Menstruation at an earlier age can increase risk

The prevalence of type 2 diabetes and related complications is rising among younger people. At the same time, the age girls begin their first period is decreasing.

“Women with earlier ages at menarche have higher odds of having type 2 diabetes than those with age at menarche of 13 years. Among young and middle-aged women with diabetes, earlier age at menarche is associated with progression of disease to premature stroke. These findings support the possibility that age at menarche may be incorporated into early-life strategies for preventing diabetes and progression of diabetes complications,” the study authors noted.

Their research examined data as part of the National Health and Nutrition Examination Surve(NHANES), which spanned from 1999 to 2018.

More than 17,000 women between 20 and 65 were included in the study. Each of the women had reported when they had their first period. These responses were then categorized into 10 or younger, 11, 12, 13, 14, and 15 and older.

Researchers noted that 10% of the women in the study had been diagnosed with type 2 diabetes and 11% of those women had some form of cardiovascular disease.

The researchers reported that even after accounting for potential influential factors such as race, ethnicity, age, education, physical activity and weight, those who began periods before the age of 13 were at an increased risk of type 2 diabetes.

Those who had their first period at the age of 10 or younger had a 32% greater risk while those who had their first period at 11 had a 14% greater risk and those who had their first period at the age of 12 had a 29% greater risk.

After accounting for other potential influential factors, the researchers also found that the women studied with diabetes who were a young age at their first period had a heightened risk of stroke. That risk more than doubled for women below 65 who had diabetes and who had their first period at 10 or younger.

That risk then decreased with increasing age of a first period. The risk of stroke was 81% for those who had their first period at 11, 32% for those who began periods at 12, and 15% for those who began periods at 14.

Dr. Julie Quinlivan, PhD, an adjunct clinical professor at the Institute for Health Research at the University of Notre Dame Australia, said the results of the study aren’t surprising.

“The onset of puberty is directly related to weight and body mass and a hormone called leptin. And when children have an increased body weight, their levels of leptin change, and they go through puberty at an early age,” Dr. Quinlivan, who was not involved in the study, told Medical News Today.

“Going back to the turn of the last century, the 1900s, our children often had body masses between 17 and 23 and now, children’s body masses are considerably higher. And that is one of the leading drivers of early puberty. And that, in turn, is programming their body to high blood pressure, and diabetes and to a whole stack of vascular complications.”

— Dr. Julie Quinlivan, PhD

Periods will typically begin two years after breasts first begin to develop. This is known as thelarche or breast budding and is considered the onset of puberty.

Research suggests that this onset has decreased by about 3 months for every decade between 1977 to 2013. The age of menarche, or a first period, has also decreased.

“It’s crazy. Since I started practicing, it’s lowered over a year. It can’t be healthy and I don’t know if we really have a good explanation for it,” Dr. G. Thomas Ruiz, an OB-GYN Lead at MemorialCare Orange Coast Medical Center in California, who was not involved in the study, told MNT.

“With the onset of the production of estrogen, a young girl will start to develop her secondary sexual characteristics, the various stages of breast development, eventually, the ovaries will kick in and they’ll start to ovulate on a regular basis,” he said.

The estrogen that plays an important role in puberty may also offer some protective effect for the cardiovascular system.

“In terms of cholesterol metabolism, we describe good cholesterol and bad cholesterol. In the presence of estrogen, the good cholesterol is elevated, the bad cholesterol goes down. So a woman, generally speaking, has this cardio protective up until the time she goes into menopause.”

— Dr. G. Thomas Ruiz, OB-GYN

The study was observational and while it established an association between early menstruation and type 2 diabetes, experts emphasize this did not mean causation has been found.

“They describe an association, but we kind of have to be mindful and make sure we have some appropriate pause before we install concern and fear. But I do think it definitely leads the way that we should continue to look at underlying mechanism and biology,” Dr. Yalda Afshar, an assistant professor in-residence of obstetrics and gynecology at the University of California Los Angeles who was not involved in the study, told MNT.

“Overall, our understanding of basic women’s health and normal women physiology is completely understudied. It’s half the world’s population and we don’t even understand the basic biology. As we start understanding what is normal, we can start thinking about abnormal. So this is just the tip of the iceberg. And lots more work needs to be done in this realm.”

— Dr. Yalda Afshar