by Kirti Salunkhe, MD
Early menopause is defined as premature ovarian failure between the ages of 40–45 years.1-3 This condition affects about 1-5% of American women and is characterized by failure of the ovaries leading to increased serum levels of follicle-stimulating hormone (FSH).2,3 Ovarian failure can be a result of conditions such as gynecologic (ovarian) surgery, smoking and toxin exposure, certain autoimmune conditions including thyroiditis or Addison’s Disease, chemotherapy, or familial/genetic link.3,4
Data have shown that early menopause is linked to increased risk for early mortality, osteoporosis, cardiovascular disease (CVD) as well as depression and insomnia.2 Signs and symptoms of early menopause include those commonly seen in perimenopause: hot flashes, mood swings, incontinence, night sweats, and intolerance to hot or cold temperatures.4 While many of the signs and symptoms of this condition are usually managed by hormone replacement therapy (HRT) along the lines of usual menopause, many clinicians also advocate lifestyle changes such as improved diet and increased physical activity to improve heart and bone health in particular. However, in 2012, a controversy whether physical activity was to be promoted in these patients was ignited by data from a 10-year study involving over 3,000 women (35–56 years) that looked at the effects of physical activity and risk for early natural menopause.5 Results of this study indicated women who exercised between 8–10 hours/week were 17% more likely to begin menopause in their 40s or younger (early natural menopause).5 These findings seemed to conflict with conventional wisdom and other clinical data regarding the general benefits of exercise on heart and bone health in women undergoing the menopausal transition.6
However, a recent study published in Human Reproduction, from researchers at the University of Massachusetts, Amherst, MA; Brigham and Women’s Hospital; Harvard Medical School; and the Harvard TH Chan School of Epidemiology, Boston, MA, now provides data that contradicts the conclusions of the earlier study and, in fact, shows no link between physical activity and risk for early, natural, menopause.7
The study, a 22 year-long clinical trial (1989–2011) evaluated 107,275 women aged 25–42 years from the Nurses Health Study II who were premenopausal at baseline.7 Every two years, for 22 years, the participants completed questionnaires about the time they spent in recreational physical activities such as walking, running, cycling, racquet sports, swimming laps, aerobic activities, yoga, weight training, and high-intensity activities such as lawn mowing.7 Information was also collected about race, ethnicity, age, education, height, age of menarche (first period), gestational history, use of oral contraceptives and hormone therapy, smoking history, weight and body mass index (BMI), diet, and use of dietary supplements.7
In order to assess the frequency, duration, and intensity of physical activity, the researchers multiplied the hours per week of each activity by its metabolic equivalent (MET) score to create total MET hours per week. One MET equals one kilogram calorie per kilogram per hour (kcal/kg/h), which is the amount of energy expended by sitting quietly for an hour.2,8
The results of this study showed:7
- 2,786 (2.5%) women experienced natural menopause before age 45
- There was no significant difference in risk of early natural menopause between women reporting less than 3 MET hours/week of physical activity and women reporting ≥ 42 MET hours/week
- There was no relationship between physical activity and early natural menopause regardless of BMI or smoking status
- There was no association between physical activity levels at any age and onset of early natural menopause
Why is this Clinically Relevant?
- Early menopause, natural or due to other etiology, occurring before the age of 45 years can lead to increased risks for CVD, osteoporosis, early mortality, and/or depression
- Prior research suggested linked increased physical activity to increased risk for early natural menopause
- Results of this larger, longer, and more comprehensive study shows that there is no link between physical activity and risk for early menopause
- Clinicians should encourage all patients to improve heart health by lifestyle modifications including dietary intake and physical activity
- In patients who are undergoing natural menopause, both early and usual, bone and heart health can be improved by promoting physical activity and management of dietary intake through a nutritionist or lifestyle educator
- Laughlin D, Thorney Croft IH. Amenorrhea. In: DeCherney AH, Nathan L, editors. Current obstetric and gynecologic diagnosis and treatment. 9th edition. New York: McGraw Hill Companies; 2003. pp. 991–1000.
- Jewelwicz R, Schwartz M. Premature ovarian failure. Bull N Y Acad Med. 1986;62:219–236.
- Women’s Health. https://www.womenshealth.gov/menopause/early-or-premature-menopause. Accessed October 1, 2018.
- Okeke TC, Anyaehie UB, Ezenyeaku CC. Premature Menopause. Ann Med Health Sci Res. 2013; 3(1):90–95.
- Nagata C, Wada K, Nakamura K. Associations of physical activity and diet with the onset of menopause in Japanese women. Menopause. 2012;19(1):75-81.
- Joshi S, Khandwe R, Bapat D, Deshmukh U. Effect of yoga on menopausal symptoms. Menopause Int. 2011;17:78–81.
- Zhao M, Whitcomb BW, Purdue-Smithe AC. Physical activity is not related to risk of early menopause in a large prospective study. Hum Reprod. 2018;33(10):1960-1967.
- Compendium of Physical Activities. https://sites.google.com/site/compendiumofphysicalactivities/. Accessed October 1, 2018.