Wednesday, January 15, 2020

Women who reported to have sex weekly during the study period were 28% less likely to experience menopause than women who had sex less than monthly

Sexual frequency is associated with age of natural menopause: results from the Study of Women's Health Across the Nation. Megan Arnot and Ruth Mace. Royal Society Open Science, Volume 7, Issue 1, January 15 2020.

Abstract: It is often observed that married women have a later age of natural menopause (ANM) than unmarried women; however, the reason for this association is unknown. We test an original hypothesis that sexual frequency acts as a bio-behavioural mediator between marital status and ANM. We hypothesize that there is a trade-off between continued ovulation and menopause based on the woman's chances of becoming pregnant. If a woman is sexually inactive, then pregnancy is impossible, and continued investment in ovulation would not be adaptive. In addition, we test an existing hypothesis that the observed relationship is because of the exposure to male pheromones. Data from 2936 women were drawn from 11 waves of the Study of Women's Health Across the Nation, which is a longitudinal study conducted in the United States. Using time-varying Cox regression, we found no evidence for the pheromone hypothesis. However, we did observe that women who reported to have sex weekly during the study period were 28% less likely to experience menopause than women who had sex less than monthly. This is an indication that ANM may be somewhat facultative in response to the likelihood of pregnancy.

4. Discussion

While women often stop reproducing many years prior to the menopause [63], the permanent reproductive cessation resulting from the menopause means a woman is no longer physically able to increase her direct fitness. Many lifestyle factors have been found to associate with ANM, and these are seldom discussed from an evolutionary perspective. Here, we have focused specifically on the relationship between marital status and ANM, testing an original hypothesis that sexual frequency acts as a bio-behavioural mediator between ANM and marital status, in addition to the existing hypothesis that married women enter menopause later owing to male pheromones [7]. To test the latter hypothesis, three measures of male–female cohabitation were used as a proxy of exposure to male pheromones, and we found no evidence to suggest that menopause timing was responsive to living with a male, and therefore possibly male pheromones. It should be noted that this hypothesis could be fundamentally flawed, as there is no conclusive evidence either that humans produce pheromones, or that they are capable of detecting them [64]. Nonetheless, this is, to our knowledge, the first study addressing the pheromonal hypothesis since it was originally proposed, and while male household presence is merely a proxy of pheromones—and it may be that the hypothesis is moot owing to the absence of evidence for human pheromones—it is an indication that the relationship between marital status and ANM is not capturing the effect of male pheromones on the menstrual cycle.
This study did not replicate findings from previous research that married women enter menopause later. In fact, following complete adjustment, the converse was found, with women who were married or in a relationship having an increased risk of entering menopause compared to divorced, separated and single women. Conflicting results regarding marital status' effect on ANM have been found elsewhere (e.g. [65]), and one reason for this may be the way in which the researcher chooses to code the variable. In this analysis, romantic partnerships that may not have been acknowledged in previous studies owing to having not been formalized by a marriage ceremony (e.g. cohabiting but unmarried) were taken into account. In addition, some prior studies have not included marital status as time-variant and dichotomized the variable as ‘ever married’ or ‘never married’ (e.g. [66]). Hence, the responsive way in which this study coded marital status may account for the difference in results.
Another reason for this difference may be the cultural setting of previous studies. For example, research originating from Iran found that ever married women experience a later menopause than those who never married [8]. However, in the case of Iran where dowry is still common practice, it means marriage is contingent upon family wealth [67]. Therefore, the effect of marital status on ANM would be confounded by a woman's socioeconomic position, which itself would relate to other aspects of her health and life history that have been associated with menopause timing—such as BMI and age of menarche—therefore resulting in a significant difference in ANM between those who have and have not been married. Within Iran, sex outside of marriage is prohibited both legally and socially, meaning marital status would be highly correlated with sexual behaviour [68]. Hence, it may be that previous studies identifying married women enter menopause later are simply capturing the effect of health and lifestyle patterns that themselves associate with both marital status and menopause timing, rather than demonstrating that marital status itself is a cross-cultural correlate of ANM. Future research should aim to address the cultural setting in which the data were collected when interpreting the results.
Evidence supporting the notion that ANM associated with sexual frequency during the pre- and peri-menopause was found. Even following complete adjustment, results still indicated that women who engage in sexual activity weekly or monthly have a lower risk of entering menopause relative to those who report having some form of sex less than monthly. If we interpret these results from a fitness-maximizing framework, it may be the physical cues of sex signal to the body that there is a possibility of becoming pregnant, and therefore an adaptive trade-off may occur between continued energetic investment in ovulation and reproductive cessation. During ovulation, the woman's immune function is impaired making the body more susceptible to disease [28,29]. Hence, if a pregnancy is unlikely owing to a lack of sexual activity, then it would not be beneficial to allocate energy to a costly process, especially if there is the option to invest resources into existing kin [30,31]. The idea that women cease fertility in order to invest in kin is known as the Grandmother Hypothesis, which predicts that the menopause originally evolved in humans to reduce reproductive conflict between different generations of females, and allow women to increase their inclusive fitness through investing in their grandchildren [30,69,70]. It may be costly for a woman to cease ovulatory function if the chances of her becoming pregnant are still high. In other words, if she is still able to increase her direct fitness, then it may be better to maintain the function of her menstrual cycle for slightly longer.
It should be noted that there may be a bidirectional relationship between the physical condition of the woman when approaching the menopause and sexual engagement. As oestrogen levels decline, women are more likely to experience vaginal dryness and discomfort, making them less inclined to engage in sex [71]. This study has attempted to control for this factor through adjusting for both oestradiol levels and the woman's self-perceived overall health, with the association between sexual frequency and ANM still persisting following this adjustment. This suggests that—even when controlling for the complicated relationship between health, hormonal fluctuations and desire for sex—the menopause may be somewhat facultative in response to sexual behaviour, rather than being solely the result of a physiological constraint (e.g. degrading oocyte quality).

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