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Increased mortality and non-cancer morbidity risk may be associated with early menopause and varies with aetiology: An exploratory population-based study using data-linkage

  • E.P. Thong
    Affiliations
    Monash Centre for Health Research and Implementation-MCHRI, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
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  • R.J. Hart
    Affiliations
    Division of Obstetrics and Gynaecology, University of Western Australia, Crawley, Western Australia, Australia
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  • H.J. Teede
    Affiliations
    Monash Centre for Health Research and Implementation-MCHRI, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
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  • Author Footnotes
    1 Equal senior authors.
    A.J. Vincent
    Correspondence
    Corresponding author at: Monash Centre for Health Research and Implementation, Locked Bag 29, Clayton, Victoria 3168, Australia.
    Footnotes
    1 Equal senior authors.
    Affiliations
    Monash Centre for Health Research and Implementation-MCHRI, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
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  • Author Footnotes
    1 Equal senior authors.
    J.C. Enticott
    Footnotes
    1 Equal senior authors.
    Affiliations
    Monash Centre for Health Research and Implementation-MCHRI, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
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  • Author Footnotes
    1 Equal senior authors.

      Highlights

      • Mortality is increased in women with early menopause.
      • Survivors of breast and gynaecological cancers who have undergone early menopause have increased risks of hip fracture, circulatory and endocrine disorders compared with controls.
      • Surgical menopause for benign conditions prior to age 45 years is associated with an 8-fold increased risk of depression and anxiety compared with controls.
      • Further studies are needed to determine the long-term mental and physical impacts of early menopause in women as a result of cancer treatments or surgery for benign conditions.

      Abstract

      Objective

      Iatrogenic early menopause (EM), that is, menopause before the age of 45 years due to surgery or chemotherapy or radiotherapy, is associated with negative health impacts. However, it is unclear how these vary according to the cause of EM. We investigated mortality and non-cancer morbidity in women with iatrogenic EM of different aetiologies.

      Study design

      Population-based retrospective cohort study with 36-year follow-up using data-linkage with the Western Australia hospital morbidity database, cancer, birth and death registries, the midwives notification system and the mental health information system. The sample comprised women aged 20–44 years at index date with iatrogenic EM associated with breast or gynaecological cancer (n = 607), or benign bilateral oophorectomy (n = 414), and age-matched female controls (n = 16,998). Index date (breast, ovarian or uterine cancer diagnosis or oophorectomy procedure) ranged from 1982 to 1997, with follow-up until 2018.

      Main outcome measures

      Mortality and hospitalisation for circulatory disorders, endocrine, psychological, respiratory, musculoskeletal and gastrointestinal morbidities.

      Results

      Significant differences in mortality were observed (% dead by follow-up: cancer, 53.0; oophorectomy, 10.9; and controls, 3.5; p < 0.001). Incidence rate ratios (IRRs) were increased for circulatory (1.23, 95 % CI 1.07–1.42) and endocrine disorders (1.31, 95%CI 1.08–1.56) and hip fracture (3.90, 95 % CI 1.83–7.40) in cancer survivors, compared with controls. IRRs for circulatory (0.62, 95 % CI 0.53–0.72) and endocrine disorders (0.62, 95 % CI 0.38–0.97) were reduced in the oophorectomy group, but were increased for psychological (8.53, 95 % CI 7.29–9.94) and gastrointestinal morbidities (1.43, 95%CI 1.21–1.67) compared with controls.

      Conclusion

      Cancer-related or benign iatrogenic EM may be associated with increased mortality and morbidity, which vary with the cause of EM.

      Keywords

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