Sex differences in human physiology
Female fertility declines after age 30 and ends with the menopause. Female physical experiences vary depending on external forces such as diet, marriage patterns, culture, and other aspects. In Western nations menstruation begins to affect females at 13 and menopause starts around 51. In non-industrialized countries, on the other hand, most females begin menstruation at a later age. More lactation in the lifetime of non-western females inhibits ovulation and extends the number of fertile years. Pregnancy in the 40s or later has been correlated with increased risk of Down syndrome in the children. Males are capable of fathering children into old age. Paternal age effects in the children include multiple sclerosis, autism, breast cancer and schizophrenia, as well as reduced intelligence. Adriana Iliescu was reported as the world's oldest woman to give birth, at age 66. Her record stood until Maria del Carmen Bousada de Lara gave birth to twin sons at Sant Pau Hospital in Barcelona, Spain on December 29, 2006, at the age of 67. In both cases IVF was used. The oldest known father was former Australian miner Les Colley, who fathered a child at age 93.
Women's Health Initiative
The WHI trial was limited by low adherence, high attrition, inadequate power to detect risks for some outcomes, and evaluation of few regimens. Subsequent to publication of the WHI, controversy arose regarding the applicability of its findings to women just entering menopause. To be properly double blinded, the study required that women not be perimenopausal or have symptoms of menopause. As the average age of menopause is 51, this resulted in an older study population, with an average age of 63. Only 3.5% of the women were 50–54 years of age, the time when women usually decide whether to initiate hormonal therapy. Further analysis of WHI data, however, demonstrated that there is no gained preventive benefit in starting hormone therapy soon after menopause.