A recent study, published in BMJ Nutrition Prevention and Health on December 5 revealed a concerning association between early menstruation in girls and the development of type 2 diabetes and stroke later in adulthood.
Researchers found that girls who experienced their first period before the age of 13 were at a heightened risk of developing type 2 diabetes in their adult years. Moreover, among women who did develop diabetes, there was a notable correlation between early menstruation and the occurrence of stroke before the age of 65, particularly for those who began menstruating at the age of 10 or younger.
Coauthor Sylvia Ley, PhD, RD, and assistant professor at Tulane University School of Public Health and Tropical Medicine in New Orleans, emphasized the significance of these findings, suggesting that women who start their periods at a very young age may face increased risks of diabetes and its complications during early adulthood and midlife.
Dr. Ley says, “These high-risk women may consider watching out for other early-onset metabolic risk factor changes, such as blood sugar levels, lipid profile [cholesterol and triglycerides], and blood pressure in early and middle adulthood.”
Dr. Yalda Afshar, MD, PhD, an assistant professor-in-residence of obstetrics and gynecology in the division of maternal and fetal medicine at UCLA Health in Los Angeles, echoed Ley’s sentiments, emphasizing the need for further research to explore the implications of these risks.
While the study highlights an association between early menstruation and subsequent health issues, including type 2 diabetes and stroke, it’s crucial to note that causation has not been established, explains Dr. Afshar, who was not involved in the study.
Nonetheless, these findings align with previous studies indicating that reproductive factors, such as the timing of menarche and menopause, can significantly impact long-term cardiometabolic health, she adds.
At What Age Do Most Girls Get Their First Menstruation?
The age of onset for the first menstrual period, known as menarche, typically falls between 10 and 10 and 16 years, with the average age in the United States being 11.9 years, explains a report from the Centers for Disease Control and Prevention (CDC) published in September 2020.
However, there has been an observed trend of girls starting their periods earlier, with the percentage of adolescents experiencing menarche before the age of 10 increasing from 7 percent in 1995 to 10 percent in 2013 through 2017, according to the report.
While the exact reasons for this trend remain unclear, factors such as increasing body fat, socioeconomic status, genetics, overall health, dietary habits, physical activity, and family size may all contribute to earlier onset menstruation.
Study One of the First to Include a Diversified Population of Women
Dr. Ley claims that the reasons for the study are the younger age of first periods — along with the rise of diabetes and diabetes complications in U.S. adults under 65 years old.
She says, “Age at menarche has been associated with higher risk of diabetes and with cardiovascular disease (CVD) independently, but it remains unclear whether age at menarche is a risk factor for CVD complications among younger women with diabetes.”
To investigate the relationship between early menarche and health outcomes, researchers analyzed data from approximately 17,000 women aged 20 to 65 years as part of the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2018. The participants included 19 percent Hispanic, 55 percent white, 20 percent black, and 6 percent other races.
According to the authors, the diversity of the study is an important factor, explaining that most of the existing studies that looked at earlier menstruation age, type 2 diabetes, heart disease complications were mostly seen in those with white American and European descent.
Higher Risks Linked to Women Who Had Early First Periods
As per the study, in total, 10.2 percent of the women had type 2 diabetes, of which 11.5 percent had cardiovascular disease, defined as either heart attack, coronary heart disease, or stroke.
As compared to those that got their first menstrual period at age 13, those that got their period at:
- 10 years or younger had a 32 percent increased risk of type 2 diabetes.
- 11 years had a 14 percent higher risk for type 2 diabetes.
- 12 years had a 29 percent higher risk for type 2 diabetes.
The findings were statistically adjusted to account for various factors including age, race and ethnicity, education, income, menopause status, family history of diabetes, smoking status, physical activity, alcohol consumption, and body mass index (BMI).
In women with diabetes, those who experienced their first menstrual period at age 10 or younger had over twice the risk of stroke (166 percent higher) compared to those who began menstruating at age 13, after accounting for these multiple variables.
However, there was no significant association found between early menstruation and coronary heart disease or overall cardiovascular disease in this group.
Likewise, among women with diabetes, the risk of stroke was elevated compared to those who had their first period at age 13, with the specific increases as follows:
- 81 percent higher for those with their first period at age 11
- 32 percent higher for those with their first period at age 12
- 15 percent higher for those with their first period at age 14
While the authors acknowledge that as an observational study, they didn’t prove that early first period causes the increased risks, but the findings do suggest that “earlier age at [first menstrual cycle] may be one of early life indicators of the cardiometabolic disease trajectory in women.”
Findings Highlight Need for More Heart Disease Risk Studies in Diverse Ethnic Female Groups
Executive director of the NNEdPro Global Centre for Nutrition and Health in Cambridge, England, Sumantra Ray, PhD, said in a press release, “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.”
“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,” said Dr. Ray.
Dr. Afshar also adds that identifying modifiable and nonmodifiable risk factors for diseases such as type 2 diabetes and heart disease can help public health officials and doctors optimize their interventions and keep women healthier.
What Impact Does the Onset Age of Menstruation Have on the Risk of Type 2 Diabetes or Stroke?
If a connection exists, one possible rationale is that women experiencing early menstruation are exposed to estrogen for extended durations, which has been linked to elevated estrogen levels explain the authors.
Furthermore, being overweight or obese might contribute. The authors observed a slight attenuation in the associations between the age of first menstruation and stroke complications after adjusting for weight, although these associations retained statistical significance.
This implies a potential role for body fat, considering that increased childhood levels of overweight and obesity correlate with earlier onset menstruation and subsequent cardiometabolic diseases later in life, they suggest.
Advice from Experts for Women at Higher Risk
Dr. Ley advises women who experienced early menstruation, particularly at age 10 or younger, to actively engage with their healthcare provider in discussing metabolic risk factors. They should monitor changes in blood sugar, cholesterol, triglyceride levels, and blood pressure during early and middle adulthood.
In addition, Dr. Afshar hopes that studies like this one will remove stigmas around talking about periods. “I hope that the findings become an impetus for reproductive-age people to discuss their menstrual histories with their physicians, early and openly,” she says.
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