Increased incidence of abdominal aortic aneurysm in women with early menopause

Objective: In several countries, including the United States and United Kingdom, screening tests are conducted on men 65 years of age or older who smoke to diagnose abdominal aortic aneurysm (AAA) before rupture. In women, however, the incidence of AAA is low, so screening tests are not cost effective and therefore not recommended. Early detection and treatment of AAA are important for women as they face a four times higher risk of rupture and worse surgery outcomes compared with men. Accordingly, we analyzed how differences in the period of exposure to female hormones affect women's AAA risk to find unique risk factors. Methods: We collected data from the National Health Insurance System database for women aged 40 or older who underwent medical checkups and female cancer tests from January to December 2009 (n = 3,109,509). Those who were menopausal (n = 1,393,271) were included in the study. Participants were tracked until December 2019 to confirm whether AAA was diagnosed. Results: There were 3629 cases diagnosed with AAA. A comparison of the AAA and non-AAA cohorts showed a decreasing trend with advancing age at menopause. Compared with women who reached menopause before the age of 40, those who reached menopause after 55 had a 23% lower risk of AAA. Those who experienced more than 40 years of menstruation had a 20% lower risk of AAA compared with fewer than 30 years of menstruation. Conclusions: Women with early menopause face a higher incidence of AAA, so attention should be paid to early diagnosis.