Inequality’s Toll on the Ovarian Clock: A 12-Country Survival Analysis of Early Menopause in South and Southeast Asia

Md Anwer Hossain , Max Planck Institute for Demographic Research (MPIDR)
D. Susie Lee, Max Planck Institute for Demographic Research (MPIDR)
Zafer Büyükkececi, Max Planck Institute for Demographic Research
Chia Liu, University of St Andrews
Mikko Myrskyla, Max Planck Institute for Demographic Research
Hill Kulu, University of St Andrews

Premature (<40 years) and early menopause (40–44 years) heighten women’s lifetime risks of cardiovascular disease, osteoporosis, neurocognitive decline, and premature mortality. South and Southeast Asia (SSEA) exhibit among the highest prevalence of premature and early menopause worldwide, yet determinants in these settings are poorly understood. Leveraging Demographic and Health Surveys from 12 countries and a cohort of 481,048 women, we applied Kaplan–Meier estimators and Cox proportional hazards models to examine the effects of education, parity, wealth, and residence. By age 45, 5.2% of women were postmenopausal. In South Asia, no education (HR 1.37, 95% CI 1.04–1.79), having one child (HR 1.29, 1.13–1.48), and low wealth (HR 1.36, 1.26–1.47) predicted earlier menopause (all p<0.05). Although Southeast Asia exhibited a lower baseline hazard (HR 0.62, 0.45–0.85; p=0.003), the adverse effects of low education (HR 1.70, 1.31–2.19), high parity (HR 2.13, 1.45–3.13), and rural residence (HR 1.31, 1.13–1.51) were significantly stronger (all p<0.001). Contrary to high income countries, higher parity was linked to earlier menopause. These findings underscore that socio-demographic disadvantages accelerate ovarian ageing in SSEA and call for policies to expand girls’ education, strengthen rural reproductive health services, and reduce economic inequities.

Keywords: Sexual and Reproductive Health and Rights, Health and Morbidity, Population Ageing

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  Presented in Session 34. Menopause: Social and Demographic Consequences