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. 2025 Jun 3;194(6):1726-1734.
doi: 10.1093/aje/kwae320.

Association of parity with the timing and type of menopause: a longitudinal cohort study

Natalie V Scime  1 , Beili Huang  2 , Hilary K Brown  1   3 , Erin A Brennand  2   4
Affiliations

Association of parity with the timing and type of menopause: a longitudinal cohort study

Natalie V Scime et al. Am J Epidemiol. .

Abstract

We investigated the time-varying association between parity and timing of natural menopause, surgical menopause, and premenopausal hysterectomy among 23 728 women aged 40-65 years at enrollment in the Alberta's Tomorrow Project cohort study (2000-2022), using flexible parametric survival analysis. Overall, natural menopause was most common by study end (57.2%), followed by premenopausal hysterectomy (11.4%) and surgical menopause (5.3%). Risks of natural menopause before age 50 years were elevated for 0 births (adjusted hazard ratio [aHR] at age 45, 1.33; 95% CI, 1.18-1.49) and 1 birth (aHR age 45, 1.21; 95% CI, 1.07-1.38), but similar for ≥3 births (aHR age 45, 0.95; 95% CI, 0.85-1.06) compared to 2 births (reference). Elevated risks of surgical menopause before age 45 years for 0 births (aHR age 40, 1.37; 95% CI, 1.09-1.69) and 1 birth (aHR age 40, 1.11; 95% CI, 0.85-1.45) attenuated when excluding women with past infertility or recurrent pregnancy loss, and reduced risks were observed over time for ≥3 births (aHR age 50, 0.84; 95% CI, 0.75-0.94). Risks of premenopausal hysterectomy were lower before age 50 years for 0 births (aHR age 45, 0.82; 95% CI, 0.76-0.88) but elevated after age 40 years for ≥3 births (aHR age 50, 1.25; 95% CI, 1.08-1.45). These complex associations necessitate additional research on the sociobiological impacts of childbearing on gynecologic health.

Keywords: Alberta’s tomorrow project; childbirth; hysterectomy; longitudinal study; menopause; oophorectomy; parity.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Cumulative incidence of natural menopause, surgical menopause, and premenopausal hysterectomy by parity. Y-axes of panel B and C were resized for better visualization. The number of participants at risk at each timepoint excludes participants who experienced menopause and participants who were censored premenopausally.
Figure 2
Figure 2
Adjusted association of parity and timing of natural menopause. Models controlled for birth year, education, smoking, and duration of hormonal contraceptive use.
Figure 3
Figure 3
Adjusted association of parity and timing of surgical menopause. Models controlled for birth year, education, smoking, and duration of hormonal contraceptive use.
Figure 4
Figure 4
Adjusted association of parity and timing of premenopausal hysterectomy. Models controlled for birth year, education, smoking, and duration of hormonal contraceptive use.
See this image and copyright information in PMC

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