Younger age at menopause linked with increased likelihood of T2D

Onset of early natural menopause was associated with increased likelihood of developing type 2 diabetes in postmenopausal women examined in a recent study.

“Our findings show that women who experience menopause before the age of 40 were almost four times more likely to develop type 2 diabetes than those experiencing menopause after 55 years old,” Eralda Asllanaj, MD, MSc, of the department of epidemiology at Erasmus MC, Rotterdam, Netherlands, told Medical Economics. “Moreover, those who had menopause between 40 to 44 years were 2.4 times more likely to have diabetes later in life.”

These results were in published in Diabetologia, in the study "Age at natural menopause and risk of type 2 diabetes: a prospective cohort study."

According to Asllanaj, the age at the final menstrual period is crucial not only for reproductive ageing but also for future disease risk and mortality. Previous studies have established a link between age at menopause and cardiovascular disease, reporting that experiencing early menopause (age below 45 years) increased the risk of developing cardiovascular disease.

“Considering that type 2 diabetes is a major risk factor for cardiovascular disease and commonly manifests during the mid-life coinciding with the timing of the menopausal transition in women, we conducted this study in order to examine whether age at menopause is associated with risk of type 2 diabetes,” Asllanaj said.

Next: Study details

The study included 3,639 postmenopausal women taken from the prospective Rotterdam Study. Women self-reported age at natural menopause. The researchers categorized women’s menopause as premature (<40 years), early (40-44 years), normal (45-55 years) and late (>55 years).

With a median follow-up of almost 10 years, the researchers identified 348 women with incident type 2 diabetes. Women with premature natural menopause had a hazard ratio of 3.7 for type 2 diabetes (95% CI, 1.8-7.5). This decreased with increasing age at menopause. Women with early menopause had a hazard ratio of 2.4 (95% CI, 1.3-4.3) and women with normal menopause had a hazard ratio of 1.60 (95% CI, 1.0-2.8).

The risk of having diabetes reduced by 4% per 1 year older at menopause (HR=0.96; 95% CI, 0.94-0.98).

The researchers adjusted for factors including body mass index, glycemic traits, metabolic factors, C-reactive protein, endogenous sex hormone levels or shared genetic factors; none of which affected the association between age of onset of menopause and type 2 diabetes. According to Asllanaj, this suggests that early menopause can be an independent marker for having type 2 diabetes later in life.

“This was a surprise to us since previous work from our research group have shown that higher endogenous estradiol levels, as well as low levels of other sex hormones such as sex hormone binding globulin and dehydroepiandrosterone in postmenopausal women are linked to an increased risk of type 2 diabetes,” Asllanaj said. “However, in our study the levels of these sex hormones were measured further from menopause, and not at time of menopause onset. Therefore, future studies should look whether levels of these hormones assessed during the menopause transition can explain the results we found.”

Based on these results, Asllanaj said that menopause may 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.