Starting menstruation before age 11 or after age 16 is associated with a higher risk of coronary heart disease later in life, compared with starting menstruation at age 13, according to a new study.

“This pattern did not differ significantly between lean, overweight, and obese women; between current, past smokers, and never smokers; or between women in low, middle, and high socioeconomic groups,” Dr. Dexter Canoy of the University of Oxford (England) and his colleagues wrote in the Dec. 15 issue of Circulation ( doi:10.1161/circulationaha.114.010070 ).

The researchers also found similar risks for “incident cerebrovascular and hypertensive disease, although the magnitude of the risks for early and late menarche was weaker than that observed for coronary heart disease,” Dr. Canoy and his colleagues wrote.

Compared to the women who began menstruating at 13 years old, those who started at or before 10 years old were 27% more likely to have coronary heart disease, with an adjusted hazard ratio of 1.27). The risk was 23% greater for those who began menstruating at age 17 or older, with an adjusted hazard ratio of 1.23.

The researchers used data from the Million Women Study , which enrolled English and Scottish women, aged 50-64, who had been invited to routine breast cancer screenings between 1996 and 2001. Among the 1.2 million women assessed in the study, a quarter of the women started menstruation at 13 years old, the average across the sample. Those with menarche at age 10 or younger comprised 3.9% of the participants, and 1.4% of the women started menstruating at age 17 or older.

Over an average of 11.6 years of follow-up, more than 73,000 women had coronary heart disease, more than 25,000 had cerebrovascular disease, and nearly 250,000 had hypertensive disease. Women with menarche at age 13 had the lowest risk of these diseases.

The research was funded by Cancer Research UK, the Medical Research Council, and the NHS Cancer Screening Programme, with support from the British Heart Foundation. The authors reported no disclosures.


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