Menopause and Diabetes: What You Need to Know

For women with diabetes, menopause can be an especially challenging time.

Is it Menopause or Diabetes?To combat the notorious weight gain associated with menopause, Dr. Pinkerton counsels women with diabetes to decrease their daily calories by about 300.

One thing is for certain: fluctuating estrogen and progesterone levels can wreak havoc on blood sugars. Hormonal shifts can up the risk of vaginal and urinary tract infections, already more prevalent in women with diabetes. Hot flashes and night sweats can interfere with sleep and a lack of shut-eye can affect blood sugar readings. Osteoporosis can increase significantly, which is a special problem for women with diabetes who have more joint and bone issues.

Add on extra pounds that can impact cardiovascular health—a worry for women with diabetes—and a loss of libido, which can also be aggravated by diabetic neuropathies.

And while it's hard to separate the effects of age and weight, there is some evidence that hormonal shifts during menopause can be a risk factor for developing type 2 diabetes. Here's the tricky thing about menopause if you don't have diabetes—they share so many symptoms that distinguishing between the two can be difficult.

Vaginal dryness, urinary tract infections, and other problems down there can be caused by reduced estrogen levels as well as elevated glucose levels. Night sweats, hot flashes, and moodiness—menopause hallmarks—can be related to low blood sugar and—you guessed it—menopause. Unfortunately, not enough research has been conducted about diabetes risk and menopause be conclusive.

The Hormones Have It

“It’s vital that women who develop symptoms of diabetes (excessive thirst, increased urination especially at night, blurry vision, fatigue, cuts/wounds that are slow to heal) during this time get tested for the disease,” says JoAnne Z. Pinkerton, MD, executive director of the Midlife Health Center and Professor of Obstetrics and Gynecology at the University of Virginia, who notes that she is “amazed” at how infrequently women are tested.

“If you do a hemoglobin A1C test you will know where you are. Women feel so much better when they drop from a 7 to a 5.5. They also need to know what their lipids (fats) are and their BMI (Body Mass Index),” explains Dr. Pinkerton. “It’s an opportunity for intervention.”

Type 1 and Menopause 

If you have type 1, you should be prepared for more difficulty controlling your blood glucose levels during the menopausal phase of life. For type 1s there is evidence that menopause starts earlier —for type 1s the average age is 41.6; for the rest of the US population, it's 51. This has clinical implications as type 1s also generally start menarche later so the window of time for childbearing is smaller. It has been well established that women with type 1 diabetes, particularly those with poor metabolic control, are at high risk for perinatal morbidity and mortality.

Cardiovascular disease is also more of a concern for premenopausal type 1 women since an earlier transition to menopause may exacerbate the likelihood of developing these complications during their postmenopausal years.

Fighting Menopausal Weight Gain

A healthy lifestyle is the best defense against the effects of menopause. And the best time to start is in the years before menopause or perimenopause, to prevent weight gain and to build muscle, which helps the body use insulin more efficiently.

“Due to changes in metabolism and hormonal shifts, many women have a weight gain of about 4.5 pounds, and begin to have abdominal obesity which increases their waist circumference, which is not good for their health or risk of diabetes,” says Pinkerton.

To help combat menopausal weight gain, Pinkerton counsels women to decrease their daily calories by about 300, limit carbohydrates, fats, sugar, and alcohol intake, reduce stress, and increase daily exercise. 

“We try to find an exercise that can fit it into their lifestyle,” she says. “You can do ten minutes of aerobic exercise three times a day and still get the benefit. We also recommend strength training, not only to lose weight but to increase muscle mass, which can improve the efficiency of insulin.”

Post-menopause and Diabetes

With menopause comes a fluctuation of the hormones estrogen and progesterone, which can cause shifts in blood sugar levels. While there is evidence that HT (hormone therapy) may help reduce type 2 diabetes,  cut menopausal weight gain and lower fasting blood sugars,  “because it’s hard to show major long-term prevention from hormones, HRT therapy is not government approved for diabetes,” says Pinkerton. She does, however, suggest consulting with your practitioner about the use of HT in your particular case.

Among the problems of diabetes and menopause: instability of blood sugar levels. Fluctuations in estrogen and progesterone can make your sugars yo-yo up and down.

To deal with this, Pinkerton recommends taking your sugars regularly and talking to your endocrinologist about glucose readings and other health factors impacted by menopause, including blood pressure and cholesterol levels. You may need to adjust your diabetes medications and add a cholesterol-lowering medication to prevent against an increased risk of cardiovascular disease.

  • Vaginal infections. Menopause changes the climate of the vagina for everyone, but women with diabetes who have problems with glucose control have an even higher risk of yeast and urinary tract infections. Recurrent infections can be a sign of pre-diabetes, warns Pinkerton.
  • Sleep problems. Night sweats caused by elevated blood sugars can keep you awake and be mistaken for hot flashes,  so it’s important to check your sugars to make sure of their source. Sleep problems can also be caused by low sugars. Sometimes HT can help sleep and increase REM sleep, says Dr. Pinkerton.
  • Sexual issues. “Women can start to lose their libido as they move through menopausal transition,” says Pinkerton. Medicines for mood changes or diabetic neuropathies can also interfere with sexual desire. To combat vaginal dryness or inflammation of the vaginal walls, vaginal lubricants or prescription estrogen creams may help.
  • Osteoporosis. “During the first five years of menopause you can lose 20 percent of bone density,” says Pinkerton. Pinkerton recommends taking at least 1200 mg of calcium daily, either through diet or supplements. She also suggests getting a blood test for Vitamin D, and to consider over the counter supplements, or estrogen therapy to prevent bone fractures.

“Women shouldn’t suffer in silence whether they have depression, painful sex or difficulty controlling blood sugars during menopause,” says Pinkerton. “They can be helped.”

Updated on: April 18, 2019
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