Görker SEL, Hasan ULUBAŞ, Banuhan ŞAHİN, Canan SOYER ÇALIŞKAN, Samettin ÇELİK

Menopoz Tipi ve Süresinin Postmenopozal Kadınlarda Pre-Diyabet ve Diyabet Gelişimine Etkisi

Amaç: Menopozal başlangıç kadınların hayat kalitesini belirleyen önemli faktörlerden biridir. Bu çalışmanın amacı postmenopozal kadınlarda doğal veya cerrahi menopozlu olmanın, menopozal sürenin ve serum gonadotropin düzeylerinin pre-diyabet (pre-DM) ve diyabet (DM) gelişimi üzerine etkisini incelemektir. Gereç ve Yöntemler: Bu retrospektif olgu kontrol çalışmasına 140 pre-DM, 148 DM postmenopozal kadın ile 265 sağlıklı postmenopozal kadın dâhil edildi. Grupların menapoz tipi, süresi ve serum folikül stimüle edici hormon (FSH), luteinize edici hormon (LH) ve östradiol (E2) serum düzeyleri karşılaştırıldı. İstatistiksel değerlendirmede ANOVA ve Kruskal Wallis Testi kullanıldı. Bulgular: Doğal ya da cerrahi menopozlu olmanın pre-DM veya DM gelişimleri üzerine etkisi bulunmadı (p=0,393). Artmış menopoz süresi en fazla DM’li kadınlarda görüldü ve kontrollere göre farklılık istatistiksel olarak anlamlı bulundu (p=0,019). DM grubunda düşük serum FSH ve LH düzeyleri ile yüksek serum E2 düzeyleri gözlendi ve aradaki fark kontrol grubuna göre anlamlıydı (sırasıyla, p=0,001, p=0,001ve p=0,012). Sonuç: Cerrahi veya doğal yolla menopoza başlangıç yapmak kadınlarda gelişebilecek pre-DM ve DM oluşumunu etkilememektedir. DM’li kadınların menapozal süresi daha uzundur. DM öncesi ve DM’li kadınlar daha düşük serum FSH ve LH ve daha yüksek serum E2 düzeylerine sahiptir. Bu durum kısmen adiposite ve insulin direnci ile açıklanabilir.

Anahtar Kelimeler:

cerrahi menopoz, diyabet, doğal menopoz, pre-diyabet

The Impact of the type of Menopause and Menopausal Duration on the Development of Pre-Diabetes Mellitus and Diabetes Mellitus in Postmenopausal Women

Aim: The onset of menopause is an important factor determining quality of life in females. The aim of this study was to evaluate the effect of natural or surgical menopause, the duration of the menopausal period, and serum gonadotropin levels on the development of pre-diabetes mellitus (pre-DM) and diabetes mellitus (DM) in postmenopausal women. Material and Methods: This retrospective study included 140 postmenopausal women with pre-DM, 148 postmenopausal women with DM and 265 healthy postmenopausal women. The groups were compared in respect of menopause type, the duration of the menopausal period, and serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) levels. Statistical evaluations were made. Results: There was found to be no significant effect of natural or surgical menopause on the development of pre-DM or DM (p=0.393). Increased duration of menopause was mostly seen in women with DM and the difference was statistically significant compared to the controls (p=0.019). Serum decreased FSH and LH levels and increased E2 level were observed in the DM group and the difference was significant compared to the control group (respectively, p=0.001, p=0.001 and p=0.012). Conclusion: The onset of natural or surgical menopause does not affect the development of pre-DM and DM. Women with DM have a longer menopausal period. Women with pre-DM and DM have lower serum FSH and LH levels and higher serum E2 levels. This can be explained in part by adiposity and insulin resistance.

Keywords:

diabetes mellitus, natural menopause, pre-diabetes mellitus, surgical menopause,

PDF

___

Referans 1. Mishra G, Kuh D. Perceived change in quality of life during the menopause. Soc Sci Med 2006; 62: 93-102. Referans 2. Cheung E, Tsang S, Bow C, Soong C, Yeung S, Loong C, et al. Bone loss during menopausal transition among southern Chinese women. Maturitas 2011;69: 50-56. Referans 3. Minkin MJ. Menopause: Hormones, Lifestyle, and Optimizing Aging. Obstet Gynecol Clin North Am 2019; 46: 501-514. Referans 4. Stachowiak G, Pertyński T, Pertyńska-Marczewska M. Metabolic disorders in menopause. Prz Menopauzalny 2015; 14: 59-64. Referans 5. Korytkowski MT, Krug EI, Daly MA, Deriso L, Wilson JW, Winters SJ. Does androgen excess to the cardiovascular risk profile in postmenopausal women with type 2 diabetes? Metabolism 2005; 54: 1626-1631. Referans 6. Mauvais-Jarvis F, Manson JE, Stevenson JC, Fonseca VA. Menopausal Hormone Therapy and Type 2 Diabetes Prevention: Evidence, Mechanisms, and Clinical Implications. Endocr Rev 2017; 38: 173-188. Referans 7. Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, et al. Twelve-year trends in the prevalence and risk factors of diabetes and pre-diabetes in Turkish adults. Eur J Epidemiol 2013; 28: 169-180. Referans 8. Chen L, Magliano DJ, Zimmet PZ. The worldwide epidemiology of type 2 diabetes mellituse present and future perspectives. Nat Rev Endocrinol 2012; 8: 228e36. Referans 9. Çiçek M, Akyürek C, Çelik Ç, Haberal A. Kadın Hastalıkları ve Doğum Bilgisi, Güneş Kitabevi Ankara, 2004; 1163-1180. Referans 10. Ding EL, Song Y, Malik VS, Liu S. Sex differences of endogenous sex hormones and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA 2006; 295: 1288e99. Referans 11. Park SK, Harlow SD, Zheng H, Karvonen-Gutierrez C, Thurston RC, Ruppert K, et al. Association between changes in oestradiol and follicle-stimulating hormone levels during the menopausal transition and risk of diabetes. Diabet Med 2017; 34: 531-538. Referans 12. Cheung CL, Kung AWC, Tan KCB. Serum follicle stimulating hormone is associated with reduced risk of diabetes in postmenopausal women: The Hong Kong osteoporosis study. Maturitas 2018; 114: 41-45. Referans 13. Kalyani RR, Franco M, Dobs AS, Ouyang P, Vaidya D, Bertoni A, et al. The association of endogenous sex hormones, adiposity, and insulin resistance with incident diabetes in postmenopausal women. J Clin Endocrinol Metab 2009; 94: 4127-4135. Referans 14. Harlow SD, Gass M, Hall JE, Lobo R, Maki P, Rebar RW, et al. STRAW + 10 Collaborative Group. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Fertil Steril 2012; 97: 843-851. Referans 15. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010; 33(Suppl. 1): 62-69. Referans 16. Stefanska A, Cembrowska P, Kubacka J, Kuligowska-Prusinska M, Sypniewska G. Gonadotropins and Their Association with the Risk of Prediabetes and Type 2 Diabetes in Middle-Aged Postmenopausal Women. Dis Markers 2019; 5: 2384069. Referans 17. Carr MC. The emergence of the metabolic syndrome with menopause. J Clin Endocrinol Metab 2003; 88: 2404–2411. Referans 18. Soriguer F, Morcillo S, Hernando V, Valdés S, Ruiz de Adana MS, Olveira G, et al. Type 2 diabetes mellitus and other cardiovascular risk factors are no more common during menopause: longitudinal study. Menopause 2009; 16: 817-821. Referans 19. Szmuilowicz ED, Stuenkel CA, Seely EW. Influence of menopause on diabetes and diabetes risk. Nat Rev Endocrinol 2009; 5: 553-558. Referans 20. Kim C. Does menopause increase diabetes risk? Strategies for diabetes prevention in midlife women. Womens Health (Lond Engl) 2012; 8: 155-167. Referans 21. Janssen I, Powell LH, Crawford S, Lasley B, Sutton-Tyrrell K. et al. Menopause and the metabolic syndrome: the Study ofWomen’s Health Across the Nation. Arch Intern Med 2008; 168: 1568-1575. Referans 22. Appiah D, Winters SJ, Hornung CA. Bilateral oophorectomy and the risk of incident diabetes in postmenopausal women. Diabetes Care 2014; 37: 725-733. Referans 23. Lejskova M, Pit’ha J, Adamkova S, Auzký O, Adámek T, Babková E, et al. Bilateral oophorectomy may have an unfavorable effect on glucose metabolism compared with natural menopause. Physiol Res 2014; 63 Suppl 3: 395-402. Referans 24. Carr MC, Kim KH, Zambon A, Mitchell ES, Woods NF, Casazza CP, et al. Changes in LDL density across the menopausal transition. J Investig Med 2000; 48: 245-250. Referans 25. Godsland IF. Oestrogens and insulin secretion. Diabetologia 2005; 48: 2213-2220. Referans 26. Randolph JF Jr, Zheng H, Sowers MR, Crandall C, Crawford S, Gold EB, et al. Change in follicle-stimulating hormone and estradiol across the menopausal transition: effect of age at the final menstrual period. J Clin Endocrinol Metab 2011; 96: 746-754. Referans 27. Hale GE, Zhao X, Hughes CL, Burger HG, Robertson DM, Fraser IS. Endocrine features of menstrual cycles in middle and late reproductive age and the menopausal transition classified according to the Staging of Reproductive Aging Workshop (STRAW) staging system. J Clin Endocrinol Metab 2007; 92: 3060-3067. Referans 28. Wang N, Kuang L, Han B, Li Q, Chen Y, Zhu C, et al. Follicle-stimulating hormone associates with prediabetes and diabetes in postmenopausal women. Acta Diabetol 2016; 53: 227-236.