, while longer menstrual cycle and higher number of pregnancies were positively associated with the outcome. This study adds to other national studies on the subject and is able to help in clinical practice when health professionals have access to quality data, in the discussion and formulation of more comprehensive women's health policies that work on associated factors with the intention of minimizing the impacts that can be generated in the age of menopause and consequently in the comorbidities arising from an early menopause.