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From Menarche to Menopause: timing the reproductive health bookends of women in LMICs

Understanding the timing and determinants of age at menarche and menopause is key to determining potential linkages between the onset of puberty, the end of reproductive life and health outcomes from a life course perspective. Yet, we have little information in low- and middle-income countries (LMICs) mainly due to lack of data and some would argue lack of interest. Scant evidence shows that age at menarche is lowering due mainly to improvements in nutrition and age at menopause might be occurring earlier in low-income settings but so far, the data relate to small studies and are not generalisable. This could have implications for women’s wellbeing. This presentation will present the issues around data availability and health framing as well as trends in menarche and menopause in LMICs and the interconnection between the two (where possible) both at macro and micro level. 

Using 260 DHS datasets from 1986 to 2020 for early (before age 40) and premature (between 40 and 45) menopause and 28 for menarche (cohorts between 1932 and 2002) we calculated the mean age at menarche and the truncated singulate mean age at menopause (SMAM) due to the surveys stopping at age 49 and the mean age at menarche across countries and time. A work in progress, this study shows that there is a considerable gap in both literature and data on menarche. We see a trend in menarche which is declining rapidly (from 14.66 to 12.86 years for the 1932 and 2002 cohorts respectively), possibly at a faster pace than high-income countries and with a strong link to socio-economic status. 

Results on the menopause show variation in early menopause prevalence between 0.4% in Gabon and Jordan in 2012 to 24.2% in Tanzania in 1994. The truncated SMAM varies from 37.39 years in Tanzania in 1994 to 46.11 years in Jordan in 2002. This is evidence of both premature and early menopause. This study calls for further research into the timing and impact of menarche and menopause in LMICs. 

Speaker 

Tiziana Leone is an Associate Professor at the London School of Economics. Tiziana’s research agenda is focused on maternal and reproductive health, including a life course approach to women’s health. She is currently analysing secondary data on the linkages that menarche, menopause and mid-life age have on fertility outcomes and health in later life. She has collaborated in expert roles with international organisations (eg: WHO, UNFPA and UNICEF) in tracking the progress of the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs) in LMICs in maternal and child health. 

Before working in academia, she was a statistician in the UN Statistics Division where she coordinated technical cooperation on census and civil registration data collection in Low-Income Countries. As a social statistician she has worked within multidisciplinary teams in linking up data from different sources and of different nature (e.g.: qualitative and quantitative) using a range of innovative methods (from longitudinal analysis, pathway analysis, to mixed methods to quasi-experimental analysis). She focuses on the secondary analyses of data sources in innovative ways to construct longitudinal analysis in datasets where only cross-sectional data are available (e.g.: User fees work in SAA and Palestinian data projects). She has held several grants which included international collaborations in Africa, Asia and Latin America. 

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