BACKGROUND: Menopause marks a key reproductive milestone with significant implications for women's long-term cardiometabolic health. However, the influence of cardiometabolic health during the reproductive years on the timing of menopause remains poorly understood. We prospectively examined the association between cardiometabolic health profiles and menopause onset in South Asian women, a population at high risk of early cardiometabolic dysfunction. METHODS: We analyzed longitudinal data from menstruating women aged 30-50 years in the CARRS cohort from 2010 to 2024. Baseline cardiometabolic measures included overweight/obesity (body mass index ≥25 kg/m2), hypertension (systolic blood pressure ≥140 or diastolic blood pressure ≥90 mmHg, prior history, or medication use), diabetes (hemoglobin A1c ≥6.5%, physician diagnosis, or use of glucose-lowering medication), and non-high-density lipoprotein cholesterol (non-HDL-C ≥ 130 mg/dl). Using Cox proportional hazards models, we examined associations between baseline cardiometabolic status and time to natural menopause, adjusting for sociodemographic and reproductive factors. RESULTS: Among 2225 women (median age 37 years; IQR: 33, 40), 44% reached natural menopause at a median age of 46 (IQR: 43, 49) years. Women with hypertension reached natural menopause approximately 1 year earlier than those without hypertension. In adjusted models, women with hypertension experienced relatively earlier natural menopause over follow-up (HR 1.34, 95% CI: 1.19-1.52). In contrast, the timing of natural menopause did not differ by baseline diabetes, weight, or non-HDL-C status. CONCLUSION: Hypertension was associated with earlier timing of menopause in South Asian women. Further research is needed to explore underlying mechanisms and long-term health implications.