BMJ Glob Health. 2026 Jul 7;11(7):e023742. doi: 10.1136/bmjgh-2026-023742.
ABSTRACT
BACKGROUND: Premature (<40 years) or early (40-44 years) menopause is associated with increased risks of cardiovascular disease, osteoporosis and premature mortality. Low- and middle-income countries (LMICs) appear to have a higher prevalence, although multicountry comparative data are scarce. Therefore, this study aimed to estimate the pooled prevalence and determinants of premature or early menopause among women aged 30-49 years in 44 LMICs.
METHODS: The most recent round of Demographic and Health Surveys from 44 countries conducted since 2015 was pooled together, accounting for 716 648 women aged 30-49. Premature or early menopause was defined as cessation of menstruation for ≥6 months, self-reported menopause or hysterectomy before age 45. We calculated pooled weighted prevalence with 95% CIs and used multivariable logistic regression to identify associated factors, accounting for complex survey design.
RESULTS: The pooled prevalence of premature or early menopause was 7.1% (95% CI 7.0% to 7.2%). Country-level prevalence ranged from 2.3% in Jordan and 2.6% in Gabon to 12% in Ethiopia and 11.5% in Indonesia. Prevalence was consistently higher in rural than urban areas across all regions, with South Asia and East Asia and Pacific showing the highest regional burden. In multivariable analysis, higher education, employment, marriage at age 18 years or older, first birth at age 18 years or older and parity of three or more children were associated with lower odds of early menopause. Conversely, middle wealth index and rural residence were associated with increased odds of premature or early menopause.
CONCLUSION: Premature or early menopause affects 1 in 14 women aged 30-49 in LMICs, with marked rural disadvantage and strong protective effects of education and delayed childbearing. Findings underscore the urgent need to integrate menopause into reproductive health and non-communicable disease programmes, particularly targeting rural areas and addressing social determinants, including girls' education and delayed marriage.
PMID:42414208 | DOI:10.1136/bmjgh-2026-023742