Abstract
Context: Metabolic health impacts the menopausal transition. Metabolic characteristics like body mass index (BMI) affect vasomotor syndrome incidence, but the role of elevated insulin, an early marker of metabolic dysfunction, remains understudied.
Objective: To determine whether midlife insulin levels are associated with vasomotor symptom incidence or reproductive hormone trajectories.
Methods: Longitudinal analyses of community-based data from the Study of Women's Health Across the Nation (SWAN) were conducted. We analyzed the 704 SWAN participants (of 3302) without oophorectomy or hysterectomy who had metabolic data for age 47 and did not take insulin/medications for hyperglycemia. Mean fasting insulin at 47 was 10.117 µIU/mL (SD = 6.711), with 27.0 kg/m2 BMI (SD = 6.6); mean age of final menstrual period for these participants was 51.0 years (SD = 2.3). Main outcome measures included vasomotor symptom timings and durations, and trajectories of estradiol, follicle-stimulating hormone (FSH), and testosterone across the menopausal transition.
Results: Higher insulin at 47 predicted younger onsets of hot flashes and night sweats, longer durations of hot flashes and cold sweats, and greater testosterone rise. BMI associations with vasomotor symptoms paralleled those of insulin, but BMI appeared more closely linked to slower estradiol decline and blunted FSH rise. In Cox proportional hazards models, elevated age-47 insulin was associated with increased likelihood of hot flashes; this remained significant with BMI and glucose as covariates.
Conclusions: Perimenopausal fasting insulin and BMI show complementary but distinct associations with menopausal changes. Elevated insulin predicts earlier and prolonged vasomotor symptoms, and is associated with higher testosterone.
Objective: To determine whether midlife insulin levels are associated with vasomotor symptom incidence or reproductive hormone trajectories.
Methods: Longitudinal analyses of community-based data from the Study of Women's Health Across the Nation (SWAN) were conducted. We analyzed the 704 SWAN participants (of 3302) without oophorectomy or hysterectomy who had metabolic data for age 47 and did not take insulin/medications for hyperglycemia. Mean fasting insulin at 47 was 10.117 µIU/mL (SD = 6.711), with 27.0 kg/m2 BMI (SD = 6.6); mean age of final menstrual period for these participants was 51.0 years (SD = 2.3). Main outcome measures included vasomotor symptom timings and durations, and trajectories of estradiol, follicle-stimulating hormone (FSH), and testosterone across the menopausal transition.
Results: Higher insulin at 47 predicted younger onsets of hot flashes and night sweats, longer durations of hot flashes and cold sweats, and greater testosterone rise. BMI associations with vasomotor symptoms paralleled those of insulin, but BMI appeared more closely linked to slower estradiol decline and blunted FSH rise. In Cox proportional hazards models, elevated age-47 insulin was associated with increased likelihood of hot flashes; this remained significant with BMI and glucose as covariates.
Conclusions: Perimenopausal fasting insulin and BMI show complementary but distinct associations with menopausal changes. Elevated insulin predicts earlier and prolonged vasomotor symptoms, and is associated with higher testosterone.
| Original language | English |
|---|---|
| Article number | dgaf699 |
| Pages (from-to) | 1-10 |
| Number of pages | 10 |
| Journal | Journal of Clinical Endocrinology & Metabolism |
| Volume | Advance Article |
| Early online date | 6 Jan 2026 |
| DOIs | |
| Publication status | E-pub ahead of print - 6 Jan 2026 |
Keywords
- Hot flashes
- Hyperinsulinemia
- Study of Women’s Health Across the Nation (SWAN)
- Climacteric
- Androgen
- Insulin resistance