Early menopause affects around one in 13 Bangladeshi women aged 30-49: icddr,b study

Infographic: TBS

Around one in 13 Bangladeshi women aged 30-49 experiences premature or early menopause, according to the largest and most geographically diverse multi-country analysis of its kind, led by icddr,b researchers. 

Published last week in BMJ Global Health, the study analysed nationally representative health data from 716,648 women across 44 low- and middle-income countries (LMICs). It found that premature or early menopause affected 7.1% of women aged 30-49, or around one in 14.

Bangladesh recorded a prevalence of 7.5%, slightly above the overall rate. Within South Asia, the figure was close to Nepal's 7.9% and India's 8%, while Pakistan recorded 5.9%.

Menopause marks the permanent end of menstrual periods and typically occurs between the ages of 45 and 55. Menopause before 40 is classified as premature, while menopause between the ages of 40 and 44 is considered early.

Early or premature menopause is associated with higher lifetime risks of cardiovascular disease, osteoporosis, metabolic disorders, cognitive decline, depression and premature death. It can also affect women's quality of life and daily activities.

How menopause was measured

The study used Demographic and Health Survey (DHS) data from women aged 30-49. The surveys collect information on women's menstrual and reproductive histories.

Under the DHS methodology, women were identified as menopausal if they had not menstruated for at least six months or reported menopause or hysterectomy. Researchers then estimated whether menopause had occurred before age 45 and classified such cases as premature or early menopause.

Education and later marriage linked to lower odds

The study found marked social inequalities associated with premature or early menopause.

After accounting for education, wealth, employment and reproductive history, rural women had 17% higher odds of experiencing premature or early menopause than women living in urban areas.

Education showed one of the strongest associations. Compared with women with no formal education, those with primary education had 11% lower odds of premature or early menopause. The odds were 28% lower among women with secondary education and 58% lower among those with higher education.

Women who married at 18 or later had 34% lower odds than those who married earlier. Those who had their first child at 18 or older had 25% lower odds than women who gave birth earlier.

As the study was cross-sectional, the findings show associations and do not establish that education, residence or reproductive timing directly caused earlier or later menopause.

Across the 44 countries studied, Ethiopia recorded the highest prevalence at 12%, followed by Indonesia at 11.5% and Myanmar at 10.3%. Jordan had the lowest rate at 2.3%, followed by Gabon at 2.6% and Armenia at 2.8%.

Researchers call for earlier care

Lead author Raisha Binte Islam, a researcher at icddr,b, said the findings suggested that premature or early menopause was shaped by much more than biology.

"Women with less education, those living in rural communities, and those marrying or giving birth at a younger age consistently experienced a greater burden. Improving girls' education and ensuring equitable access to quality healthcare could have benefits that extend well beyond reproductive health," she said.

Anisur Rahman, senior director of the Maternal and Child Health Division at icddr,b, said premature or early menopause should be recognised as an important marker of women's future health rather than simply a reproductive milestone.

He urged physicians to routinely ask women about the age at which they experienced menopause, saying the information could help identify those at higher risk of osteoporosis, cardiovascular disease, depression and cognitive decline. This could allow earlier preventive care and long-term follow-up, he added.

Study limitations

The researchers noted that the DHS definition used six months without menstruation, while the World Health Organisation's clinical definition requires 12 consecutive months. The data also could not always distinguish natural menopause from menopause linked to hysterectomy or contraceptive-related absence of menstruation.

However, a separate analysis using the 12-month threshold produced similar prevalence estimates and patterns.

The study could not assess smoking, alcohol use, physical activity, diet, chronic diseases and several other factors because comparable data were unavailable across all participating countries.