Early Menopause in Type 2 Diabetes - A Study from a South Indian Tertiary Care Centre

Unraveling the Link: A Comprehensive Literature Review of Type 2 Diabetes and Menopause Onset

Women with diabetes mellitus (DM), a metabolic endocrine illness, may experience a variety of reproductive problems. The age at menopause onset has been extensively studied as a major predictor of women's health in the future; however, its relationship to diabetes in Indian women has received less attention. This literature review looked at the consequences of diabetes in women as well as the association between diabetes and the age at which menopause begins. The average age at menopause onset among women with type 2 diabetes mellitus (T2DM) has decreased globally. According to one Indian study, the average menopause age dropped to 45 years for 26% of women with T2DM. In the current review, 10 studies indicated that women with T2DM displayed an imbalanced hormonal profile resulting in an extended anovulatory period. Two investigations highlighted the significance of altered body composition of women with T2DM, thereby suggesting obesity as the primary risk factor of ovarian aging and early climacteric symptoms. T2DM may lower the average age at menopause onset; however, further research on Indian women is necessary. There is a need of studies on T2DM in premenopausal women are needed to demonstrate how the changes in body composition impact the age at which menopause begins. Delaying the onset of menopause in women with T2DM necessitates diet and lifestyle interventions to minimize ovarian aging and hormonal imbalance.

Early Menopause and Cardiovascular Disease Risk in Women With or Without Type 2 Diabetes: A Pooled Analysis of 9,374 Postmenopausal Women

OBJECTIVE

Early menopause may be associated with higher cardiovascular disease (CVD) risk. Type 2 diabetes mellitus (T2DM), coupled with early menopause, may result in even greater CVD risk in women. We examined CVD risk in women with early compared with normal-age menopause, with and without T2DM overall, and by race/ethnicity.

RESEARCH DESIGN AND METHODS

We pooled data from the Atherosclerosis Risk in Communities study, the Multi-Ethnic Study of Atherosclerosis, and the Jackson Heart Study. We included women with data on menopausal status, menopausal age, and T2DM, excluding pre- or perimenopausal women and those with prevalent CVD. Outcomes included incident coronary heart disease (CHD), stroke, heart failure (HF), and atherosclerotic cardiovascular disease (ASCVD) (CHD or stroke). We estimated the risk associated with early (<45 years) compared with normal-age menopause using Cox proportional hazards models. Covariates included age, race/ethnicity, education, BMI, blood pressure, cholesterol, smoking, alcohol consumption, antihypertensive medication, lipid-lowering medication, hormone therapy use, and pregnancy history.

RESULTS

We included 9,374 postmenopausal women for a median follow-up of 15 years. We observed 1,068 CHD, 659 stroke, 1,412 HF, and 1,567 ASCVD events. T2DM significantly modified the effect of early menopause on CVD risk. Adjusted hazard ratios for early menopause and the outcomes were greater in women with T2DM versus those without (CHD 1.15 [95% CI 1.00, 1.33] vs. 1.09 [1.03, 1.15]; stroke 1.21 [1.04, 1.40] vs. 1.10 [1.04, 1.16]; ASCVD 1.29 [1.09, 1.51] vs. 1.10 [1.04, 1.17]; HF 1.18 [1.00, 1.39] vs. 1.09 [1.03, 1.16]). The modifying effect of T2DM on the association between early menopause and ASCVD was only statistically significant in Black compared with White women.

CONCLUSIONS

Early menopause was associated with an increased risk for CVD in postmenopausal women. T2DM may further augment the risk, particularly in Black women.

Reproductive Health and Metabolic Parameters in Women with Type 2 Diabetes

Aim: This study evaluated the correlations between metabolic parameters and reproductive health data in women with type 2 diabetes mellitus (T2DM).

Material and methods: In this observational retrospective study, data from the medical records of 324 adult women with T2DM attending their regular diabetes check-ups were collected and analyzed (i.e., anthropometric parameters at first outpatient visit and yearly thereafter, first recorded HbA1c and all HbA1c for the entire follow-up duration, as well as obstetrical/gynecological information).

Results: Age at the diagnosis of T2DM correlated positively with age at menarche (r = 0.21, [95% CI: 0.09, 0.31], p = 0.0002) and age at menopause (r = 0.18 [95% CI: 0.07, 0.29], p <0.01). Age at menarche correlated negatively with mean weight (r = –0.21 [95% CI: –0.31, –0.10], p: 0.0002) and mean BMI (–0.22 [–0.32, –0.11], p <0.0001) over the follow-up time. Patients with shorter time difference between age at menarche and age at onset of T2DM (≤45 years) had higher mean weight (83.8 ± 14.5 kg vs. 78.4 ± 16.0 kg, p = 0.0001), BMI (33.2 ± 5.6 kg/m2 vs. 31.8 ± 5.7 kg/m2, p <0.05), and HbA1c over time (6.9 ± 0.8% vs. 6.6 ± 0.9%, p <0.0001). Women with T2DM with earlier menarche (<12 years old), with irregular menses during their reproductive life, and ≥3 pregnancies had higher overall BMI, but mean HbA1c were not significantly different. However, women diagnosed with T2DM before menopause had a higher mean HbA1c over time (7.1 ± 0.8% vs. 6.7 ± 0.9%, p <0.01).

Conclusion: The BMI correlated with several indicators of reproductive health (earlier menarche, irregular menses, and higher number of pregnancies), while earlier onset of T2DM influenced metabolic control in women with T2DM.

Epidemiological characteristics and risk factors of T2DM in Chinese premenopausal and postmenopausal women

Objective

This study was to analyse the prevalence of type 2 diabetes mellitus (T2DM) in premenopausal and postmenopausal women.

Methods

A total of 3227 women met the requirements from June to December in 2014, including 207 cases of premenopausal women and 3020 cases of postmenopausal women. The prevalence of T2DM and the associated risk factors in the two groups were analysed.

Results

The prevalence of premenopausal women with T2DM was 12.1%, while the prevalence in postmenopausal women was 19.4% (P < 0.05). Total serum protein (TP) (OR = 1.164 95% CI = 1.023–1.324) (P = 0.021) is a major risk factor for premenopausal women with T2DM. The prevalence of T2DM increased with the increase in TP. In postmenopausal groups, the prevalence of T2DM was associated with age (OR = 1.037 95% CI = 1.024–1.051) (P < 0.001), BMI (OR = 1.076 95% CI = 1.044–1.109) (P < 0.001), blood pressure (OR = 1.521 95% CI = 1.234–1.875) (P < 0.001), triglycerides (TG) (OR = 1.106 95% CI = 1.027–1.190) (P = 0.008), blood urea nitrogen (BUN) (OR = 1.065 95% CI = 1.004–1.129) (P = 0.036), alanine aminotransferase (ALT) (OR = 1.009 95% CI = 1.003–1.016) (P = 0.004) and TP (OR = 1.031 95% CI = 1.005–1.057) (P = 0.018).

Conclusions

Postmenopausal women have a higher rate of type 2 diabetes than premenopausal women. TP is a major risk factor for premenopausal women with T2DM. TP, ALT, and BUN are postmenopausal risk factors in addition to traditional risk factors such as obesity, lipidaemia and blood pressure. We should monitor risk factors and take early prevention and intervention measures to reduce the prevalence of diabetes and improve the quality of life of postmenopausal women.

Trial registration

ChiCTR, ChiCTR-TRC-14005029. Registered 29 July 2014,http://www.chictr.org.cn/showproj.aspx?proj=4545

The association between diabetes and age at the onset of menopause: a systematic review protocol

BACKGROUND

Age at the onset of menopause is the most important determinant of women's future health outcomes. While the basic mechanisms contributing to the onset of menopause are still not fully understood, age at menopause depends on a complex set of various factors. In this regard, the effects of diabetes (DM I/II) on the age at the onset of menopause have received little attention.

METHODS AND ANALYSIS

Electronic databases including PubMed/MEDLINE, Web of Science, Scopus, EMBASE, and Google Scholar will be searched for articles published during January 2000 to August 2018 and containing combinations of related MeSH terms, i.e., "age at menopause" and "diabetes." Additional studies will also be extracted from the reference lists of the selected papers, gray literature, and key journals in the field. A set of inclusion criteria will be defined, and all eligible observational studies will be included. Two reviewers will independently conduct the study selection, data extraction, and quality assessment of the selected studies. All cases of disagreement will be resolved through consensus. The methodological assessment of the primary studies will be performed based on the Newcastle-Ottawa Scale (NOS). In case of the availability of sufficient data, fixed or random effects models will be used to combine all data. Heterogeneity will be assessed by I 2 statistic and chi-square test. Stata V.11.1 will be used for data analysis (CRD42017080789).

ETHICS AND DISSEMINATION

This systematic review will not raise any ethical issues. Journal publication and conference presentations will facilitate the wide dissemination of the findings to relevant clinicians and researchers.

Factors associated with early menopause among women in Nigeria

OBJECTIVES

Effective antiretroviral therapy has prolonged the survival of patients with HIV. Accordingly, studies of the consequences of ageing are increasingly important. We determined the prevalence of early menopause (EM) and its associated factors in a cohort of HIV-infected and HIV-negative controls in Jos, Nigeria.

METHODS

HIV-infected women accessing care in an ambulatory setting and their negative counterparts from the general population were included. Menopause was defined as having gone one year since the last menstrual period. EM was defined as the onset of menopause at ≤45 years of age. Baseline characteristics were compared and logistic regression analyses were used to determine factors independently associated with EM.

RESULTS

Out of a total of 253 women included, 58 attained menopause early, giving an EM prevalence of 22.9% (95% confidence interval [CI] 17.9-28.6%). Women with EM were younger (P<0.001) and had been infected with HIV for a shorter period (P=0.007). Baseline CD4+ cell count (P=0.66) and viral load (P=0.15) were similar among those with and without EM. For all subjects, HIV infection (adjusted odds ratio [AOR}=10.95, 95% CI 1.39-86.33) and sexual activity (AOR=2.37, 95% CI 1.24-4.52) were associated with EM while early menarche (AOR=14.88, 95% CI 1.37-161.10) and sexual activity (AOR=2.02, 95% CI 1.03-3.96) were independently associated with EM.

CONCLUSION

Over a quarter of our postmenopausal women attained menopause early. No HIV-related factor predicted EM in this study. A better understanding of ageing in these women is important to determine a more appropriate disease-management approach during this period of life.

Ovarian aging in women with diabetes: An overview

Type 2 diabetes is a global epidemic, and the prevalence and incidence of type 1 diabetes are increasing. The negative effects of diabetes on kidneys, nerves, and vessels are well established. The effect of diabetes on reproductive function is less well understood, but important to characterize, given the increasing numbers of young women with diabetes. In this review, we summarize the available literature on how women with diabetes experience ovarian aging, from menarche to menopause. We report that women with type 1 diabetes appear more likely to have ovarian dysfunction, manifested by delayed menses, menstrual irregularities, and possibly earlier menopause. Studies of women with type 2 diabetes are inconsistent but suggest increased anovulation and earlier menopause. Differences in reproductive aging between women with type 1 and type 2 diabetes raise questions about potential differences in the mechanisms contributing to ovarian aging. Although there is shared glycemic dysregulation, fundamental differences in insulin presence and processing distinguish the two diseases. This review suggests that insulin, age at diagnosis, and weight play a role in ovarian dysfunction. More long-term studies are needed to evaluate the multitude of factors that may disrupt hypothalamic, pituitary, and ovarian function in women with diabetes.