A PRELIMINARY study has found that hyperinsulinaemia may be significantly associated with abnormal uterine bleeding (AUB) in reproductive-aged women, reinforcing the idea that the uterus acts as an end organ sensitive to metabolic dysfunction.
The cross-sectional study included 205 premenopausal women aged 18 to 54, of whom 116 experienced AUB. Researchers assessed fasting insulin levels along with other metabolic markers such as body mass index (BMI), HDL, LDL, and waist-to-hip ratio. Results showed that women with hyperinsulinaemia were three times more likely to experience AUB compared to those with normal insulin levels (OR=3.009, P=0.0085).
However, when BMI was added to the regression model, the strength of the insulin-AUB association decreased—suggesting a possible overlapping or mediating effect. The final model, which adjusted for age, race, LDL, and waist-to-hip ratio, yielded a 73% concordance in predicting AUB risk.
While the study’s small sample size and cross-sectional design limit definitive conclusions, the findings point to a potential metabolic underpinning of AUB—an area rarely considered in clinical practice. The authors advocate for larger longitudinal studies to better understand whether targeting insulin resistance and obesity could form part of a preventative or therapeutic approach to managing AUB.
Reference
Salcedo A et al. The uterus is an end organ: a preliminary study of the association between abnormal uterine bleeding and hyperinsulinemia. Menopause. 2025;DOI: 10.1097/GME.0000000000002548.
