Age at menopause in women with type 1 diabetes mellitus: the OVADIA study

Abstract

Study question: Is type 1 diabetes a determinant of advanced ovarian ageing, resulting in an early age at natural menopause?

Summary answer: No clear evidence was provided that type 1 diabetes is a determinant of accelerated ovarian ageing resulting in an early menopause.

What is known already: The association between type 1 diabetes and early menopause has been examined previously with inconsistent results.

Study design, size, duration: A cross-sectional study was performed in 140 post-menopausal women with, and 5426 post-menopausal women without, diabetes.

Participants/materials, setting, methods: Both women with and without diabetes had experienced natural menopause. Study participants filled out a standardized questionnaire including report of their age at last menstrual period. Differences in menopausal age were analysed using linear regression analyses, with adjustment for possible confounders.

Main results and the role of chance: Mean age at natural menopause was 49.8 ± 4.7 years in women with type 1 diabetes and 49.8 ± 4.1 in women without diabetes. Linear regression analyses showed that type 1 diabetes was not associated with an earlier menopause compared with the reference group without diabetes, after adjustment for age, smoking history and parity (difference in age at menopause between women with type 1 diabetes and reference group 0.34 years, 95% confidence interval -0.34, 1.01).

Limitations, reason for caution: Age at menopause was self-reported and assessed retrospectively. We had no information regarding microvascular complications therefore a possible association between vascular health and menopausal age could not be investigated.

Wider implications of the findings: It has been hypothesized that the possible mechanism behind an accelerated ovarian ageing process in type 1 diabetes is prolonged poor glycaemic control and subsequent effects on vascular health. The improved glycaemic control during the last decades may have prevented vascular damage from occurring to an extent that would affect organ function. Nevertheless, the present findings are reassuring for reproductive health prospects in women with type 1 diabetes.

Trial registration: ClinicalTrials.gov NCT01665716.

Keywords: age at menopause; natural menopause; ovarian ageing; type 1 diabetes; vascular health.