Effect of primary ovarian insufficiency and early natural menopause on mortality: a meta-analysis

Objective The aim of this review was to systematically evaluate the associations of all-cause, cardiovascular and all-cancer mortality with primary ovarian insufficiency (POI) and early natural menopause (ENM).Methods Electronic databases for relevant studies were searched up to February 28, 2015. POI and ENM were usually defined as spontaneous menopause before age 40 years and at age 40-44 years, respectively.Results A total of nine articles were derived from seven prospective cohort studies. In all studies, age of menopause was self-reported. Our meta-analysis showed that POI women had a higher risk of death from all causes (pooled relative risk (RR) 1.39, 95% confidence interval (CI) 1.10-1.77) and ischemic heart disease (IHD) (pooled RR 1.48, 95% CI 1.02-2.16) when compared with women at normal age at natural menopause (ANM). No significant association was detected from stroke and all-cancer mortality between POI women and normal ANM women. Only a slightly higher risk of death from IHD (pooled RR 1.09, 95% CI 1.00-1.18) was found when ENM women were compared with normal ANM women.Conclusion The results of our study demonstrated that POI was associated with a higher risk of IHD and all-cause mortality; ENM was only associated with a slightly higher risk of IHD mortality.