Long or Highly Irregular Menstrual Cycles as a Marker for Risk of Type 2 Diabetes Mellitus
Abstract
CONTEXT: Although oligomenorrhea has been associated cross-sectionally with insulin resistance and glucose intolerance, it is not known whether oligomenorrhea is a marker for increased future risk of type 2 diabetes mellitus (DM). OBJECTIVE: To prospectively assess risk of type 2 DM in women with a history of long or highly irregular menstrual cycles. DESIGN AND SETTING: The Nurses' Health Study II, a prospective observational cohort study. PARTICIPANTS: A total of 101 073 women who had no prior history of DM and who reported their usual menstrual cycle pattern at age 18 to 22 years on the baseline (1989) questionnaire. MAIN OUTCOME MEASURE: Incident reports of DM, with follow-up through 1997, compared among women categorized by menstrual cycle length (5 categories). RESULTS: During 564 333 person-years of follow-up, there were 507 cases of type 2 DM. Compared with women with a usual cycle length of 26 to 31 days (referent category) at age 18 to 22 years, the relative risk (RR) of type 2 DM among women with a menstrual cycle length that was 40 days or more or was too irregular to estimate was 2.08 (95% confidence interval [CI], 1.62-2.66), adjusting for body mass index at age 18 years and several other potential confounding variables. The RR of type 2 DM associated with long or highly irregular menstrual cycles was greater in obese women, but was also increased in nonobese women (at body mass indexes at age 18 years of <25, 25-29, and >/=30 kg/m, RRs were 1.67 [95% CI, 1.14-2.45], 1.74 [95% CI, 1.07-2.82], and 3.86 [95% CI, 2.33-6.38], respectively). CONCLUSION: Women with long or highly irregular menstrual cycles have a significantly increased risk for developing type 2 DM that is not completely explained by obesity.
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PCOS is associated with a two times increased risk for type 2 diabetes.
“For this reason, PCOS is associated with a two times increased risk for type 2 diabetes (T2D) [15].”
From From Prediabetes to Type 2 Diabetes Mellitus in Women with Polycystic Ovary Syndrome: Lifestyle and Pharmacological Management (2020) · cites this paper as [15]
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“In the Nurses’ Health Study, the risk of development of diabetes was increased two-fold among women with long or irregular menstrual cycles, including the nonobese women (39).”
BackgroundPolycystic Ovary Syndrome and Risk for Long-Term Diabetes and Dyslipidemia
Wang, E. T., Calderon-Margalit, R., Cedars, M. I., Daviglus, M. L., Merkin, S. S., Schreiner, P. J., Sternfeld, B., Wellons, M., Schwartz, S. M., Lewis, C. E., et al. (2011) · Obstetrics & Gynecology · doi:10.1097/aog.0b013e31820209bb · Cited by 146 · see citing works
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Taponen, S., Martikainen, H. K., Järvelin, M., Sovio, U., Laitinen, J. H., Pouta, A. M., Hartikainen, A., McCarthy, M. I., Franks, S., Paldanius, M., et al. (2004) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-031720 · Cited by 111 · see citing works
The Utility of Menstrual Cycle Length as an Indicator of Cumulative Hormonal Exposure
Mumford, S. L., Steiner, A. Z., Pollack, A. Z., Perkins, N. J., Filiberto, A. C., Albert, P. S., Mattison, D. R., Wactawski‐Wende, J., & Schisterman, E. F. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2012-1350 · Cited by 109 · see citing works
Searching for polycystic ovary syndrome in postmenopausal women
Krentz, A. J., von Mühlen, D. G., & Barrett-Connor, E. L. (2007) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0b013e31802cc7ab · Cited by 108 · see citing works
“irregular menses predicts the development of both CVD(62) and diabetes.(63) A recent cross-sectional study from Finland reported that premenopausal women”
BackgroundMenstrual Bleeding Patterns Among Regularly Menstruating Women
Dasharathy, S. S., Mumford, S. L., Pollack, A. Z., Perkins, N. J., Mattison, D. R., Wactawski‐Wende, J., & Schisterman, E. F. (2012) · American Journal of Epidemiology · doi:10.1093/aje/kwr356 · Cited by 107 · see citing works
“Our findings provide a baseline for women and medical professionals when considering abnormalities in bleeding patterns in regularly menstruating women and suggest that detailed characterizations of bleeding patterns may provide noninvasive markers for endocrine status in a given cycle, which could be associated with…”
BackgroundCobin, R. H., Futterweit, W., Nestler, J. E., Reaven, G. M., Jellinger, P. S., Handelsman, Y., Redmond, G. P., & Thatcher, S. S. (2005) · Endocrine Practice · doi:10.4158/ep.11.2.125 · Cited by 104 · see citing works
Li, K., Urteaga, I., Wiggins, C. H., Druet, A., Shea, A. A., Vitzthum, V. J., & Elhadad, N. (2020) · npj Digital Medicine · doi:10.1038/s41746-020-0269-8 · Cited by 100 · see citing works
Sam, S., Legro, R. S., Essah, P. A., Apridonidze, T., & Dunaif, A. E. (2006) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0602025103 · Cited by 96 · see citing works
LeBlanc, E. S., Kapphahn, K., Hedlin, H., Desai, M., Parikh, N. I., Liu, S., Parker, D. R., Anderson, M. L., Aroda, V. R., Sullivan, S. D., et al. (2016) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000000714 · Cited by 95 · see citing works
Gender-related hormonal risk factors for oral cancer
Suba, Z. (2007) · Pathology & Oncology Research · doi:10.1007/bf02893499 · Cited by 94 · see citing works
Menstrual Cycle Irregularity and Metabolic Disorders: A Population-Based Prospective Study
Dovom, M. R., Tehrani, F. R., Djalalinia, S., Cheraghi, L., Behboudi‐Gandevani, S., & Azizi, F. (2016) · PLoS ONE · doi:10.1371/journal.pone.0168402 · Cited by 90 · see citing works
Menstrual irregularity and asthma and lung function
Real, F. G., Svanes, C., Omenaas, E. R., Antó, J. M., Plana, E., Janson, C., Jarvis, D., Zemp, E., Wjst, M., Leynaert, B., et al. (2007) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2007.04.041 · Cited by 90 · see citing works
Merz, C. N. B., Shaw, L. J., Azziz, R., Stanczyk, F. Z., Sopko, G., Braunstein, G. D., Kelsey, S. F., Kip, K. E., Cooper-DeHoff, R. M., Johnson, B. D., et al. (2016) · Journal of Women's Health · doi:10.1089/jwh.2015.5441 · Cited by 87 · see citing works
“%) were postmenopausal, nonhormone therapy and nonoral contraceptive users, who could be classified for clinical features of PCOS.”
BackgroundInfluentialLongterm management of Polycystic Ovarian Syndrome (PCOS)
Bates, G. W., & Legro, R. S. (2013) · Molecular and Cellular Endocrinology · doi:10.1016/j.mce.2012.10.029 · Cited by 106 · see citing works
“The second iteration of the Nurses Health Study demonstrated that women who reported long or irregular cycles between 18 and 22 years of age were twice as likely to subsequently develop diabetes even when controlling for obesity (Solomon et al., 2001).”
Insulin resistance of pregnancy involves estrogen-induced repression of muscle GLUT4
Barros, R. P. A., Morani, A., Moriscot, A. S., & Machado, U. F. (2008) · Molecular and Cellular Endocrinology · doi:10.1016/j.mce.2008.07.008 · Cited by 84 · see citing works
“…be involved in the gestational-induced insulin resistance, since other41 conditions characterized by elevated levels of estrogen are also accompanied by insulin 42 resistance (Solomon et al., 2001, Okuno et al., 1995, Livingstone and Collison, 2002, Kaaja 43 and Greer, 2005, Dunaif et al., 1989).”
BackgroundWang, Y., Shan, Z., Arvizu, M., Pan, A., Manson, J. E., Missmer, S. A., Sun, Q., & Chavarro, J. E. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.27928 · Cited by 83 · see citing works
Bloomgarden, Z. T. (2003) · Diabetes Care · doi:10.2337/diacare.26.4.1297 · Cited by 81 · see citing works
Association between sleep duration and menstrual cycle irregularity in Korean female adolescents
Nam, G. E., Han, K., & Lee, G. (2017) · Sleep Medicine · doi:10.1016/j.sleep.2017.04.009 · Cited by 80 · see citing works
The Severity of Menstrual Dysfunction as a Predictor of Insulin Resistance in PCOS
Brower, M. A., Brennan, K., Pall, M., & Azziz, R. (2013) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-2815 · Cited by 79 · see citing works
The hypothalamus–pituitary–ovary axis and type 1 diabetes mellitus: a mini review
Arrais, R. F., & Dib, S. A. (2005) · Human Reproduction · doi:10.1093/humrep/dei353 · Cited by 79 · see citing works
“…as a possible indicator for predicting the risk of glucose intolerance or of the development of T2DM (Pulido and Salazar, 1999; Cooper et al., 2000; Solomon et al., 2001) within the general population and especially in high-risk groups such as the Pima Indian women of Arizona (Roumain et al.,…”
InfluentialDefinitions of the Insulin Resistance Syndrome
Bloomgarden, Z. T. (2004) · Diabetes Care · doi:10.2337/diacare.27.3.824 · Cited by 78 · see citing works
“Women with PCOS have 30 and 10% prevalence of impaired glucose tolerance and diabetes, respectively (22), and in the Nurses’ Health Study (NHS) of 101,073 women followed for 8 years, oligomenorrheic women had a twofold higher rate of conversion to type 2 diabetes (23).”
BackgroundRacial and Ethnic Differences in Physiology and Clinical Symptoms of Polycystic Ovary Syndrome
Wang, S.-P., & Alvero, R. J. (2013) · Seminars in Reproductive Medicine · doi:10.1055/s-0033-1348895 · Cited by 74 · see citing works
Menses resumption after cancer treatment–induced amenorrhea occurs early or not at all
Jacobson, M. H., Mertens, A. C., Spencer, J. B., Manatunga, A. K., & Howards, P. P. (2015) · Fertility and Sterility · doi:10.1016/j.fertnstert.2015.11.020 · Cited by 75 · see citing works
“Further, it may serve as a marker for more than just reproductive health (3); recent literature suggests that menstrual function patterns are linked to bone fracture and osteoporosis (8, 9), cardiovascular disease (10, 11) and mortality (12), breast (13) and ovarian cancer (14), diabetes mellitus (15, 16), and decreas…”
BackgroundAssociation of asthma and hay fever with irregular menstruation
Svanes, C. (2005) · Thorax · doi:10.1136/thx.2004.032615 · Cited by 74 · see citing works
Retarding the progression of renal disease
Brenner, B. M. (2003) · Kidney International · doi:10.1046/j.1523-1755.2003.t01-2-00052.x · Cited by 74 · see citing works
Yu, M., Han, K., & Nam, G. E. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.11.036 · Cited by 73 · see citing works
“…health; women with this condition could experience serious health outcomes, such as breast cancer (Harlow and Ephross, 1995), type 2 diabetes (Solomon et al., 2001), cardiovascular disease (Solomon et al., 2002), osteoporosis (Kaplan and Manuck, 2004), and infertility (Klemetti et al.,…”
Timing of Menopause and Patterns of Menstrual Bleeding
Weinstein, M. (2003) · American Journal of Epidemiology · doi:10.1093/aje/kwg223 · Cited by 67 · see citing works
Tomlinson, J., Millward, A., Stenhouse, E., & Pinkney, J. (2010) · Diabetic Medicine · doi:10.1111/j.1464-5491.2010.02994.x · Cited by 66 · see citing works
Key Developments in Endocrine Disrupter Research and Human Health
Phillips, K. P., & Foster, W. G. (2008) · Journal of Toxicology and Environmental Health Part B · doi:10.1080/10937400701876194 · Cited by 67 · see citing works
“A role for sex steroids, including estrogens, in glucose homeostasis was suggested by both normal physiology (menstrual cycle [Case & Reid, 2001; Solomon et al., 2001], pregnancy [Okuno et al., 1995; Kaaja and Greer, 2005]) and pathological conditions, including gestational diabetes mellitus…”
BackgroundCardiometabolic Risk in PCOS: More than a Reproductive Disorder
Torchen, L. C. (2017) · Current Diabetes Reports · doi:10.1007/s11892-017-0956-2 · Cited by 65 · see citing works
Palm-Fischbacher, S., & Ehlert, U. (2014) · Journal of Psychosomatic Obstetrics & Gynecology · doi:10.3109/0167482x.2014.912209 · Cited by 67 · see citing works
Sharma, S. T., & Nestler, J. E. (2006) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2006.02.003 · Cited by 64 · see citing works
Flannery, C. A., Rackow, B., Cong, X., Duran, E., Selen, D. J., & Burgert, T. S. (2013) · Pediatric Diabetes · doi:10.1111/j.1399-5448.2012.00902.x · Cited by 62 · see citing works
Glueck, C. J., Morrison, J. A., Daniels, S., Wang, P., & Stroop, D. (2011) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2011.01.018 · Cited by 63 · see citing works
Glucose intolerance states in women with the polycystic ovary syndrome
Pasquali, R., & Gambineri, A. (2013) · Journal of Endocrinological Investigation · doi:10.1007/bf03346757 · Cited by 63 · see citing works
“In the Nurses Health Study II (14), the risk for T2D was significantly increased in women with menstrual irregularities, even after adjusting for multiple confounders [relative risk 1.”
Whitworth, K. W., Baird, D. D., Stene, L. C., Skjærven, R., & Longnecker, M. P. (2010) · Diabetologia · doi:10.1007/s00125-010-2003-6 · Cited by 63 · see citing works
“However, the Nurses’ Health Study reported an increased risk of developing type 2 diabetes among women with long cycles (RR 2.0 [95% CI 1.6–2.7]) or very irregular cycles (RR 1.5 [95% CI 1.3–1.8]) [ 4 ].”
InfluentialGaete, X., Vivanco, M., Eyzaguirre, F. C., López, P., Rhumie, H. K., Unanue, N., & Codner, E. (2010) · Fertility and Sterility · doi:10.1016/j.fertnstert.2009.08.039 · Cited by 73 · see citing works
History of infertility and risk of type 2 diabetes mellitus: a prospective cohort study
Tobias, D. K., Gaskins, A. J., Missmer, S. A., Hu, F. B., Manson, J. E., Louis, G. M. B., Zhang, C., & Chavarro, J. E. (2015) · Diabetologia · doi:10.1007/s00125-015-3493-z · Cited by 62 · see citing works
“However, in support of a role for PCOS in the observed association, long and irregular menstrual cycles (a manifestation of PCOS) were previously linked to a higher risk of type 2 diabetes in this cohort [36].”
BackgroundAssociations Between Psychiatric Disorders and Menstrual Cycle Characteristics
Barron, M. L., Flick, L. H., Cook, C. A. L., Homan, S. M., & Campbell, C. R. (2008) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2007.11.001 · Cited by 60 · see citing works
“…cycle patterns can have a direct influence on physical well-being, including ovarian function, pregnancy maintenance, cardiovascular disease, migraine headaches, diabetes mellitus, and breast cancer (Solomon et al., 2002; Solomon et al, 2001; Terry, Willett, RichEdwards, Hunter & Michels, 2005).”
BackgroundTreatment of polycystic ovary syndrome with insulin-lowering agents
Wang, P., Streicher, P., & Glueck, C. J. (2002) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.3.8.1177 · Cited by 62 · see citing works
“In Type 2 diabetes, 82% of women have polycystic ovaries on ultrasound [84] and 27% of women with Type 2 diabetes have been shown to have PCOS [85].”
BackgroundMental health, psychotropic medication use, and menstrual cycle characteristics
Nillni, Y. I., Wesselink, A. K., Hatch, E. E., Mikkelsen, E. M., Gradus, J. L., Rothman, K. J., & Wise, L. A. (2018) · Clinical Epidemiology · doi:10.2147/clep.s152131 · Cited by 61 · see citing works
Insulin-sensitizing agents: use in pregnancy and as therapy in polycystic ovary syndrome
Checa, M. Á., Requena, A., Salvador, C., Tur, R., Callejo, J., Espinós, J. J., Fábregues, F., Herrero, J. C., & (Reproductive Endocrinology Interest Group of the Spanish Society of Fertility) (2005) · Human Reproduction Update · doi:10.1093/humupd/dmi015 · Cited by 60 · see citing works
“mellitus in women with PCOS may be independent of obesity (Solomon et al., 2001).”
BackgroundPolycystic ovary syndrome and reproductive health of women: a curious association
Zehravi, M., Maqbool, M., & Ara, I. (2021) · International Journal of Adolescent Medicine and Health · doi:10.1515/ijamh-2021-0031 · Cited by 61 · see citing works
Reproductive risk factors across the female lifecourse and later metabolic health
Nichols, A. R., Chavarro, J. E., & Oken, E. (2024) · Cell Metabolism · doi:10.1016/j.cmet.2024.01.002 · Cited by 59 · see citing works
Insulin resistance in patients with polycystic ovary syndrome
Schröder, A. K., Tauchert, S., Ortmann, O., Diedrich, K., & Weiss, J. M. (2004) · Annals of Medicine · doi:10.1080/07853890410035296 · Cited by 59 · see citing works
Effect of Air Pollution on Menstrual Cycle Length—A Prognostic Factor of Women’s Reproductive Health
Merklinger-Gruchała, A., Grazyna Jasienska, A., & Kapiszewska, M. (2017) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph14070816 · Cited by 58 · see citing works
“Identifying environmental factors affecting menstrual cycle and phase-length is vital from the perspective of public health, because it may have important implications for population health, namely infertility, reproductive cancers [26,27], osteoporosis [28], and metabolic disorders [29,30].”
BackgroundApoptotic Markers Indicate Nonalcoholic Steatohepatitis in Polycystic Ovary Syndrome
Tan, S., Bechmann, L. P., Benson, S., Dietz, T., Eichner, S., Hahn, S., Janssen, O. E., Lahner, H., Gerken, G., Mann, K., et al. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2009-1834 · Cited by 58 · see citing works
- Authors
- Solomon, C. G.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- Solomon, Caren G.
- ORCID
- Solomon, Caren G.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2001-11-21
- Volume
- 286
- Issue
- 19
- Pages
- 2421
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2043815784
- Cited by
- 362
- References
- 31
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 11 · 2023: 15 · 2022: 25 · 2021: 23 · 2020: 12 · 2019: 6 · 2018: 15 · 2017: 15 · 2016: 13 · 2015: 14 · 2014: 9 · 2013: 15 · 2012: 23
- FWCI
- 17.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (CA50385, R01CA050385)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Reproductive Medicine › Hypothalamic control of reproductive hormones
- Keywords
- type 2 diabetes, menstrual cycle length, oligomenorrhea, menstrual irregularity, diabetes risk, obesity, insulin resistance, impaired glucose tolerance, women's health, Nurses' Health Study II
- MeSH terms
- Adult, Diabetes Mellitus, Type 2, Female, Humans, Menstrual Cycle, Obesity, Oligomenorrhea, Prospective Studies, Regression Analysis, Risk Factors, Body Mass Index
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