Primary ovarian insufficiency more than doubles midlife multimorbidity risk

Key takeaways:

• Women with primary ovarian insufficiency had a higher multimorbidity risk vs. women without.
• Approximately half of women with primary ovarian insufficiency did not receive appropriate hormone therapy.

Women with premature ovarian insufficiency and early menopause have increased multimorbidity compared with women with menopause onset at an average age of 46 to 55 years, according to findings published in Fertility and Sterility.

“There is increasing evidence regarding the detriments of early menopause to overall health, due to the multiple functions of estrogen in cardiovascular, immune, neurological and musculoskeletal systems,” Abirami Kirubarajan, MD, MSc, doctoral student in the department of obstetrics and gynecology at McMaster University in Canada, and colleagues wrote. “However, there is controversy over whether menopause itself or simply advancing age irrespective of menopause status is the primary contributor to morbidity. In addition, previous research is mostly limited to studies that report a single comorbidity of menopausal status, such as osteoporosis or cardiovascular disease.”

Kirubarajan and colleagues conducted a prospective cohort study using data from 12,339 postmenopausal women from the Canadian Longitudinal Study on Aging (2010-2015). Self-reported menopausal status was collected at baseline. Researchers evaluated women with primary ovarian insufficiency (onset of menopause before age 40 years), early menopause (onset at age 40-45 years), women with menopause onset at age 46 to 55 years, and late-onset menopause, defined as onset at age 56 to 65 years, as well as women who underwent hysterectomy.

Primary outcome was multimorbidity, defined as two or more chronic conditions. Secondary outcomes included severe multimorbidity, defined as three or more chronic conditions, and frequencies of specific chronic conditions.

Overall, 3% of women had primary ovarian insufficiency, 11.3% had early menopause, 58.7% had menopause at age 46 to 55 years, 6.6% had late menopause and 20.2% had a hysterectomy. Mean age of menopause onset for women with primary ovarian insufficiency was 34.8 years compared with 51 years for women with normal menopause.

Multimorbidity prevalence as 64.8% for women with primary ovarian insufficiency and 51.1% for women with early menopause compared with 43.9% of women with normal menopause (OR = 2.5; 95% CI, 2-3.1). This observation remained after adjusting for confounders (adjusted OR = 2; 95% CI, 1.5-2.5).

Severe multimorbidity prevalence was double for women with primary ovarian insufficiency and early menopause vs. women with normal menopause (39.2% vs. 21.1%).

In addition, compared with women with normal menopause, those with primary ovarian insufficiency and early menopause had significantly increased risks for ischemic heart disease (aOR = 2.8; 95% CI, 1.7-4.7), gastric ulcers (aOR = 1.6; 95% CI, 1.1-2.3) and osteoporosis (aOR = 1.6; 95% CI, 1.2-2.1).

Despite the increased multimorbidity risk, only 53.5% of women with primary ovarian insufficiency reported ever using menopausal hormone therapy (HT). Mean duration of HT use was 7.1 years; 80% of women discontinued HT before baseline data collection.

“Health care providers should counsel this patient population regarding their risks and assess accordingly,” the researchers wrote. “The findings underscore the necessity for comprehensive, patient-centered interventions involving family physicians, dieticians and specialists to address the complex health care needs of individuals with premature menopause.”