Menopause in Type 1 Diabetic Women

Abstract

Women with type 1 diabetes have a delayed menarche and a greater prevalence of menstrual disorders than women without diabetes. However, little is known about the menopause transition among type 1 diabetic women. The Familial Autoimmune and Diabetes (FAD) Study recruited both adult individuals who were identified from the Children's Hospital of Pittsburgh Type 1 Diabetes Registry for the years 1950 -1964 and their family members. Unrelated nondiabetic control probands and their relatives were also evaluated. Women with type 1 diabetes (n ‫؍‬ 143) compared with nondiabetic sisters (n ‫؍‬ 186) or unrelated control subjects (n ‫؍‬ 160) were more likely to have an older age at menarche (13.5, 12.5, and 12.6 years, respectively, P < 0.001), more menstrual irregularities before 30 years of age (45.7, 33.3, and 33.1%, respectively, P ‫؍‬ 0.04), and a younger age at menopause (41.6, 49.9, and 48.0 years, respectively, P ‫؍‬ 0.05). This resulted in a 6-year reduction in the number of reproductive years (30.0, 37.0, and 35.2 years, respectively, P ‫؍‬ 0.05) for women with type 1 diabetes. Risk factors univariately associated with earlier menopause included type 1 diabetes (hazard ratio [HR] 1.99, P ‫؍‬ 0.04), menstrual irregularities before 30 years of age (HR 1.87, P ‫؍‬ 0.04), nulliparity (HR 2.14, P ‫؍‬ 0.01), and unilateral oophorectomy (HR 6.51, P < 0.0001). Multivariate analysis confirmed that type 1 diabetes (HR 1.98, P ‫؍‬ 0.056), menstrual irregularities by 30 years of age (HR 2.36, P ‫؍‬ 0.01), and unilateral oophorectomy (HR 9.76, P < 0.0001) were independent determinants of earlier menopause in our cohort. We hypothesize that an earlier menopause, which resulted in a 17% decrease in reproductive years, is a major unstudied complication of type 1 diabetes.

Cancer incidence and mortality in patients with insulin-treated diabetes: a UK cohort study

“…The expected effect on ovarian cancer risk would be too small, however, to explain our findings. It is unclear whether parity differs between women with type I diabetes and other women (Dorman et al, 2001), but the differences would need to be very large to explain our results. We know of no evidence on oophorectomy prevalence in women with diabetes.…”

“…It is a limitation that we do not have individual data on menstrual or reproductive factors in our cohort, but menstrual factors in studies of women with type I diabetes have been in a direction to give diminished, not raised, risk of ovarian cancer: episodes of amenorrhoea are more frequent in women with insulin-dependent diabetes than in women in general (Kjaer et al, 1992); menarche is delayed in women with diabetes incident under age 10 years (Kjaer et al, 1992); and limited evidence suggests that menopause is considerably younger in women with childhood onset type I diabetes (Dorman et al, 2001). Oral contraceptive (OC) use is protective against ovarian cancer , and there is evidence that OC use is less common in patients with diabetes (Dorman et al, 2001), because of potential side effects.…”

“…Oral contraceptive (OC) use is protective against ovarian cancer , and there is evidence that OC use is less common in patients with diabetes (Dorman et al, 2001), because of potential side effects. The expected effect on ovarian cancer risk would be too small, however, to explain our findings.…”

Calorie intake misreporting by diet record and food frequency questionnaire compared to doubly labeled water among postmenopausal women

“…A population of interest is postmenopausal women because although natural menopause represents a normal aspect of aging, it is also associated with increased risk for a variety of diseases such as osteoporosis (Eichner et al, 2003), type 1 diabetes (Dorman et al, 2001), cardiovascular diseases (Gorodeski, 1994, and breast cancer (Edwards et al, 2002). Because numerous studies use data from self-reported questionnaires to assess the association between diet and disease in postmenopausal women it is important to understand the magnitude of dietary intake misreporting in this population.…”

Menopause and Diabetes? No Sweat!

“…While it has not been definitively proven, some recent studies suggest that T1D patients may experience an earlier onset of menopause compared to the general population [15]. Early menopause means ovarian failure occurs earlier, decreasing the number of years available to have children.…”