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Author ORCID Identifier


Campus-Only Access for Five (5) Years

Document Type


Degree Name

Doctor of Philosophy (PhD)

Degree Program

Public Health

Year Degree Awarded


Month Degree Awarded


First Advisor

Elizabeth R. Bertone-Johnson

Second Advisor

Brian W. Whitcomb

Third Advisor

Susan E. Hankinson

Fourth Advisor

Lynnette L. Sievert

Subject Categories



Early natural menopause, defined as the cessation of ovarian function before the age of 45 years, affects approximately 10% of women in Western populations. Women experiencing early menopause are at increased risk of cardiovascular disease and other major health conditions. The reproductive aging process is characterized by the gradual decrease in both the quantity and quality of oocytes and may be accelerated or delayed by certain reproductive factors which potentially affect menopause timing. The majority of prior studies examining the association of reproductive factors with menopause timing have been limited by cross-sectional examination of the reproductive factors; consequently, it remains unclear how much reverse causality affects results. This dissertation examines time-varying reproductive factors including parity, breastfeeding, oral contraceptive use, tubal ligation, in utero exposures and pregnancy conditions and their association with early natural menopause among the 116,429 participants in the Nurses' Health Study II (NHSII) prospective cohort. Self-reported reproductive factors, menopause status and age at menopause were assessed at baseline (1989) and every two years for 28 years. Our findings may identify modifiable risk factors and help elucidate the complex physiology of early natural menopause.