Adverse childhood experiences and age at menopause: a cross-sectional analysis in the UK Biobank and US Health and Retirement Study

Adverse childhood experiences (ACE) represent a pervasive global health burden, yet evidence regarding their association with age at menopause remains mixed and largely derived from single-cohort studies. This cross-sectional study aimed to investigate the association between ACE and age at menopause across two large-scale cohorts. This cross-sectional analysis included 34,872 women from the UK Biobank and 5,163 from the Health and Retirement Study. Cumulative ACE scores were derived using validated instruments. Multivariable linear and logistic regression models were used to assess the associations of ACE with age at menopause (continuous) and with menopause before age 40, 45, and 48 years. Subgroup analyses examined effect modification across socioeconomic and behavioral strata. Higher ACE scores were significantly associated with a small difference toward earlier menopause in both cohorts (UKB: β = -0.074, 95% CI: -0.116 to -0.032; HRS: β = -0.254, 95% CI: -0.372 to -0.136) and with increased odds of menopause before age 40, 45, and 48 years. The absolute difference was approximately 0.9 months per additional ACE in UKB and approximately 3 months per additional ACE in HRS. In exploratory analyses, different ACE components were associated with earlier menopause across cohorts: direct maltreatment (physical abuse, emotional abuse, and sexual abuse) in UKB and parental death in HRS. The association was generally similar in direction across subgroups. In UKB, it appeared stronger among women in more socioeconomically deprived areas, but this interaction was not replicated in HRS. ACE was associated with earlier menopause in both large-scale cohorts, with a similar direction of association. In UKB, the association appeared stronger among women in more socioeconomically deprived areas, although this interaction was not replicated in HRS. The absolute difference in age at menopause was small, and its clinical significance should be interpreted with caution. These findings warrant further investigation into the association between childhood adversity and earlier menopause.