Increase screening for women who start their periods at a young age or those reaching menopause early, experts suggest

Women who start their periods at an early age, or experience an early menopause, are at greater risk of cardiovascular disease, new research suggests.

While researchers say it is not clear whether reproductive factors are driving the increased risks, they say that more frequent screening of women whose reproductive history suggests that they might be at higher risk of cardiovascular disease could help to prevent or delay its onset.

“Further research into the underlying causes of these findings is really important because this helps us to come up with interventions, either population-based or individual-targeted,” said Dr Sanne Peters, an epidemiologist and co-author of the latest study from the University of Oxford.

Earlier menopause puts women at greater risk of heart failure, study shows Read more

Writing in the journal Heart, Peters and co-author Professor Mark Woodward, describe how they sought to scrutinise such links further by examining data from the UK Biobank – a database of genetic, medical and lifestyle information from more than half a million men and women aged between 40 and 69.

The team looked at more than 267,000 women and 215,000 men who were healthy and had no history of cardiovascular disease, and then looked at what happened to those participants in the seven years that followed.

The data showed 5,782 participants developed coronary heart disease and there were 3,489 cases of stroke. Altogether, 9,054 participants developed one or both cardiovascular diseases, 34% of whom were women.

Once age and other factors including BMI, smoking status and blood pressure were taken into account, the team found that women who started menstruating before the age of 12 had a 10% higher risk of cardiovascular disease compared to those who began their periods aged 12 or older. In particular, they had a 17% higher risk of stroke and a 5% higher risk of coronary heart disease.

But Peters says it is not clear what is behind the link, pointing out that obesity in childhood could play a role, but that the study only considered BMI at the time of data collection.



Women undergoing natural menopause before the age of 47 were also found to have a greater risk of problems than those experiencing it later, being at a 33% higher risk of cardiovascular disease, with an increased risk of both coronary heart disease and stroke.

Again, says Peters, the reasons for the link are unclear. “It is really the chicken and the egg: is it sub-clinical cardiovascular disease causing early menopause, or is it early menopause causing cardiovascular disease?” she said.

While some have suggested that the link might be down to women with early menopause having a lower lifetime exposure to oestrogen – a hormone thought to be protective against cardiovascular disease – Peters said the jury was still out.

Should we be worried about early puberty? Read more

Peters added it would be helpful to analyse the genetics of participants to explore whether the associations for early puberty and early menopause with cardiovascular disease are direct links, or down to another common factor, such as environmental or lifestyle influences. “There’s quite a number of genes that have been identified to be associated with [female] reproductive lifespan,” she said. “The question [is] whether those genes are also involved in the physiology of cardiovascular disease, or indeed also other conditions like cancers or diabetes.”

The risk of coronary heart disease was also increased in both men and women with children, the risk increasing with number of children.



That, said Peters, suggests that the link is not simply down to the effects of pregnancy but is likely complex, involving social, cultural and other factors.

In addition, miscarriage and hysterectomy were linked to a 14% and 20% higher risk of coronary heart disease respectively, while stillbirth was linked to a greater risk of stroke.

Dr John Perry, co-leader of the growth and development programme at the University of Cambridge’s MRC Epidemiology Unit, welcomed the research.

But, he added, it was not yet clear whether factors such as early puberty and early menopause were driving the higher risk of cardiovascular disease. “Further studies are however needed to ascertain if these represent causal, rather than correlative, associations,” he said.