Age at natural menopause in refugee and domicile women who lived in Tuzla Canton in Bosnia and Herzegovina during and after the war.
OBJECTIVE
This study aims to estimate age at onset of natural menopause in domicile and refugee women who lived in Tuzla Canton in Bosnia and Herzegovina during the war (1992-1995) and in the postwar period until the interview.


METHODS
A cross-sectional study was conducted on a sample of 331 postmenopausal women-264 (80%) domicile women and 67 (20%) refugee women-between June 2009 and February 2011.


RESULTS
The study encompassed 331 women with a mean age of 57.0 years (range, 39-75 y). The overall mean age at menopause was 49.1 years. The mean age at menopause was higher in domicile women (49.3 y) than in refugee women (48.0 y; unpaired t test, P = 0.023). After adjustment for age at menarche, education, marital status, living place, body mass index, number of abortions, use of contraceptives, and current smoking, only refugee status and parity remained as significant independent predictors of age at menopause (score test, P = 0.025). Refugee women had an increased probability of earlier onset of menopause compared with nonrefugee women (adjusted hazard ratio, 1.33; 95% CI, 1.02-1.75; P = 0.039), whereas there was a decreased probability of experiencing menopause with increasing number of births (adjusted hazard ratio, 0.92; 95% CI, 0.84-0.996; P = 0.04).


CONCLUSIONS
The age at onset of menopause in refugee women is lower than that in domicile women, indicating that war, independently of other factors, could influence the age when menopause occurs. On average, women who lived in Bosnia and Herzegovina during the war and postwar period entered menopause earlier than did women from Europe.
From the 1Center for Human Reproduction "Dr Balić," Tuzla, Bosnia and Herzegovina; 2Ob/Gyn Clinic, University Clinical Center, Tuzla, Bosnia and Herzegovina; and 3Institute for Biostatistics and Medical Informatics, University of Ljubljana, Ljubljana, Slovenia.
Devleta
D
Balić
Mirzeta
M
Rizvanović
Mojca
M
Cizek-Sajko
Adem
A
Balić
D000328:Adult; D017668:Age of Onset; D000368:Aged; D017522:Bosnia and Herzegovina; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D016017:Odds Ratio; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D014857:Warfare; D044465:White People / Q000706:statistics & numerical data*; D016387:Women's Health