Factors Associated with Later Menopause and Longer Reproductive Lifespan Interview with:
Duke Appiah, Ph.D., MPH
Assistant Professor,Public Health
Texas Tech University What is the background for this study?

Response: Reports from several countries point towards increasing trends in age at natural menopause. However, epidemiological report from the United States on the long-term trends in age at natural menopause or reproductive life span among a nationally representative sample of women is lacking. Understanding changes in the timing of age at natural menopause and length of the reproductive life span and their associated factors are important. For instance, earlier age at natural menopause is reported to be associated with cardiovascular diseases, neurological diseases and osteoporosis while later onset of menopause has been associated with the occurrence of breast, endometrial, and ovarian cancers. Similarly, longer durations of reproductive life span are associated with reduced morbidity and mortality. What are the main findings?

Response: In this study, we observed that over the past six decades, the mean age at natural menopause and reproductive lifespan among U.S. women have increased by 1.5 years and 2.1 years, respectively. What should readers take away from your report?

Response: Over the past 60 years, age at menopause and reproductive lifespan (age at menopause minus age at menarche) has increased among U.S. women. Additionally, Black or Hispanics race/ethnicity, poverty, current and former smoking status, and hormone therapy use were associated with earlier age at natural menopause and shorter reproductive lifespan, while greater years of education and oral contraceptives use were associated with later age at natural menopause and longer reproductive lifespan. What recommendations do you have for future research as a result of this work?

Response: Available evidence links later age at natural menopause with reduced all-cause and cardiovascular mortality but an increased risk of breast, endometrial and ovarian cancers. Whether the 1.5 years increase in age at natural menopause over 60 years observed in this study has clinical significance for women’s health apart from reproduction is unknown. Future longitudinal studies are needed to determine the causal association between increasing trends in age at natural menopause and the incidence of chronic diseases. 

All the authors (Duke Appiah, PhD MPH, Chike C. Nwabuo, MD MPH, Imo A Ebong, MD MS, Melissa F. Wellons, MD, MHS, and Stephen J. Winters MD) have no conflicts to disclose.


Appiah D, Nwabuo CC, Ebong IA, Wellons MF, Winters SJ. Trends in Age at Natural Menopause and Reproductive Life Span Among US Women, 1959-2018. JAMA. 2021;325(13):1328–1330. doi:10.1001/jama.2021.0278



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Last Updated on April 10, 2021 by Marie Benz MD FAAD