Increased risk of multimorbidity for women with premature menopause, study suggests

Written by Georgia Cousins

New research highlights the increased risk of multimorbidity facing women who experience premature menopause. The findings could encourage healthcare professionals to consider screening programs for women with premature menopause to ensure an early diagnosis of multimorbidity.

The world’s leading reproductive medicine journal, Human Reproduction, recently published findings from researchers at The University of Queensland (Brisbane, Australia), suggesting that multimorbidity was almost three times more likely to develop in women who experience premature menopause compared with women who went through the menopause at the typical age. The results are based on data pertaining to 5107 women who took part in a prospective national cohort study of 11,258 Australian women, aged 45—50 years, in 1996 and who were followed until 2016. The findings could encourage health professionals to consider screening programs for women with premature menopause to ensure an early diagnosis of multimorbidity.

More than 60% of elderly women are affected by multimorbidity. A significant factor that contributes to this high proportion of women affected, is the loss of the ovarian hormone, estrogen. Estrogen mediates several fundamental aging processes at cellular, organ and system levels throughout the body; therefore, when levels are depleted throughout menopause, multimorbidity can arise.

Many studies have previously shown associations between premature menopause, occurring at the age of 40 years or younger, and the onset of individual medical problems later in life. However, until now, there has been little research into the association between premature menopause and multimorbidity.

In this study, researchers from the Centre for Longitudinal and Life Course Research at The University of Queensland (Brisbane, Australia), extracted data from the Australian Longitudinal Study on Women’s Health. This large, prospective, national cohort study of Australian women enabled the researchers to generate a large sample size of 5107 women, aged 45—50, in 1996 and track their health progression over 20 years.

The women were asked to complete self-administered questionnaires every 3 years and to reveal whether they had been diagnosed or treated for any of the following 11 conditions: diabetes, asthma, arthritis, breast cancer, osteoporosis, depression, anxiety, chronic obstructive pulmonary disease, stroke, hypertension or heart disease. For the study, age at natural menopause was confirmed as cessation of menses for at least 12 months without any form of intervention, and multimorbidity was defined by the diagnosis of two or more of the 11 listed chronic conditions.

Of the 5107 study participants, 2.3% experienced premature menopause, occurring at age 40 years or younger; researchers observed that these women were almost three times more likely to develop multimorbidity in their 60’s compared with women who experienced menopause between the ages of 50 and 51 years.

A plausible explanation for the association between premature menopause and the development of multimorbidity is the impact of certain environmental and genetic risk factors. The researchers from this study found that socioeconomic, reproductive and health behavioural risk factors were common between the women who had developed multimorbidity and experienced a natural premature menopause. 

In agreement with previous studies, researchers also determined that a high proportion (55%) of elderly women suffer from multimorbidity. Since the life expectancy for women in high-income countries is now over 80 years old, a third of a woman’s lifetime is spent after menopause. For these reasons, it is essential that we continue to develop a better understanding of the risk factors involved in the development of premature menopause. This will also enable healthcare professionals to highlight which conditions emerge earlier, so that they can elucidate solutions to predict and prevent the onset of other chronic conditions around menopausal transition.

Senior study author Gita Mishra (The University of Queensland) commented: “Our findings indicate that multimorbidity is common in mid-aged and early-elderly women. Premature menopause is associated with an increased risk of developing multimorbidity, even after adjusting for previous chronic conditions and for possible factors that could affect the results, such as whether or not the women had children, how many, education, body mass index, smoking and physical activity.”

Mirsha concluded: “Our findings suggest that health professionals should consider providing comprehensive screening and assessment of risk factors when treating women who experience natural premature menopause in order to assess their risk of multimorbidity.”


Xu X, Jones M, Mishra GD. Age at natural menopause and development of chronic conditions and multimorbidity: results from an Australian prospective cohort. Hum. Reprod. doi:10.1093/humrep/dez259 (2020) (Epub ahead of print);