Insulin levels early in perimenopause inform vasomotor symptom incidence across the menopausal transition

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dc.contributor.authorAthar, Faria
dc.contributor.authorGregory, Sarah
dc.contributor.authorHouston, Emma J.
dc.contributor.authorTempleman, Nicole M. 
dc.date.accessioned2026-05-07T17:31:18Z
dc.date.available2026-05-07T17:31:18Z
dc.date.issued2026
dc.description.abstractContext Metabolic health affects 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 This work aimed 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 age 47 was 10.117?µIU/mL (SD = 6.711), with 27.0 BMI (SD = 6.6); the mean age of the 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 (E2), follicle-stimulating hormone (FSH), and testosterone (T) across the menopausal transition. Results Higher insulin at age 47 predicted younger onsets of hot flashes and night sweats, longer durations of hot flashes and cold sweats, and greater T rise. BMI associations with vasomotor symptoms paralleled those of insulin, but BMI appeared more closely linked to slower E2 decline and blunted FSH rise. In Cox proportional hazards models, elevated age-47 insulin was associated with increased likelihood of hot flashes; this remained statistically significant with BMI and glucose as covariates. Conclusion 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 T.
dc.description.reviewstatusReviewed
dc.description.scholarlevelFaculty
dc.description.sponsorshipTempleman Lab research is supported by funding from the Canadian Institutes of Health Research (PJT—183618). N.M.T. is a Tier 2 Canada Research Chair in Metabolic Determinants of Reproduction and Aging, and a Michael Smith Health Research BC Scholar. This study uses publicly available data from SWAN, which has had grant support through the National Institutes of Health (NIH), the Department of Health and Human Services, the National Institute on Aging, the National Institute of Nursing Research, and the NIH Office of Research on Women’s Health.
dc.identifier.citationAthar, F., Gregory, S., Houston, E. J., & Templeman, N. M. (2025). Insulin levels early in perimenopause inform vasomotor symptom incidence across the menopausal transition. The Journal of Clinical Endocrinology & Metabolism. https://doi.org/10.1210/clinem/dgaf699
dc.identifier.urihttps://doi.org/10.1210/clinem/dgaf699
dc.identifier.urihttps://hdl.handle.net/1828/23843
dc.language.isoen
dc.publisherJournal of Clinical Endocrinology and Metabolism
dc.rightsCC BY-NC-ND
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjecthot flashes
dc.subjecthyperinsulinemia
dc.subjectStudy of Women's Health Across the Nation (SWAN)
dc.subjectclimacteric
dc.subjectandrogen
dc.subjectinsulin resistance
dc.subjectSexual and Reproductive Health and Rights (SRHR) Aspiration Research Cluster
dc.subject.departmentDepartment of Biology
dc.titleInsulin levels early in perimenopause inform vasomotor symptom incidence across the menopausal transition
dc.typeArticle

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