Cross-Sectional analysis of the association between type 2 diabetes and earlier onset of natural menopause in Syrian women.

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by hyperglycemia, represents a growing global health burden. Natural menopause in women is defined as continuous cessation of menstruation for more than twelve consecutive months, and it is an important determinant of their future health. The average age at natural menopause is around 51 years. Early menopause is defined as the onset of menopause between the ages of 40 and 45 years, while genetic and environmental factors influence menopause timing, evidence suggests T2DM may accelerate ovarian aging. The aim of this study is to explore the existence of a relationship between T2DM and the natural age of menopause in Syrian women-a population with unique genetic and lifestyle factors underrepresented in existing literature.

Methods: A cross-sectional study was conducted at Al-Mouwasat and National University Hospitals in Damascus, from 2022 to 2024. 175 naturally postmenopausal women aged over 45 years were included in the study, with participants stratified by T2DM status, which was confirmed either by an HbA1c level of ≥ 6.5% or a physician's diagnosis. The age at menopause was ascertained based on self-reported cessation of menses for at least 12 months, exclusion of surgical or iatrogenic menopause cases, and validation against medical records. Data were analyzed using SPSS 25.0 with multivariable linear regression (α = 0.05).

Results: The mean age at natural menopause did not differ significantly between women with and without T2DM (p = 0.099); key differences emerged in subgroup analyses. Women with T2DM demonstrated a 2.3-fold higher prevalence of early menopause (< 45 years) compared to non-diabetic counterparts (20.2% vs. 10.5%; p = 0.023). Notably, those with long-standing diabetes (> 10 years duration) experienced menopause ~ 2 years earlier than controls (p = 0.040). Furthermore, women with T2DM microvascular complications- specifically retinopathy (p = 0.044) and nephropathy (p = 0.000) - showed significantly earlier menopause compared to diabetes-free women.

Conclusions: T2DM itself was not associated with a significantly earlier average age at natural menopause in Syrian women, but specific aspects of T2DM were significantly linked to earlier menopause, which are longer disease duration (> 10 years), and presence of microvascular complications (retinopathy or nephropathy). Critically, women with T2DM had a significantly higher prevalence of early menopause, indicating a doubled risk compared to non-diabetic women.