28 June, 2019
Who are the women that live longer?
A new study from the Netherlands attempted to find markers that may predict higher longevity in women . A subgroup of the Netherlands Cohort Study (NLCS) consisted of those who were born in 1916-1917 and were followed until death or until reaching age 90 (in the years 2006-2007). Out of 2697 eligible women with complete data, 928 lived to be 90 and 1769 died at earlier ages. Lifestyle, dietary habits, reproductive and medical history, and cancer risk factors were collected when women were around age 70, using a self-administered 11-page questionnaire. Mortality was recorded based on a linkage with central national registries. The results were rather disappointing, as very few parameters were found to significantly correlate with longevity: age at first childbirth, and ever-use of HRT in women with an early menopause (< 50 years) were associated with the likelihood of reaching the age of 90 years. Many other variables, generally thought to be relevant to longevity, failed to show a linkage (i.e., age at menarche or at menopause, menstruation lifespan, history of childbirth).
Despite the universal wish to better understand the reasons why women live longer than men, and what might in general be the reasons for extreme longevity, this Dutch study did not provide definite answers. Interestingly for menopause specialists, ever-use of HRT in women entering menopause before age 50 did influence longevity.
Personally, I was not surprised to see the above results, since the issue of longevity is certainly very complex, involving genetic and medical, dietary, socio-economical, environmental and other factors. Just one example that might affect the outcomes of this particular cohort: the participating women were born during World War 1 and lived several years within their occupied country during World War 2. I would imagine that this might have had an impact on future health and disease, on physical and emotional parameters and on reproductive factors. Also, and not taking a view as an expert epidemiologist or a statistician, the fact that the cohort was rather small, and the variables tested were so many, makes it a-priori very difficult to reach significance for any potential association.
The study data on the use of HRT could be used as an additional argument in favor of prescription of hormones in the case of premature or early menopause. Premature ovarian insufficiency (POI) confers an increased risk for ischemic heart disease and stroke, osteoporotic fractures, cognitive decline to dementia and Parkinsonism  and therefore may potentially accelerate aging  and reduce longevity. In women with POI, menopausal hormone therapy therefore is highly recommended by all major menopause societies [2, 3, 4] and is FDA-approved for this condition independently from the presence of symptoms . MHT should be initiated early and continued until the woman reaches the average age at menopause of the relevant region or ethnic group . The latest JAMA opinion article on MHT, written by Shifren et al  also states: “Women experiencing early surgical or natural menopause (before 45 years) should be encouraged to use hormone therapy until the typical age of natural menopause”.
Concluding, although this is a nice and unique study, mother nature is probably much more sophisticated and much beyond our current knowledge and understanding of human biology and physiology.
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Brandts L, van Poppel FWA, van den Brandt PA. Female reproductive factors and the likelihood of reaching the age of 90 years. The Netherlands Cohort Study. Maturitas 2019; 125:70-80.
- Baber RJ, Panay N, Fenton A; IMS Writing Group. 2016 IMS Recommendations on women's midlife health and menopause hormone therapy. Climacteric. 2016 Apr;19(2):109-50.
- The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause. 2017 Jul;24(7):728-753
- Mishra GD, Chung HF, Cano A, Chedraui P, Goulis DG, Lopes P, Mueck A, Rees M, Senturk LM, Simoncini T, Stevenson JC, Stute P, Tuomikoski P, Lambrinoudaki I. EMAS position statement: Predictors of premature and early natural menopause. Maturitas. 2019 May;123:82-88.
- Shifren JL, Crandall CJ, Manson JE. Menopausal Hormone Therapy. JAMA 2019 May 30.