Menopause in type 1 diabetic women - Is it premature?

Women with type I diabetes have a delayed menarche and a greater prevalence of menstrual disorders than women without diabetes. However, little is kno wn about the menopause transition among type I diabetic women. The Familial Autoimmune and Diabetes (FAD) Study recruited both adult individuals who w ere identified from the Children's Hospital of Pittsburgh Type 1 Diabetes R egistry for the years 1950-1964 and their family members. Unrelated nondiab etic control probands and their relatives were also evaluated. Women with t ype I diabetes (n = 143) compared with nondiabetic sisters (n = 186) or unr elated 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 menstr ual irregularities before 30 years of age (45.7, 33.3, and 33.1%, respectiv ely, 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 = 0.0 4), menstrual irregularities before 30 years of age (HR 1.87, P = 0.04), nu lliparity (HR 2.14, P = 0.01), and unilateral oophorectomy (HR 6.51, P < 0. 0001). Multivariate analysis confirmed that type I 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 determinant s of earlier menopause in our cohort. We hypothesize that an earlier menopa use, which resulted in a 17% decrease in reproductive years, is a major uns tudied complication of type 1 diabetes.