Which is a known risk factor for premature menopause?

• A. Obesity
• B. Diabetes Mellitus
• C. Tobacco use
• D. Both Diabetes Mellitus and tobacco use

Answer: (D)

Premature menopause means the ovaries stop functioning before age 40–45 due to loss of ovarian reserve. The strongest known modifiable risk factor is tobacco use: nicotine and other tobacco toxins accelerate follicular depletion, so women who smoke tend to reach menopause earlier than nonsmokers.

Diabetes mellitus is also linked to earlier ovarian aging in some studies. Metabolic and autoimmune factors associated with diabetes can affect ovarian function and reserve, contributing to earlier menopause in certain individuals.

Because of these, having both diabetes and tobacco exposure increases the likelihood of premature menopause more than either factor alone, which is why the option that includes both is the best choice. Obesity is not a well-established risk factor for premature menopause and in some cases is associated with higher estrogen levels that can delay menopause, so it does not fit as a primary risk factor.