Type I diabetes not associated with early menopause [OVADIA study]

1. After adjusting for age, smoking history and parity, there was no significant association between type I diabetes and early menopause.

Evidence Rating Level: 2 (Good)  

Study Rundown: The average age of menopause, which is defined as 12 months of amenorrhea, is 51.2 years among American women, although age at menopause varies widely between individuals. Menopause marks the end of a woman’s childbearing years and is also associated with a number of other health changes, including decreased bone density and an increased risk for cardiovascular disease. Previously, these health changes were attributed to the associated decrease in circulating estrogen. However, given estrogen replacement therapy does not prevent cardiovascular disease, and may even increase risk, some experts think that the opposite may be true: vascular compromise leads to premature ovarian aging, decreased estrogen, and early menopause. Since women with type I diabetes are prone to premature vascular aging, researchers hypothesized that diabetics would also experience earlier menopause compared with non-diabetics. Prior research on this topic have been of poor quality and produced mixed results.

In this cross-sectional analysis, there was no significant difference in the ages of menopause between diabetics and non-diabetics. While the use of a population-based non-diabetic control cohort was a strength, there are some notable methodological shortcomings that may limit these results. First, age at menopause in the diabetic group was assessed retrospectively, which may have lead to recall bias. Second, researchers were unable to collect data on microvascular complications. Future studies might assess markers of vascular compromise and glycemic control as a function of prospectively collected data on age of menopause to better characterize this relationship.

Click to read the study in Human Reproduction

Relevant Reading: Menopause in Type I Diabetic Women: Is it Premature?

In-Depth [Cross-sectional study]: One hundred and forty post-menopausal women with type I diabetes were compared to a national control cohort of 5426 postmenopausal women without diabetes. Age at last menstrual period (menopause), along with relevant health issues, was retrieved through a standardized, retrospective questionnaire.

The average age of menopause in diabetics was 49.8 ± 4.7 years compared with 49.8 ± 4.1 years for non-diabetics. After adjusting for age, smoking history and parity, there was no significant difference in age at menopause between the two groups (age difference=0.34 years, 95%CI: -0.34-1.01).

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