Premature menopause may negate ‘longevity benefit’ of women vs. men

Key takeaways:

• Women with natural or surgical premature menopause had lower all-cause mortality risk vs. men.
• Mean lifespan was similar for women with premature menopause and men, regardless of menopause type.

Menopause onset before age 40 years appears to negate a longevity benefit women typically have over men, particularly among women who also undergo hormone therapy, researchers reported.

In a propensity score matching analysis published in Menopause, researchers also found that women with premature menopause had a lower risk for all-cause mortality compared with men; regardless of whether menopause occurred naturally or surgically. However, the advantage in lifespan that women typically have over men was not significant.

“This is surprising because women generally live longer than men in the general population,” Zailing Xing, MPH, a doctoral candidate in epidemiology at the College of Public Health at the University of South Florida, told Healio. “Still, this longevity benefit appears to be negated by premature menopause, particularly among those who undergo hormone therapy. Women who did not take hormone therapy had a longer lifespan than men, while women who took hormone therapy did not show a significant difference in lifespan from men. This challenges the common belief that hormone therapy universally benefits long-term health.”

Xing and colleagues evaluated data from 3,214 women and 23,067 men (mean age, 61 years) from the National Health and Nutrition Examination Survey from 1999 to 2018 and the NHANES III from 1988 to 1994. All women had premature menopause, defined as menopause onset before age 40 years, and all participants were older than 40 years at the time of the study. Researchers matched women with premature menopause and men to assess sex differences in all-cause mortality and survival.

Overall, 1,584 women had premature menopause before age 35 years and 1,629 had premature menopause from age 35 to 39 years; there were 874 cases of surgical menopause.

Women younger than 35 years (adjusted HR = 0.65; 95% CI, 0.54-0.78), those aged 35 to 39 years (aHR = 0.72; 95% CI, 0.59-0.87) and those younger than 40 years (aHR = 0.67; 95% CI, 0.6-0.76) at natural or surgical premature menopause onset had lower all-cause mortality vs. men. Researchers observed no significant difference in surviving to the 75th percentile of lifespan between matched deceased women with natural or surgical premature menopause before age 40 years and men.

In the subgroup analysis, mean lifespan did not significantly differ between the 1,553 deceased women with premature menopause using hormone therapy and men. Conversely, researchers noted that the average lifespan was longer for the 1,661 women who never used hormone therapy vs. men (78.3 years vs. 76.6 years; P = .0154).

“Health care providers should be vigilant about monitoring and managing conditions associated with premature menopause, such as cardiovascular disease and osteoporosis. Additionally, the risks and benefits of hormone therapy should be carefully evaluated on an individual basis,” Xing told Healio. “Clinicians should weigh the potential long-term health consequences of hormone therapy, such as its effects on cardiovascular health and cancer risks, against its benefits in alleviating menopausal symptoms.”

Xing said more research is needed to understand the mechanisms that drive the diminished lifespan advantage for women with premature menopause compared with men.

“Specifically, studies should focus on the biological, hormonal and lifestyle factors that may influence mortality and lifespan in this group,” Xing said. “In addition, more longitudinal studies are needed to assess the long-term risks and benefits of hormone therapy.”

Xing added that research should explore the effectiveness of nonhormonal therapies for improving the health and lifespan of women with premature menopause.

For more information:

Zailing Xing, MPH, can be reached at xingzailing@gmail.com.