New data suggest that diabetes risk after menopause is driven by cardiometabolic factors rather than when or how menopause occurs.
Early and premature menopause have long been associated with elevated risks of cardiovascular disease, but a new large-scale analysis suggests that the timing or type of menopause does not independently increase the risk of developing diabetes. Findings from a UK Biobank cohort study were published online in Menopause, the journal of The Menopause Society.1
The investigators examined whether women who experienced menopause before age 45—including early menopause (ages 40–45) or premature menopause (before age 40)—were more likely to develop type 1 or type 2 diabetes compared with women who underwent menopause at a typical age. Although menopause is often accompanied by metabolic changes such as increased adiposity and insulin resistance, evidence linking menopausal timing to diabetes onset has remained limited and inconsistent.
To address this gap, researchers analyzed data from 146,764 women enrolled in the UK Biobank between 2006 and 2010, with follow-up through the end of 2023. The mean follow-up period was 14.5 years. Age at menopause was categorized as:
Surgical menopause was also evaluated alongside natural menopause. Survival models with a Weibull distribution were used to assess time to diabetes onset, adjusting for behavioral factors, comorbidities, and blood test results.
Over the course of follow-up, 6598 women developed diabetes, corresponding to a cumulative incidence of 4.5%. Crude incidence rates were higher among women with earlier menopause, increasing from 4.2% in those older than 45 years at menopause to 5.2% in those aged 40–45 years and 7.4% in those younger than 40 years. However, these differences did not persist after multivariate adjustment. Compared with women who experienced menopause after age 45, the adjusted hazard ratio for diabetes was 1.00 for early menopause and 0.97 for premature menopause, indicating no independent association. “Surgical menopause was likewise not associated with a greater risk of diabetes compared with natural menopause,” the authors stated.
Investigators stated these findings suggest that previously observed associations may be explained by confounding factors rather than a direct effect of menopausal timing. The Menopause Society emphasized that although diabetes incidence appeared higher in women with earlier menopause in unadjusted analyses, stating, “the significance disappeared in multivariate modeling,” in a press release, underscoring the importance of accounting for coexisting risk factors.2
Multiple factors were strongly associated with diabetes risk regardless of menopausal timing. A significantly higher incidence of diabetes was observed among women who smoked (7.5%), those with obesity (10.8%), women reporting no intake of vegetables (6.8%), those taking cholesterol-lowering medications (10.0%), and individuals with a high intake of added salt (7.0%).
More than 60% of women in the cohort were classified as overweight or obese, highlighting the contribution of cardiometabolic and lifestyle factors to diabetes risk in midlife and older women.
“The results of this study highlight that, although postmenopausal women are at increased risk for diabetes, it does not appear to be related to the age at menopause onset or whether menopause occurs naturally or due to surgery but rather to cardiovascular and lifestyle risk factors,” said Stephanie Faubion, MD, medical director for The Menopause Society, in a statement. “This is somewhat reassuring in that cardiovascular risk factors, such as hypertension and hyperlipidemia, can be controlled, and lifestyle factors, such as smoking, diet, and exercise are modifiable, whereas age at menopause is not.”
The authors cautioned that the observational design limits causal inference and called for further research to clarify pathways linking menopause, cardiometabolic health, and long-term disease risk.1
Still, the findings suggest that prevention strategies should focus less on menopausal timing and more on addressing established lifestyle and cardiovascular risk factors to reduce diabetes risk in postmenopausal women.
References:
1. Quesada JA, Bertomeu-Gonzalez V, Cordero A, et al. Timing and type of menopause are not risk factors for the onset of diabetes: a UK Biobank cohort study. Menopause. Published January 12, 2026. Accessed January 14, 2026. https://menopause.org/press-releases/diabetes-risk-not-associated-with-timing-or-type-of-menopause
2. Diabetes risk not associated with timing or type of menopause. The Menopause Society. Press release. Published January 12, 2026. Accessed January 14, 2026. https://menopause.org/press-releases/diabetes-risk-not-associated-with-timing-or-type-of-menopause
