From Exposome to Health Outcomes: A Population-Based Approach to Understanding and Mitigating Early Menopause in Singapore's Diverse Communities

Detailed Description

Background and Rationale: Early menopause, defined as cessation of ovarian function before age 45, affects approximately 5-12% of women globally and is associated with increased risks of cardiovascular disease, osteoporosis, and cognitive decline. Growing evidence suggests that environmental exposures, including persistent organic pollutants, air pollution, and endocrine-disrupting chemicals, may accelerate ovarian aging and contribute to earlier menopausal timing. The exposome concept involves the totality of environmental exposures experienced by individuals throughout their lifetimes, including chemical, physical, biological, and social factors.

Study Hypothesis We hypothesize that combined exposure to environmental pollutants, lifestyle factors, and social conditions accelerates biological aging processes and leads to earlier menopause onset in women. These exposome effects are mediated through changes in gene expression patterns, metabolic profiles, and gut microbiome composition, ultimately increasing the risk of adverse health outcomes.

Study Design: This is a prospective observational cohort study employing a longitudinal design with 18-month follow-up. The study integrates comprehensive exposome assessment with multi-omics profiling to investigate the complex relationships between environmental factors and menopausal health outcomes in a multi-ethnic Asian population.

Population and Setting: Four hundred women aged 40-50 years will be recruited from diverse communities across Singapore. Participants must have experienced no menstruation for the last 2 months or irregular menstrual cycles in the last 6 months, be proficient in English, and plan to reside in Singapore for the study duration. The study will include Chinese, Malay, and Indian ethnicities reflecting Singapore's demographic composition.