Women with type 1 diabetes experience a significantly shorter reproductive period, according to research published in Menopause.

There are research gaps and conflicting findings regarding the age of menarche and menopause in women with type 1 diabetes. The current study included 2 cohorts:  women with type 1 diabetes from the Pittsburgh Epidemiology of Diabetes Complications (EDC) study and women without diabetes from the Study of Women’s Health Across the Nation (SWAN) study. The investigators, led by Tina Costacou, PhD, of the University of Pittsburgh, hypothesized that women with type 1 diabetes have a shorter reproductive period.

Women in the first group (n=105) were statistically significantly younger compared with women in the second group (n=178; 42.8±7.3 vs 46.0±2.4 years). Mean diabetes duration was 33.5(±8.0) years, and age at diabetes onset was 9.3(±3.9) years.


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Women in the first group had a 0.6-year delay in menarche (13.2±1.7 vs 12.6±1.5 years); age at menarche did not differ significantly between women with type 1 diabetes who had a diabetes onset after menarche.

At the last available follow-up period, mean age of women in the first group was 58.7(±6.1) years (vs 64.0±3.6). Women in this group were less likely to have ever used oral contraceptives and to have been pregnant (63.5% and 72.4% vs 77.5% and 91%, respectively).

The unadjusted age at natural menopause was 2.6 years younger in the EDC cohort vs the SWAN cohort (49.5±4.1 vs 52.1±2.8). This finding was statistically significant in women diagnosed with type 1 diabetes both before and after menarche. Women with type 1 diabetes had a 3.4-year shorter unadjusted length of their reproductive period vs women without diabetes (36.2±4.4 vs 39.6±3.2 years), regardless of whether diabetes onset was before or after menarche.

Results of a multivariate analysis showed that the delay in age at menarche was 0.5 years after adjusting for race. Difference in age at natural menopause between cohorts was reduced from 2.6 to 2.0 years after adjusting for age, race, body mass index, smoking status, hypertension, high-density lipoprotein cholesterol, oral contraceptive use, and number of pregnancies.

Type 1 diabetes was found to be associated with 2.5 fewer reproductive years after adjustment.

In multivariable models stratified by menarche before or after diabetes onset, differences remained statistically significant only in women with type 1 diabetes onset before menarche.

Results were similar when the analysis included SWAN women with data for menopause age or EDC women who provided their self-reported age at natural menopause without sex hormone data.

Study limitations included differences in how menopause status was determined between cohorts, younger chronological age of women with type 1 diabetes at baseline leading to potential residual confounding, and a lack of data on reproductive health, including hormone levels, prior to the twelfth EDC study follow-up visit, representing potential selection or survival bias.

“Our data suggest that women with type 1 diabetes have a shorter reproductive period compared with nondiabetic women, exhibiting delayed menarche and earlier natural menopause,” the researchers concluded. “Given the high likelihood of experiencing early menopause in type 1 diabetes, and the enormous impact on health associated with early menopause, further studies are needed to determine modifiable factors that contribute to early menopause to improve reproductive health in women with type 1 diabetes.”

Reference

Yi Y, Khoudary SRE, Buchanich JM, et al. Women with type 1 diabetes experience a shorter reproductive period compared with nondiabetic women: the Pittsburgh Epidemiology of Diabetes Complications (EDC) study and the Study of Women’s Health Across the Nation (SWAN). Published online March 1, 2021. Menopause. doi: 10.1097/GME.0000000000001758