Around one in every 14 women aged 30 to 49 in low- and middle-income countries experiences early or premature menopause, a large international analysis published in BMJ Global Health has found, raising fresh concerns about women's long-term health and widening social inequalities. Researchers analysed data from 716,648 women across 44 countries using the Demographic and Health Surveys (DHS) Programme, making it one of the largest studies of its kind.

Menopause usually occurs between 45 and 55 years of age. It is considered early when it happens before 45 and premature before 40. Losing ovarian function earlier than expected can increase the risk of heart disease, weak bones that fracture easily, diabetes and other metabolic illnesses, memory problems, depression and even early death.

The pooled analysis found that just over 7% of women—more than 51,000 participants—had experienced early or premature menopause, with the highest prevalence among women aged 40 to 44 years. Ethiopia, Indonesia and Myanmar recorded the highest rates, while Jordan, Gabon and Armenia had the lowest.

A striking finding was the consistent rural-urban divide. Women living in rural communities were more likely to experience early menopause in every region studied. According to the researchers, this “reflects fundamental inequalities in healthcare access, nutritional status, educational opportunities and occupational exposures", adding that women in these areas are more likely to work as manual labourers and face workplace hazards, including exposure to agricultural chemicals.

The analysis also found that early marriage, giving birth before the age of 18, having three or more children, living in poverty, lacking education, and having limited exposure to media are associated with a higher prevalence of early menopause. By contrast, women with a college education were 58% less likely to experience early or premature menopause than those with no formal education, while employment was also associated with a lower risk. Because the research is observational, however, it cannot prove that these factors directly cause early menopause.

The findings broadly echo evidence from the World Health Organization and the International Menopause Society, which have highlighted the lifelong health consequences of early menopause and the need for timely care. The authors acknowledged limitations, including reliance on self-reported information and the inability to distinguish between natural and surgically induced menopause or account for smoking, diet, physical activity and other lifestyle factors.

“With populations in [these countries] ageing rapidly and women expected to spend an increasing proportion of their lives in the postmenopausal state, the prevalence represents a substantial and growing burden on health systems already constrained by competing priorities and limited resources,” they write.

The 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,” they conclude.