Fertility

Fertility (women)


LASA119 (wave B)
LASA181

Contact: Dorly Deeg

Background
The period of fertility in women runs from menarche to menopause. The timing of both events has been shown to be associated with the rate of ageing. An earlier menopause, for example, is associated with epigenetic age acceleration (Levine et al 2016). Early menopause, either due to natural ovarian insufficiency or to bilateral surgery of the female sex organs (salpingo-oophorectomy), has also been shown to have adverse long-term consequences for cognition, mood, cardiovascular, bone and sexual health, and in terms of an increased rate of mortality (Faubion et al 2015, Vermeulen et al 2017).

Ample evidence shows that the period of menopause has an impact on quality of life, which may last for many years, due to symptoms such as hot flushes, pain, and mood disturbances (Geukes et al 2012, Hess et al 2012). These effects may be reduced by hormone replacement therapy (HRT) (Utian & Woods 2013). In the past decade, the effect of HRT on mortality has been the topic of debate, with most studies suggesting a positive effect (Tuomikoski et al 2014, Mikkola et al 2015). However, there is a lack of studies with a long duration of follow-up, so that the evidence remains inconclusive.

Measurement instruments in LASA
At baseline (1992-93), in the self-administered questionnaire, questions were asked to the female respondents about their fertility history, including age at first menstruation (menarche), number of children, number of pregnancies, age at first-born child, and contraceptive pill use including its duration. Subsequent questions about the menopause included the age (in months and years) of the last menstruation, whether the menopause was natural or surgical, and symptoms (hot flushes, excessive transpiration, muscle pain, dryness of vagina, and pain during intercourse).

In 1995-96, additional questions were asked to specify a surgical menopause as hysterectomy and/or oophorectomy as well as the age of the last surgery (if more surgeries were experienced). Because the majority of women was past menopause, the ages at first and last experienced hot flushes were asked. Further additions were questions about hormone therapy, including its type, starting age and duration.

At the recruitment of the LASA-2 cohort (2002-03), the questionnaire was revised and combined the questions asked in 1992-93 and 1995-96. Also, additional details were asked, including the age of starting with the contraceptive pill. This questionnaire was also used for the baseline measurement of the LASA-3 cohort (2012-13).

In the Migrant cohort, a shortened questionnaire included age at menarche and age at menopause, details of hysterectomy and oophorectomy, the use of hormone therapy, and the occurrence of menopausal symptoms.

Questionnaires
LASAB119 (self-administered questionnaire, in Dutch);
LASAC181 / LAS2B181 / LAS3B181 / LASMB181(medical interview, in Dutch)

Variable information
LASAB119
(pdf)

LASAC181 / LAS2B181 / LAS3B181 / LASMB181
(pdf)

Availability of information per wave 1

 

B

C

D

E


2B*

F

G

H



3B*

MB*

I J
Fertility
Sa 
 
Me - - Me - - - Me Me  - -

1 More information about the LASA data collection waves is available here.

* 2B=baseline second cohort;
   3B=baseline third cohort;
   MB=migrants: baseline first cohort

Me=data collected in medical interview;
Sa=data collected in self-administered questionnaire

Previous use in LASA
One article reported on the association of a genetic component (anti-Mullerian hormone signaling) with the onset of menopause in a study combining the Rotterdam study and LASA (Kevenaar et al 2007).

References

  1. Faubion SS, Kuhle CL, Shuster LT, Rocca WA. Long-term health consequences of premature or early menopause and considerations for management. Climacteric 2015; 18(4): 483–491. doi:10.3109/13697137.2015.1020484
  2. Geukes M, van Aalst MP, Nauta MC, Oosterhof H. The impact of menopausal symptoms on work ability. Menopause 2012; 19(3): 278-282.
  3. Hess R, Thurston RC, Hays RD, … Matthews KA. The impact of menopause on health-related quality of life: results from the STRIDE longitudinal study. Qual Life Res 2012; 21(3): 535-544. doi: 10.1007/s11136-011-9959-7.
  4. Kevenaar ME, Themmen APN, Rivadeneira FF, Uitterlinden AG, Laven JSE, van Schoor NM, Pols HAP, Visser JA. A polymorphism in the AMH type II receptor gene is associated with age at menopause in interaction with parity. Human Reproduction 2007; 22(9): 2382-2388.
  5. Levine ME, Lu AT, Chen BH, … Horvath S. Menopause accelerates biological aging. Proc Natl Acad Sci USA 2016; 111(33): 9327-9332.
  6. Ley SH, Li Y, Tobias DK, Manson JE, Rosner B, Hu FB, Rexrode KM. Duration of Reproductive Life Span, Age at Menarche, and Age at Menopause Are Associated With Risk of Cardiovascular Disease in Women. J Am Heart Assoc 2017 Nov 2; 6(11). doi: 10.1161/JAHA.117.006713
  7. Mikkola TS, Tuomikoski P, Lyytinen H, … Ylikorkala O. Estradiol-based postmenopausal hormone therapy and risk of cardiovascular and all-cause mortality. Menopause 2015; 22(9): 976-983. doi: 10.1097/GME.0000000000000450
  8. Tuomikoski P, Lyytinen H, Korhonen P, … Mikkola TS. Coronary heart disease mortality and hormone therapy before and after the Women's Health Initiative. Obstet Gynecol 2014; 124(5): 947-953.
  9. Utian WH, Woods NF. Impact of hormone therapy on quality of life after menopause. Menopause 2013; 20(10): 1098-1105. doi: 10.1097/GME.0b013e318298debe.
  10. Vermeulen RFM, Beurden MV, Korse CM, Kenter GG. Impact of risk-reducing salpingo-oophorectomy in premenopausal women. Climacteric 2017; 20(3): 212-221. doi: 10.1080/13697137.2017.1285879.
  11. Zhang X, Liu L, Song F, Song, Dai H. Ages at menarche and menopause, and mortality among postmenopausal women. Maturitas 2019; 130: 50-56. doi: 10.1016/j.maturitas.2019.10.009