Age at menopause and major metabolic disorders among Chinese middle-aged and older women

The menopausal transition is a period of heightened vulnerability for women; however, the association between menopause timing and metabolic multimorbidity risk remains unclear. We aimed to investigate the association between age at menopause and the risk of metabolic multimorbidity among Chinese middle-aged and older women. We utilized data from 6,298 postmenopausal women participating in the China Health and Retirement Longitudinal Study (2011–2018). Age at menopause was self-reported and categorized as early (< 45 years), normal (45–55 years, reference), or late (> 55 years). The primary outcome was incident metabolic multimorbidity, defined as the co-occurrence of two or more of hypertension, diabetes, and dyslipidemia. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for sociodemographic and lifestyle factors. Restricted cubic spline analyses were used to examine dose-response relationships. Over 12,632 person-years of follow-up, 583 women developed metabolic multimorbidity. Late menopause was associated with a 48% increased risk of metabolic multimorbidity (adjusted HR: 1.48, 95% CI: 1.08–2.02), while early menopause showed no significant association (adjusted HR: 0.93, 95% CI: 0.72–1.20). Each one-year increase in menopause age was associated with a 2% higher multimorbidity risk (adjusted HR: 1.02, 95% CI: 1.01–1.04). For individual components, late menopause was associated with increased diabetes risk (HR: 1.49, 95% CI: 1.05–2.11). No significant associations were found for dyslipidemia, and a modest linear increase in hypertension risk was observed with later menopause (HR: 1.01 per year, 95% CI: 1.001–1.02). Subgroup analyses did not reveal significant interactions between age at menopause and educational level or area of residence with risk of metabolic multimorbidity. Late age at menopause was associated with metabolic multimorbidity among Chinese middle-aged and older postmenopausal women. Our study provided valuable insights into preventive strategies for metabolic multimorbidity.