Not everything that happens as a result of diabetes is officially a "complication," but it sure can make things complicated sometimes! For women with diabetes, monthly menstrual cycles can bring not only typical symptoms of bloating and fatigue, but also increased resistance to insulin and food cravings -- making blood glucose control extra difficult.

Not to mention the hormonal chaos that occurs when menstrual cycles stop, or at least slow down, as menopause starts to set in... What happens to diabetes management as a woman goes through this life change?

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In fact, diabetes and menopause have been called a twin challenge because together, they can initiate a slew of symptoms including fluctuations in blood sugar levels, weight gain, yeast and urinary track infections, sleep problems and vaginal dryness. Ugh! 

But just like with all other diabetes-related challenges, knowledge is power, so we've compiled some key information that can help women cope.

 

What to Know About Menopause + Diabetes

Menopause of course refers to the phase of life during or after a woman's periods stop and estrogen levels decline. It typically occurs in American women between the ages of 45-55. It can sometimes be brought on by surgery, when a woman's ovaries are removed for other medical reasons. It effects every woman differently, but typical symptoms include hot flashes. chills, night sweats, sleep problems, and mood changes.

"There are certain aspects of menopause unique to women with diabetes," says Michele Laine, a respected Nurse Practitioner and Certified Diabetes Educator (CDE) at the Florida Medical Clinic's Division of Endocrinology and Metabolism in Tampa, FL.

As a woman with diabetes, here are some key things you should know:

  • Just like with your menstrual cycle, changes in the hormones estrogen and progesterone will affect how you respond to insulin. During the transitional years of premenopause and perimenopause (when menstrual cycles slow down but haven't stopped), these hormones are unstable, and cause problems with diabetes management. Higher levels of estrogen usually improve insulin sensitivity, while higher levels of progesterone cause resistance. As those changes happen, you'll notice your diabetes might be more unstable on some days.
  • Any time hormones change, weight can change, and weight has a major impact on diabetes. Women who gain weight during and after menopause can see an increased need in insulin or oral meds, so keep on top of trends and don't assume things will "go back to normal." And those with pre-diabetes may find themselves with type 2 diabetes, so if you're at risk, be aware of these changes.
  • As if diabetes wasn't uncomfortable enough, now you can add hot flashes and night sweats to the mix. These can cause big problems with sleeping soundly, which in turn can make your blood sugar levels skyrocket, especially if stress affects your diabetes.
  • Those menopause symptoms, including hot flashes and moodiness, can sometimes be mistaken for symptoms of high or low blood sugars. It's best to not rely on your "feelings" and actually test your blood sugar or keep a close eye on your CGM, lest you treat a high blood sugar with juice!
  • If you have type 2 diabetes, you may notice additional health problems set in at the onset of menopause. Women with type 2 diabetes are at higher risk of atherosclerosis, which is the hardening and thickening of the artery walls that can lead to stroke or heart attack. Menopause coupled with a sedentary lifestyle also poses a risk for osteoporosis (bone density problems). Although women with type 1 diabetes are at a higher risk overall for osteoporosis, the risk seems to be even more pronounced for women with type 2.
  • Women with type 1 diabetes may experience an earlier onset of menopause compared to the general population. Therefore, planning pregnancy is important if you are concerned about missing your window to have a child. There are many options available for women who may have concerns regarding early menopause such as cryopreservation (egg freezing).

 

How to Know When Menopause is Starting

CDE Laine explains that the biggest clue is menstrual irregularity.

"Symptoms that you may be progressing toward menopause include that your menstrual cycles may lengthen or shorten, and you may begin having menstrual cycles in which your ovaries don't release an egg (ovulate). You may also experience menopause-like symptoms, such as hot flashes, sleep problems and vaginal dryness. These symptoms are all caused by the level of estrogen in your body rising and falling," she says.

Menopause marks the end of a women’s reproductive life, and is officially defined as full menopause by the permanent cessation of menses for 12 months. With increasing lifespan, many women are surviving into their 90’s and spending roughly one third of their life in menopause these days, Laine notes.



Michele Laine, Certified Diabetes Educator

Managing Glucose Levels During Menopause

There's no doubt that blood glucose control becomes difficult during menopause due to changes in insulin sensitivity. What's happening is that changing hormone levels and fat storage lead the body to become less sensitive to insulin.

There is no magic fix for this, but Laine emphasizes: "It is important to monitor your blood sugars more frequently through finger testing or use of a CGM. Insulin dosing may need to be adjusted and keeping in contact with your healthcare provider is important."

Hot flashes can often be mistaken for symptoms of hypoglycemia (low blood sugar), leading to over-eating and eventual weight gain. Alternatively, hot flashes can also easily be mistaken for hypoglycemic (high blood sugar) episodes. So the general advice is simply that women with diabetes should monitor blood sugar more intensely during the transition to menopause.

 

Menopause Treatment for Women with Diabetes

What about hormone therapy for women with diabetes? Several studies suggest that the use of hormone replacement therapy may help to improve the symptoms of menopause as well as improve overall glycemic control, Laine says. Women treated with hormone replacement therapy were shown to have higher levels of metabolism and increased insulin sensitivity. Women with T1D and preexisting heart disease should not receive hormone replacement therapy and should undergo careful monitoring by cardiology experts.

But before you get to hormone therapy, there are some simple remedies you can try, Laine says:

  • Behavior modification such as avoiding spicy foods and alcohol will help
  • Wearing layered clothing and increasing exercise will also help to alleviate some of the symptoms
  • Some of the symptoms of menopause have been successfully treated with antidepressants

"What works for some women will not work for others, so I tell most of my patients to try the non-hormonal therapies first and if all fails, to see an OB/GYN for treatment. I find the management of blood glucose during this time is more difficult as the insulin resistance starts to settle in," Laine says. 

"It is not uncommon for me to prescribe a GLP drug such as Victoza, Trulicity or Ozempic for patients to use to help with post- meal high glucose as well as the weight gain that will come with menopause. I have used this in type 1 as well with the understanding that is an off-label use of this drug and dose titration will be slower. I also like to see patients' CGM sensor data or glucose log data at least every couple of weeks so titration of their medications can be made earlier if needed."

These are great tips on what you may want to discuss with your own doctor or CDE. 

Menopause is an uncomfortable but unfortunately inevitable part of life for every woman — diabetes or not. Hopefully this provides some insight into what to look out for as you head into this big life change with diabetes on board.