title: Natural menopause among women below 50 years in India: A population-based study.
abstract: OBJECTIVE
  The age at which menopause naturally occurs may reflect nutritional and environmental circumstances as well as genetic factors. In this study we examined natural menopause as a marker of women's health at the population level in India and in some major States.
  
  
  METHODS
  Data from the Indian District Level Household Survey (DLHS) carried out during 2007-2008 covering 643,944 ever-married women aged 15-49 yr were used; women of older ages were not included in this survey. Since not all women in this age group had achieved natural menopause at the time of survey, Cox proportional hazard regression models were employed to obtain the median age of women reporting a natural menopause, excluding those who underwent hysterectomy. Hazard ratios (HRs) were estimated for key socio-economic and reproductive variables that could potentially affect the age at natural menopause <40 yr.
  
  
  RESULTS
  Overall, menopause prior to age 40 was reported by approximately 1.5 per cent of women. In the national data set, significant associations with age at natural menopause were identified with marriage breakdown or widowhood, poverty, Muslim religious affiliation, 'scheduled caste' status, not having received schooling, rural residence, having never used contraceptive pills, not been sterilized or had an abortion, low parity and residence in the western region. Within data from five selected States examined separately, the strength of these associations varied.
  
  
  CONCLUSIONS
  Associations of natural menopause with sociocultural, family planning and demographic variables were noted. Most importantly, there was an association with poverty that would require further investigation as to causality. The proportion of women experiencing early menopause may represent a useful overall indicator of women's health. The data are reassuring with regard to possible late effects of sterilization on ovarian function.
authors.affiliation: Portsmouth-Brawijaya Centre for Global Health, Population and Policy, University of Portsmouth, Portsmouth, UK; University of Brawijaya, Malang, Indonesia.
authors.forename: Saseendran
authors.initials: S
authors.lastname: Pallikadavath
authors.affiliation: Primary Care & Health Sciences, University of Keele, Keele, UK.
authors.forename: Reuben
authors.initials: R
authors.lastname: Ogollah
authors.affiliation: International Institute for Population Sciences, Mumbai, India.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Singh
authors.affiliation: Portsmouth-Brawijaya Centre for Global Health, Population and Policy, University of Portsmouth, Portsmouth, UK.
authors.forename: Tara
authors.initials: T
authors.lastname: Dean
authors.affiliation: Portsmouth-Brawijaya Centre for Global Health, Population and Policy, University of Portsmouth, Portsmouth, UK.
authors.forename: Ann
authors.initials: A
authors.lastname: Dewey
authors.affiliation: School of Medicine, University of St. Andrews, St. Andrews, UK.
authors.forename: William
authors.initials: W
authors.lastname: Stones
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008393:Marriage; D008593:Menopause / Q000502:physiology*; D008594:Menopause, Premature / Q000502:physiology*; D008875:Middle Aged; D010298:Parity; D011247:Pregnancy; D012424:Rural Population; D012959:Socioeconomic Factors; D016387:Women's Health; D055815:Young Adult