Methods: A comprehensive literature search, covering publications from 1984 to 2017, was done using several databases such as MEDLINE, PubMed, and Google scholar. Evidence from 13 research articles was analyzed for a rural-urban difference in natural menopausal age. The search was later expanded to explore correctable confounding factors such as smoking habits, physical activities, and BMI.

Results: Rural women in the Asian region appeared to reach their natural menopausal age earlier than their urban counterparts. This was in contrast with the majority of findings in the non-Asian regions, suggesting a regional variation in the rural-urban difference in natural menopausal age. Based on the findings, earlier menopausal age was related to smoking prevalence and this relationship was consistent in both Asian and non-Asian regions. Similarly, higher physical activity was linked to the early age of natural menopause in both Asian and non-Asian regions. Finally, the results revealed the association between higher BMI and higher menopausal age in the Asian region although this association was not observed in the non-Asian regions.

Conclusions: The rural-urban difference in menopausal age has regional variations with rural Asian women reaching menopause earlier than their urban counterparts, but this association was not replicated in the non-Asian regions. Eventually, this difference was affected by factors such as tobacco smoking, high physical activity, and BMI.