Study Results Link Menopause Before 40 to Increase in Atrial Fibrillation, Heart Failure

Analysis supports positive lifestyle habits, such as exercising and quitting smoking, investigators say.

Menopause before aged 40 years is associated with elevated risks of atrial fibrillation (AF) and heart failure (HF), according to the results of a study published in the European Heart Journal.

In the study of more than 1.4 million women, results showed that the younger the individual is at menopause, the higher the risk of new-onset HF and AF.

“Women with premature menopause should be aware that they may be more likely to develop heart failure or atrial fibrillation than their peers,” Ga Eun Nam of Korea University College of Medicine, Seoul, Republic of Korea, said in a statement. “This may be good motivation to improve lifestyle habits known to be linked with heart disease, such as quitting smoking and exercising.”

Investigators included postmenopausal women who were aged 30 years or older and completed a National Health Interview Survey health check-up in 2009. Investigators followed up with individuals until the end of 2018 for new-onset HF and AF.

Information on demographics, health behaviors, and reproductive factors, including age at menopause and use of hormone replacement therapy, were collected.

Investigators categorized age at menopause as below aged 40, 40 to 44, 45 to 49, and 50 years or older. Premature menopause was defined as the individual’s final menstrual period before the aged 40 years.

Approximately 2% of individuals had a history of premature menopause. Of these women, the average age at menopause was 36.7 years. The average age at study enrollment for women with and without a history of premature menopause was 60 and 61.5 years, respectively.

During an average follow up of 9.1 years, 3.2% developed AF and 3% of individuals developed HF.

Investigators analyzed the association between history of premature menopause and incident HF and AF after adjusting for age, smoking, alcohol, physical activity, income, body mass index, and other factors that could have affected the incidence.

They found that women who experienced premature menopause had a 33% higher risk of HF and a 9% higher risk of AF compared with those who did not.

“The misconception that heart disease primarily affects men has meant that sex-specific risk factors have been largely ignored. Evidence is accumulating that undergoing menopause before the age of 40 may increase the likelihood of heart disease later in life,” Nam said in the statement

“Our study indicates that reproductive history should be routinely considered in addition to traditional risk factors such as smoking when evaluating the future likelihood of heart failure and atrial fibrillation,” she said.

Investigators also analyzed the association between age at menopause and the incidence of AF and HF after adjusting for the same factors as in the previous analyses.

The risk of HF increased as the age at menopause decreased.

Compared with those aged 50 years and older at menopause, those aged 45 to 49, 40 to 44, and below 40 years had an 11%, 23%, and 39% greater risk of incidence HF, respectively.

Additionally, the risk of AF increased as age decreased with 4%, 10%, and 11% higher, respectively, compared with women aged 50 years and above at menopause.

Several factors could explain the associations, including changes in body fat distribution and a drop in estrogen levels, investigators said.


Premature menopause is associated with increased risk of heart problems. News release. EurekAlert. August 3, 2022. Accessed August 5, 2022.