Common type of diabetes triples risk of an early menopause in women under 45

Diabetes is a huge and increasing international problem. The International Diabetes Federation estimates that 366m people had diabetes in 2011 -- more than the entire population of the USA. This figure is predicted to rise to 552m by 2030. 90% of those with diabetes have type 2 diabetes.

A group led by Dr Álvaro Monterrosa-Castro, of the University of Cartagena, Colombia asked 6079 women aged between 40 and 59 years from 11 Latin American countries a series of questions related to menopause, depression, and diabetes. They then associated their responses with a series of variables such as weight, blood pressure, HRT use. Using a statistical programme developed by the Centre for Disease Control in the USA, they were able to pull out a series of correlations -- some expected, but some more surprising. The main finding was:

• Menopause itself does not increase the risk of diabetes. But in contrast, women under 45 who have type 2 diabetes have almost three times (Odds Ratio, 2.76) the risk of an early menopause; the average age of menopause in women with diabetes was 48.5 years, as opposed to 50.1 years in non-diabetic women (there were no other significant differences between the groups). This means that 29.5% of diabetic women aged 40 to 44 had experienced the menopause.

Other findings of the research are:

• Living at an altitude of more than 2500m is associated with a lower diabetes risk (26% )
• Women with a BMI of ≥30 were 57% more likely to have diabetes
• High blood pressure significantly increased the risk of Diabetes (87%)

In contrast to previous studies, this work found that Hormone Replacement Therapy (HRT) increased the risk of diabetes by 14%. Dr Monterrosa-Castro commented "This result is different to the majority of previous work which has shown that HRT reduces the risk for diabetes. However, it is possible that the differences may be explained by genetic differences or by the fact that nowadays women tend to use lower doses of estrogen than when most of the previous studies were carried out."

The study also found a mixed result for the association of alcohol with type 2 diabetes, with those women taking lower or moderate doses of alcohol having a reduced risk, whereas high alcohol intake was associated with a higher diabetes risk.

Dr Monterrosa-Castro said 'the study shows several things. Firstly, menopause itself does not increase the risk of diabetes, but conversely having type 2 diabetes triples the risk of an early menopause. Secondly, the associations between diabetes and menopause can be complex, which reinforces the message that women approaching the menopause need to be treated as individuals, and evaluated according to their own general health, background and risk factors. Diabetes is also associated with a generally poor quality of life, so we should encourage women to avoid risk factors for type 2 diabetes, such as being overweight or having high blood pressure."

Commenting, Climacteric editor Dr Nick Panay (London) said "premature ovarian insufficiency (POI) can impair health and life expectancy if poorly managed. This study reinforces the importance of early diagnosis to detect and treat associated conditions such as diabetes, thus optimizing short and long term wellbeing."