Diabetes and the Menopause
Menopause is the phase of life after your periods have stopped. Peri-menopause is the name for the transition period when your periods can start to become irregular and you may experience other symptoms such as hot flushes.
Levels of the female hormones (most notably oestrogen and progesterone) fall dramatically during the menopause. Such hormonal changes can have various effects on your body, including the following:
Changes in blood glucose levels
The hormones oestrogen and progesterone affect how the cells in the body respond to insulin. Because of this, after the menopause changes in your hormone levels can trigger fluctuations in your blood glucose levels. You may notice that your blood glucose levels are more variable or less predictable than before.
A drop in your level of oestrogen may make your body more resistant to insulin, so your diabetes medication may have to be reviewed and increased. However, a drop in your progesterone levels may improve your sensitivity to insulin, and so one factor can partly cancel out the other.
Because these changes are unpredictable, it is important to monitor the effects that the menopause is having on your blood glucose control during this period, either through home blood glucose testing, if you do this, or by regular HbA1c checks.
If you use home blood glucose testing, then monitor your blood glucose levels more regularly, make a note of your readings and discuss them with your diabetes care team so that you can control your blood glucose levels through a combination of meal planning, exercise and diabetes medication or insulin.
Many women find that they gain weight because of hormone changes or becoming more sedentary as they proceed through menopause. This can increase the need for insulin or oral medication.
To fight the fat that often accumulates during middle age, make sure you have a healthy diet and try to maintain or increase your level of activity. Start a walking programme, join a health club or think about taking up a sport or hobby that you've always wanted to try.
The risk of developing type 2 diabetes increases with age and it is now often diagnosed during menopause. Risk factors for type 2 diabetes, including obesity, inactivity and high cholesterol, all increase as you get older and a healthy lifestyle with good diet and exercise is very important.
Even before menopause, high blood glucose levels can contribute to urinary and vaginal infections. After menopause, when a drop in oestrogen levels makes it easier for bacteria and yeast to thrive in the urinary tract and vagina, the risk is even higher. If you notice problems like the need to pass urine frequently or burning and stinging when you pass urine, contact your doctor.
After menopause, hot flushes and night sweats may stop you from sleeping well. In turn, the sleep deprivation can make it harder to manage your blood glucose levels. If you are taking medication that can cause low blood glucose (hypoglycaemia), like insulin or sulpholylureas (gliclazide, glimepiride or glipizide), it is important that you check your blood glucose levels during the night to rule out hypoglycaemia.
Diabetes can damage the nerves of the cells that line the vagina. This can interfere with arousal and orgasm. Vaginal dryness, a common symptom of menopause, may make the problem worse by causing pain during sex.
Hormone replacement therapy (HRT) and diabetes
Many women take HRT during and after the menopause. Whether or not to take HRT is a complicated issue. It can greatly help with symptoms like hot flushes, but it may increase the risk of heart disease, stroke, blood clots and breast cancer, particularly if used for prolonged periods of time after the age of natural menopause. Different types of HRT carry different risks.
Many factors can influence the decision to use HRT, such as whether you are at higher risk of diseases such as cancer, heart disease and osteoporosis. Family history and lifestyle factors such as smoking, obesity and diet will also need to be considered. If you are thinking about taking HRT, the first step is to discuss it in detail with your doctor or diabetes care team. They will help you decide if traditional HRT is an appropriate treatment option for you.
For further reading on the menopause and HRT, click here.