Menopausal Timing and Its Determinants Among Iranian Women: Findings From the 2021 National Steps Survey Publisher



Djalalinia S ; Azizpour Y ; Rezaei N ; Almasi G ; Azadnajafabad S ; Golestani A ; Ahmadi N ; Farzi Y ; Kazemi A ; Dilmaghani Marand A ; Yoosefi M ; Rashidi M M ; Ghasemi E ; Abdolhamidi E Show All Authors
Source: Journal of Diabetes and Metabolic Disorders Published:2026

Abstract

Background: Menopausal timing is an important marker of women’s long-term health, yet nationally representative evidence on menopause categories and their correlates remains limited in Iran. This study aimed to estimate the prevalence and timing of menopause and to examine sociodemographic, nutritional, cardiometabolic, and geographic factors associated with different menopause categories among Iranian women. Methods: We analyzed data from the 2021 Iran WHO STEPwise approach to non-communicable disease risk factor surveillance (STEPS), including 14,656 women aged ≥ 18 years. Menopause status and age at menopause were self-reported and categorized as premature ovarian insufficiency (POI; <40 years), early menopause (40–44 years), normal menopause (45–54 years), or late menopause (≥ 55 years). Weighted descriptive analyses and multinomial logistic regression models accounting for the complex survey design were used to assess associations with sociodemographic, lifestyle, nutritional, and cardiometabolic factors. Results: Overall, 32.72% (95% CI: 31.87–33.57) of women were postmenopausal, with the majority experiencing menopause between 45 and 54 years. Among menopausal women, 74.37% had normal menopause, 11.15% late menopause, 9.83% early menopause, and 4.65% POI. In adjusted analyses, early menopause was associated with higher educational attainment and poor nutritional status, while moderate and good dietary patterns were protective. Late menopause was negatively associated with education and positively associated with hypertension. Diabetes and dyslipidemia were more prevalent among postmenopausal women but were not independently associated with menopausal timing. No significant predictors of POI were identified. Substantial provincial variation in menopause prevalence and timing was observed. Conclusion: Menopausal timing among Iranian women reflects heterogeneous socioeconomic, nutritional, and cardiometabolic patterns. Incorporating menopause assessment into routine women’s health care and strengthening nutrition and hypertension prevention strategies may facilitate earlier risk identification and promote healthier aging, particularly in the context of marked regional disparities. © The Author(s), under exclusive licence to Tehran University of Medical Sciences 2026.