Diabetes and Uterine Fibroid Diagnosis in Midlife: Study of Women's Health Across the Nation (SWAN)

Susanna D Mitro & Nanette Santoro et al.

Abstract

Context

Fibroids are noncancerous uterine tumors potentially associated with cardiovascular risk factors.

Objective

We aimed to examine prospectively associations of glucose, insulin, sex hormone–binding globulin (SHBG), and diabetes with incidence of fibroid diagnoses in midlife.

Methods

Participants in the Study of Women's Health Across the Nation (SWAN) cohort (n = 2570) reported fibroid diagnoses at enrollment (1996-1997) and 13 follow-up visits (1996-2013). At all visits, we measured glucose, insulin, and SHBG in fasting blood samples and calculated homeostatic model assessment for insulin resistance (HOMA-IR). Diabetes was defined using glucose levels, self-reported diabetes, or diabetes medication use. We used discrete-time survival models to estimate hazard ratios (HR) and 95% CI for associations of time-varying biomarkers and diabetes with incident fibroid diagnoses, adjusted for demographics and health care utilization. We also evaluated effect modification by menopausal status.

Results

At baseline, 2.7% of participants (n = 70) were using diabetes medication. Time-varying glucose, insulin, HOMA-IR, and SHBG were not associated with fibroid diagnosis. However, diabetes was associated with a 28% lower incidence of fibroid diagnosis (adjusted HR 0.72, 95% CI 0.44, 1.17), driven by participants using metformin (adjusted HR 0.49, 95% CI 0.21, 1.12), though precision was limited. After stratification by menopausal status, higher HOMA-IR and insulin were associated with greater incidence of fibroid diagnosis during premenopause but not perimenopause, while the inverse association between diabetes and fibroids was strongest during perimenopause.

Conclusion

The effect of diabetes and biomarkers on fibroids may vary by menopausal status. Fibroid risk may increase with insulin resistance and decrease with diabetes treatment.

Links
DOIPubMed
Journal
The Journal of Clinical Endocrinology & Metabolism
Institutions
Decision ResearchUniversity Of Colorado Cancer Center
Authors
Susanna D Mitro, Catherine Lee, Nanette Santoro
Funding
Study of Women's Health Across the Nation (SWAN) V: Coordinating Center - Administrative SupplementUniversity of California, San Francisco/Kaiser Permanente Northern California Division of Research Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) K12 ProgramThe Study of Women's Health Across the Nation (SWAN): The Impact of Midlife and the Menopause Transition on Health and Functioning in Early Old AgeStudy of Women's Health Across the Nation (SWAN) V: Coordinating Center - Administrative SupplementStudy of Women's Health Across the Nation - VStudy of Women's Health Across the Nation (SWAN) V: UCLA SiteNIH HHS FundingStudy of Women's Health Across the Nation (SWAN) V: Chicago siteNCATS NIH HHS FundingSTUDY OF WOMEN'S HEALTH ACROSS THE NATION (SWAN) V: UC DAVIS/KAISERSTUDY OF WOMEN'S HEALTH ACROSS THE NATION (SWAN) V: UC DAVIS/KAISERStudy of Women's Health Across the Nation(SWAN) V: PittsburghStudy of Women's Health Across the Nation (SWAN) V: Central LaboratoryThe Study of Women Across a Lifespan: SWANThe Study of Women Across a Lifespan: SWANStudy of Women's Health Across the Nation (SWAN V): Michigan SiteStudy of Women's Health Across the Nation (SWAN) V: UCLA SiteStudy of Women's Health Across the Nation (SWAN V): Michigan SiteStudy of Women's Health Across the Nation(SWAN) V: PittsburghThe Study of Women's Health Across the Nation (SWAN): The Impact of Midlife and the Menopause Transition on Health and Functioning in Early Old AgeStudy of Women's Health Across the Nation (SWAN) V: Central LaboratoryStudy of Women's Health Across the Nation - VSWAN Genomic Analyses and SWAN LegacySWAN Genomic Analyses and SWAN LegacyDHHS FundingStudy of Women's Health Across the Nation (SWAN) V: Chicago siteNational Institutes of Health FundingNational Institute on Aging FundingNational Institute of Nursing Research FundingStudy of Women's Health Across the Nation (SWAN V): Michigan SiteStudy of Women's Health Across the Nation (SWAN) V: Chicago siteThe Study of Women Across a Lifespan: SWANStudy of Women's Health Across the Nation - VStudy of Women's Health Across the Nation (SWAN) V: UCLA SiteStudy of Women's Health Across the Nation(SWAN) V: PittsburghStudy of Women's Health Across the Nation (SWAN) V: Coordinating Center - Administrative SupplementSTUDY OF WOMEN'S HEALTH ACROSS THE NATION (SWAN) V: UC DAVIS/KAISERStudy of Women's Health Across the Nation (SWAN) V: Central LaboratoryThe Study of Women's Health Across the Nation (SWAN): The Impact of Midlife and the Menopause Transition on Health and Functioning in Early Old AgeSWAN Genomic Analyses and SWAN LegacyNational Center for Advancing Translational Sciences Funding

NIAMS NIH HHS

K12 AR084219

NIH Office of Research on Women's Health

U19AG063720

NIH Office of Research on Women's Health

U01AG012553

NIH Office of Research on Women's Health

U01AG012531

NIH Office of Research on Women's Health

U01AG012539

NIA NIH HHS

U01 AG012505

NIH Office of Research on Women's Health

U01AG012554

NIA NIH HHS

U01 AG012554

NIH Office of Research on Women's Health

U01AG012546

NIH Office of Research on Women's Health

U01AG012495

NIH Office of Research on Women's Health

U01AG012535

NIA NIH HHS

U01 AG012535

NIA NIH HHS

U01 AG012553

NINR NIH HHS

U01 NR004061

NIA NIH HHS

U01 AG012539

NIH Office of Research on Women's Health

U01NR004061

NIA NIH HHS

U01 AG012546

NIA NIH HHS

U19 AG063720

NIA NIH HHS

U01 AG012495

NIA NIH HHS

U01 AG012531

NIA NIH HHS

U01 AG017719

NIH Office of Research on Women's Health

U01AG017719

NIH Office of Research on Women's Health

U01AG012505

NIH Office of Research on Women’s Health

U01NR004061

NIH Office of Research on Women’s Health

U01AG012505

NIH Office of Research on Women’s Health

U01AG012535

NIH Office of Research on Women’s Health

U01AG012531

NIH Office of Research on Women’s Health

U01AG012539

NIH Office of Research on Women’s Health

U01AG012546

NIH Office of Research on Women’s Health

U01AG012553

NIH Office of Research on Women’s Health

U01AG012554

NIH Office of Research on Women’s Health

U01AG012495

NIH Office of Research on Women’s Health

U19AG063720

NIH Office of Research on Women’s Health

U01AG017719