Early menopause affects one in 13 women

A landmark multi-country study led by researchers at icddr,b has found that around one in every 13 Bangladeshi women experiences menopause before the age of 45, highlighting a significant but often overlooked public health concern.

The study, published last week in BMJ Global Health, found that Bangladesh recorded a prevalence of 7.5 per cent, slightly higher than the average of 7.1 per cent across 44 low- and middle-income countries (LMICs).

Within South Asia, Bangladesh’s rate was comparable to Nepal (7.9 per cent) and marginally lower than India’s 8.0 per cent, while Pakistan reported 5.9 per cent, underscoring that premature or early menopause is a significant public health issue across the region.

Menopause is a natural stage in a woman’s life, marking the permanent end of menstrual periods, and typically occurs between the ages of 45 and 55. Menopause before the age of 45 is classified as early menopause, while menopause before the age of 40 is considered premature menopause.

According to the researchers, women who experience menopause at an early age lose the protective effects of oestrogen sooner than expected, increasing their lifetime risk of cardiovascular disease, osteoporosis, cognitive decline and depression.

The study analysed nationally representative Demographic and Health Survey (DHS) data from 716,648 women aged 30 to 49 years across 44 LMICs.

Women who had not menstruated for at least six months, or who reported menopause or hysterectomy, were identified as menopausal using the DHS methodology. The findings remained consistent when tested against the World Health Organization’s 12-month definition of menopause.

The research also revealed notable social and geographical disparities.
Women living in rural areas were more likely to experience menopause before the age of 45 than their urban counterparts.

Even after adjusting for education, wealth, employment and reproductive history, rural women remained 17 per cent more likely to experience premature or early menopause, pointing to persistent inequalities in healthcare access, nutrition and living conditions.

Education emerged as one of the strongest protective factors.

Compared with women who had no formal education, those with primary education had 11 per cent lower odds of experiencing premature or early menopause. The likelihood fell by 28 per cent among women with secondary education and by 58 per cent among those with higher education.

The study also found that women who married at the age of 18 or later were significantly less likely to experience menopause before the age of 45 than those who married earlier. A similar pattern was observed for age at first childbirth, with women giving birth at 18 or older also facing a lower risk.

“Our findings show that premature or early menopause is shaped by much more than biology. Across 44 countries, women with less education, those living in rural communities, and those marrying or giving birth at a younger age consistently experienced a greater burden,” said Raisha Binte Islam, lead author of the study and a researcher at icddr,b.

She said improving girls’ education and ensuring equitable access to quality healthcare could deliver benefits extending well beyond reproductive health.

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 indicator of women’s future health rather than simply a reproductive milestone.

“The findings show that early menopause affects a substantial proportion of Bangladeshi women, highlighting the need to integrate menopause history into routine healthcare,” he said.

The researchers called for greater investment in girls’ education, stronger efforts to prevent child marriage, improved access to quality reproductive healthcare, and further prospective research to better understand the biological and social factors contributing to premature and early menopause.