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To assess the impact of childhood socioeconomic disadvantage (SED) on the risks of depression and physical multimorbidity in later life and to explore whether depression mediates the association between childhood SED and physical multimorbidity.Data on 8214 adults from the China Health and Retirement Longitudinal Study were analyzed. The mean (SD) age of the study population was 57.0 (8.0) years at baseline (2011) and 51.9 % were females. Multivariable logistic regressions were used to examine the associations of childhood SED (indexed by food insecurity, highest education level of parents, and self-perceived household financial situation, and scored 0-3) with later-life depression (scored ≥10 on the 10-item Center for Epidemiologic Studies Depression Scale) and physical multimorbidity (having two or more doctor-diagnosed chronic conditions) assessed in the 2018 follow-up survey. Mediation analysis was conducted in the overall sample and further stratified by sex to estimate the degree to which the association between childhood SED and physical multimorbidity could be explained by baseline depression.Participants with a childhood SED score of 3 (i.e., the most disadvantaged) had 2.63 (95 % confidence interval [CI]: 1.91-3.63) times and 2.08 (95 % CI: 1.56-2.77) times higher odds of depression and physical multimorbidity respectively compared with those who had a score of 0 (i.e., the least disadvantaged). Depression mediated 20 % of the association between childhood SED and physical multimorbidity (36 % in females and 5 % in males).Childhood SED was associated with higher risks of depression and physical multimorbidity in later life, and the association of childhood SED with physical multimorbidity was mediated by depression, especially among females.

Some reproductive factors are found to be associated with metabolic outcomes in women; however, little is known about reproductive lifespan characteristics and the mutual effect of age at menarche and age at menopause on cardiovascular risk. This systematic review evaluated reproductive lifespan characteristics and describes the mutual effect of age at menarche and age at menopause on the risk of type 2 diabetes (T2DM) and hypertension at midlife. PubMed, EMBASE, and Web of Science were screened for studies published up to September 1, 2020. The individual effect estimates were reviewed and synthesized without meta-analysis due to methodological and clinical or conceptual diversity in reported studies. Of the 3033 identified studies, 20 were included in the final synthesis: 6 reported reproductive life span; 12 reported age at menarche, and 7 reported age at menopause. Synthesis of two cohorts, with a median follow-up of 9-11 years, showed that a shorter reproductive lifespan was positively associated with T2DM, yielding 6-15% higher risk of T2DM for a one-year decrease in reproductive lifespan. A few studies also demonstrated that women who experienced early menarche (four of six studies) and early menopause (two of five studies) were positively associated with risk of T2DM. The association between reproductive lifespan and hypertension was unclear due to the limited availability of studies. Our findings suggest that a shorter reproductive lifespan is associated with T2DM risk in postmenopausal women, especially those with early menarche and early menopause. Large cohort studies are needed to assess the association between reproductive lifespan and incident hypertension in midlife.

Objective To ascertain the association between vasomotor menopausal symptoms (VSM), hot flushes and night sweats, and cardiovascular disease, coronary heart disease and cerebrovascular disease. Study design The study sample comprised 8881 women (aged 45–50 years) with available hospital separation data from the 1946-51 cohort (1996–2016) of the ongoing Australian Longitudinal Study on Women’s Health, a national prospective cohort study. Main outcome measures First fatal or non-fatal cardiovascular disease, coronary heart disease, and cerebrovascular disease events were obtained through linkage with hospital admission data, the National Death Index, and Medicare Benefits Schedule. Hot flushes and night sweats were assessed via questionnaires at each main survey. Additionally, we calculated the duration of symptoms based on whether or not women reported vasomotor menopausal symptoms in each survey. Results There were 925 cardiovascular disease, 484 coronary heart disease and 154 cerebrovascular disease events. There was no consistent evidence of any association with vasomotor menopausal symptoms, hot flushes and night sweats. We did find marginally statistically significant associations between presence of night sweats and cardiovascular disease (Hazard Ratio = 1.18, 95 % Confidence Interval: 1.01–1.38), and between the duration of vasomotor menopausal symptoms [years] and coronary heart disease (Hazard Ratioper year = 1.03, 95 % Confidence Interval: 1.00–1.05). However, given the number of associations tested, these findings could very well have arisen by chance. Conclusion In this large longitudinal study with 20 years of follow-up and clinical outcomes we did not find a convincing association between vasomotor menopausal symptoms, hot flushes, night sweats and cardiovascular disease, coronary heart disease and cerebrovascular disease.

New evidence on the association between use of menopausal hormone therapy and increased risk of cutaneous melanoma (CM) is emerging. In the Australian Longitudinal Study on Women's Health, we followed 18,850 postmenopausal women for a median of 13.2 years, and observed 356 incident CMs. We found an indication of an association between use of unopposed oestrogen therapy and CM risk (hazard ratio (HR) 1.26; 95% confidence interval (CI) 0.98, 1.61), and no association between use of oestrogen-progestin therapy and CM risk (HR 0.99; 95% CI 0.37, 2.67). More studies are needed to elucidate the potential impact of different types of hormone therapy on CM risk.

This study examined the association between reproductive lifespan and incident type 2 diabetes mellitus (T2DM) and hypertension in mid-age women. Also, the combined effect of reproductive lifespan and body mass index (BMI) on the risks of T2DM and hypertension were explored.Reproductive lifespan was defined as the difference between age at menopause and age at menarche, and categorized as35, 35-37, 38-40, and ≥41 years based on the quartile distribution. A multivariable Cox proportional hazard regression was used, adjusting for socio-demographic, lifestyle, and reproductive factors.Of 6357 postmenopausal women included (mean [SD] age at last follow-up, 66.3[3.3] years), a total of 655 developed incident T2DM (10.3%) and 1741 developed hypertension (30.0%) during 20 years of follow-up. The total sample had a mean (SD) reproductive lifespan of 37.9 (4.5). Compared with the women who had a reproductive lifespan of 38-40 years, those with a short reproductive lifespan (35 years) had a 30% increased risk of T2DM and twice the risk of hypertension. Under the combined model, women who had a short reproductive lifespan (35 years) and who had a BMI ≥30 kg/mA higher risk of both incident T2DM and hypertension at midlife was found among women experiencing a shorter reproductive lifespan, with pronounced risk for women experiencing both a short reproductive lifespan (35 years) and a higher baseline BMI (≥30 kg/m

Previous reviews have found that menstrual and reproductive factors are associated with lung cancer risk, but evidence on a possible association with age at menopause is inconsistent. This review aimed to determine the association of early and late menopause with lung cancer risk. Publications were reviewed and obtained through PubMed, EMBASE and Scopus database search up to March 2021. The pooled relative risks (RRs) or odds ratios (ORs) and corresponding 95% CIs were estimated using a random-effects meta-analysis. Twenty-eight studies were included in at least one meta-analysis, of age at menopause (lowest vs highest; n=26), early menopause (≤45 vs ≥50/51 years or middle; n=11), late menopause (≥55 vs

Objectives To investigate whether menstrual symptoms are associated with increased risk of hypertension among young women, and whether the relationship is bi-directional. Study design We included 7729 women participating in the Australian Longitudinal Study on Women’s Health, aged 22–27 years in 2000 and who were followed up every 3 years until 2015. Premenstrual syndrome, painful (dysmenorrhoea), heavy (menorrhagia), and irregular menstrual periods over the previous 12 months were self-reported and recorded as ‘never’, ‘rarely’, ‘sometimes’, or ‘often’. Questions regarding physician-diagnosed hypertension were asked, specifically for other than during pregnancy (defined as chronic hypertension) and during pregnancy (hypertensive disorder in pregnancy, HDP). Longitudinal data were analysed with generalised estimating equation time-lagged models to estimate relative risks (RRs) and 95 % confidence intervals (CI), adjusted for time-varying covariates. Mian outcome measures Chronic hypertension, HDP, and menstrual disorders. Results Over 15 years of follow-up, 757 women (9.8 %) reported having been diagnosed with chronic hypertension. Among 4473 parous women, 483 (10.8 %) reported a diagnosis of HDP. Women who often experienced heavy periods had an increased risk of incident chronic hypertension (RR 1.53, 1.13−2.09), compared with those who had not experienced heavy periods. We also found that women with chronic hypertension had an increased risk of incident heavy (RR 1.23, 1.02−1.50) and irregular periods (RR 1.42, 1.17−1.72). However, there was no apparent association between any menstrual symptoms and subsequent risk of HDP. Conclusions The association between heavy periods (menorrhagia) and chronic hypertension may be bi-directional in young women. Chronic hypertension may also be associated with subsequent risk of irregular periods.

There is substantial multimorbidity at mid-life but little is known about the strength of evidence on multimorbidity and health-related quality of life (HrQoL) at mid-life. This review addresses this gap, focusing on studies of the general population. PubMed, Web of Science, Embase and APA PsycNET databases were screened on 6 March 2017 for original research on multimorbidity and HrQoL in adults aged 40-65 years from the general population. Studies focused on index conditions, using single-item HrQoL measures, unlikely to represent the general population (e.g. primary care), and papers that were not in the English language were excluded. A narrative synthesis was presented due to heterogeneity in the measurement of multimorbidity. Of the 2557 articles, 83 underwent full text screening and 8 were included in the review. Included studies were of moderate to high quality and no exclusions were made on the basis of quality or bias. Multimorbidity was associated with poorer HrQoL at mid-life. Two cross-sectional studies found that adults with multimorbidity at early mid-life reported poorer HrQoL than adults with multimorbidity at late mid-life, while another found the reverse. Two distinct disease clusters were identified: mental health conditions and cardiovascular disease (CVD). Those in the mental health cluster reported poorer HrQoL than those in the CVD cluster, women more so than men. Limitations of the selected studies include lack of longitudinal evidence, use of self-reported conditions and no assessment of disease severity. Multimorbidity is associated with poor HrQoL at mid-life at the population level, with some evidence of differences in association with age and disease cluster and sparse evidence on sex differences. Longitudinal research using a weighted disease severity index and multimorbidity trajectories is needed to strengthen the evidence base.

Introduction Postmenopausal osteoporosis is a highly prevalent disease. Prevention through lifestyle measures includes an adequate calcium intake. Despite the guidance provided by scientific societies and governmental bodies worldwide, many issues remain unresolved. Aims To provide evidence regarding the impact of calcium intake on the prevention of postmenopausal osteoporosis and critically appraise current guidelines. Materials and methods Literature review and consensus of expert opinion. Results and conclusion The recommended daily intake of calcium varies between 700 and 1200 mg of elemental calcium, depending on the endorsing source. Although calcium can be derived either from the diet or supplements, the former source is preferred. Intake below the recommended amount may increase fragility fracture risk; however, there is no consistent evidence that calcium supplementation at, or above, recommended levels reduces risk. The addition of vitamin D may minimally reduce fractures, mainly among institutionalised people. Excessive intake of calcium, defined as higher than 2000 mg/day, can be potentially harmful. Some studies demonstrated harm even at lower dosages. An increased risk for cardiovascular events, urolithiasis and even fractures has been found in association with excessive calcium intake, but this issue remains unresolved. In conclusion, an adequate intake of calcium is recommended for general bone health. Excessive calcium intake seems of no benefit, and could possibly be harmful.

Simoncini, Tommaso/0000-0002-2971-0079; Chung, Hsin-Fang/0000-0003-3261-5942; Mishra, Gita/0000-0001-9610-5904 WOS:000468709100014 PubMed ID: 31027683 Introduction: While the associations of genetic, reproductive and environmental factors with the timing of natural menopause have been extensively investigated, few epidemiological studies have specifically examined their association with premature (< 40 years) or early natural menopause (40-45 years). Aim: The aim of this position statement is to provide evidence on the predictors of premature and early natural menopause, as well as recommendations for the management of premature and early menopause and future research. Materials and methods: Literature review and consensus of expert opinion. Results and conclusions: Strong genetic predictors of premature and early menopause include a family history of premature or early menopause, being a child of a multiple pregnancy and some specific genetic variants. Women with early menarche and nulliparity or low parity are also at a higher risk of experiencing premature or early menopause. Cigarette smoking (with a strong dose-response effect) and being underweight have been consistently associated with premature and early menopause. Current guidelines for the management of premature and early menopause mainly focus on early initiation of hormone therapy (HT) and continued treatment until the woman reaches the average age at menopause (50-52 years). We suggest that clinicians and health professionals consider the age at menopause of the relevant region or ethnic group as part of the assessment for the timing of HT cessation. In addition, there should be early monitoring of women with a family history of early menopause, who are a child of a multiple pregnancy, or who have had early menarche (especially those who have had no children). As part of preventive health strategies, women should be encouraged to quit smoking (preferably before the age of 30 years) and maintain optimal weight in order to reduce their risk of premature or early menopause.

Objectives There is limited research on hot flushes and night sweats in women with a hysterectomy with ovarian conservation. We aimed to describe the patterns of these symptoms in a cohort of Australian women and to investigate the relationship between distinct symptom patterns and hysterectomy status. Study design and outcome measures Repeated-measures latent class analysis (LCA) was used to identify hot flushes and night sweats symptom patterns across seven surveys (over 17 years) in the mid-cohort of the Australian Longitudinal Study on Women⿿s Health. Multinomial logistic regression was used to assess the associations of the symptom patterns in women with a hysterectomy with ovarian conservation (n = 1129) versus women without a hysterectomy (n = 4977). Results A higher proportion of women with a hysterectomy than of those without experienced a constant pattern of hot flushes (15% versus 30%) and night sweats (9% versus 19%). Women with a hysterectomy had higher odds of constant hot flushes versus minimal hot flushes (OR = 1.97, 95% CI: 1.64, 2.35) and constant versus minimal night sweats (OR = 2.09, 95% CI: 1.70, 2.55). Smoking, a ⿿lower level of education to non-professional occupation⿿ pathway and body mass index (BMI) patterns of ⿿always obese⿿ and ⿿increasingly obese⿿ were also associated with a higher risk of constant symptoms. Conclusions Women who have a hysterectomy (with ovarian conservation) have a higher risk of hot flushes and night sweats that persist over an extended period.

The educational mobility of mid-age women is rarely studied. We analysed the baseline socio-economic position (SEP) and health factors associated with obtaining further education in 4117 mid-age Australian women between 1996 and 2010 (aged 45-50 at baseline, 62-67 at follow-up) from a population-based study. Women either unemployed or working part-time at baseline had higher odds of a stable low and middle education over time (ORs ranging from 1.61 to 3.86) versus educational mobility. Apart from obesity, characteristics that may signal an unhealthy lifestyle in early mid-life were not useful indicators of women's future educational mobility.

Taking a life course approach to the study of reproductive health involves the investigation of factors across life and, also across generations, that influence the timing of menarche, fertility, pregnancy outcomes, gynaecological disorders, and age at menopause. It also recognises the important influence of reproductive health on chronic disease risk in later life. Published literature supports the use of an integrated life course approach to study reproductive health, which examines the whole life course, considers the continuity of reproductive health and the interrelationship between the different markers of this. This is in contrast to more traditional approaches that tend to focus only on contemporary risk factors and which consider each marker of reproductive health separately. For instance, we found evidence linking early life factors such as growth, socioeconomic conditions, and parental divorce with ages at menarche and menopause, although the nature of the relationship differs. We discuss the different theoretical models that are used within life course epidemiology and which postulate pathways linking exposures across the life course to health outcomes, using examples of relevance to the study of reproductive health. These highlight the importance of examining timing of exposures, such as during critical periods in early life, and the temporal order of exposures. How life course frameworks of reproductive health can be developed to help identify hypotheses to be tested is also demonstrated. This approach has implications for the development of effective health policy that moves beyond identifying not only the type of intervention but also the most appropriate time across life to intervene.

Objective This study investigates the influence of body mass index (BMI) at ages 15, 20, 26, 36, and 43, and of BMI trajectories from 20 to 36 years on the timing of menopause and hormone therapy (HT) use until age 57 years. Methods A nationally representative British cohort of 1583 women born in March 1946 with prospective data across the life course. Results By age 57, a total of 695 women had experienced natural menopause while 431 women had started HT prior to menopause. Cox regression models indicated no significant associations between BMI at any age, or BMI trajectory, and timing of natural menopause. At every age BMI was strongly (p ≤ 0.01) and linearly associated with age at HT use and BMI from 26 years onwards was associated with age at first event (menopause or HT use). Decreasing BMI was associated with earlier HT use at all ages. These associations were not accounted for by parity, cigarette smoking or childhood and adult social class. Conclusion BMI across the reproductive lifespan did not influence age at menopause to an extent that would be clinically relevant for postmenopausal health. Lower BMI at all ages and underweight trajectory were related to an earlier start of HT. Further studies are required to understand whether such relationships are due to underweight women experiencing menopause earlier (and because of menopausal symptoms starting HT earlier) than heavier women, or having behavioural characteristics related to earlier HT use, independent of menopause.

Objective To examine the association of depressive symptoms with subsequent urinary incontinence (UI) symptoms among young women. Subjects and methods Data were from a cohort of 5391 young women (born 1973–1978) from the Australian Longitudinal Study on Women's Health. Generalised Estimating Equations (GEEs) were used to link depressive symptoms, and history of doctor diagnosed depression at Survey 2 (S2) in 2000 with the incidence of UI symptoms in subsequent surveys (from S3 in 2003 to S6 in 2012). Results 24% of women reported the incidence of UI over the nine-year study period, while the prevalence rose over time from 6.8% (at S2, aged 22–27 years) to 16.5% (at S6, aged 34–39). From univariable GEE analysis, women with depressive symptoms or a history of depression were more likely to report subsequent UI symptoms. This remained after adjusting for socio-demographic, body mass index, health behaviours and reproductive factors, with depressive symptoms associated with 37% higher odds (odds ratio 1.37, 95% CI 1.16 to 1.61) and history of depression with 42% higher odds (1.42, 1.17 to 1.74) of incidence of UI. Conclusions When woman seek treatment for UI symptoms, health professionals should consider her current or history of depression.

Introduction: Premature menopause and early menopause are known risk factors for adverse health outcomes in later life. While cigarette smoking is an established risk factor for earlier age at menopause, the overall size and strength of its relationship with premature or early menopause is yet to be fully elucidated.Objectives: To quantify the magnitude of the relationship between cigarette smoking status with the age at final menstrual period (FMP).Methods: The International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE) enables the use of pooled data on 51 450 women from nine longitudinal observational studies in the UK, Scandinavia, Australia and Japan. Age at FMP was confirmed by at least 12 months of cessation of menses and categorised as: premature menopause (FMP before age 40), early menopause (FMP 40–44 years), 45–49 years, 50–51 years, 52–53 years, or 54 or more years. Cigarette smoking was categorised as current smoker, past smoker, or never smoker. Multinomial logistic regression was used to identify associations with age categories for FMP, after adjusting for birth year, age at menarche, education level, marital status, parity, and body mass index during midlife.Findings: Overall 18% of the women were smokers, with a mean age at FMP of 48.9 years (SD 4.2). The mean (SD) for never or past smokers was 50.1 (4.2) years. Current smokers were at a higher risk of having premature menopause (RRR 1.48, 95% CI 1.17 to 1.88), early menopause (1.70, 1.43 to 2.03), FMP at 45–49 years (1.43, 1.31 to 1.56) compared with never smokers. Past smokers had similar risks as never smokers.Conclusions: This study identified robust evidence for the effect of cigarette smoking on the timing of menopause before the age of 50, with the effect being highest for early menopause. Findings underscore support for smoking prevention and quitting programmes for women of reproductive age.

Objectives To ascertain the prevalence of premenstrual syndrome (PMS) and dysmenorrhea in Australia women and to examine whether there is population subgroups with distinct symptom trajectories. Study design A prospective cohort study, including 9671 young women random sampled from national Medicare database and followed up for 13 years, examined the prevalence, the trend and the symptom trajectories of the conditions. Main outcome measures Prevalence of PMS and dysmenorrhea over time, their symptom trajectories, and the probability of symptom reporting at follow-up. Results The prevalence of PMS varied between 33 and 41% and that of dysmenorrhea between 21 and 26%. The probabilities of reporting PMS and dysmenorrhea were 0.75 (95% CI, 0.73, 0.76) and 0.70 (95% CI, 0.68, 0.72), respectively, among women who reported them in three previous consecutive surveys. Four unique trajectories were identified for both conditions. PMS was experienced by 80% of women some time during the study period, with normative (22.1%), late onset (21.9%), recovering (26.5%) and chronic (29.5%) groups revealed. Dysmenorrhea occurred in 60% of women with normative (38.3%), low (28.0%), recovering (17.2%) and chronic (16.5%) groups identified. Conclusions PMS and dysmenorrhea are common among young women. Both have relatively stable prevalence over time, but exhibit considerable variation at the individual level. Four subgroups of women who followed similar symptom trajectories were identified. PMS was experienced by 80% of women during the study period and it tended to be a long-lasting problem in many. Although 60% of women experienced dysmenorrhea, only a small group continuously reported it. Smoking and illicit drugs use, and smoking and obesity were more common among women with persistent PMS and dysmenorrhea respectively.

Evidence from population-based studies of women increasingly points to the inter-related nature of reproductive health, lifestyle, and chronic disease risk. This paper describes the recently established International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease. InterLACE aims to advance the evidence base for women's health policy beyond associations from disparate studies by means of systematic and culturally sensitive synthesis of longitudinal data. Currently InterLACE draws on individual level data for reproductive health and chronic disease among 200,000 women from over thirteen studies of women's health in seven countries. The rationale for this multi-study research programme is set out in terms of a life course perspective to reproductive health. The research programme will build a comprehensive picture of reproductive health through life in relation to chronic disease risk. Although combining multiple international studies poses methodological challenges, InterLACE represents an invaluable opportunity to strength evidence to guide the development of timely and tailored preventive health strategies.

Using prospective data from 983 British women born in 1946, the study aims to describe the profiles of symptoms of stress, urge, and severe incontinence, and to relate these to change in quality of life. Based on the longitudinal patterns of symptoms experienced, four groups of women were defined: ‘low symptom’, ‘onset’, ‘recovering’, and ‘chronic’. Childhood enuresis was associated with being in the ‘chronic’ group for urge and severe incontinence. Women in the ‘recovering’ group for stress incontinence experienced an improvement in the physical health domain (regression coefficient (95% CI): 0.1(0.02, 0.18)) compared with women without symptoms. This relationship existed beyond the effects of ageing, menopausal status, current life stress, and reproductive, lifestyle, and social factors. More research is needed to understand the mechanism that link childhood enuresis to being in the ‘chronic’ group for urge and severe incontinence.

Objectives: Trouble sleeping affects 43% of women in the United Kingdom and is associated with detrimental outcomes, including depression and stroke. The causes of trouble sleeping require further elucidation. Understanding of how women manage such trouble is limited. The objectives of this paper are 1) to study the relationship between menopausal transition status and trouble sleeping, and 2) to identify how women manage trouble sleeping. Analysis adjusts for current psychological, vasomotor, and somatic symptoms, and other social and lifestyle factors. Methods: The analysis utilized a cohort of 889 British women followed from birth in 1946 through age 54. Generalized estimating equations were utilized for repeated measures of trouble sleeping, menopausal transition status, and health symptoms from ages 48 to 54. Classification trees were used to describe women seeking conventional and alternative/complementary therapies. Results: While current psychological, vasomotor, and somatic symptoms attenuated the relationship between menopausal transition status and trouble sleeping, women who transitioned to postmenopause (adjusted odds ratio [95% CI]: 1.51 [1.08, 2.10]) or had a hysterectomy (1.57 [1.14, 2.15]) were more likely to report trouble sleeping than women who remained premenopausal. Adjustment for other factors did not alter these relationships. Women with greater educational attainment and of non-manual social class were more likely to seek conventional and alternative/complementary therapies. Conclusions: Treatment of psychological, vasomotor, and somatic symptoms may contribute to improved sleep during the menopausal transition. Women may require additional attention for sleep around the time of transition to postmenopause or hysterectomy.