OBJECTIVES To systematically review the evidence on the association between age at natural menopause (NM) and reproductive factors such as age at menarche, parity and ever use of oral contraceptives. STUDY DESIGN A literature search was carried out in PubMed, Scielo, Scopus and LILACS databases, without restriction of publication year until July 6, 2017. We excluded clinical trials, case-control studies, case reports and studies using statistical methods other than Cox proportional hazard models to assess the factors associated with age at NM. Cross-sectional studies evaluating women aged <50 years were also excluded. Random-effects models were used to pool the estimates. We registered the systematic review in the International Prospective Register of Systematic Review (PROSPERO) in August 2018, CRD42018099105. RESULTS We identified 30 articles to include in the meta-analysis. We found that previous ever use of oral contraceptives (OC) (HR = 0.87, CI = 0.82, 0.93), age at menarche ≥13 years (HR = 0.90, CI = 0.84, 0.96), and having at least one live birth (HR = 0.79, CI = 0.74, 0.85) were associated with a later age of NM. CONCLUSIONS Despite differences in results between countries and study design, our findings suggest that previous use of OC, age at menarche ≥13 and having at least one live birth are associated with later menopause. The results suggest that these factors could be markers of later ovarian aging.

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自然绝经时的生殖因素和年龄：系统评价和荟萃分析

目的 系统地审查自然绝经 (NM) 年龄与生殖因素（如初潮年龄、产次和口服避孕药的使用情况）之间关联的证据。研究设计 在 PubMed、Scielo、Scopus 和 LILACS 数据库中进行了文献检索，不限制出版年份，直到 2017 年 7 月 6 日。我们排除了临床试验、病例对照研究、病例报告和使用非 Cox 比例统计方法的研究。风险模型来评估与 NM 年龄相关的因素。评估<50 岁女性的横断面研究也被排除在外。随机效应模型用于合并估计值。我们于 2018 年 8 月在国际前瞻性系统评价注册 (PROSPERO) 中注册了系统评价，CRD42018099105。结果 我们确定了 30 篇文章纳入荟萃分析。我们发现以前使用过口服避孕药 (OC) (HR = 0.87, CI = 0.82, 0.93)，初潮年龄 ≥ 13 岁 (HR = 0.90, CI = 0.84, 0.96)，并且至少有一次活产 ( HR = 0.79, CI = 0.74, 0.85) 与 NM 较晚的年龄相关。结论 尽管国家和研究设计之间的结果存在差异，但我们的研究结果表明，既往使用 OC、初潮年龄≥13 岁以及至少有一次活产与更年期晚有关。结果表明，这些因素可能是晚期卵巢衰老的标志。85) 与较晚的 NM 年龄相关。结论 尽管国家和研究设计之间的结果存在差异，但我们的研究结果表明，既往使用 OC、初潮年龄≥13 岁以及至少有一次活产与更年期晚有关。结果表明，这些因素可能是晚期卵巢衰老的标志。85) 与较晚的 NM 年龄相关。结论 尽管国家和研究设计之间的结果存在差异，但我们的研究结果表明，既往使用 OC、初潮年龄≥13 岁以及至少有一次活产与更年期晚有关。结果表明，这些因素可能是晚期卵巢衰老的标志。