title: Effects of alcohol consumption on plasma and urinary hormone concentrations in premenopausal women. Acute effect of alcohol on estradiol, estrone, progesterone, prolactin, cortisol, and luteinizing hormone in premenopausal women. Reproducibility and validity of self-reported menopausal status in a prospective cohort study. Alcohol effects on naloxone-stimulated luteinizing hormone, prolactin and estradiol in women. Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study Pharmacodynamic effects of intravenous alcohol on hepatic and gonadal hormones: influence of age and sex. Reproductive and dietary determinants of the age at menopause in EPIC-Heidelberg. Factors associated with age of onset and type of menopause in a cohort of UK women. Associations of physical activity and diet with the onset of menopause in Japanese women A prospective analysis of alcohol consumption and onset of perimenopause. Alcohol consumption and age of maternal menopause are associated with menopause onset. Factors associated with onset of menopause in women aged 45-49. Dietary and lifestyle predictors of age at natural menopause and reproductive span in the Shanghai Women's Health Study Prospective study of factors influencing the onset of natural menopause. Red wine, white wine, liquor, beer, and risk for coronary artery disease hospitalization. The epidemiology of alcohol use in Australian women: findings from a national survey of women's drinking. Correlates of menstrual cycle characteristics among nulliparous Danish women
abstract: BACKGROUND Most epidemiologic studies of the relationship between alcohol consumption and breast cancer risk  over the past decade have shown that persons who consume a moderate amount of alcohol are at 40%-100 % greater risk of breast cancer than those who do not consume alcohol . Dose-response effects have been observed , but no causal relationship has been established . PURPOSE This study examines the hypothesis that alcohol consumption affects levels of reproductive hormones . METHODS A controlled-diet study lasting for six consecutive menstrual cycles was conducted . Participants were r and omly assigned to two groups , and a crossover design was used . During the last three menstrual cycles , alcohol consumption of the two groups was reversed . Thirty-four premenopausal women , aged 21 - 40 years , with a history of regular menstrual cycles , consumed 30 g of ethanol ( equivalent to approximately two average drinks ) per day for three menstrual cycles and no alcohol for the other three . All food and alcohol consumed were provided by the study . Caloric intake was monitored to ensure that each woman would maintain body weight at approximately the baseline level . Hormone assays were performed on pooled plasma or 24-hour urine specimens collected during the follicular ( days 5 - 7 ) , peri-ovulatory ( days 12 - 15 ) , and mid-luteal ( days 21 - 23 ) phases of the third menstrual cycle for subjects on each diet . RESULTS Alcohol consumption was associated with statistically significant increases in levels of several hormones . Plasma dehydroepi and rosterone sulfate levels were 7.0 % higher in the follicular phase ( P = .05 ) . In the peri-ovulatory phase , there were increases of 21.2 % ( P = .01 ) in plasma estrone levels , 27.5 % ( P = .01 ) in plasma estradiol levels , and 31.9 % ( P = .009 ) in urinary estradiol levels . In the luteal phase , urinary estrone levels rose 15.2 % ( P = .05 ) , estradiol levels increased 21.6 % ( P = .02 ) , and estriol levels rose 29.1 % ( P = .03 ) . No changes were found in the percent of bioavailable estradiol , defined by the sum of percent free estradiol and percent albumin-bound estradiol . However , increased total estradiol levels in the peri-ovulatory phase suggest elevated absolute amounts of bioavailable estradiol . CONCLUSION This study has shown increases in total estrogen levels and amount of bioavailable estrogens in association with alcohol consumption in premenopausal women . IMPLICATION This possible explanatory mechanism for a positive association between alcohol consumption and breast cancer risk merits further investigation BACKGROUND Heavy alcohol consumption is associated with menstrual irregularities , including anovulation , luteal-phase dysfunction , recurrent amenorrhea , and early menopause . In addition , moderate to heavy alcohol intake has been found to increase the risk of spontaneous abortions and breast cancer . These adverse effects could at least in part originate from alcohol-mediated changes in hormone levels . METHODS The acute effect of alcohol on the hormone balance in women using oral contraceptives ( OC+ ) and also in nonusers ( OC- )  , was evaluated in 30 OC- and 31 OC+ subjects , representing the whole period of the menstrual cycle . It was also evaluated in 40 OC- and 47 OC+ subjects during the midcycle phase and in 10 OC+ subjects with unknown cycle phase . RESULTS We found that among subjects who used oral contraceptives  , estradiol levels increased and progesterone levels decreased after intake of alcohol ( 0.5 g/kg ) . No dose effect ( 0.34 - 1.02 g/kg ) on progesterone was observed in a sub study on 10 OC+ subjects . With regard to estrone levels , no effect was observed , although a significant increase was found in the estradiol-to-estrone ratio . Among subjects not using oral contraceptives , progesterone levels decreased after intake of alcohol ( 0.5 g/kg ) . No effect was found in estradiol , estrone , or the estradiol-to-estrone ratio during midcycle in this study group . A transient elevating effect of alcohol ( 0.5 g/kg ) on prolactin levels was observed in both study groups . We found that alcohol ( 0.5 g/kg ) had no significant effect on luteinizing hormone ( LH ) levels among subjects not using oral contraceptives , and observed a decline among subjects using oral contraceptives at midcycle . CONCLUSIONS We suggest that the estradiol and progesterone effects are related to decreased steroid catabolism , result ing from the alcohol-mediated increase in the hepatic NADH-to-NAD ratio . The transient effect on prolactin levels may reflect acute changes in opioid and dopamine levels in the hypothalamus . The present findings regarding female sex steroids may be of relevance in the association between moderate to heavy alcohol consumption and the development of breast cancer The reproducibility and validity of self-reported menopausal status were evaluated among the 121,700 female US registered nurses aged 30 - 55 years in 1976 who are participants in the Nurses ' Health Study , a prospect i ve cohort study of diseases in women . When question ed in 1978 , 6,591 of the women who were premenopausal in 1976 reported that their menses had ceased and provided their age at menopause . Two years later , in 1980 , 98.8 per cent of the 6,591 women again reported that they were postmenopausal and again gave the reasons for menopause ( natural or surgical ) . Among those women who reported surgical menopause during the 1976 - 1978 follow-up interval , age at menopause was reported to within one year on both the 1978 and 1980 question naires by 95 per cent of women . Among those reporting natural menopause during the 1976 - 1978 period , 82 per cent of women reported their age at menopause to within one year on the two follow-up question naires . A r and om sample of 255 women reporting surgical menopause between 1982 and 1984 was identified and medical records were obtained for 200 . For all but two women , there was complete agreement between self-report and medical record for details of hysterectomy and extent of ovarian surgery . The reproducibility of self-reported age at menopause was assessed among 31,405 women who were menopausal in 1976 . Reported age at menopause on consecutive question naires showed increasing within-person variance with increasing duration since menopause . ( ABSTRACT TRUNCATED AT 250 WORDS Plasma luteinizing hormone ( LH ) , estradiol , prolactin and progesterone levels were measured in nine normal adult women prior to and following administration of naloxone and oral ingestion of ethanol or placebo-control solution .  Each subject served as her own control in a double-blind study carried out during the midluteal phase of the menstrual cycle . The mean ( + /- SD ) progesterone level was 13.9 + /- 1.3 during control conditions and 13.9 + /- 1.7 during alcohol conditions . The mean peak blood alcohol level was 100 + /- 13 mg/dl within 45 - 60 min after initiation of drinking . Under placebo-control conditions , naloxone stimulated a significant increase in plasma LH and prolactin but did not increase estradiol or progesterone . Alcohol did not attenuate the significant naloxone stimulation of LH , and progesterone levels were equivalent under alcohol and control conditions . Alcohol significantly enhanced naloxone stimulation of prolactin and estradiol . Alcohol administration significantly augmented the naloxone-induced increase in plasma prolactin levels . After alcohol administration , naloxone also induced a significant increase in plasma estradiol levels , which was sustained throughout the 180-min sampling period . The mechanisms underlying alcohol 's enhancement of naloxone-stimulated prolactin and estradiol remain to be determined . The alcohol-related increase in naloxone-stimulated prolactin secretion may reflect increased hypothalamic and /or pituitary sensitivity to alcohol following endogenous opioid blockade by naloxone or an effect of increased estrogen levels . The significant increase in plasma estradiol levels following concurrent naloxone and alcohol administration may occur as a consequence of alterations in steroid biotransformation associated with intrahepatic ethanol catabolism Objective To compute the burden of cancer attributable to current and former alcohol consumption in eight European countries based on direct relative risk estimates from a cohort study . Design Combination of prospect i ve cohort study with representative population based data on alcohol exposure . Setting Eight countries ( France , Italy , Spain , United Kingdom , the Netherl and s , Greece , Germany , Denmark ) participating in the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) study . Participants 109 118 men and 254 870 women , mainly aged 37 - 70 . Main outcome measures Hazard rate ratios expressing the relative risk of cancer incidence for former and current alcohol consumption among EPIC participants . Hazard rate ratios combined with representative information on alcohol consumption to calculate alcohol attributable fractions of causally related cancers by country and sex . Partial alcohol attributable fractions for consumption higher than the recommended upper limit ( two drinks a day for men with about 24 g alcohol , one for women with about 12 g alcohol ) and the estimated total annual number of cases of alcohol attributable cancer . Results If we assume causality , among men and women , 10 % ( 95 % confidence interval 7 to 13 % ) and 3 % ( 1 to 5 % ) of the incidence of total cancer was attributable to former and current alcohol consumption in the selected European countries . For selected cancers the figures were 44 % ( 31 to 56 % ) and 25 % ( 5 to 46 % ) for upper aerodigestive tract , 33 % ( 11 to 54 % ) and 18 % ( −3 to 38 % ) for liver , 17 % ( 10 to 25 % ) and 4 % ( −1 to 10 % ) for colorectal cancer for men and women , respectively , and 5.0 % ( 2 to 8 % ) for female breast cancer . A substantial part of the alcohol attributable fraction in 2008 was associated with alcohol consumption higher than the recommended upper limit : 33 037 of 178 578 alcohol related cancer cases in men and 17 470 of 397 043 alcohol related cases in women . Conclusions In western Europe , an important proportion of cases of cancer can be attributable to alcohol consumption , especially consumption higher than the recommended upper limits . These data support current political efforts to reduce or to abstain from alcohol consumption to reduce the incidence of cancer BACKGROUND Growth hormone (GH)-insulin-like growth factor-1 ( IGF-1 ) axis and gonadal hormones demonstrate extensively associated regulation ; however , little is known about the effects of acute alcohol exposure on these hormones . This study examined the effects of intravenous alcohol on the GH-IGF-1 axis and gonadal hormone concentrations , and the influence of age and sex on their regulation . METHODS Forty-eight healthy volunteers ( 24 men and 24 women each in the 21 to 25 and 55 to 65 year age groups ) underwent a 2-session single-blinded study . Subjects received in r and omized counter-balanced order , alcohol infusions , individually computed based on a physiologically based pharmacokinetic model , to maintain a steady-state ( " clamped " ) exposure of 50 mg% or saline for 3 hours in separate sessions . Blood sample s collected at baseline and postinfusion in each session were assayed for levels of GH , IGF-1 , free testosterone , and estradiol . RESULTS Acute alcohol administration result ed in changes in gonadal hormones that differed by sex . Change in free testosterone showed a significant treatment × baseline interaction ( p < 0.001 ) , indicating that alcohol-induced suppression of testosterone occurred predominantly in men . On the other h and , change in estradiol showed a significant treatment × sex interaction ( p = 0.028 ) , indicating that alcohol-induced increases in estradiol occurred predominantly in women . There was a trend for alcohol-induced decreases in IGF-1 levels . Change in GH showed a significant main effect of baseline ( p < 0.001 ) and a trend for treatment by baseline interaction , suggesting an alcohol-induced decrease in individuals with high baseline GH values . There was also a significant main effect of sex ( p = 0.046 ) indicating that men had greater changes in GH across treatment compared with women . CONCLUSIONS Alcohol induced a complex pattern of hormonal responses that varied between younger and older men and women . Some of the observed sex-based differences may help improve our underst and ing of the greater susceptibility to alcohol-related hepatic damage seen in women OBJECTIVES The aim of the study was to explore the influence of reproductive and dietary factors on the age at menopause . METHODS During follow-up of the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) cohort in Heidelberg ( median duration 5.8 years ) , 1009 women experienced natural menopause . They were compared to 3798 women who did not experience menopause .  Baseline dietary intake  was obtained by means of vali date d food frequency question naires . Data on reproductive history and medication was collected by means of question naires . Cox ' proportional hazard models were applied in order to identify determinants of the age at natural menopause . RESULTS Increasing age at first full term pregnancy and a longer time interval until occurrences of regular menses are associated with later onset of natural menopause . Compared to never smokers , current smokers have the risk of younger age at menopause . High carbohydrate consumption and high intake of vegetable , fibre and cereal products are inversely related to the age at natural menopause . Women with higher intake of total fat , protein and meat experienced a delayed onset of natural menopause . CONCLUSION Age at natural menopause is influenced by lifestyle and dietary factors . Further studies including biological markers are needed to clarify these associations OBJECTIVE We sought to describe the pattern of  age at menopause  and factors associated with type of menopause . STUDY DESIGN This was a prospect i ve cohort study of 5113 postmenopausal health survey respondents in the Royal College of General Practitioners ' Oral Contraception Study .  Logistic regression was used to evaluate associations between sociodemographics , lifestyle , and medical history and menopause type . RESULTS Median age at natural menopause ( n = 3650 ) was 49.0 years ( interquartile range , 45.0 - 51.0 ) , and at surgical menopause ( n = 1463 ) was 42.4 years ( 38.0 - 46.4 ) . Early natural menopause was associated with smoking , ever-use of oral contraception , sterilization , and history of endometriosis ( all increased odds ratios ) and ever-use of hormone replacement therapy ( decreased ) . Surgical menopause was associated with manual social class , sterilization , and having a history of endometriosis , menorrhagia , or painful menstruation ( all increased ) , and ever-use of hormone replacement therapy ( decreased ) . CONCLUSION Age at natural menopause was younger in this cohort than in other studies . More associations were found for surgical menopause than early natural menopause Objective Prospect i ve studies on physical activity and diet and the onset of natural menopause are scarce . The aim of this study was to examine the association of physical activity and dietary factors potentially related to endogenous estrogen levels such as fats , dietary fiber , soy isoflavones , and alcohol with the onset of  menopause in a cohort of premenopausal women . Methods Study participants were 3,115 premenopausal Japanese women aged 35 to 56 years derived from the participants in the Takayama Study .  Physical activity  was assessed by a vali date d question naire at baseline , and the metabolic equivalent score was calculated . The  dietary intakes  were estimated by a vali date d food frequency question naire at baseline and adjusted for total energy .  Menopause status was defined as the absence of menstruation for 12 months or more . The Cox proportional hazard model was used to estimate the hazard ratio of the occurrence of menopause after controlling for age , parity , body mass index , smoking status , years of education , and lifelong irregular menstrual cycle . Results During the 10-year follow-up , 1,790 women experienced natural menopause . A high physical activity level and a high intake of polyunsaturated fat were moderately but significantly associated with the earlier onset of menopause ; the hazard ratios for the highest versus lowest quartile were 1.17 ( 95 % CI , 1.02 - 1.34 ) for physical activity and 1.15 ( 95 % CI , 1.01 - 1.31 ) for polyunsaturated fat intake . Total fat , other types of fat , dietary fiber , soy isoflavones , and alcohol were not associated with the onset of menopause . Conclusions These data suggest that high levels of physical activity and polyunsaturated fat intake are associated with earlier onset of menopause OBJECTIVES We prospect ively assessed the association between alcohol consumption and onset of perimenopause in women of late reproductive age using data from the Harvard Study of Moods and Cycles . Specific types of alcoholic beverages - red wine , white wine , beer , and liquor - were evaluated . METHODS Among 502 women aged 36 - 45 years residing in seven Boston communities , we assessed self-reported perimenopausal symptoms over a 5-year period . The onset of perimenopause was defined using changes in menstrual characteristics . We administered a semiquantitative food frequency question naire at enrollment to measure regular alcohol consumption during the past year . Hazard ratios ( HRs ) and 95 % confidence intervals were derived from Cox regression models . RESULTS No association was found between total alcohol consumption and time to perimenopause . Compared with women consuming < 1 alcoholic drink per month , HRs for those drinking red wine in quantities of 1 - 3 glasses per month , 1 glass per week , or > or=2 glasses per week were all below 1.0 , after accounting for other sources of alcohol . Among never smokers , the inverse association with red wine was stronger and a positive association was observed with liquor consumption although numbers were small . No associations were observed with white wine or beer . CONCLUSION While there was no association between total alcohol consumption and onset of perimenopause , there was some suggestion of an inverse association between red wine and risk of perimenopause , particularly among never smokers OBJECTIVES To examine whether a number of nutritional and familial factors were associated with menopausal development . METHODS A prospect i ve postal survey amongst a r and om sample of 1227 women aged 47 to 51 who were premenopausal in a cross-sectional survey 2 years previously . Women were classed into three groups ; premenopause ( regular menstruation ) ; irregular menstruation ; postmenopausal ( absence of menstrual cycle for at least 6 months )  . Proportional odds regression was used to identify those factors which were independently predictive of subsequent menopausal development . RESULTS There was an 80 % ( n = 983 ) survey response rate . After exclusion of current HRT users ( n = 178 ) ; 150 ( 19 % ) women were postmenopausal , 277 ( 34 % ) had erratic menstruation and 378 ( 47 % ) were premenopause . There were significant univariate associations between menopausal status and age ( P < 0.001 ) , age of maternal menopause ( P = 0.006 ) , alcohol consumption ( P = 0.005 ) and social class ( P = 0.03 ) . Maternal age and alcohol consumption were significantly correlated with estradiol levels ( r = 0.45 , P = 0.02 , and r = 0.61 , P = 0.02 for maternal age and alcohol consumption , respectively ) . In proportional odds regression analyses , age , maternal menopausal age , alcohol consumption and smoking were independently associated with menopausal status . CONCLUSIONS These results suggest that , ( 1 ) there is a strong familial association in menopausal age , and ( 2 ) moderate consumption of alcohol is associated with delayed menopausal development This paper uses a cross-sectional sample of women aged 45 - 49 to investigate factors that might be associated with an early menopause . Using logistic regression analysis we found that age , smoking , age of maternal menopause , parity , social class , meat and alcohol consumption were all independently associated with an early natural menopause .  Meat , alcohol consumption and maternal menopausal age do not seem to have been previously noted as associated with the timing of the menopause . These associations would merit further study , preferably using prospect i ve data . However , this study in line with much previous work shows that smoking is associated with a reduction in menopausal age Objective : Modifiable factors predicting the onset of menopause , a transition with important implication s for women 's health , have not been fully characterized . We evaluated the impact of dietary , lifestyle and reproductive factors on age at natural menopause and reproductive span in Chinese women . Design : Study participants were Chinese women aged 40 to 70 who experienced natural menopause and participated in a population -based , prospect i ve study , the Shanghai Women 's Health Study ( N = 33,054 ) .  Dietary intake  at the baseline survey was assessed by food-frequency question naire . Regression ( & bgr ; ) coefficients , calculated by multivariable linear regression , were used to estimate the effects of dietary , lifestyle , and reproductive patterns on age at menopause and the number of reproductive years , adjusting for potential confounding factors . Results : Early menarche , younger age at first live birth , older age at last live birth , longer duration of breast-feeding , and higher parity were associated with longer reproductive years ( Ptrend < 0.01 for all ) . Higher body mass index at age 20 , mid-life weight gain , and leisure-time physical activity during adolescence and adulthood predicted later menopause and longer reproductive span ( Ptrend < 0.01 for all ) . Total intake of calories , fruits , and protein  was positively associated with later menopause ( Ptrend < 0.05 for all ) and longer reproductive span ( Ptrend < 0.05 ) , except for carbohydrates ( Ptrend = 0.06 ) , and long-term tea consumption predicted longer reproductive span ( Ptrend = 0.03 ) . Vegetable , fat , soy , and fiber intakes did not significantly affect reproductive span or age at menopause . Smoking was inversely associated with both early age at menopause and shorter reproductive span ( Ptrend < 0.01 ) . Conclusions : In addition to reproductive factors , intake of fruits and protein , smoking , tea consumption , lifetime patterns of physical activity , and weight gain influenced the onset of menopause and /or reproductive span in Chinese women Late or early menopause has been implicated in risk of several chronic diseases in women . To study factors influencing the onset of natural menopause , the authors analyzed the follow-up data of 4694 premenopausal women who enrolled in the New York University Women Study at ages 34 - 61 . In an average of 5.4 years of observation , there were 2035 incidences of menopause , with the median age of 51.3 years . Current smokers experienced menopause 0.75 years earlier than never-smokers . Those who smoked more than 10 cigarettes per day had a 40 % increase in risk of earlier menopause . In contrast , women who had three or more children experienced menopause 0.86 years later than nulliparous women , and Jewish women , 0.66 years later than Catholic women . There was also a modest increase in the age at menopause with increasing body mass index . This prospect i ve study provides solid epidemiologic evidence that several factors other than cigarette smoking have impact on the onset of natural menopause International comparison data suggest that wine may be more protective against coronary artery disease than beer or liquor . There are potentially protective antioxidants in wine , especially red wine . However , prospect i ve population studies suggest that each beverage type may reduce coronary risk . The role of alcoholic beverage choice in coronary risk remains unresolved . We performed a prospect i ve study of coronary disease hospitalizations among 128,934 adult members of a Northern California prepaid comprehensive health care program . Alcohol data were supplied at health examinations . Using Cox proportional-hazards models with 9 covariates , analyses were performed of the roles of each major beverage type ( wine , beer , and liquor ) and of drinking only table wine ( red , white , or both ) . Generally , coronary risk traits were most favorable for wine drinkers and least favorable for liquor drinkers . Among 3,931 persons hospitalized for coronary disease , total alcohol drinking was inversely related to risk in both sexes . Uncontrolled for total alcohol , each beverage type showed evidence for coronary protection , weakest for liquor and strongest for beer in men and wine in women . Controlled for total alcohol , these relations were much reduced , and lost statistical significance except for beer in men and both red and white wine ( combined ) in all persons . We conclude that ( 1 ) drinking ethyl alcohol apparently protects against coronary disease , and ( 2 ) there may be minor additional benefits associated with drinking both beer and wine , but not especially red wine This is the first study of alcohol use , alcohol problems and alcohol dependence in a general population sample of Australian women using a st and ardized screening instrument developed by the World Health Organization , the Alcohol Use Disorders Identification Test ( AUDIT ) . Sixty-six percent of a sample of 6000 women r and omly selected from the electoral rolls responded to the question naire . The majority of women ( 87 % ) had drunk alcohol at some time in their lives , while 82 % had consumed alcohol within the past 12 months . Of the women who currently drank alcohol , 34 % were classified as hazardous drinkers , 4 % as harmful drinkers and 1 % as dependent according to AUDIT definitions . Using a cut-off score of 8 for the AUDIT , 8 % of women were classified as currently having a drinking pattern of hazardous or harmful alcohol consumption . These women were more likely to be younger ( 17 - 44 years ) , single , or living in a de facto relationship . The results of this survey provide important data which can be used as a bench-mark to measure changes in women 's drinking behaviour and drinking related problems Objective We examined the association between lifestyle factors and menstrual cycle characteristics among nulliparous Danish women aged 18–40 years who were participating in an Internet-based prospect i ve cohort study of pregnancy planners . Methods We used cross-sectional data collected at baseline to assess the association of age , body mass index ( BMI ) , physical activity , alcohol and caffeine consumption , and smoking with the prevalence of irregular cycles , short ( ≤25 days ) and long ( ≥33 days ) cycles , and duration and amount of menstrual flow . We used log-binomial and multinomial logistic regression to estimate prevalence ratios and 95 % confidence intervals . Results Low physical activity and heavy alcohol consumption were associated with an increased prevalence of irregular periods . High BMI , smoking , and caffeine and alcohol consumption were related to an increased prevalence of short menstrual cycles and heavy menstrual bleeding . Women in their mid-to-late thirties had shorter and lighter menstrual flow , but a lower prevalence of irregular cycles , compared with women 18–25 years of age . Discussion In this study , increased age , high BMI , and sedentary behavior were associated with menstrual-pattern irregularities . These factors may influence the balance and level of endogenous hormones conducive to optimal menstrual function
target: WIDER IMPLICATION S The findings of this review indicate that alcohol consumption , particularly low and moderate alcohol intake , might be associated with later onset of menopause although the magnitude of the association is low .
background: BACKGROUND Early onset of menopause is associated with long-term health risks , including cardiovascular disease and premature death .
  Although alcohol intake has been suggested to affect the age at which natural menopause occurs , results from observational studies are not consistent .
  OBJECTIVE AND RATIONALE In the view of the differing risks to the health of early menopause and the increasing trends in alcohol consumption in women , in this systematic review , we aim ed to quantify the association between all levels of alcohol consumption and menopause onset .