1. In this large retrospective matched cohort study of women aged 18-40 years, a history of abnormal menstruation was associated with an increased risk of cardiometabolic outcomes in later life
Evidence Rating Level: 2 (Good)
According to estimates from the global burden of disease study, cardiovascular disease (CVD) is the leading cause of mortality in women accounting for 35% of total deaths worldwide. Menstrual cycle history and its link to CVD are not mentioned in recent literature reviews and consensus statements, which support the association between female reproductive factors and the risk of CVD in later life. Long or irregular menstrual cycles are associated with cardiovascular risk factors including hyperinsulinemia, dyslipidemia, hypertension, and diabetes mellitus. Its management has predominantly focused on addressing infertility implications, leaving other potential longer-term risks such as CVD underappreciated. This retrospective cohort study utilizes electronic health data from UK primary care to investigate the association between menstrual cycle characteristics and long-term risk of cardiometabolic outcomes. From the study population of women aged 18-40 years two cohorts were created and matched to controls — one composed of 215,378 women with a history of irregular or absent menstrual cycles and the other composed of 36,947 women with infrequent or frequent menstrual cycles. Comparing women with irregular menstrual cycles to those with regular menstrual cycles the hazard ratio for composite CVD was 1.08 (95% CI 1.00–1.19; p = 0.062). Comparing infrequent or frequent menstruation to menstrual cycles of normal frequency, a hazard ratio for composite CVD of 1.24 (95% CI 1.02–1.52; p = 0.031) was observed. Both irregular menstrual cycles and frequent or infrequent cycles were linked with an increased risk of hypertension and type 2 diabetes mellitus. Overall, these findings suggest that a history of irregular, frequent, or infrequent menstrual cycles is associated with an increased risk of cardiometabolic outcomes later in life. This opens up an avenue to apply menstrual history as a screening tool to identify and periodically assess individuals at a higher risk of poor future cardiometabolic health.
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