Women’s Health
Premenstrual syndrome and incident type 2 diabetes in a prospective study Aparna Tiwari* Aparna Tiwari Tiwari Tiwari Tiwari Tiwari Tiwari Tiwari Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA
Type 2 diabetes (T2D) prevalence is rising among women in the US. Women bear more severe consequences from T2D than men, making it a major public health concern. Premenstrual syndrome (PMS) is a reproductive disorder with heterogeneous physical and emotional symptoms occurring during the luteal phase of the menstrual cycle. Common physiological mechanisms appear to contribute to both PMS and T2D, including dysfunction of the stress response, renin-angiotensin-aldosterone system, and immune systems, which suggests that PMS may be an early marker of an elevated risk for developing T2D. We tested this hypothesis using prospective data from women enrolled in the Nurses’ Health Study II PMS Substudy who were 25-42 years of age at baseline. Participants included 1,257 women meeting validated criteria for incident moderate-to-severe PMS during follow-up (1991-2005) and 2,463 age-matched comparison women without PMS, assessed using a validated questionnaire based on the Calendar of Premenstrual Experiences. Women self-reported incident T2D diagnosed after PMS assessment until 2021, with diagnoses further confirmed using a supplemental questionnaire and standard criteria. Over 20-30 years of follow-up, 105 women with PMS and 140 without PMS reported T2D. Adjusting for age, race, childhood trauma, and time-varying covariates, including body mass index, smoking, physical activity, and alternative healthy eating index, women with PMS had a modest, non-significant higher risk of T2D (HR=1.18; 95% CI, 0.87, 1.60). Risk was significantly higher for T2D diagnosed at younger ages; PMS was associated with a 59% higher risk of T2D diagnosed before age 54, the median age at diagnosis in the cohort (HR=1.59; 95% CI, 1.04-2.41; p-for-interaction= 0.07). Our findings suggest that PMS may be a novel indicator of T2D risk in women, particularly for younger-onset T2D. This association should be assessed in other population-based prospective studies.