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Current Topics in Menopause, 2013, 3-19 3 A Life Course Approach to Reproductive Aging Sarah E. Tom 1 and Gita D. Mishra 2,* CHAPTER 1 1 Department of Preventive Medicine and Community Health University of Texas Medical Branch, 301 University Blvd., Galveston, Texas 77555, USA and 2 School of Population Health, University of Queensland, Herston, QLD 4006, Australia Abstract: We describe how a woman’s age at menopause and whether she experiences natural or surgical menopause depends on her social and biological experiences from prenatal through adult life. We contrast evidence from Western industrialized nations and developing countries. Menopause occurs because of the depletion of the follicular reserve or as a result of surgery. Among the most robust risk factors for age at natural menopause are those that influence follicular pool development and decline, including birth outcomes, early life development and socioeconomic status, smoking, and parity. Relationships with indicators of reproductive health from earlier in life, adult weight, and adult socioeconomic status have less robust relationships with age at and type of menopause. Hysterectomy is related to socioeconomic status across the life course, parity, and weight in mid to later adulthood. While studies from Western industrialized countries are more numerous, studies from developing countries suggest differences in socioeconomic status and early life development for both age at menopause and type of menopause. We close by providing suggestions for how future research may further the understanding of the interaction of social and biological contributors to age at and type of menopause. Keywords: Natural menopause, hysterectomy, life course, weight, socioeconomic status, birth outcomes, reproductive characteristics, age at menarche, reproductive aging, genetics, developing countries. INTRODUCTION Send Orders of Reprints at bspsaif@emirates.net.ae In 2010 women over the age of 50 comprised 11% of the world’s population. This figure will rise to 18% by 2050 [1]. Because of these shifts in population distribution, understanding women’s reproductive aging is an increasing priority for health care providers and policy makers alike. Reproductive aging indicates underlying health and serves as a sentinel for future health status [2, 3], including *Address correspondence to Gita D. Mishra: School of Population Health, The University of Queensland, Herston, QLD 4006, Australia; Tel: +61 7 3346 5224; Fax: +61 7 3365 5540; E-mail: g.mishra@uq.edu.au Volodymyr Dvornyk (Ed) All rights reserved-© 2013 <strong>Bentham</strong> <strong>Science</strong> Publishers
4 Current Topics in Menopause Tom and Mishra risk of breast [4, 5] and endometrial cancer [6-8], poor bone health [9, 10], cardiovascular disease [11] and mortality [12-15]. A life course epidemiology approach demonstrates that type of menopause and timing of menopause, two indicators of reproductive aging, relate to characteristics that are concurrent and those that trace back to earlier adulthood, adolescence, childhood, and infancy. This approach studies how social and biological factors operating at different stages of the life course and across generations contribute to the heterogeneity in reproductive aging. Understanding factors over the life course will inform to strategies to improve health both at these earlier stages of life and in older ages. In this chapter we review recent advances in women’s reproductive aging from a life course perspective. The majority of life course studies of women’s reproductive aging come from Western industrialized countries that have a high level of economic development. It is important to understand the context of developing countries that have experienced less economic development, which comprise the regions of the world with the fastest population aging, both in terms of absolute numbers and in terms of population distribution [16]. Economic development has strong implications for the social and physical environment, access to health care, and nutrition. Because these experiences have health and human developmental influences over the life course, it is unclear if women in developing and Western industrialized countries will have similar experiences with reproductive aging. Although great diversity exists amongst both developing and Western industrialized countries, we use these groupings as a guide in organization of the results. We recognize that each country is a unique context for reproductive aging, and indeed that even more local geographic patterns are likely. Throughout the chapter we examine existing data from both regions of the world. We discuss the connections among physical health and development, health behaviors, reproductive health, and social circumstances from prenatal life through adulthood and the timing and type of menopause. We conclude by underscoring challenges in the study of women’s reproductive aging from a life course perspective and offering suggestions for future directions in this area of research.
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