MATERIALS AND METHODS

Several studies have reported increased mortality risk with early natural menopause. More recently, mortality risk was reported to be reduced among women who gave birth at age £40 years. The association between reproductive history and mortality was explored among 826 women in a prospective study involving 18,959 person-years of follow-up (from age 50 to 1990-1991) and 108 deaths. After adjustment for age and other covariates, the risk ratio among parous women was 1.53 (95 % confidence interval: 0.58, 4.07) for natural menopause at age £45 years compared with £51 years. In contrast to a previous report, however, the highest estimated mortality risk was seen among women who gave birth in their forties (adjusted risk ratio = 2.14, 95% confidence interval: 1.05, 4.38) compared with having a last birth at ages 30-34 years. Am J Epidemiol 2000;151:620-3. menopause; mortality; parity Snowdon et al. (1) suggested that natural menopause may represent a marker of general health and aging. Hormonal changes associated with menopause may also influence risk for some specific diseases. Recent studies have reported increased mortality rates among women with an early natural menopause (menopause at age <40 or <45 years) (1-3) and decreased mortal-ity rates among women with a livebirth at age>40 years (4). Therefore, we studied the association between menopausal and reproductive history and mortality risk in a cohort of 826 women followed fro