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Stroke risk may be linked to menstruation onset
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Women who began menstruating at age 13 and younger were at a higher risk for a stroke, according to research published in Neuroepidemiology. Researchers also found that those who stopped menstruating at age 45 years and younger were more likely to experience a cerebral infarction, but not a stroke.
“The association between menstrual factors and stroke has not been well studied and the published findings are inconsistent,” Keiko Murakami, MPH, DMSc, assistant professor, department of hygiene and public health, Teikyo School of Medicine, and colleagues wrote. “In addition, most studies have examined only one component of menstrual factors.”
To gather more data on the subject, Murakami and colleagues studied 1,412 postmenopausal women in Japan between 1998 and 2010 that were aged 35 years and older who had no history of stroke. The mean age of the participants was 65.9 years, the mean age during menarche was 14.8 years, and the mean age during menopause was 48.8 years. Information regarding BMI, birth year, age, alcohol intake, parity, hormone therapy, smoking, menopause type, and any diagnoses and/or treatment of hypercholesterolemia, heart disease hypertension and diabetes was also collected. Participants were followed until the study period ended, the person moved, died, or had a stroke.
The researchers found that participants aged 13 and younger at the time of menarche had a significantly higher probability of stroke incidence compared with women aged 15 at the time of menarche (adjusted HR = 1.83; 95% CI, 1.04–3.22). Participants aged 45 years and younger during menopause had a higher probability of stroke incidence compared with women aged 50 during menopause, but this association did not reach statistical significance. Among covariates, lower BMI, shorter height, older age, and presence of hypertension were significantly associated with increased risk for stroke.
In addition, participants aged 13 and younger at the time of menarche were significantly more likely to develop cerebral infarction than women aged 15 years during menarche (HR = 2.34; 95% CI, 1.18-4.66). Participants who entered menopause aged 45 years and younger had a higher risk for cerebral infarction than women aged 50 years at the onset of menopause (HR = 3.25; 95% CI, 1.54-6.86).
First strokes were observed in 143 participants and cerebral infarctions were observed in 97 participants during the course of the study.
“This suggested that early menarche and all its associated features might be a useful tool for future intervention strategies targeting modifiable factors that trigger menstrual onset, such as lifestyle, environmental and social factors,” Murakami and colleagues wrote.
Another factor associated with increased risk of stroke among women is pre-term delivery independent of other risk factors, and pregnancy-associated stroke risk has been shown to be higher in younger women. – by Janel Miller
Disclosure: The researchers report no relevant financial disclosures.
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Mitchell S.V. Elkind, MD, MS, MPhil
This study is one of a number of studies that have explored the relationship of various presumably hormonal factors in women and the risk for stroke. I think there’s been a lot of controversy about whether estrogen is protective against risk for stroke. There’s evidence from some studies that those who have earlier menopause may have an increased risk for stroke, presumably because of the decreased exposure to estrogen, which is going to be protective. That at least is the hypothesis. The problem is, there’s been evidence on both sides of that question and there’s a lot of potential confounders in these associations, and so it’s really hard to know what the final answer is on that question. This study does not necessarily resolve the question in my mind one way or the other. It’s not necessarily a better study or a more definitive study than the others that have been done, so the question is still out there, quite honestly, as to whether or not menopause or menarche or total life duration of hormone exposure is associated with risk for stroke. There is more work that needs to be done. I don’t think we’ve reached the point yet where all the studies are lining up to show the same kind of result in order to make a determination that there really is an association. One wants to see consistency among the various studies that are done first.Click Here to Manage Email Alerts