Background: Type 1 diabetes mellitus (T1DM) is historically associated with perturbations of the hypothalamic-pituitary ovarian axis, leading to hypogonadism, amenorrhea and infertility. Given modern therapies and aims for tighter glycaemic control, few studies have re-evaluated reproductive abnormalities in T1DM.
Aims: To evaluate menstrual disturbance, contraceptive use and reproductive outcomes in women of reproductive age with T1DM, compared to age-matched women without T1DM.
Methods: A cross-sectional analysis was performed using data from the Australian Longitudinal Study in Women’s Health, a large community-based study. Women from two different age cohorts were included in this study: women aged 18-23 years old who participated in Survey 1 (2013) born between 1989-1995, and those aged 34-39 years old who responded to Survey 6 (2012) born between 1973-1978. Univariable analyses were performed, followed by multivariable logistic regression analyses adjusting for significant and clinically relevant covariates.
Results: A total of 23,752 women were included, comprising 162 women with self-reported T1DM and 23,590 non-diabetic, age-matched controls. There were no differences between mean age (25.3 vs. 25.8 years, p=0.37), body mass index (25.9 vs. 25.0 kg/m2, p=0.06) or age at menarche (12.8 vs. 12.8 years, p=0.59) between groups. Self-reported polycystic ovary syndrome was significantly higher in T1DM (14.2% vs 5.1%, p<0.001). Irregular menses (54.3% vs. 39.2%, p=0.008), menorrhagia (54.9% vs. 39.5%, p=0.006) and dysmenorrhea (58.0% vs. 40.7%, p=0.002) were more common in T1DM in univariable analyses. The increased risk of menstrual dysfunction persisted after adjustment for clinical and sociodemographic factors. No differences between modes of contraceptive use or pregnancy rates were observed between groups; however the adjusted risk of stillbirth was significantly higher in T1DM (OR 4.31, 95%CI 1.40-12.55, p<0.01).
Conclusions: Young women with T1DM are at increased risk of menstrual disturbance and adverse pregnancy outcomes. Screening for menstrual irregularities and pre-conception counselling in this cohort remains vital.