Early-onset menstruation may signal future CVD, metabolic syndrome

Early-onset menstruation in women could be a red flag for an increased risk of cardiovascular disease and metabolic difficulties later in life, according to a report published in PLOS One.

A review of 1,413 women enrolled in the Western Australia Pregnancy Cohort (Raine) Study, a long-running project that’s collected information about these patients from before their birth through young adulthood, found women who started their periods in their preteen years were more prone to CVD and had a higher BMI, on average, than those who started their first period a few years later.

“Earlier onset of puberty and age at menarche have been linked to a broad range of adult chronic diseases, including cardiometabolic health in adulthood,” author Roger J. Hart, MD, and coauthors at the University of Western Australia wrote. “Earlier age at menarche has been associated with increased levels of risk factors for CVD including obesity and hypertension, left ventricular dysfunction, type 2 diabetes and the metabolic syndrome in adulthood.

"Moreover, there is evidence for a relation between menarche and morbidity from CVD, with results from meta-analysis suggesting an association between early menarche and higher CVD-related risk.”

But those analyses generally rely on self-reported information about menstruation, asking women to recall decades later the exact start date of their first period. The Raine Study recorded those events as they happened, increasing accuracy, and adjusted for drivers of menstruation like childhood BMI along with lifestyle factors like smoking.

Hart and colleagues considered 846 young women from the Raine Study whose age at first menstruation had been recorded. Around half underwent metabolic assessment at 17 years old, while the other half underwent assessment at 20.

The average age a Raine participant started her period was 12.7 years old, the authors reported. Each year later onset of menstruation was linked to a 0.75-unit reduction in BMI and an approximate 30 percent reduction in the odds of being in a high-risk metabolic cluster at 17 or 20 years of age, as well as a 40 percent reduction in the odds of developing metabolic syndrome at 20 years old.

“Importantly, our findings show these associations were largely accounted for by elevated BMI in childhood,” Hart et al. wrote, noting their results shouldn’t suggest that an early-onset period itself is responsible for an increased risk of CVD. The authors didn’t find any association between age at first menstruation and risk factors like blood pressure, fasting lipids, glucose, insulin and HOMA-IR at 17 and 20 years, meaning an elevated CVD risk is more likely attributable to a higher BMI at a young age.

Women’s smoking status, alcohol consumption, physical activity, birth control habits and socioeconomic status didn’t have any bearing on results.

“Our findings suggest that the association between early menarche and cardiometabolic risk factors is due to underlying childhood adiposity, suggesting that targeting childhood adiposity may increase both age at menarche and CV health later in life,” Hart and colleagues said. “For girls who experience menarche at a younger (primary school) age who have modifiable risk factors for CVD such as obesity, targeted interventions such as weight reduction may reduce the risk of CVD in later life.”