A Systematic Review and Meta-analysis on the Average Age of Menopause among Iranian Women

Document Type : Systematic Review

Authors

1 PhD Student of Reproductive Health, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 PhD Student, Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 MSc, Research Center for Prevention of Psychosocial Impairment, Ilam University of Medical Sciences, Ilam, Iran

4 Assistant Professor, Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background: Menopause age is a determinant of health status and the risks for future diseases.
Aim: The current study aimed to determine the average age of menopause among Iranian women in a meta-analysis.
Method: This systematic review and meta-analysis was performed in August 2017. The articles were searched in Persian databases, including Iran Medex, SID, and Magiran, as well as international databases, including Scopus, PubMed, and Web of Knowledge, without any time limitation. The search process was accomplished using the following keywords: “Menopause” OR “Menopause age” OR “Age of menopause” OR “Menopause age and Iran”. Begg’s and Egger tests were used to identify publication bias. Data analysis was performed in Stata statistical software (version 14) using random effect model.
Results: The search process resulted in the inclusion of 28 articles with a total of 40,042 subjects published during 1998-2017. The mean age of menopause was evaluated as 48.57 years (CI: 47.96- 49.18). Analysis of subgroups indicated that the mean ages of menopause were evaluated as 47.21 (CI: 46.94-47.48), 48.43 (CI: 47.76-49.10), 47.53 (CI: 47.17-47.88), 47.80 (CI: 47.49-48.11), and 47.83 (CI: 47.34-48.32) in smoking women (based on nine studies), non-smoking women, women with normal body mass index (based on eight studies), overweight women (based on seven studies), and obese women (based on six studies), respectively. The minimum mean age was 47.97 years, which belonged to the north region.
Implications for Practice: The results suggested that the average age of menopause is still within a normal range despite its rise with a normal slope. It seems that the changes in the women’s lifestyle have affected the menopause age. Consequently, special attention should be paid to some factors confounding menopause age among Iranian women to promote their health and reduce the health problems related to menopause.

Keywords

Main Subjects

Full Text

Introduction

Menopause is the time in a woman's life when fertility period ceases. This period is considered a critical transition period in a woman’s reproductive life. Age of menopause is a determinant of health status and risk of future diseases in women (1). Natural menopause is defined as the permanent absence of menstrual periods for 12 months without any pathological causes as a result of the absence of ovarian follicular activity (2) .

Biochemical and hormonal changes in this period lead to physical and psychological symptoms and changes in the quality of life in this population (3). Menopause age varies among different female populations (4). A woman’s menopause age is affected by a number of factors, including the age at which the woman’s mother and sister experience menopause (5), gravidity, body mass index (BMI), smoking (3), physical activity, and place of residence (6). A woman’s age at natural menopause is a predictor of postmenopausal diseases and mortality (7).

Age of menopause is an important health indicator. In this regard, each year of increase in menopause age will reduce the total mortality rate by 2%, as well as the mortality due to acute cardiac ischemia (8). Moreover, early menopause will enhance the risk of cardiovascular diseases, osteoporosis, and mental disorders (9). On the other hand, late menopause is associated with a higher risk of breast cancer (10). Iranian population is making transition from a young age structure to an old age one as a consequence of medical advances, higher life expectancies, and lower birth rates.

According to the World Health Organization (WHO), the Iranian population aged 60+ will increase to 33% over the coming 35 years (i.e., by 2050) (11). Accordingly, there would be a rise in the number of postmenopausal women in Iran over the coming years. The evaluation of menopause age plays a significant role in the management of postmenopausal complications through national health policies. With this background in mind, the present study was conducted to evaluate the average age of menopause among Iranian women through a meta-analysis.

 

Methods

The present systematic review and meta-analysis was conducted to identify the average age of menopause among Iranian women in August 2017. This study was performed based on preferred reporting items for systematic reviews and meta-analyses checklist. For the purpose of the study, the articles related to the subject of interest were searched in several Persian databases, including Iran Medex, SID, and Magiran, as well as a number of international databases, including Scopus, PubMed, and Web of Knowledge. The search process was performed using the following keywords: “Menopause” OR “Menopause age” OR “Age at menopause” OR “Menopause age and Iran”.

Only cross-sectional studies were included in the study. The search process resulted in the identification of 605 articles, 574 cases of which were removed after scanning their titles and abstracts due to irrelevancy, absence of a full-text version, and duplication. In the final stage, 28 articles were included in the review process after assessment for eligibility (Figure 1). The cross-sectional studies that had considered the mean age of healthy postmenopausal women at natural menopause or applied prospective methods were included in the study.

The recorded data included the mean and standard deviation of age at menopause, author’s name, year of publication, sample size, and demographic characteristics of the study participants. For the purpose of searching for the articles, first, a list of titles and a summary of all articles available at the databases were searched by two independent researchers. After the removal of the duplicate or irrelevant articles, the full-text versions of the articles were investigated by the two researchers. In case of disagreement between the two researchers, a third person re-examined the article to achieve a consensus.

A critical appraisal tool was used to assess the quality of the included cross-sectional studies. This valid tool facilitated the assessment of the introduction, methods, results, and discussion, and 2 other questions. This tool entailed 20 questions, each of which was answered through selecting “Yes”, “No”, or “Don’t Know”. This valid tool is applied for review studies (12). In this scale, the total score ranges between 0 and 20; in this regard, the studies with a score of 16 or more were included in the review process.

Heterogeneity among study was checked using Q test with α2 index. Begg’s and Egger tests were also adopted to identify the publication bias. Random effect model and Stata statistical software  

 

 

Figure 1. Flowchart presenting the process of article selection

 

(version 14) were used for data analysis regarding the study heterogeneity.

 

Results

The number of the participants of the reviewed studies corresponded to a total of 40,042 women. In order to estimate age of menopause in Iran, 28 articles published during 1998-2017 were analyzed (Table 1). The results of the Chi-square test indicated that heterogeneity was significant for all subgroups; furthermore, I2 index showed that heterogeneity for all subgroups was above 90%.

The mean age of menopause in 28 studies was evaluated as 48.57 years (CI: 47.96-49.18, I2=99.9, Pheterogeneity=0.000; χ2=44491.96, P=0.001; Figure 3). The majority of the reviewed articles investigated the center of Iran (10), furthermore, 5 studies were related to the north, east (6), west (2), and south (3), and 2 cases had been conducted at a national level. In a meta-analysis study conducted in 2011, the average age of menopause was reported as 48.14 years; however, as our results demonstrated, this age has reached to 48.57 by 2017.

With regard to subgroup analysis, the average ages of menopause were evaluated as 47.21 (CI: 46.94-47.48, I2=94.7, Pheterogeneity=0.000) and 48.438 (CI: 47.76-49.10, I2=97.4, Pheterogeneity=0.000) years in eight studies among smoking and non-smoking women, respectively.  The BMI was calculated in three groups of normal, overweight, and obese women. Based on 9, 7, and 6 studies, the average ages

 

Table 1. Information of the included studies

General characteristics of study participants

Population

Age (year)

Sample

size

Location

Author (year)/ references

1.4% smoker/ 37.1% obese/ 37.1% overweight

63.6% living in urban areas, 36.4% living in rural areas

50-60

51.20±5.31

4898

11 regions

Parsaeian M. (2017) (23)

11.49% obese, mean of menarche age: 13.15 years

<75

48.66 ± 3.79

960

Isfahan

Golshiri P. (2016) (24)

44.1% overweight, 22.7% obese

31-59

48.56±3.35

289

Kerman

Foroud A. (2016) (25)

mean menarche age: 13.6±1.3 years

43-65

49.60±4.02

400

Hamadan

Shobeiri F. (2014) (26)

21.6% smoker, 40.2% overweight, 37.1% obese

35-65

52[51.9-52.5]

2498

Mashhad

Esmaili H. (2013) (27)

0.5% smoker, 40.8% overweight, 39.2% obese

30-60

47.60± 4.45

804

Golestan

Abdollahi A. (2013) (28)

mean BMI: 24.19±3.6 kg/m2

29-73

46.57±4.95

403

Tehran

Jafaree F. (2011) (29)

mean age at menarche: 13.29±0.71 years

>46

50.02±0.21

300

Mazandaran

Faghani Aghoozi M. (2011) (30)

34.4% obese, 1% smoker

45-63

47.70± 4.90

1397

Mazandaran

Agajani Delavar M (2011) (31)

1% smoker, mean BMI: 29.2±5.0 kg/m2, mean age at menarche: 13.3±1.6 years

45-63

46.60±5.60

1620

Mazandaran

Delavar M. A. (2011) (32)

6.7% smoker, 33.4% overweight, 31.8% obese

35-65

49.60±4.50

1114

Tehran

Farahmand M. (2010) (33)

8.7% smoker

45-55

47.13±3.90

1500

Tehran

Nahidi F. (2010) (34)

-

>30

52.40±5.02

3404

Semnan

Sadat Hashemi M. (2009) (35)

-

-------

49.49±3.30

140

Khuzestan

Ziaee S. (2009) (36)

-

36-60

49.90±3.62

140

Kashan

Kafaee M. (2008) (37)

32% overweight, 26% obese

40-70

47.39±5.09

346

Yazd

Fallahzadeh H. (2007) (38)

5.4% smoker

>35

47.71

2462

Tehran

Ashrafi M. (2007) (39)

7% smoker, 10% obese and overweight

<60

47.30±6.30

500

Sistan and Bluchestan

Ansari H. (2007) (40)

50.4% living in urban areas, 49.6% living in rural areas 48% overweight, 7.6% obese

--------

48.20±2.34

458

Arak

Rafee M. (2006) (41)

-

40-60

47.97±4.17

1612

Khuzestan

Nuhjah S. (2005) (42)

5% smoker, 38.4% overweight, 29.5% obese

------

48.30± 5.30

948

Shiraz

Ayatollahi H. (2005) (43)

-

30-65

50.40±4.30

8194

-

Mohammad K. (2004) (44)

26.8% overweight, 31% obese

46-50

47.63±4.94

400

East Azarbayjan

Shahnazarli G. (2004) (45)

8.5% smoker, mean age at menarche: 13.5±1.61 years

39-87

48.51±4.45

441

Tehran

Jahanfar S. (2002) (46)

54% living in urban areas, 46% living in rural areas

40-55

47.93±4.37

3036

Mazandaran

Abdollahi F. (2002) (47)

30.5% overweight, 12.1% obese

>40

47.19±5.31

 

807

South Khorasan

Mortazavi Moghadam G. (2000) (48)

mean BMI: 24.65±3.77 kg/m2, 30.2% living in urban areas, 69.8% living in rural areas

40-55

46.34±3.69

398

Razavi Khorasan

Askari F. (2000) (49)

3.3% smoker

40-60

48.40±4.70

573

Kerman

Kamyabi Z. (1998) (50)

 

 

 

 

Figure 2. Funnel plot for checking publication bias

 

 

Figure 3. Evaluation of the average age of menopause according to random effects model, the author’s name, and year of study (each line segment is indicating a confidence interval of 95%. The diamond sign shows the evaluation of a combination of total average ages of menopause and confidence interval in each subgroup.)

 

of menopause in the normal, overweight, and obese groups were obtained as 47.53 (CI: 47.17-47.88, I2=91.3, Pheterogeneity=0.000), 47.80 (CI: 47.49-48.11, I2=83.4, Pheterogeneity=0.000), and 47.83 (CI: 47.34-48.32, I2=93.3, Pheterogeneity=0.000) years, respectively.

The results of Begg’s funnel plot and Egger test (P=0.221) demonstrated that publication bias was not significant. Figure 2 illustrates the funnel plot for checking the publication bias. The mean ages of menopause during the time courses of 1998-2004,  2005-2009, 2010-2014, and 2014-2017 were estimated as 48 (46.68-49.33), 48.74 (47.44-50.04), 48.54 (47.40-49.68), and 49.48 (47.52-51.43) years, respectively.

Based on the geographical regions, the maximum mean menopause age was 50.8 years in two national studies, while the minimum mean age was 47.97 years related to the north region. In addition, the mean ages for the studies conducted at a national level and in the north, east, west, south, and center of Iran were 50.8 (50.01-51-580), 47.97 (46-47-49.48), 48.23 (46.35-50.12), 48.62 (46.69-50.55), 48.54 (47.83-49.26), and 48.61 (47.47-49.75) years, respectively.

To evaluate heterogeneity, a meta-regression was run between the years of publication and sample size of studies and menopause age. The results revealed that the sample size of studies and menopause age were significant (P=0.01). However, the years of publication was not significant (P=0.06).

 

Discussion

Based on the analysis of 28 studies, the average age of menopause in Iran was estimated as 48.57 (CI: 47.96-49.18) years. In a systematic review and meta-analysis study performed in 2014, the average age of menopause in six countries was obtained as 48.3 (CI: 48.78-49.2) years (13). It seems that menopause-related changes may arise from different biological factors (e.g., genetic and nutritional factors or history of reproduction) across different geographical locations. These variations can be also affected by such factors as lifestyle, occupation, smoking, place of residence, and socioeconomic status (3, 14).

In our study, the average ages of menopause in eight studies were estimated as 47.21 (CI: 46.94-47.48) and 48.43 (CI: 47.76-49.10) years in smoking and non-smoking women, respectively. Younger age of menopause will increase several types of physical and psychological complications. Early menopause is associated with some 2% of annual mortality and increased risk of cardiovascular disease, diabetes, and osteoporosis (15).

Based on the evidence, long-term smoking will reduce the age of menopause. In the same vein, the duration and severity of smoking (i.e., the number of cigarettes used per day) affect the menopause age (16). According to a number of studies, the detrimental effect of cigarette on the number of children and female reproductive system paves the way for the incidence of early menopause (17).

There are different assumptions on the relationship of the biological effects of smoking with early menopause. In this regard, it has been stated that the smoking women have a more significant drop in estradiol levels in the middle of their menstrual cycle and luteal phase as compared to the non-smoking ones. Experimental models suggest that nicotine causes follicle loss in ovaries and blocks aromatase enzyme that is responsible for the conversion of androgen to estrogen (18).

In our study, the average age of menopause in the overweight group (mean: 47.80; CI: 47.49-48.11) was higher than that of the group with a normal BMI (mean: 47.53; CI: 47.17-47.88). Accordingly, the obese group had the highest average age of menopause (mean: 47.83; CI: 47.34-48.32).

In a study carried out by Tao et al. (2015), the hazard ratios of early menopause in overweight and obese women were reported as 0.92 and 0.88, respectively, which were higher than the ratio obtained for underweight women (19). Adipose tissues in obese people increase the production of estrogen as a result of the conversion of androgen to estrogen in the peripheral adipose tissue, thereby leading to late menopause (20).

It seems that the high prevalence of obesity in Iran can result in late menopause in the near future. Although menopause age is currently within a normal range with an increasing slope, it may exceed the normal range if this trend continues. According to the literature, although late menopause can reduce the hazard ratio (0.98) of cardiovascular diseases per year, it increases the risk of gynecological cancers (8).

The results of our study showed that in the time course of 1998-2009, the average menopause age increased from 48 to 48.74 years. However, during 2010-2014, it decreased to 48.54 years, and then underwent an increase to 49.48 years from 2014 to 2017. Based on the geographical region, the women in the north region had the lowest mean age (47.97 years). Generally, it seems that many factors, such as diet, race, and reproductive issues, can affect this issue.

The results of the present study suggested that in Iran, the average age at menopause is increasing with a gentle slope per year. Although this relationship is not statistically significant, it is very critical regarding the great impact of menopause on women’s health. In line with our study, in a European study, it was reported that menopause age differs across Europe and shifts towards an older age. 

The strength of our study is the analysis of menopause age in terms of different time courses and geographical regions of Iran, which showed that the age of menopause varies across different times and regions. Additionally, the results of this study are very powerful given its cohort design. One of the limitations of this study is the use of medical records for data collection. Furthermore, none of the included studies reported the effect of chemical exposure on menopause age; therefore, this issue remained unaddressed, which is another limitation of this research.

Furthermore, all included studies were cross-sectional. The accuracy of reporting menopause age can be different in each study, which may have affected our results. In addition, many confounding factors, such as race, reproductive factors, and lifestyle, should be adjusted when estimating the menopause age. The physical well-being and life satisfaction among menopausal women should be also taken into account (21). With regard to the transition of Iranian life style from traditional to modern (22), the health threatening factors during menopausal period should be given more attention.

 

Implications for Practice

As the results of the current study indicated, the average age of menopause is still within a normal range in Iran despite its rise with a normal slope. It seems that the change in women’s lifestyle have affected the menopause age. Some remediable factors that confound menopause age among Iranian women need special attention to promote women’s health. Consequently, health providers should plan for monitoring the health of premenopausal and menopausal women.

 

Acknowledgments

This study is related to the project NO:1396/46456 From Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran. We also appreciate the “Student Research Committee” and “Research & Technology Chancellor” in Shahid Beheshti University of Medical Sciences for their financial support of this study.

 

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Brand JS, van der Schouw YT, Onland-Moret NC, Sharp SJ, Ong KK, Khaw KT, et al. Age at menopause, reproductive life span, and type 2 diabetes risk: results from the EPIC-InterAct study. Diabetes Care. 2013;36(4):1012-9.
  2. Jonatan S, Berek J. Novak's gynecology. 14th ed. Philadelphia: Lippincott Williams and Wilkins Publishers; 2012.
  3. Ceylan B, Özerdoğan N. Factors affecting age of onset of menopause and determination of quality of life in menopause. Turk J Obstet Gynecol. 2015;12(1):43-9.
  4. Stepaniak U, Szafraniec K, Kubinova R, Malyutina S, Peasey A, Pikhart H, et al. Age at natural menopause in three central and eastern European urban populations: the HAPIEE study. Maturitas. 2013;75(1):87-93.
  5. Hassa H, Tanir HM, Tekin B, Senses T, Oge T, Mutlu FS. Possible factors affecting the age at menopause among women in the central anatolian region of Turkey. Clin Exp Obstet Gynecol. 2006;33(1):59-60.
  6. Park YJ, Kim HS, Kang HC. The age at menopause and related factors in Korean women. J Korean Acad Nurs. 2002;32(7):1024-31.
  7. Cooper GS, Sandler DP. Age at natural menopause and mortality. Ann Epidemiol. 1998;8(4):229-35.
  8. Ossewaarde ME, Bots ML, Verbeek AL, Peeters PH, van der Graaf Y, Grobbee DE, et al. Age at menopause, cause-specific mortality and total life expectancy. Epidemiology. 2005;16(4):556-62.
  9. Shuster LT, Rhodes DJ, Gostout BS, Grossardt BR, Rocca WA. Premature menopause or early menopause: long-term health consequences. Maturitas. 2010;65(2):161-6.
  10. Moron FJ, Ruiz A, Galan JJ. Genetic and genomic insights into age at natural menopause. Genome Med. 2009;1(8):76.
  11. World Health Organization. World report on ageing and health. Geneva: World Health Organization; 2015.
  12. Downes MJ, Brennan ML, Williams HC, Dean RS. Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS). BMJ Open. 2016;6(12):e011458.
  13. Schoenaker DA, Jackson CA, Rowlands JV, Mishra GD. Socioeconomic position, lifestyle factors and age at natural menopause: a systematic review and meta-analyses of studies across six continents. Int J Epidemiol. 2014;43(5):1542-62.
  14. Bansal P, Chaudhary A, Soni RK, Gupta VK. Epidemiological determinants of age at natural menopause in rural women of Punjab. J Res Med Dent Sci. 2017;2(1):24-8.
  15. Yang HJ, Suh PS, Kim SJ, Lee SY. Effects of smoking on menopausal age: results from the Korea national health and nutrition examination survey, 2007 to 2012. J Prev Med Public Health. 2015;48(4):216-24.
  16. van Asselt KM, Kok HS, van der Schouw YT, Grobbee DE, te Velde ER, Pearson PL, et al. Current smoking at menopause rather than duration determines the onset of natural menopause. Epidemiology. 2004;15(5):634-9.
  17. Oboni JB, Marques-Vidal P, Bastardot F, Vollenweider P, Waeber G. Impact of smoking on fertility and age of menopause: a population-based assessment. BMJ Open. 2016;6(11):e012015.
  18. Parente RC, Faerstein E, Celeste RK, Werneck GL. The relationship between smoking and age at the menopause: a systematic review. Maturitas. 2008;61(4):287-98.
  19. Tao X, Jiang A, Yin L, Li Y, Tao F, Hu H. Body mass index and age at natural menopause: a meta-analysis. Menopause. 2015;22(4):469-74.
  20. Akahoshi M, Soda M, Nakashima E, Tominaga T, Ichimaru S, Seto S, et al. The effects of body mass index on age at menopause. Int J Obes Relat Metab Disord. 2002;26(7):961-8.
  21. Barfarazi H, Pourghaznein T, Mohajer S, Mazlom SR, Asgharinekah SM. Evaluating the effect of painting therapy on happiness in the elderly. Evid Based Care J. 2018;8(3):17-26. (Persian)
  22. Sheikhan Z, Ozgoli G, Azar M, Alavimajd H. Domestic violence in Iranian infertile women. Med J Islam Repub Iran. 2014;28:152.
  23. Parsaeian M, Pouraram H, Djazayery A, Abdollahi Z, Dorosty A, Jalali M, et al. An explanation for variation in age at menopause in developing countries based on the second national integrated micronutrient survey in Iran. Arch Iran Med. 2017;20(6):361-7. (Persian)
  24. Golshiri P, Akbari M, Abdollahzadeh MR. Age at natural menopause and related factors in Isfahan, Iran. J Menopausal Med. 2016;22(2):87-93. (Persian)
  25. Foroud A, Mehdipour S, Nikvarz F, Shafieian T. The natural menopause age and associated factors at women menopause in Kerman, Iran. Caspian Sea J. 2016;10(1):298-301. (Persian)
  26. Shobeiri F, Nazari M. Age at menopause and its main predictors among Iranian women. Int J Fertil Steril. 2014;8(3):267-72. (Persian)
  27. Esmaili H, Alimi R, Javanrouh N, Azizi H, Vahid Roudsari F. Age at menopause and associated factors in middle-aged women in Mashhad city, 2010-2011. Iran J Obstet Gynecol Infertil. 2013;15(36):1-7. (Persian)
  28. Abdollahi AA, Qorbani M, Asayesh H, Rezapour A, Noroozi M, Mansourian M, et al. The menopausal age and associated factors in Gorgan, Iran. Med J Islam Repub Iran. 2013;27(2):50-6.
  29. Jafari F, Zafarghandi N, Abbasi M, Khodashenas Z. The average age of menopause and its associated factors among women in Tehran. Alborz Univ Med J. 2013;2(2):76-81. (Persian)
  30. Faghani Aghoozi M, Babapoor A, Bayani F, Khani S, Jannati Y, Hamta A. Menopuse age and the associated factors in postmenopausal women in Babol, Iran. J Babol Univ Med Sci. 2015;17(3):60-7. (Persian)
  31. Delavar MA, Hajiahmadi M. Age at menopause and measuring symptoms at midlife in a community in Babol, Iran. Menopause. 2011;18(11):1213-8.
  32. Delavar MA, Hajiahmadi M. Factors affecting the age in normal menopause and frequency of menopausal symptoms in northern Iran. Iran Red Crescent Med J. 2011;13(3):192-8.
  33. Farahmand M, Tehrani FR, Azizi FE. Menopause age and affecting factors in Tehran Lipid and Glucose Study (TLGS). J Qazvin Univ Med Sci. 2011;15(1):47-54. (Persian)
  34. Nahidi F, Karman N, Vallaei N, Fazli Z. Studying incidence of menopause and its effective factors in Tehran. Res Med. 2010;33(4):258-65. (Persian)
  35. Sadat Hashemi SM, Khalajabadi Farahani F, Kavehei B, Ghorbani R, Askari Majdabadi HA, Kalalian H, et al. The pattern of the age at natural menopause in Semnan province, Iran. Payesh. 2009;8(2):155-62. (Persian)
  36. Ziaei S, Ziagham S, Sayahi M. The relationship between menopausal age and metabolic syndrome in nonobese postmenopausal women. Arak Med Univ J. 2013;5(74):42-8. (Persian)
  37. Kafaei M, Sarafraz N, Bagheri A. Relationship between syadat and menopuase age. J Teb Tazkieh. 2008;69:44-50. (Persian)
  38. Fallahzadeh H. Age at natural menopause in Yazd, Islamic Republic of Iran. Menopause. 2007;14(5):900-4.
  39. Ashrafi M, SKazemi A, Eshrati B, Kashfi F, Malekzadeh F, Amirchaghmaghi E, et al. The study of mean age of natural menopause and influencing factors in Iranian women living in Tehran. Trauma Mon. 2007;2007(1):75-82.
  40. Ansari H, Noruzi M, Vahedi M, Rahimi E, Rahmani A, Ghorbani M. The study of the association of some demographic factors (demographic) with natural menopausal age in Zahedan. J Health Syst Res. 2011;7(4):1-10. (Persian)
  41. Rafiei M, Jamilian M, Fayaz AS, Amirifard E. The survey of age at natural menopause according to determinants factors in Arak city in 2007. J Arak Univ Med Sci. 2007;10(3):36-47. (Persian)
  42. Nouhjah S, Mohammad JR, Latifi SM. The mean age of menopause and its determinant factors: a cross-sectional study in Ahwaz 2001-2002. Jundishapur Sci Med J. 2005;4(446):216-22. (Persian)
  43. Ayatollahi SM, Ghaem H, Ayatollahi SA. Sociodemographic factors and age at natural menopause in Shiraz, Islamic Republic of Iran. East Mediterr Health J. 2005;11(1-2):146-54.
  44. Mohammad K, Sadat Hashemi SM, Farahani FK. Age at natural menopause in Iran. Maturitas. 2004;49(4):321-6.
  45. Shah Nazarli G, Sattarzadeh N, Kushavar H. Age of menopause and its related factors in menopausal women in Tabriz, 2004. Tabriz Nurs Midwifery J. 2006;3:39-45. (Persian)
  46. Jahanfar S, Ramezani Tehrani F, Hashemi SM. Early complications of menopause among women in Tehran. J Reprod Infertil. 2002;3(2):31-40. (Persian)
  47. Abdollahi F, Shabankhani B, Zarghami M. Study of menopausal age in women living in Mazandaran province in 2002. J Mazandaran Univ Med Sci. 2004;14(42):61-70. (Persian)
  48. Mortazavi GR, Khazaii Z, Izadpanah AM. Menopausal age and its influencing factors, Birjand, 2001. J Shahrekord Univ Med Sci. 2003;5(3):53-61. (Persian)
  49. Askari F, Basiri MK, Basiri MM, Torabi S, Gholamfarkhani S, Mohareri M, et al. Age of natural menopause and the comparison of incidence of its early complications in menopause transition stages in women from Gonabad city. Horizon Med Sci. 2012;17(4):42-8. (Persian)
  50. Kamyabi Z, Aflatonian MR, Bahrampour A. Determination of the mean age of menopause and it's distribution terms of known variables in Kerman. J Kerman Univ Med Sci. 1997;5(4):178-85. (Persian)

 

Evidence Based Care
Volume 8, Issue 4
January 2019
Pages 26-34

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