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Frailty is inversely related to age at menopause and elevated in women who have had a hysterectomy: an analysis of the Canadian Longitudinal Study on Aging.

Background
Frailty is a complex pathophysiological phenomenon that will impact a significant proportion of adults over the age of 65 and contributes to the risk of several adverse health outcomes. Although women have a disproportionately higher risk of frailty, the sex-specific factors related to this syndrome are not well-described. Hence, we sought to examine the relationship of age at menopause, hysterectomy status and hormone replacement therapy (HRT) use with prevalent frailty in older women.


Methods
We performed a cross-sectional analysis of the Canadian Longitudinal Study on Aging (CLSA) Baseline Comprehensive cohort (n=30 097, 45-85 years old). Frailty was operationalized using both the deficit accumulation (frailty index) and frailty phenotype (Fried) models. Post-menopausal women were categorized as: premature (30-39 years old), early (40-45 yrs), normal (46-54 yrs) and late (55+) menopause, or hysterectomy. Associations were determined using multivariate analysis, adjusting for sociodemographics, lifestyle factors, social support and HRT use.


Results
Age at menopause was inversely related to frailty in older Canadian women. The frailty index decreased 1.2% of the mean (p<0.001) with every year of menopause onset, and was significantly higher for women in the premature (24%; p<0.001) and early (8%; p<0.01) menopause and hysterectomy (21%; p<0.001) groups, compared to the normal menopause group. The odds for being classified as frail using Fried's criteria was higher for the premature menopause (OR=1.45, 95%CI=0.75-2.81) and hysterectomy (OR=1.48, 95%CI=1.11-1.99) groups.


Conclusions
Our study supports a role for age at menopause and hysterectomy in the risk of frailty in older women, and warrants further investigation.