Relationship Between Age at Menopause and Diabetes Onset Not Clinically Significant

A recent study published in Menopause determined that there was no independent or clinically significant relationship between age or type of menopause and the onset of diabetes. Despite the findings, the authors wrote that additional research is needed to elucidate any causal pathways between early or premature menopause as well as its association with morbidity and mortality to effectively implement appropriate prevention and screening measures.¹

Understanding the Menopausal Transition

The menopausal transition is accompanied by metabolic changes that predispose women to diabetes, particularly type 2 diabetes (T2D), as menopause results in increased risk of upper body adipose tissue accumulation and increased incidence of insulin resistance, wrote authors of a review published in Nature Reviews Endocrinology. Equally, diabetes can affect the aging of ovaries, potentially causing women with type 1 diabetes (T1D) and early-onset T2D to experience menopause earlier than women who do not have diabetes. These authors wrote that earlier age at menopause has been associated with a higher risk of T2D later in life and that menopausal hormone therapy can reduce the risk of T2D and improve glycemic control in women with preexisting diabetes.²

Additionally, the current study authors explained that early and premature menopause have previously been shown to be positively associated with both stroke and coronary heart disease. Because there is less evidence on the relationship between diabetes onset and the timing and type of menopause, the authors conducted this study to determine any present associations.¹

Exploring Links Between Early Menopause and Diabetes

For their research, the investigators enrolled participants from the UK Biobank between 2006 and 2010, with a follow-up to the end of 2023. The outcome variable was diagnosis of T1D or T2D during follow-up, and the main explanatory variable was age at menopause, with “normal” defined as older than 45 years, “early” as 40 to 45 years, and “premature” as younger than 40 years. Additionally, the investigators collected behavioral factors (eg, frequency of alcohol consumption, tobacco use, daily hours of sleep, physical activity), comorbidities (eg, cardiovascular disease), and blood tests from all participants. Survival models with Weibull distribution were fitted to the time of diabetes onset.¹

Among the 146,764 women who were analyzed over a mean follow-up of about 14.5 years, 6598 women developed diabetes (cumulative incidence: 4.5%). Rates were highest in women who were considered to have premature menopause (7.4%), followed by early menopause (5.2%) and normal menopause (4.2%); however, the authors noted that multivariate analysis showed no independent association (early: hazard ratio [HR], 1.00; premature: HR, 0.97), taking the normal age of menopause as the reference. Surgical menopause was likewise not associated with a greater risk of diabetes compared with natural menopause.¹

A significantly higher incidence of diabetes was also observed in women with other risk factors, such as 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%); acute myocardial infarction, angina, or stroke (11.6%); hypertension (8.1%); taking cholesterol medication (10.0%); father (6.8%) or mother (8.7%) with diabetes; blood type BB (7.9%); low HDL cholesterol (11.7%); high urate levels (16.2%); high basal glucose levels (13.9%); and hemoglobin A_1c levels between 4.5% and 5.7% (13.8%) or higher than 6.5% (74.4%).¹

Further results determined that any potential association between age and menopause onset is not direct and instead appears to be because of confounding effects of other factors—such as cardiovascular risk factors, which are already common in postmenopausal women—rather than the presence of menopause itself. In a large cohort of women with long-term follow-up, no independent or clinically significant relationship between age or type of menopause and the onset of diabetes was observed.¹

“The results of this study highlight that, although postmenopausal women are at increased risk for diabetes, it does not appear to be related to the age at menopause onset or whether menopause occurs naturally or due to surgery but rather to cardiovascular and lifestyle risk factors,” Stephanie Faubion, MD, MBA, medical director for The Menopause Society, said in a news release. “This is somewhat reassuring in that cardiovascular risk factors, such as hypertension and hyperlipidemia, can be controlled, and lifestyle factors, such as smoking, diet, and exercise, are modifiable, whereas age at menopause is not.”³

REFERENCES

1. Quesada JA, Bertomeu-Gonzalez V, Cordero A, et al. Timing and type of menopause are not risk factors for the onset of diabetes: a UK Biobank cohort study. Menopause. 2026;33(6):000–000. doi:10.1097/GME.0000000000002720

2. Lambrinoudaki I, Paschou SA, Armeni E, Goulis DG. The interplay between diabetes mellitus and menopause: clinical implications. Nat Rev Endocrinol. 2022;18(10):608-622. doi:10.1038/s41574-022-00708-0

3. The Menopause Society. Diabetes Risk Not Associated With Timing or Type of Menopause. News release. January 12, 2026. Accessed January 15, 2026. https://menopause.org/press-releases/diabetes-risk-not-associated-with-timing-or-type-of-menopause