July 24, 2017
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Premature, early menopause increase risk for type 2 diabetes

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Women who experience premature or early menopause are at higher risk for developing type 2 diabetes when compared with women who experience menopause after age 55 years, independent of traditional type 2 diabetes risk factors, according to findings from a Dutch study.

“The age at the final menstrual period is crucial not only for reproductive ageing, but also for future disease risk and mortality,” Taulant Muka, MD, MPH, PhD, head of diabetes theme in the department of epidemiology at Erasmus MC at the University Medical Center in the Netherlands, told Endocrine Today. “Considering that type 2 diabetes is a major risk factor for cardiovascular disease and commonly manifests during the midlife coinciding with the timing of the menopausal transition in women, we conducted this study to examine whether age at natural menopause is associated with risk of type 2 diabetes.”

Taulant Muka
Taulant Muka

Muka and colleagues analyzed data from 3,639 postmenopausal women without diabetes at baseline from the Rotterdam Study, a Dutch, population-based study initiated in 1990 with follow-up approximately every 4 years (mean baseline age, 67 years). Women self-reported age at natural menopause, health status and medication use at baseline; type 2 diabetes status was determined through medical records and glucose measurements at follow-up visits. Age at menopause was stratified by four categories: premature (before aged 40 years); early (aged 40-44 years); normal (aged 45-55 years) and late menopause (aged at least 55 years). Researchers used Cox proportional hazard models to evaluate whether age at natural menopause as a continuous or categorical variable was associated with risk for type 2 diabetes.

Within the cohort, mean age at natural menopause was 50 years; 2.3% experienced premature menopause; 8.2% experienced early menopause. Median time since menopause was 15 years.

During a mean of 9.2 years of follow-up, 348 women developed type 2 diabetes.

Both premature and early menopause were associated with higher risk for developing type 2 diabetes when compared with women who experienced late menopause. The HR for developing type 2 diabetes among women experiencing premature menopause was 3.65 (95% CI, 1.76-7.55) and 2.36 (95% CI, 1.3-4.3) for women experiencing early menopause, whereas the HR for women experiencing normal menopause was 1.62 (95% CI, 0.96-2.76).

The HR for type 2 diabetes per 1 year older age at natural menopause was 0.96 (95% CI, 0.94-0.98), according to researchers. Results persisted after adjustment for BMI, glycemic control, and metabolic and lifestyle risk factors, as well as inflammatory markers and prevalent CVD. Further adjustment for genetic risk score of age at natural menopause also did not change the associations.

“Our results indicate that menopause might be a critical period to evaluate women’s risk for type 2 diabetes as it may be an appropriate time to introduce interventions to reduce this risk,” Muka said. “Women who enter menopause early may want to regularly control their blood sugar, cholesterol, lipid levels and other factors affecting their health.”

Muka noted that this study and others are limited to absolute risks or lifetime risk without combining information about quantity and quality of remaining years lived with or without diabetes, raising a gap in the intuitive understanding of risk and impact communicated among physicians and patients.

“Therefore, in our next projects, we would like to investigate if having early menopause influences your total life expectancy and life expectancy with and without cardiometabolic diseases,” Muka said. “This study would provide a better understanding of the health risks associated with early onset of menopause, and basis to develop effective interventions and accurate projections of future health care costs.” – by Regina Schaffer

For more information:

Taulant Muka , MD, MPH, PhD, can be reached at Erasmus University Medical Center, Department of Epidemiology, Dr. Molewaterplein 50, Office NA29-14, PO Box 2040, 3000, CA Rotterdam, the Netherlands; email: t.muka@erasmusmc.nl.

Disclosure: Muka reports no relevant financial disclosures.