Development and External Validation of a Home-based Risk Prediction Model of Natural Onset of Menopause-Teuta

Abstract

Objective: To develop and externally validate a 10-year risk prediction model of natural onset of menopause using ready-to-use predictors.

Design: Population-based prospective cohort study.

Participants: Community-dwelling, premenopausal women aged 28 years and older enrolled in the Swiss (CoLaus) and Dutch (PREVEND) study.

Main outcome measure: Incidence of self-reported natural menopause.

Model development: Based on existing literature, 11 predictors were tested in this study. The CoLaus cohort was used to develop the model by applying the backward-elimination approach and Bayesian Model Averaging. Internal validation was performed by bootstrapping. External validation was performed using data from the PREVEND cohort and recalibrating the baseline survival estimate. C-statistics, calibration slopes, and expected/observed probabilities were calculated as measures of model internal and/or external performances.

Results: The final analysis included 750 and 1032 premenopausal women from the CoLaus and the PREVEND cohorts, respectively. Among them, 445 (59%) from CoLaus and 387 (38%) from PREVEND experienced menopause over a median follow-up of 10.7 and 9 years, respectively. The final model included age, alcohol consumption, smoking status, education level, and systolic blood pressure. Upon external calibration in the PREVEND cohort, the model exhibited good discrimination, with a C-statistic of 0.888 and an expected/observed probability of 0.82.

Conclusion: We present the first internally and externally validated prediction model of natural menopause onset using readily available predictors. Validation of our model to other populations is needed.

Keywords: family planning; menopause; prediction; validation.