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Age At Natural Menopause And The Risk Of Type 2 Diabetes: A Prospective Cohort Study

Menopause is a natural process that marks the end of the reproductive period in women. This major life transition happens when the ovaries no longer release an egg every month and, due to the cessation of estrogen and progesterone production, menstruation stops.

The age at which menopause occurs varies greatly from woman to woman. However, the age of final menstruation is key to predicting future health and disease risk. Later age of natural menopause is associated with reduced morbidity and mortality, reduced risk of cardiovascular disease and complications, and overall better quality of life. The average age of menopause in the United States is 51 years old, with premature menopause being defined by final menstruation before the age of 40. Menopause is associated with weight gain, impaired glucose homeostasis, and an increase in visceral fat, all major risk factors for the development of type 2 diabetes.

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It is well established that early age at menopause is related to higher risk of heart diseases, but only a few studies have investigated the correlation between age at menopause and type 2 diabetes. This is relevant because type 2 diabetes is one of the major risk factors for cardiovascular diseases. According to World Health Organization statistics, the global burden of diabetes is on the rise worldwide.

Almost 1 in 2 women, compared to 1 in 3 men, will develop type 2 diabetes during their lifetime. Diabetes is the number 6 killer of women aged 45-54 and the number 4 killer of women aged 55-64 in the United States. Considering the clinical relevance and the gap in the literature, we conducted an epidemiological study in order to examine whether age at menopause was associated with type 2 diabetes. For this study, we used information on 3,639 postmenopausal women who were followed for approximately 9 years, as part of the Rotterdam Study.

During the follow-up time, 348 women out of the total developed diabetes. The results showed that having premature menopause increases the chances of developing diabetes by almost 80% compared to women with normative menopause (after 55 years old). Meanwhile, women who experienced early menopause had a 70% higher chance of having type 2 diabetes later in life. Moreover, for each year increase in the onset of menopause, the risk of developing diabetes was reduced by 4%. Correcting for factors that can influence both the timing of menopause and type 2 diabetes, like genetic predisposition, levels of sex hormones and obesity did not affect these findings.  This indicates that early timing of menopause can be an independent marker of type 2 diabetes.

These results demonstrated that menopause transition might be a critical period to evaluate a woman’s risk for type 2 diabetes, as it may be an appropriate time to introduce interventions to reduce this risk. So, women who enter menopause early may want to regularly control their blood sugar, cholesterol, lipid levels, and other factors affecting their health.

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These findings are described in the article entitled Age at natural menopause and the risk of type 2 diabetes: a prospective cohort study, recently published in the journal Diabetologica. This work was conducted by Taulant Muka, Eralda Asllanaj, Naim Avazverdi, Loes Jaspers, Najada Stringa, Jelena Milic, Symen Ligthart, M. Arfan Ikram, Joop S. E. Laven, Maryam Kavousi, Abbas Dehghan, and Oscar H. Franco from Erasmus University Medical Center.

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