Age at menopause or type of menopause (surgical or natural) did not have a clinical or statistically significant link to the development of type 1 or 2 diabetes, according to a large cohort study of women followed for more than 14 years, according to a new paper published in Menopause.

Authors, led by Jose Antonio Quesada, PhD, with the GRINCAVA Cardiovascular Research Group, Department of Clinical Medicine, Miguel Hernández University of Elche, Alicante, Spain, noted that previous research has shown that women who enter menopause before age 45 have a higher risk for coronary heart disease and stroke.

Additionally, women who had either natural or surgical menopause have a higher risk for altered glucose metabolism in the postmenopausal period. Research has also shown that for women with early or premature menopause, cardiovascular risk is higher in those with diabetes than in those without. But this study assessed whether there was any specific link between onset of diabetes and menopause type or timing and found none.

“Our study sheds new light on this question, ruling out a direct association and suggesting that any association observed is likely due to the confounding effect of cardiovascular risk factors, which are more common in postmenopausal women, rather than the presence of menopause itself,” the authors wrote.

The study included 146,764 women from the UK Biobank. Average age was 60 years and 81.9% had menopause after age 45; 14.3% between ages 40 and 45 and 3.8% before age 40. Additionally, 5.5% had surgical menopause resulting from bilateral oophorectomy.

Results Change in Multivariate Analysis

The key to the findings lies in adjusting for potential confounders, the authors wrote. Their crude analysis did show a significant link between age and type of menopause and diabetes (early menopause hazard ratio [HR], 1.19; premature menopause HR, 1.52; surgical menopause HR, 1.41; P < .001), as did the age-adjusted model (early menopause HR, 1.20; premature menopause HR, 1.58; surgical menopause HR, 1.37; P < .001). However, the significance disappeared in the multivariate model (40-45 years HR, 1.00; and < 40 years HR, 0.97) with similar nonsignificant results for surgical menopause.

Diabetes Linked With Other Risk Factors

The researchers wrote that along with the unadjusted findings for the link between diabetes and menopause, “A significantly higher incidence of diabetes was also observed in women with other risk factors: smoking (7.5%); obesity (10.8%); high basal metabolic rate (11.3%); no intake of vegetables (6.8%) or fruit (6.6%); high intake of added salt (7.0%); worse self-perceived health (13.1%); AMI [acute myocardial infarction], angina, or stroke (11.6%); hypertension (8.1%); cholesterol medication (10.0%); father (6.8%) or mother (8.7%) with diabetes; blood type BB (7.9%); low HDL cholesterol [high-density lipoprotein] (11.7%); high urate levels (16.2%); high basal glucose levels (13.9%); and HbA1c levels between 4.5% and 5.7% (13.8%) or > 6.5% (74.4%).”

We know that cardiovascular disease in women increases with age, Obstetrician/Gynecologist Jane Limmer, MD, assistant professor at the Virginia Commonwealth University School of Medicine in Richmond, Virginia, told Medscape Medical News. “We also know that the incidence of type 1 and type 2 diabetes increases with age. This study provides compelling evidence that menopause does not, in-and-of-itself, specifically create an increased risk of developing type 1 or type 2 diabetes.”

She said providers should still counsel women about the importance of a healthy diet, exercise, and controlling blood pressure and lipids to avoid metabolic disease and cardiovascular disease. She highlighted one of the limitations the authors reported: The data relied on self-reported age at menopause and self-reported diagnoses rather than International Disease Classification -10 codes.

“It is also important to note that this study specifically looked at women undergoing premature or early menopause and not at the majority of women undergoing menopause after age 45,” Limmer said. “Thus, although we can and do extrapolate this data to effects of menopause on all women, this study did not specifically look at women experiencing menopause after age 45.”

The authors and Limmer reported having no relevant financial relationships.

Marcia Frellick is a Chicago-based, independent healthcare journalist and a regular contributor to Medscape.