title: The association between educational level and age at the menopause: a systematic review.
abstract: OBJECTIVE
  To evaluate the association between educational level and age at menopause, and to describe the potential mechanisms involved.
  
  
  METHODS
  A systematic review of the literature was undertaken to evaluate this question. Educational level, which is considered one of the best socioeconomic indicators, was evaluated in this review as an exposure factor leading menopause to occur at an earlier age. The electronic search strategy was developed specifically for the different databases considered and through cross-referencing. After initially identifying 795 papers, 56 of them were selected for evaluation of the complete text.
  
  
  RESULTS
  In the end, our systematic review included 25 papers covering 29 studies. In 75.9% of the studies evaluated in this review, there was a weak association (statistically significant in 45%) between lower educational level and earlier age of the menopause. The various methodological differences between the studies were unable to substantially influence the results. The way in which educational level was measured and the methodology for comparing strata differed greatly. The complexity of socioeconomic level mechanisms on menopause imposed limitations on the conclusions from this study.
  
  
  CONCLUSIONS
  No unequivocal evidence for the existence of an association between educational level and age at menopause was found through this review.
authors.affiliation: Department of Epidemiology, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524, Rio de Janeiro, RJ, Brazil.
authors.forename: Felipe Simões
authors.initials: FS
authors.lastname: Canavez
authors.forename: Guilherme Loureiro
authors.initials: GL
authors.lastname: Werneck
authors.forename: Raphael Câmara Medeiros
authors.initials: RC
authors.lastname: Parente
authors.forename: Roger Keller
authors.initials: RK
authors.lastname: Celeste
authors.forename: Eduardo
authors.initials: E
authors.lastname: Faerstein
mesh_terms: D017668:Age of Onset; D000428:Alcohol Drinking / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D006801:Humans; D008593:Menopause; D012907:Smoking / Q000453:epidemiology