Menopause: The Journal of The North American Menopause Society最新文献

{"title":"Derivation and validation of a symptom-anchored diagnostic criterion for nocturnal polyuria in women: aligning with aging physiology.","authors":"Pei-Chi Wu, Sheng-Mou Hsiao, Ho-Hsiung Lin","doi":"10.1097/GME.0000000000002857","DOIUrl":"https://doi.org/10.1097/GME.0000000000002857","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the physiological validity of current diagnostic criteria for nocturnal polyuria and to derive and validate a symptom-anchored revision consistent with female aging.</p><p><strong>Methods: </strong>This retrospective cross-sectional study analyzed 3-day bladder diaries from 3,000 women with lower urinary tract symptoms. We assessed age-specific nocturnal polyuria prevalence using current International Continence Society definitions (nocturnal polyuria index ≥33% for women >66 y and ≥20% for women ≤65 y). To address discrepancies with aging physiology, a novel cutoff was derived using the Youden index anchored to symptom bother (King's Health Questionnaire nocturia severity score ≥1). The proposed composite definition (nocturnal polyuria index ≥28% plus symptom score ≥1) was validated using multivariable regression and randomized split-sample validation (training: n=2,500; validation: n=500).</p><p><strong>Results: </strong>Under current criteria, nocturnal polyuria prevalence was higher in younger women (75.5%) compared with older women (50.5%). Multivariable analysis identified age as a protective factor (odds ratio: 0.96; 95% CI: 0.95-0.97), inconsistent with physiology. Conversely, the proposed new definition identified age as a significant positive risk factor (odds ratio: 1.03; 95% CI: 1.02-1.04). Prevalence remained stable at 26.8% (one-in-four) in premenopausal women, rising linearly to 46.3% (one-in-two) in postmenopausal women. Internal validation confirmed model stability (area under curve: 0.86; 95% CI: 0.83-0.90).</p><p><strong>Conclusions: </strong>Current age-stratified thresholds of nocturnal polyuria result in discrepancies with aging physiology. The proposed framework establishes a physiologically plausible standard. By anchoring symptom bother score and nocturnal polyuria index of 28%, this definition facilitates the identification of symptomatic women and highlights the distinct impact of menopause.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age at natural and surgical menopause and related factors: NHANES 2013-2023.","authors":"Rebecca N Schulz, Katerina Shvartsman, Lindsey Borgia, Catherine T Witkop, James D Mancuso, Tracey P Koehlmoos, Anwar E Ahmed","doi":"10.1097/GME.0000000000002848","DOIUrl":"https://doi.org/10.1097/GME.0000000000002848","url":null,"abstract":"<p><strong>Objectives: </strong>Premature and early menopause are public health issues that increase the risk for chronic conditions, including cardiovascular disease and osteoporosis. We aimed to estimate the average age at menopause and identify factors associated with age at menopause in a nationally representative sample of American women.</p><p><strong>Methods: </strong>We used a population-based cross-sectional study to investigate menopause timing in 15,322 women aged 15 years and older from the 2013 to 2023 National Health and Nutrition Examination Survey (NHANES). The outcomes were age at natural and surgical menopause (time-to-events) and menopause onset as multinomial categories (premature, early, typical, late).</p><p><strong>Results: </strong>Life tables demonstrated a median age of natural menopause at 50 years, while survey-adjusted estimates suggested a weighted mean age of 49.5 years (95% confidence interval: 49.2-49.8). The prevalence estimates of premature and early natural menopause in postmenopausal women were 4.6% and 10.0%, respectively. Multivariate Cox proportional hazard models identified less education, smoking, and mild depression as factors associated with younger natural menopause onset, whereas obesity, high blood pressure, high cholesterol, and arthritis were significantly associated with younger age at surgical menopause. In postmenopausal women, less education, little sleep, diabetes, and mild depression demonstrated associations with increased odds for premature natural menopause.</p><p><strong>Conclusions: </strong>Differences between calculated associations and menopause timing reported in the literature are likely due to methodological and participant inclusion differences. The life table method demonstrates a similar estimate to the commonly reported value for natural menopause onset. Several modifiable factors may provide opportunities for intervention.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occupational quality of life during the menopause transition: a cross-sectional study of women faculty and staff at three universities in the United States.","authors":"Emily M Cherenack, Sarah Combs, Jeanine M Genkinger, Nancy Glass, Stacey Kaltman, Lisa M Bates, Wen Shen, Kate Pisano, Marni Sommer","doi":"10.1097/GME.0000000000002846","DOIUrl":"10.1097/GME.0000000000002846","url":null,"abstract":"<p><strong>Objectives: </strong>In the absence of menopause-friendly workplaces, the menopause transition may negatively impact women's occupational quality of life (OQoL). There is little research on women's experiences of menopause in university workplaces in the United States.</p><p><strong>Methods: </strong>From January to May 2025, 391 women faculty and staff aged 40-55 at three universities completed a cross-sectional self-report survey. Using multivariable linear regressions controlling for university clustering and sociodemographics, we tested if self-reported menopause stage was associated with the Utian Quality of Life sub-scale for OQoL, and, among women in perimenopause or postmenopause, we tested if the presence of 12 symptoms (eg, hot flashes, irritability, exhaustion, pain) occurring at work were associated with OQoL and an item measuring how much \"perimenopause or menopause impacted productivity\" at work (0 = no effect to 10 = completely prevented activities ).</p><p><strong>Results: </strong>Of 263 women in perimenopause or postmenopause, 95% had at least one recent symptom at work, most commonly physical/mental exhaustion (68%) and feeling tired at work due to sleep problems (67%). About 90% reported that perimenopause or menopause impacted productivity, with 13% having substantial disruptions (≥7). Menopause stage was not associated with OQoL. Among women in perimenopause or postmenopause, all else held constant, a greater number of symptoms and joint/muscle pain were associated with lower OQoL, and 9 of 12 symptoms and a greater number of symptoms were associated with menopause-related disruptions to workplace productivity.</p><p><strong>Conclusions: </strong>Workplace interventions may be needed to reduce the interference of symptoms with OQoL during the menopause transition.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postmenopausal vasomotor symptoms are associated with heightened cutaneous vasodilation despite preserved nitric oxide-mediated endothelial function.","authors":"Caroline Li-Maloney, Gregory W McGarr, Naoto Fujii, Tatsuro Amano, Glen P Kenny","doi":"10.1097/GME.0000000000002844","DOIUrl":"https://doi.org/10.1097/GME.0000000000002844","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether postmenopausal females with vasomotor symptoms (VMS) exhibit altered nitric oxide synthase (NOS)-dependent cutaneous vasodilation during local heating, and whether these responses vary by body region.</p><p><strong>Methods: </strong>Cutaneous vascular conductance normalized to maximum vasodilation (percentage of the maximal conductance [%CVCmax]) was assessed at the chest, abdomen, forearm, and calf using laser-Doppler flowmetry in 18 postmenopausal females (9 with current VMS, 9 without VMS). Local skin temperature was increased from 33 °C to 42 °C (~30 min) to elicit a vasodilatory plateau. NG-nitro-L-arginine methyl ester (20 mM), a NOS inhibitor, was then perfused during continued heating (~40 min). The NOS contribution was assessed by the difference in %CVCmax mediated by NG-nitro-L-arginine methyl ester.</p><p><strong>Results: </strong>Baseline %CVCmax was higher at the chest compared with the calf across groups (10.0 [3.3, 16.6]%; P = 0.0013). During the 42 °C heating plateau, females with VMS exhibited greater %CVCmax than those without VMS when responses were pooled across regions (7.2 [1.7, 23.5]%; P = 0.013), and at the abdomen (8.7 [0.6, 18.4]%), chest (10.3 [2.3, 18.4]%), and calf (8.4 [0.4, 16.5]%; all P < 0.036). However, the NOS-mediated contribution did not differ between groups or across regions (all P > 0.15).</p><p><strong>Conclusion: </strong>Although postmenopausal females with VMS exhibit heightened cutaneous vasodilatory responses to local heating, NOS-dependent vasodilation is preserved. These findings suggest that enhanced microvascular reactivity in VMS is not attributable to altered endothelial NOS function.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Menopause-associated pain: a decade review of patterns, determinants, and research priorities.","authors":"Elizabete Ertmane, Aija Lulle","doi":"10.1097/GME.0000000000002842","DOIUrl":"https://doi.org/10.1097/GME.0000000000002842","url":null,"abstract":"<p><strong>Importance and objective: </strong>Menopause-associated pain is increasingly recognized as a multidimensional symptom influenced by endocrine change, comorbidity, and psychosocial context. However, the evidence base remains fragmented across pain types, and study designs limit clinical clarity. To examine research trends in menopause-associated pain published between 2014 and 2024, identify major pain categories, severity modifiers, and management approaches across the menopause transition.</p><p><strong>Methods: </strong>A structured search of PubMed and Scopus identified peer-reviewed, English-language studies using the terms \"menopause\" and \"pain.\" After screening and full-text assessment, 115 studies were included. Data were synthesized descriptively by pain domain, study design, context, and geographical origin.</p><p><strong>Discussion and conclusion: </strong>Five major pain categories were identified: musculoskeletal, urogenital, gastrointestinal, oral/orofacial, and multisite or unspecified pain. Musculoskeletal and urogenital pain were most frequently studied. Pain severity was commonly reported to peak during early menopause and declined postmenopause, although trajectories vary by pain type and comorbidity. Across domains, psychological distress, sleep disturbance, body mass index, and social determinants of health consistently modified pain perception and functional impact. Evidence for management strategies was uneven; however, exercise-based interventions demonstrated the most consistent functional benefits. Evidence for hormone therapy and complementary approaches was heterogeneous and phenotype-dependent. Although research has become more phenotype-specific and biopsychosocial in orientation, methodological heterogeneity and geographic concentration limit generalizability. Harmonized measurement, longitudinal designs, and inclusive, rigorously conducted trials are needed to support equitable, patient-centered menopause pain management.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regeneration of the structure and function of estrogen-deficient vaginal epithelium by a novel phytoestrogen-related compound.","authors":"David J Orlicky, E Erin Smith, Thomas J Anchordoquy, Peter J Rice, Aaron M Magnuson, Andrew T Rukavina, Vijay Kumar, Michael F Wempe, Steven K Nordeen","doi":"10.1097/GME.0000000000002820","DOIUrl":"https://doi.org/10.1097/GME.0000000000002820","url":null,"abstract":"<p><strong>Objective: </strong>The loss of estradiol production that accompanies natural aging or therapeutic intervention (oophorectomy or estrogen suppression) precipitates atrophic changes in the vaginal epithelium responsible for a plethora of symptoms that, collectively, are termed genitourinary syndrome of menopause. While systemic or local hormone replacement therapy can ameliorate these symptoms, their use faces resistance from women and their physicians concerned about the risks of estrogen therapy. The goal of this study is to evaluate an alternative approach to reversing vaginal atrophy that follows the loss of estradiol.</p><p><strong>Methods: </strong>This study employs the ovariectomized rat model of menopause. Ovariectomized rats exhibit atrophic changes in the vaginal epithelium, much like humans. We delivered a novel estrogenic flavone, 3-fluoro 6,4'-dihydroxyflavone (3F), by vaginal suppository. This compound was developed and chosen for modest potency as an estrogen and inactivation once in the circulation to minimize the potential for systemic activity.</p><p><strong>Results: </strong>Vaginal administration of this flavone regenerates the structure of atrophic vaginal epithelium. This is accompanied by restoration of mucin secretion and expression of anti-microbial proteins. Greater mucin expression is seen following 3F-treatment compared with estradiol. Vaginal regeneration is accomplished without stimulating cell proliferation in the vagina or endometrial epithelium.</p><p><strong>Conclusions: </strong>The combination of local delivery, modest potency, liver metabolism, and elimination creates safeguards that support the potential for human use of 3F to alleviate symptoms associated with estrogen-deficient vaginal atrophy without the risks of systemic hormone therapy or local steroidal estrogens.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Menopause experience among people with criminal legal system involvement.","authors":"Anna M Leone, Amanda Emerson, Elana J Brotkin, Shivani Patel, Xinyang Li, Elizabeth J Geller, Jennifer Lorvick, Megha Ramaswamy, Andrea K Knittel","doi":"10.1097/GME.0000000000002843","DOIUrl":"10.1097/GME.0000000000002843","url":null,"abstract":"<p><strong>Objective: </strong>We aim to describe menopause symptom burden during and after incarceration for the growing population of women with a history of criminal legal system (CLS) involvement.</p><p><strong>Methods: </strong>We used Menopause Rating Scale symptom data from the final year of a multiwave cohort of adult women with a history of CLS involvement in three US cities. We also used qualitative semistructured interview data about menopause treatment in the community from adult women from five US states who experienced menopause during their CLS involvement. Descriptive statistics and qualitative thematic analysis were used to triangulate findings.</p><p><strong>Results: </strong>Of 507 women, 348 (68.8%) reported menstrual cycle data. The mean age was 46. Women were either premenopausal (n=151), early perimenopausal (n=25), late perimenopausal (n=10), or postmenopausal (n=162). Symptoms were common and differed by group. The most severe symptoms in premenopause, early perimenopause, late perimenopause, and postmenopause were joint pain (2.27, SD 1.12), sleep problems (2.44, SD 1.13), joint pain (2.80, SD 0.45), and hot flashes (2.42, SD 1.07), respectively. The qualitative analysis included 29 semistructured interviews focused on access to menopause treatment in the community during or after CLS involvement. Primary themes were logistical barriers (lack of provider, insurance/financial, transportation) and quality of care barriers (poor provider communication skills, lack of provider knowledge).</p><p><strong>Conclusion: </strong>Women with a history of CLS involvement commonly experience menopausal symptoms, some of which are severe. These symptoms are experienced in the context of CLS involvement that may amplify barriers to accessing care.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148405255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of vulvovaginal atrophy is associated with high levels of satisfaction and improves symptom severity and patient-reported outcomes: 12-month results of the PatieEnt satisfactiON studY (PEONY).","authors":"Maria Cristina Meriggiola, Paola Villa, Angelo Cagnacci, Stefano Luisi, Tommaso Simoncini, Massimo Stomati, Alessandra Lami, Tiziana Di Paolantonio, Silvia Marsini, Antonio Nicolucci, Cristina Puglielli, Rossella E Nappi","doi":"10.1097/GME.0000000000002737","DOIUrl":"10.1097/GME.0000000000002737","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether the benefits demonstrated after 6 months of treating vulvovaginal atrophy (VVA) with ospemifene and local vaginal estrogen therapy (LET) were maintained after 12 months. To assess the persistence and adherence to treatments, as well as the satisfaction of participants and associated factors.</p><p><strong>Methods: </strong>Longitudinal, observational study conducted in 17 Italian gynecology centers involving women already under treatment (LET or ospemifene) or new users. Participants complete questionnaires at baseline (T0), after 3 (T3), 6 (T6), and 12 months (T12). The main outcome measures were treatment satisfaction, severity of symptoms, Day-to-Day Impact of Vaginal Aging (DIVA), Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), and Short Form-12 (SF-12) Health Survey.</p><p><strong>Results: </strong>Among the 385 women included in the study, 145 (37.7%) were treated with ospemifene, and 240 (62.3%) with LET. Overall, 75.9% of women treated with ospemifene and 78.7% with LET completed the 12-month follow-up. In the ospemifene group, the treatment satisfaction score improved from 7.02 (95% CI, 6.64-7.39) at T3 to 8.32 (95% CI, 7.78-8.86) at T12 ( P <0.0001), while in the LET group the score improved from 7.36 (95% CI, 7.06-7.66) to 7.79 (95% CI, 7.5-8.08) ( P =0.001). In multivariate analysis, women treated with ospemifene had an almost threefold higher likelihood of reporting a clinically relevant improvement (effect size ≥0.5) in satisfaction score (OR=2.85; 95%CI, 1.33-6.11). The likelihood of moderate/severe VVA symptoms and urinary symptoms significantly decreased in both groups. DIVA and FSDS-R scores significantly improved in both groups.</p><p><strong>Conclusions: </strong>The PatiEnt satisfactiON studY (PEONY) documents the high effectiveness, satisfaction, and persistence after 12 months with LET or ospemifene in women with VVA.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":"799-809"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146213781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Association between reproductive span and postmenopausal metabolic syndrome: a cross-sectional study in China.","authors":"Xin Huang, Yuanyuan Hua","doi":"10.1097/GME.0000000000002875","DOIUrl":"10.1097/GME.0000000000002875","url":null,"abstract":"","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":"33 7","pages":"861"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Importance of changes in body mass index from adolescence to middle age as a risk factor for osteoporosis: the Japan Nurses' Health Study.","authors":"Takumi Kurabayash, Kazue Nagai, Kunihiko Hayashi, Toshiyuki Yasui, Kiyoshi Takamatsu, Yuki Ideno","doi":"10.1097/GME.0000000000002740","DOIUrl":"10.1097/GME.0000000000002740","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between changes in body mass index (BMI) from adolescence to middle age and osteoporosis risk among participants in the Japan Nurses' Health Study (JNHS), a nationwide prospective cohort study.</p><p><strong>Methods: </strong>Data were reviewed for 15,019 participants in the JNHS. After excluding 6,511 participants aged below 40 years or diagnosed with osteoporosis at baseline, 8,508 participants were included. The mean age at baseline was 47.5±5.4 years, and the mean follow-up period was 15.5±6.3 years. Low body weight (L) was defined as BMI <18.5 kg/m 2 , normal weight (N) as BMI ≥18.5 to <25 kg/m 2 , and overweight (O) as BMI ≥25 kg/m 2 .</p><p><strong>Results: </strong>Age-adjusted hazard ratios for new-onset osteoporosis according to change in BMI from age 18 years to baseline compared with N to N were L to L, 1.65 (95% CI: 1.10-2.47), N to L, 1.44 (1.08-1.91) and N to O, 0.65 (0.54-0.79). Multivariable-adjusted hazard ratios for osteoporosis compared with N to N were L to L, 1.51 (0.98-2.33), N to L, 1.29 (0.95-1.76) and N to O, 0.68 (0.55-0.82). Regarding age at diagnosis of osteoporosis compared with N to N, the HR for L to L was 1.97 (1.04-3.72) for participants in their 50s, and the HR for N to O was 0.56 (0.42-0.76) for participants in their 60s.</p><p><strong>Conclusions: </strong>Persistent underweight status in women from adolescence to middle age is a risk factor for developing earlier osteoporosis in menopause.</p>","PeriodicalId":18435,"journal":{"name":"Menopause: The Journal of The North American Menopause Society","volume":" ","pages":"767-774"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146052881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}