Associations of Menstrual Cycle Characteristics Across the Reproductive Life Span and Lifestyle Factors With Risk of Type 2 Diabetes | Lifestyle Behaviors | JAMA Network Open | JAMA Network
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    1 Comment for this article
    Consequences are not causes. Irregular cycles and Insulin Resistance are consequences of abnormal weight gain.
    Pandiyan Natarajan, MBBS, DGO, MD, MNAMS, FARM | Professor and Head of the department of Andrology and Reproductive Medicine, Chettinad Super Speciality Hospital, Rajiv Gandhi Salai, Kelambakkam, Chennai, Tamil Nadu, India, 603103
    Overweight and obesity are well established causes of insulin resistance, PCOS, type 2 diabetes mellitus and the metabolic syndrome. Ninety percent of patients with type 2 diabetes are obese or overweight. In the United States, more than half of the patients with PCOS are either overweight or obese.(1) Normal weight and thin individuals may also develop these conditions if they have had significant weight gain since puberty or in adulthood, even if their weight is still in the so called ‘normal BMI range.’ The natural history of PCOS is a progression from anovulation, i0rregular cycles to the classical stigmata of PCOS. Weight gain is the precipitating factor regardless of BMI.(2) Any post pubertal weight gain, other than due to pregnancy or body building, may lead to PCOS. When growth in the Y axis has stopped, growth in the X axis (weight gain) will lead to consequences. Irregular cycle is one of the earliest sign/symptom of abnormal weight gain. Oligo ovulation or anovulation and consequent irregular cycles are the outcome.

    We now believe that ‘abnormal weight gain’ is the primary pathology leading to PCOS and the other cascade of events. (2, 3). The other events like insulin resistance, menstrual irregularities, PCOS and metabolic syndromes are the consequences of this ‘abnormal weight gain, and likely not the cause of the ensuing clinical pictures.

    It may be a leap implicate menstrual irregularities in the causation of type 2 diabetes. Both conditions have a common origin- abnormal weight gain- and are unlike to be causally related.

    1) Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO 2004 The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 89:2745–2749

    2) Puvithra T and Pandiyan N Is Weight Gain the Precipitating Factor for Polycystic Ovarian Syndrome? A Hypothesis Based on a Retrospective Study. Chettinad Health City Medical Journal 2015; 4(3): 120 - 124.

    3) Puvithra.T and N.Pandiyan Polycystic Ovary Syndrome is an Epiphenomenon - An Opinion Chettinad Health City Medical Journal 2016; 5(3): 106 - 107
    Original Investigation
    Diabetes and Endocrinology
    December 21, 2020

    Associations of Menstrual Cycle Characteristics Across the Reproductive Life Span and Lifestyle Factors With Risk of Type 2 Diabetes

    Author Affiliations
    • 1Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
    • 2Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
    • 3Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
    • 4Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
    • 5Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
    • 6Department of Obstetrics and Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids
    JAMA Netw Open. 2020;3(12):e2027928. doi:10.1001/jamanetworkopen.2020.27928
    Key Points

    Question  Are irregular or long menstrual cycles and unhealthy lifestyle factors jointly associated with type 2 diabetes?

    Findings  In this prospective cohort study of 75 546 women, irregular and long menstrual cycles across the reproductive life span were associated with a greater risk of type 2 diabetes. These associations were stronger among women with overweight or obesity, low-quality diet, and low levels of physical activity.

    Meaning  These findings suggest that menstrual cycle characteristics may serve as an early sign of the long-term risk of developing type 2 diabetes and that lifestyle interventions may be a useful strategy to reduce the risk of type 2 diabetes among women with menstrual cycle dysfunction.


    Importance  Menstrual cycle dysfunction is associated with insulin resistance, a key feature early in the pathogenesis of type 2 diabetes. However, the evidence linking irregular and long menstrual cycles with type 2 diabetes is scarce and inconsistent.

    Objectives  To evaluate the associations between menstrual cycle characteristics at different points throughout a woman’s reproductive life span and risk of type 2 diabetes and the extent to which this association is modified by lifestyle factors.

    Design, Setting, and Participants  This prospective cohort study included 75 546 premenopausal US female nurses participating in the Nurses’ Health Study II from 1993 to June 30, 2017. Data analysis was performed from February 1 to December 30, 2019.

    Exposures  Self-reported usual length and regularity of menstrual cycles at the age ranges of 14 to 17 years, 18 to 22 years, and 29 to 46 years.

    Main Outcomes and Measures  Incident type 2 diabetes identified through self-report and confirmed by validated supplemental questionnaires.

    Results  Among the 75 546 women in the study at baseline, the mean (SD) age was 37.9 (4.6) years (range, 29.0-46.0 years). A total of 5608 participants (7.4%) had documented new cases of type 2 diabetes during 1 639 485 person-years of follow-up. After adjustment for potential confounders, women reporting always having irregular menstrual cycles between the age ranges of 14 to 17 years, 18 to 22 years, and 29 to 46 years were, respectively, 32% (95% CI, 22%-44%), 41% (95% CI, 23%-62%), and 66% (95% CI, 49%-84%) more likely to develop type 2 diabetes than women reporting very regular cycles (within 3-4 days of expected period) in the same age range. Similarly, women reporting a usual cycle length of 40 days or more between the age ranges of 18 to 22 years and 29 to 46 years were, respectively, 37% (95% CI, 19%-57%) and 50% (95% CI, 36%-65%) more likely to develop type 2 diabetes during follow-up compared with women reporting a usual cycle length of 26 to 31 days in the same age ranges. These associations appeared to be stronger among women with overweight or obesity, a low-quality diet, and low levels of physical activity. The relative excess risk of type 2 diabetes due to the interaction between irregular and long menstrual cycles and the overall unhealthy lifestyle score was 0.73 (95% CI, 0.57-0.89) and 0.68 (95% CI, 0.54-0.83), respectively.

    Conclusions and Relevance  In this cohort study of US female nurses participating in the Nurses’ Health Study II, irregular and long menstrual cycles throughout life were associated with a greater risk of type 2 diabetes, particularly among women with overweight or obesity, a low-quality diet, and low levels of physical activity.