Heart Disease and Stroke Associated with Age at First Menstrual Cycle

Three Teenage GirlsKnown risk factors for heart disease and stroke include obesity, high blood pressure, diabetes, and tobacco use. Now a new study published in the journal Circulation suggests that the age at which a woman begins her menstrual cycle also influences the risk.

Previous research has linked early menarche with an increased risk of coronary heart disease (CHD) among women. However, past studies have been small and have not assessed risks associated with a wide range of the onset of the menstrual cycle. Therefore, for the present study, researchers led by Dr. Dexter Canoy of the Cancer Epidemiology Unit at the University of Oxford in the United Kingdom sought to assess coronary, cerebrovascular, and hypertensive disease risks by age at menarche in a large prospective study of women in the UK.

To determine the association between age of menarcheal age and heart disease and stroke, the researchers collected health data over a decade for 1.3 million women in the UK between the ages of 50 and 64.

According to the study, women who had their first period at age 13 had the lowest risk of heart disease, stroke, and high blood pressure.

Women who started menstruating at age 10 and younger or age 17 and older had an increased risk of developing heart disease, stroke, and complications of high blood pressure. Women with early or late menarche experienced 27 percent more hospitalizations or deaths due to heart disease; 16 percent more hospitalizations or deaths from stroke; and 20 percent more hospitalizations with high blood pressure or deaths due to complications from high blood pressure.

In other words, age of menarche affects the risk for heart disease and stroke.

Because childhood obesity has been identified as a possible cause of early menstruation, the researchers believe that tackling the obesity epidemic may be one way to reduce heart disease risk among women.

Comments Dr. Canoy:

“The size of our study, the wide range of ages considered, and the vascular diseases being examined made it unique and informative. Childhood obesity, widespread in many industrialized countries, is linked particularly to early age at which the first menstrual cycle occurs. Public health strategies to tackle childhood obesity may possibly prevent the lowering of the average age of first menstrual cycle, which may in turn reduce their risk of developing heart disease over the long term.”

The effect of menarcheal age on heart disease risk was consistently found among lean, over-weight, and obese women; among never, past, or current smokers; and among women in lower, middle, or higher socioeconomic groups.

Addressing the limitations of the study, the researchers do not that few women experience extremely early or extremely lack menarche. Among the participants in the study, only four percent had their first menstrual cycle at age 10 or younger, and only one percent had their first menstrual cycle at age 17 or older.

However, another study from 2012 as published in The Journal of Endocrinology & Metabolism also linked menarcheal age with cardiovascular disease risk. After assessing 1,638 women age 40 or older, the researchers found that earlier onset of menstruation was associated with an increased risk of obesity later in life. Obesity then increases the risk of cardiovascular disease.

Comments Dr. Subbulaxmi Trikudanathan:

“This research suggests that select female reproductive risk factors, specifically onset of menarche, are associated with overall adiposity, but not with specific indices of body fat distribution. Ultimately, the important question is whether female reproductive risk factors can be used to target lifestyle interventions in high-risk women to prevent the metabolic consequences of obesity and cardiovascular disease.”

Although the age at which a woman begins her menstrual cycle is partially determined by genetics, other factors such as obesity are modifiable. Maintaining a healthy weight can prevent early or late menarche.


Age of first menstruation predicts cardiovascular disease risk:
Age at menarche and risks of coronary heart and other vascular siseases in a large UK cohort:
Factors influencing menarcheal age: Results from the cohort of Tehran lipid and glucose study:
Relation of vascular growth factors with CT-derived measures of body fat distribution: The Framingham heart study:
Women and heart disease fact sheet:
Women’s age at first menstrual cycle linked to heart disease risk:
Women’s risk of heart disease, stroke associated with age at first menstrual cycle:

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