Insulin resistance linked to abnormal uterine bleeding

Insulin resistance linked to abnormal uterine bleeding | Image Credit: © SecondSide - © SecondSide - stock.adobe.com.

There is a link between insulin resistance and abnormal uterine bleeding (AUB), according to a recent study published in Menopause, journal of The Menopause Society.¹

Link between insulin resistance and AUB

Approximately 30% of reproductive-aged women present with AUB, leading to over $34 billion in health care costs and significant adverse impacts on overall quality of life. This new data highlights shared risk factors of this condition with insulin resistance, indicating a potential link that may be used to improve prediction of AUB.

“These preliminary findings highlight the need for larger, longitudinal studies to confirm these relationships, identify causal mechanisms, and evaluate the potential of addressing hyperinsulinemia, being overweight, and obesity as part of prevention and treatment strategies for abnormal uterine bleeding,” said Stephanie Faubion, MD, MBA, medical director for The Menopause Society.

Assessing causes of AUB

The study was conducted to assess the link between fasting insulin and causes of AUB.² Participants included patients undergoing a cross-sectional evaluation of fasting insulin within the clinic system from June 2019 to August 2023. Assessments of triglycerides, high-density lipoprotein (HDL), and waist-hip ratio (WHR) were also performed.

An analysis was also conducted to evaluate the link between hyperinsulinemia and AUB. Patients aged 18 to 54 years with an AUB were compared to those with normal menses. Investigators determined AUB status and obtained blood samples in this population.

Exclusion criteria included gynecologic cancer history, prior hysterectomy, prior tamoxifen use, prior endometrial ablation, chronic steroid use, diabetes mellitus, pregnancy, and hormonal contraceptive use. Electronic medical records were assessed for demographic data, clinical characteristics, and variables.

Data collection and measurements

Investigators measured the height, weight, and WHR of participants. Fasting insulin level (FI) was determined from fasting blood samples, with a value of 10 μU/mL or higher indicating hyperinsulinemia.

There were 205 women included in the final analysis, 116 of whom had AUB and 89 had normal menstruation. Forty-two percent and 39%, respectively, were Hispanic, and median ages were 39 and 33 years, respectively. This indicated a significant increase in age among patients with AUB, which was considered a cofounder of AUB.

Similar WHRs were reported between study groups, at 0.86 in patients with AUB and 0.83 in those without AUB. Body mass indices were 29.9 and 24.8, respectively. Neither of these variables were identified as cofounders of AUB.

Cofounders of AUB

HDL, low-density lipoprotein (LDL), migraines, hypertension, smoking, and polyps or fibroids were all covariates significantly linked to AUB. LDL, triglycerides, and cholesterol levels did not significantly differ between groups.

Significant differences were observed for hypertension, HDL, migraines, and polyps or fibroids, with values of 26%, 54 mg/dL, and 45.7%, respectively, in the AUB group vs 12%, 60 mg/dL, and 9.6%, respectively, in the no AUB group.

Hyperinsulinemia was reported as the main variable of interest. This variable had a significant link with AUB and was reported in 44% of the AUB group and 33.7% of the no AUB group.

Confirming this link with statistical modelling

The Akaike Information Criterion (AIC) was used to evaluate models of AUB. When only included hyperinsulinemia, the AIC was 188. This was reduced to 145 when including age, race, LDL, and WHR. The impact of hyperinsulinemia became nonsignificant when adding body mass index, highlighting a potential overlap between these variables.

Overall, the final model had a reduction in AIC of 25.5% vs the base model. This highlighted a potential link between insulin resistance and AUB.

“This data, although preliminary, may demonstrate promise for future research in examining potential relationships between cardiovascular disease risk factors and the potential development of benign gynecologic disease,” wrote investigators.

References:

1. Abnormal uterine bleeding and insulin resistance are on the rise: Is there a connection? The Menopause Society. June 3, 2025. Accessed June 13, 2025. https://menopause.org/press-releases/abnormal-uterine-bleeding-and-insulin-resistance-are-on-the-rise-is-there-a-connection.
2. Salcedo AC, Fox L, De Los Santos G, Larson S, Yun J. The uterus is an end organ: a preliminary study of the association between abnormal uterine bleeding and hyperinsulinemia. Menopause. 2025;32(8). doi:10.1097/GME.0000000000002548