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.”
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.
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.”
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.
“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.”