One in 13 Bangladeshi women experience early menopause: Study

Around one in every 13 Bangladeshi women experiences menopause before the age of 45, according to the largest multi-country study led by researchers at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b).

Published last week in BMJ Global Health, the study analysed health data from 716,648 women aged 30 to 49 years across 44 low- and middle-income countries (LMICs). It found that one in every 14 women living in LMIC countries experiences premature or early menopause, according to a press release.

Menopause is a natural stage in a woman’s life. It marks the permanent end of menstrual periods and usually occurs between the ages of 45 and 55. Menopause occurring before the age of 45 is referred to as early menopause, while menopause occurring before the age of 40 is known as premature menopause.

When menopause occurs early, women lose the protective effects of oestrogen much earlier than expected. A growing body of global evidence shows that women who experience early menopause face a higher lifetime risk of cardiovascular disease, osteoporosis, cognitive decline, depression and can significantly affect their quality of life.

The study shows, Bangladesh recorded a prevalence of 7.5%, slightly above the overall LMIC average of 7.1%. Within South Asia, Bangladesh’s prevalence was comparable to Nepal (7.9%) and slightly lower than India (8.0%). Pakistan recorded 5.9%.

The findings highlight that premature or early menopause is a significant public health issue across the region.

The study found marked inequalities. Women living in rural areas were more likely to experience menopause before the age of 45 than women living in urban areas. After accounting for education, wealth, employment and reproductive history, rural women remained 17% more likely to experience premature or early menopause. The findings point to persistent inequalities in healthcare access, nutrition and living conditions.

Education emerged as one of the strongest protective factors. Women with primary education had 11% lower odds of premature or early menopause than women with no formal education. The reduction increased to 28% among women with secondary education and 58% among women with higher education.

Women who married at the age of 18 years or older were significantly less likely to experience premature or early menopause than those who married earlier. Similar findings were observed for age at first birth. Women who had their first child at the age of 18 years or older were also less likely to experience menopause before the age of 45.

The burden varied considerably between countries. Ethiopia recorded the highest prevalence at 12.0%, followed by Indonesia (11.5%) and Myanmar (10.3%). Jordan recorded the lowest prevalence at 2.3%, followed by Gabon (2.6%) and Armenia (2.8%). The wide variation suggests that local social, environmental and health system factors may influence when women experience menopause.

“Our findings show that premature or early menopause is shaped by much more than biology. Across 44 countries, women with less education, those living in rural communities, and those marrying or giving birth at a younger age consistently experienced a greater burden,” said Raisha Binte Islam, lead author of the study and researcher at icddr,b.

“Improving girls’ education and ensuring equitable access to quality healthcare could have benefits that extend well beyond reproductive health,” he said.

Dr Anisur Rahman, senior director of the Maternal and Child Health Division at icddr,b, said, “Premature or early menopause should be recognised as an important marker of women’s future health, not simply a reproductive milestone. The findings highlight that early menopause affects a substantial proportion of Bangladeshi women, highlighting the need to integrate menopause history into routine healthcare.

“Women with early menopause are at increased risk of osteoporosis, cardiovascular disease, depression, and cognitive decline. I encourage physicians to routinely ask women about the age at which they experienced menopause, as this simple information can help identify women who may benefit from earlier assessment, preventive interventions, and long-term follow-up care,” he added.

Although comparable smoking data were not available across all participating countries, evidence from studies worldwide consistently shows that cigarette smoking is the only established lifestyle factor associated with earlier menopause. Helping women quit smoking should therefore remain an important component of women’s health programmes, read the press release.

The researchers caution that the study was observational and cannot establish cause-and-effect relationships.

It relied on self-reported survey data and could not assess several important factors, including smoking, diet, physical activity, environmental exposures and hormonal contraceptive use, because these data were not consistently available across all DHS surveys.

The researchers call for greater investment in girls’ education, stronger efforts to prevent child marriage, improved access to quality reproductive healthcare, and prospective research to better understand the biological and social pathways leading to premature or early menopause.