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Parity, Age at Childbirth, and Premature Menopause, Hysterectomy, and Bilateral Oophorectomy before Age 40 in Women in the United States: National Health and Nutrition Examination Survey 1999-2018

Zailing Xing1*, Russell S. Kirby2

Introduction: This study examined the association of parity, age at first childbirth, and age at last childbirth with premature menopause, hysterectomy, and bilateral oophorectomy before age 40 in women in the United States.

Material and methods: The data stemmed from the National Health and Nutrition Examination Survey spanning from 1999 to 2018, with 13,108 women over 40 included. The exposure variables were parity, age at first childbirth, and age at last childbirth. The outcome variable was premature menopause, hysterectomy, and bilateral oophorectomy before the age of 40. Logistic regression models were utilized to estimate unadjusted and adjusted odds ratios (ORs) (95% confidence intervals [CIs]) controlling for confounders in the occurrence of premature menopause, hysterectomy, or bilateral oophorectomy before turning 40. We also used logistic regression models with restricted cubic splines to depict the association between parity and age at childbirth, treated as continuous variables, and the outcome variables.

Results: Parity was not associated with premature menopause, but nulliparity and parity of one had lower odds of having a hysterectomy before age 40, with adjusted ORs (95% CI) of 0.41 (0.31-0.54) and 0.81 (0.66-0.99) compared to parity of two. Nulliparity was also linked to a lower likelihood of having bilateral oophorectomy before age 40 (OR=0.58; 95% CI:0.39-0.88). Age at first childbirth was negatively related to hysterectomy or bilateral oophorectomy before 40 but not premature menopause. In comparison to age at first childbirth of 25-29 years, the adjusted ORs (95% CIs) for hysterectomy risks in women with age at first delivery of <20, 20-24, 30+ years were 2.08 (1.52-2.85), 1.40 (1.06-1.86), and 0.46 (0.23-0.91), respectively. The corresponding adjusted ORs (95% CIs) for bilateral oophorectomy risks were 2.53 (1.51-4.24), 1.66 (1.04-2.63), and 0.70 (0.26-1.84), respectively. Besides, age at last childbirth also presented inverse and nonlinear associations with premature menopause, hysterectomy, or bilateral oophorectomy prior to age 40.

Conclusions: Nulliparity was associated with lower risks of hysterectomy or bilateral oophorectomy before age 40, while early first childbirth age was related to the increased risks. Late age at last childbirth was linked to reduced risks of premature menopause, hysterectomy, or bilateral oophorectomy before age 40.