Early Severe Vasomotor Menopausal Symptoms and Diabetes
Objective. The purpose of this study was to investigate associations between profiles of vasomotor menopausal symptoms (VMS) during the menopausal transition with the prevalence of diabetes.
Methods. VMS and diabetes were measured at baseline and 3-year intervals for 15 years in 4,895 women in the Australian Longitudinal Study on Women's Health who were aged 45 to 50 years at baseline in 1996. Latent class analysis and generalized estimating equation models for binary repeated measures were performed. The VMS profiles were labeled as mild, moderate, early severe, and late severe.
Results. The prevalence of diabetes in the total group was 9.0%. Compared with mild VMS, the odds of diabetes were higher in those with a late severe profile (though not statistically significant; adjusted odds ratio, 1.28; 95% CI, 0.97-1.68) and in those with an early severe profile (adjusted odds ratio, 1.67; 95% CI, 1.20-2.32). Adjustment for body mass index attenuated this association, but the odds of diabetes were still significantly higher in women with an early severe profile than in women with mild VMS (odds ratio, 1.55; 95% CI, 1.11-2.17). The moderate profile was not associated with diabetes.
Conclusions. Women with an early severe VMS profile are more likely to have diabetes across a period of 15 years. This association is not explained by body mass index or other potential confounders. Our findings imply that the predictive value of VMS for diabetes may vary with the timing of VMS relative to menopause.
Vasomotor menopausal symptoms (VMS) include both hot flushes and night sweats and affect up to 70% of women during the menopausal transition. Several studies have demonstrated a relationship between VMS and increased cases of (subclinical) cardiovascular disease. However, the relationship of VMS with other long-term health outcomes, such as diabetes, is less clear and has been under-researched. Although a recent study showed that hot flushes are associated with a higher homeostasis model assessment index and glucose level, other work found that hot flushes emerge as blood glucose falls or are not associated with insulin resistance at all. However, none of these studies used diabetes as an outcome or distinguished between VMS at the onset of menopause and VMS occurring later in menopause. The latter may be particularly important because it has recently been suggested by the Women's Health Initiative (WHI) that the predictive value of VMS for clinical events may vary with the onset of VMS at different stages of menopause. Whereas early-onset VMS may be beneficial, VMS occurring for the first time in later postmenopausal years seem to be harmful. Determining the associations between diabetes and different VMS profiles showing distinct relationships with the timing of menopause may therefore provide valuable information about groups that are more likely to have diabetes and thus have potential interventions.
The aim of our study is to elucidate the associations between VMS profiles and diabetes. For this purpose, we use the data from the Australian Longitudinal Study of Women's Health (ALSWH), for which Mishra and Dobson previously identified four different VMS profiles through menopause.
Abstract and Introduction
Abstract
Objective. The purpose of this study was to investigate associations between profiles of vasomotor menopausal symptoms (VMS) during the menopausal transition with the prevalence of diabetes.
Methods. VMS and diabetes were measured at baseline and 3-year intervals for 15 years in 4,895 women in the Australian Longitudinal Study on Women's Health who were aged 45 to 50 years at baseline in 1996. Latent class analysis and generalized estimating equation models for binary repeated measures were performed. The VMS profiles were labeled as mild, moderate, early severe, and late severe.
Results. The prevalence of diabetes in the total group was 9.0%. Compared with mild VMS, the odds of diabetes were higher in those with a late severe profile (though not statistically significant; adjusted odds ratio, 1.28; 95% CI, 0.97-1.68) and in those with an early severe profile (adjusted odds ratio, 1.67; 95% CI, 1.20-2.32). Adjustment for body mass index attenuated this association, but the odds of diabetes were still significantly higher in women with an early severe profile than in women with mild VMS (odds ratio, 1.55; 95% CI, 1.11-2.17). The moderate profile was not associated with diabetes.
Conclusions. Women with an early severe VMS profile are more likely to have diabetes across a period of 15 years. This association is not explained by body mass index or other potential confounders. Our findings imply that the predictive value of VMS for diabetes may vary with the timing of VMS relative to menopause.
Introduction
Vasomotor menopausal symptoms (VMS) include both hot flushes and night sweats and affect up to 70% of women during the menopausal transition. Several studies have demonstrated a relationship between VMS and increased cases of (subclinical) cardiovascular disease. However, the relationship of VMS with other long-term health outcomes, such as diabetes, is less clear and has been under-researched. Although a recent study showed that hot flushes are associated with a higher homeostasis model assessment index and glucose level, other work found that hot flushes emerge as blood glucose falls or are not associated with insulin resistance at all. However, none of these studies used diabetes as an outcome or distinguished between VMS at the onset of menopause and VMS occurring later in menopause. The latter may be particularly important because it has recently been suggested by the Women's Health Initiative (WHI) that the predictive value of VMS for clinical events may vary with the onset of VMS at different stages of menopause. Whereas early-onset VMS may be beneficial, VMS occurring for the first time in later postmenopausal years seem to be harmful. Determining the associations between diabetes and different VMS profiles showing distinct relationships with the timing of menopause may therefore provide valuable information about groups that are more likely to have diabetes and thus have potential interventions.
The aim of our study is to elucidate the associations between VMS profiles and diabetes. For this purpose, we use the data from the Australian Longitudinal Study of Women's Health (ALSWH), for which Mishra and Dobson previously identified four different VMS profiles through menopause.
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