Around one in 13 Bangladeshi women experience menopause before the age of 45, putting them at higher risk of cardiovascular disease, osteoporosis, depression and cognitive decline later in life, according to a new study led by researchers at icddr,b.
Published last week in BMJ Global Health, the study is the largest analysis of premature and early menopause across low- and middle-income countries (LMICs). Researchers examined nationally representative Demographic and Health Survey (DHS) data from 716,648 women aged 30-49 across 44 countries.
The study found that 7.5% of Bangladeshi women experience menopause before turning 45, slightly higher than the overall LMIC average of 7.1%, or roughly one in every 14 women.
Menopause typically occurs between the ages of 45 and 55. Menopause before the age of 45 is classified as early menopause, while menopause before 40 is considered premature menopause. Earlier menopause shortens women's lifetime exposure to estrogen, increasing the risk of several chronic diseases and reducing overall quality of life.
The study also identified significant social inequalities linked to early menopause. Women living in rural areas were 17% more likely to experience premature or early menopause than those in urban areas, even after researchers adjusted for education, wealth, employment and reproductive history.
Education emerged as one of the strongest protective factors. Compared with women who had no formal education, those with primary education were 11% less likely to experience early menopause. The likelihood fell by 28% among women with secondary education and by 58% among those with higher education.
Researchers also found that women who married at or after the age of 18 and those who had their first child at 18 or older were significantly less likely to experience menopause before the age of 45 than women who married or gave birth earlier.
Within South Asia, Bangladesh's prevalence was comparable to Nepal (7.9%) and India (8%), while Pakistan recorded a lower prevalence of 5.9%.
Across the 44 countries studied, Ethiopia reported the highest prevalence of premature or early menopause at 12%, followed by Indonesia at 11.5% and Myanmar at 10.3%. Jordan recorded the lowest prevalence at 2.3%, followed by Gabon at 2.6% and Armenia at 2.8%.
Lead author Raisha Binte Islam, a researcher at icddr,b, said the findings suggest that premature and early menopause are shaped by much more than biological factors.
"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. Improving girls' education and ensuring equitable access to quality healthcare could have benefits that extend well beyond reproductive health," she said.
Dr Anisur Rahman, senior director of the Maternal and Child Health Division at icddr,b, said premature and early menopause should be recognized as important indicators of women's future health rather than simply reproductive milestones.
"Premature or early menopause should be recognized 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," he said.
He said women experiencing early menopause face increased risks of osteoporosis, cardiovascular disease, depression and cognitive decline, and urged physicians to routinely ask patients about the age at which menopause occurred to enable earlier assessment, preventive interventions and long-term follow-up care.
Although comparable smoking data were unavailable across all participating countries, researchers noted that previous studies consistently identify cigarette smoking as the only established lifestyle factor associated with earlier menopause. They said helping women quit smoking should remain an important component of women's health programs.
The researchers cautioned that the study was observational and could not establish cause-and-effect relationships. It also relied on self-reported survey data and could not account for factors such as smoking, diet, physical activity, environmental exposures and hormonal contraceptive use because those data were not consistently available across all DHS surveys.
They called for greater investment in girls' education, stronger efforts to prevent child marriage, improved access to quality reproductive healthcare and more long-term research to better understand the biological and social factors contributing to premature and early menopause.
