title: Relationship between arsenic skin lesions and the age of natural menopause.
abstract: BACKGROUND
  Chronic exposure to arsenic is associated with neoplastic, cardiovascular, endocrine, neuro-developmental disorders and can have an adverse effect on women's reproductive health outcomes. This study examined the relationship between arsenic skin lesions (a hallmark sign of chronic arsenic poisoning) and age of natural menopause (final menopausal period) in populations with high levels of arsenic exposure in Bangladesh.
  
  
  METHODS
  We compared menopausal age in two groups of women--with and without arsenic skin lesions; and presence of arsenic skin lesions was used as an indicator for chronic arsenic exposure. In a cross-sectional study, a total of 210 participants were randomly identified from two ongoing studies--participants with arsenic skin lesions were identified from an ongoing clinical trial and participants with no arsenic skin lesions were identified from an ongoing cohort study. Mean age of menopause between these two groups were calculated and compared. Multivariable linear regression was used to estimate the relationship between the status of the arsenic skin lesions and age of natural menopause in women.
  
  
  RESULTS
  Women with arsenic skin lesions were 1.5 years younger (p <0.001) at the time of menopause compared to those without arsenic skin lesions. After adjusting with contraceptive use, body mass index, urinary arsenic level and family history of premature menopause, the difference between the groups' age at menopause was 2.1 years earlier (p <0.001) for respondents with arsenic skin lesions.
  
  
  CONCLUSIONS
  The study showed a statistically significant association between chronic exposure to arsenic and age at menopause. Heavily exposed women experienced menopause two years earlier than those with lower or no exposure.
authors.affiliation: BRAC Research and Evaluation Division, BRAC Centre, 75 Mohakhali, Dhaka 1212, Bangladesh. dryunus155@gmail.com.
authors.forename: Fakir Md
authors.initials: FM
authors.lastname: Yunus
authors.forename: Musarrat Jabeen
authors.initials: MJ
authors.lastname: Rahman
authors.forename: Md Zahidul
authors.initials: MZ
authors.lastname: Alam
authors.forename: Samar Kumar
authors.initials: SK
authors.lastname: Hore
authors.forename: Mahfuzar
authors.initials: M
authors.lastname: Rahman
mesh_terms: D000328:Adult; D000367:Age Factors; D001151:Arsenic / Q000009:adverse effects* / Q000032:analysis; D020261:Arsenic Poisoning / Q000150:complications* / Q000473:pathology; D001459:Bangladesh; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis; D005260:Female; D006801:Humans; D016014:Linear Models; D008593:Menopause; D008875:Middle Aged; D060728:Reproductive Health; D012871:Skin Diseases / Q000139:chemically induced* / Q000473:pathology
chemical_list: D001151:Arsenic