Longitudinal Changes in Serum Urate Levels From Premenopause Through Postmenopause: Interrupted Time-Series Analyses

Hyperuricemia (HU) and gout are common in postmenopausal women. We aimed to identify the longitudinal changes in serum urate (SU) levels during and after the menopausal transition and its interaction with coexisting SU-modifying conditions.

This longitudinal study included Japanese women who underwent annual medical examinations from April 2004 to September 2024 and had at least one visit before and after self-reported menopause. Menopausal transition stages were categorized into premenopause, perimenopause (5 years before and up to the menopause), and postmenopause. Longitudinal changes in SU and HU (SU ≥6.8 mg/dL or taking medications for gout or HU) were examined by interrupted time-series analyses and evaluated across stratified subgroups.

We analyzed 8,169 eligible participants with 93,511 visits over a median follow-up of 13.8 years. SU levels gradually increased during premenopause, rose sharply over perimenopause, and stabilized in postmenopause. Compared to premenopause, the mean SU level was 0.41 mg/dL (95% confidence interval: 0.38-0.43) higher in postmenopause. HU prevalence increased from <1.0% during premenopause to 4% to 5% during postmenopause. Compared to premenopause, the associations of a low estimated glomerular filtration rate (<60 mL/min per 1.73 m²) and a high body mass index (≥25) with HU were greater in postmenopause; HU was observed in approximately 18% of overweight or obese women at menopause.

SU levels rapidly increase during perimenopause and are already elevated by the time of menopause. Maintaining a normal body weight and preserving kidney function before menopause may decrease postmenopausal HU and potentially prevent subsequent gout in women.