Women exposed to famine while in the fetal stage of development may be at risk for early natural menopause as well as premature ovarian failure (POF), according to a study published in Menopause.1

Between June 2011 and January 2012, researchers conducted a retrospective cohort study of women born during the Chinese famine period (1956-1964) to examine the association of early life exposure to famine with reproductive aging outcomes indicated by early menopause and POF. A total of 2868 women included in the final analyses completed a structured questionnaire of demographic questions.

Participants were divided into 3 categories based on status of famine exposure: the childhood-exposed group (born between October 1, 1956, and September 30, 1961); the fetal-exposed group (born between October 1, 1959, and September 30, 1961); and the nonexposed group (born between October 1, 1962, and September 30, 1964). Menopause was defined as lack of menstrual bleeding for at least 12 months; the age at menopause was recorded in the survey, and early menopause was measured for those who experienced menopause at age ≤45 years. POF was defined as age of menopause at ≤40 years. Secondary outcomes included other reproductive function variables, including nulliparity and spontaneous abortion.

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Among the 2868 women who participated in our study, 751 were included in the fetal-exposed group, 1029 (35.9%) in the childhood-exposed group, and 1088 (37.9%) in the nonexposed group. Compared with women in the nonexposed group, women in the fetal-exposed group were more likely to experience early menopause (odds ratio [OR] 1.56, P =.03) but not POF. Women who had fetal exposure to famine also showed a nonsignificant trend of higher risk of developing menopause before 40 years of age (adjusted OR of POF, 1.93). Childhood exposure to famine was not associated with either early menopause or POF.

Compared with women in the fetal-nonexposed group, women in the fetal-exposed group were found to be at higher risk of developing POF (OR, 2.07) and a slightly significant higher risk of early menopause (OR, 1.37). No statistical significance was found for the associations between famine exposure and other reproductive function variables.

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In an accompanying press release,2 JoAnn Pinkerton, PhD, executive director of the North American Menopause Society, stated, “The findings that natural menopause occurs earlier after prenatal famine exposure suggests that food deprivation during early fetal life affects how long the future ovaries function. For those women, if they are not taking estrogen therapy until the average age of menopause, their early menopause could be associated with increased risk of heart disease, osteoporosis, depression, and memory changes, and changes in vaginal and sexual health.”


  1. Wang N, Huang Y, Wen J, et al. Early life exposure to famine and reproductive aging among Chinese women [published online December 3, 2018]. Menopause. doi: 10.1097/GME.0000000000001259
  2. Insufficient nutrition during fetal development may lead to early menopause [news release]. Cleveland, OH: The North American Menopause Society; December 5, 2018. https://www.menopause.org/docs/default-source/press-release/famine-exposure-impacts-early-menopause-12-5-18.pdf. Accessed December 10, 2018.