Starting to menstruate before age 13 linked with diabetes, stroke risk: BMJ Study

Starting to menstruate before turning 13 years old is linked to a heightened risk of developing type 2 diabetes in mid-life, a US research published in the British Medical Journal (BMJ) Nutrition Prevention & Health has found.

Further, having periods early in life, especially before 10 years of age, is also associated with an increased risk of getting a stroke before the age of 65 in those having diabetes, researchers found after analysing data of more than 17,000 women aged between 20 and 65.

The researchers from Tulane University and Brigham and Women’s Hospital in the US said that being an observational study, they couldn’t establish the causes behind these associations.

“Earlier age at [first menstrual cycle] may be one of early life indicators of the cardiometabolic disease trajectory in women,” they suggested in their study.

The women included in the study came from the nationally representative cross-sectional National Health and Nutrition Examination Survey 1999-2018. The women had specified the age at which they had had their first menstrual cycle.

Of the women studied, about 10 per cent, or 1773, reported a diagnosis of type 2 diabetes. Further, 11.5 per cent of these, or 203, reported some type of cardiovascular disease, the researchers found.

They quantified the increased risk of type 2 diabetes due to beginning to menstruate early in life as 32 per cent (periods at age 10 or before) through 14 per cent (age 11) to 29 per cent (age 12).

They also found that menstruating before turning 10 was linked with a more than doubling in stroke risk among women below the age of 65 with diabetes. Specifically, they calculated the risk to be 81 per cent among those having their first period at the age of 11, 32 per cent at 12, and 15 per cent at 14.

“One potential pathway explanation may be that [such] women are exposed to oestrogen for longer periods of time, and early [menstruation] has been associated with higher oestrogen levels,” the researchers explained.

They also said weight could be another important factor influencing the results, as when they adjusted the data for weight, the observed associations between age at first menstrual cycle and stroke complications weakened slightly, albeit remaining significant.

The researchers said that these findings supported the possibility that age of getting the first period may be incorporated into early-life strategies for preventing diabetes and progression of diabetes complications.

“These findings add another dimension to the potentially less well understood determinants of cardiometabolic risk, particularly in women who have been relatively underrepresented in this area of research,” said Sumantra Ray, Executive Director of the NNEdPro Global Centre for Nutrition & Health, which co-owns BMJ Nutrition Prevention & Health.

“And they provide a clear steer on the need to design interventional studies looking at the prevention of cardiometabolic disease in ethnically diverse groups of women who start menstruating at a young age,” he said.