Early onset of menopause and diabetes may limit life span

Only in science fiction novels can scientists predict people's lifespans. However, researchers have advanced the understanding of those risk factors that adversely affect mortality rates. A new study concludes that women who experienced early menopause lived shorter lives and spent fewer years without diabetes than women who experienced normal or late menopause. Study results are published online in Menopause, the journal of The North American Menopause Society (NAMS).

It is a well-accepted fact in the medical community that both diabetes and early onset of natural menopause may be associated with early death. Emerging evidence shows an association between age at menopause and diabetes, with studies reporting almost a two-fold increased risk of type 2 diabetes with early onset of menopause. To date, however, there are no other known studies that have quantified (calculated the number of years lived with and without diabetes) the combined association of early menopause and type 2 diabetes with life expectancy.

In this study involving 3,650 postmenopausal women, the difference in life expectancy was compared in women experiencing early, normal, and late menopause, as well as in those with and without diabetes. Compared with late menopause (defined as menopause that occurs at age 55 years and older), the difference in life expectancy for women who experienced early menopause (defined as menopause that occurs at age 44 years or younger) was -3.5 years overall and -4.6 years in women without diabetes. Compared with age at normal menopause (defined as menopause that occurs at 45-54 years of age), the difference in life expectancy for women who experienced early menopause was -3.1 years overall and -3.3 years in women without diabetes.

Results of this study are reported in the article "Age at natural menopause and life expectancy with and without type 2 diabetes." The authors suggest the need for future research to examine the mechanisms behind this association to help tailor prevention and treatment strategies that improve women's health across all age categories of menopause.

"Early age at natural menopause may be linked to earlier mortality," says Dr JoAnn Pinkerton, NAMS executive director. "Women with early natural menopause were found to have a shorter lifespan, were more likely to be diagnosed with diabetes, and lived fewer years without diabetes than those with menopause occurring after age 45 or even after age 55."

Abstract
Objective
To investigate associations between reproductive factors and survival to age 90 years.

Methods
This was a prospective study of postmenopausal women from the Women's Health Initiative recruited from 1993-1998 and followed until the last outcomes evaluation on August 29, 2014. Participants included 16,251 women born on or before August 29, 1924 for whom survival to age 90 during follow-up was ascertained. Women were classified as having survived to age 90 (exceptional longevity) or died before age 90. Multivariable logistic regression models were used to evaluate associations of ages at menarche and menopause (natural or surgical) and reproductive lifespan with longevity, adjusting for demographic, lifestyle, and reproductive characteristics.

Results
Participants were on average aged 74.7 years (range, 69-81 years) at baseline. Of 16,251 women, 8,892 (55%) survived to age 90. Women aged ≥12 years at menarche had modestly increased odds of longevity (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.00-1.19). There was a significant trend toward increased longevity for later age at menopause (natural or surgical; Ptrend =0.01), with ORs (95% CIs) of 1.19 (1.04-1.36) and 1.18 (1.02-1.36) for 50-54 and ≥55 compared with <40 years, respectively. Later age at natural menopause as a separate exposure was also significantly associated with increased longevity (Ptrend =0.02). Longer reproductive lifespan was significantly associated with increased longevity (Ptrend=0.008). The odds of longevity were 13% (OR, 1.13; 95% CI, 1.03-1.25) higher in women with >40 compared with <33 reproductive years.

Conclusions
Reproductive characteristics were associated with late-age survival in older women. 

Reference

Eralda Asllanaj et al, Age at natural menopause and life expectancy with and without type 2 diabetes, Menopause (2018). DOI: 10.1097/GME.0000000000001246