Clinical and Metabolic Predictors of Abnormal Uterine Bleeding in Women With Type 2 Diabetes Mellitus: A Retrospective Cohort Study

Background: Abnormal uterine bleeding (AUB) may be associated with metabolic and endocrine dysfunction in women with type 2 diabetes mellitus (T2DM), but factors associated with newly documented AUB in this population remain incompletely characterized.Objective: To evaluate clinical and metabolic factors associated with incident AUB among premenopausal women with T2DM.Methods: This multicenter retrospective cohort study included 150 women aged 18-55 years with established T2DM and no documented AUB at baseline.Clinical, anthropometric, and biochemical variables were obtained from records between January 2025 and January 2026.Incident AUB was defined according to the International Federation of Gynecology and Obstetrics criteria.Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs), with study center included in the multivariable model.Results: During a median follow-up of 9.2 months, 45 women (30.0%) developed AUB.Women with incident AUB had higher HbA1c (8.8% vs 7.9%; p < 0.001), higher BMI (31.7 vs 28.9 kg/m²; p = 0.002), and longer diabetes duration (9.3 vs 7.1 years; p = 0.010).In multivariable analysis, HbA1c (aHR: 1.48 per 1% increase, 95% CI: 1.19-1.84),BMI (aHR: 1.41 per 5 kg/m² increase, 95% CI: 1.07-1.86),diabetes duration (aHR: 1.29 per five years, 95% CI: 1.01-1.65),and documented PCOS (aHR: 1.92, 95% CI: 1.04-3.55)were independently associated with incident AUB.Women with concurrent obesity and HbA1c ≥8.5% had the highest observed adjusted hazard (aHR: 3.68, 95% CI: 1.65-8.23).Conclusion: Higher HbA1c and greater adiposity were consistently associated with incident AUB among women with T2DM.Routine assessment of menstrual symptoms may help identify women who warrant timely gynecological evaluation.These observational findings require confirmation in larger prospective studies.