Association between changes in oestradiol and follicleâ stimulating hormone levels during the menopausal transition and risk of diabetes

Abstract

AimTo investigate the association between changes in oestradiol and follicleâ stimulating hormone levels during the menopausal transition and incident diabetes.MethodsWe followed 1407 preâ menopausal women, aged 42â 52 years at baseline, who experienced natural menopause, from baseline to the 12th annual followâ up visit in the Study of Women’s Health Across the Nation (SWAN). Diabetes was defined based on fasting glucose level, medication use and selfâ report of physician diagnosis. Cox proportional hazards regression was used to evaluate the associations of incident diabetes with three components of the rate of change in hormones: the intercept (preâ menopausal levels) and two pieceâ wise slopes representing change during the early and late transition, respectively.ResultsDuring 15 years of followâ up, 132 women developed diabetes. After adjusting for potential confounders, a higher oestradiol intercept, but not its rate of change, was borderline significantly associated with lower risk of diabetes [hazard ratio for an interquartile range increase (75.2 pmol/L) 0.53, 95% CI 0.27â 1.06]. For follicleâ stimulating hormone, a greater rate of increase in the early transition, but not the intercept or late transition, was significantly associated with lower risk of diabetes [hazard ratio for an interquartile range increase (5.9 IU/L/year) 0.31, 95% CI 0.10â 0.94].ConclusionsLower preâ menopausal oestradiol levels and a slower rate of follicleâ stimulating hormone change during the early transition were associated with higher risk of developing diabetes. Given that obesity plays an important role in diabetes risk and in the levels and changes in oestradiol and follicleâ stimulating hormone over the menopausal transition, weight control in earlier midâ life is important to prevent future diabetes development.What’s new?This is the first study to examine prospectively the associations between levels of and change in oestradiol and follicleâ stimulating hormone (FSH) during the menopausal transition and incident diabetes in a cohort of women.The study shows that, independent of age and other important risk factors of diabetes, women with lower preâ menopausal oestradiol levels and a slower rate of FSH change during the early menopause transition had a higher risk of developing diabetes.Given that obesity plays an important role in diabetes risk as well as in the levels and changes in oestradiol and FSH over the menopausal transition, weight control in earlier midâ life is important to prevent future diabetes development.