Menopause is the phase of life after your periods have stopped. Peri-menopause is the transition period when periods can start to become irregular and other symptoms such as flushing may occur. Levels of the female hormones (most notably estrogen and progesterone) fall dramatically during the menopause. Such hormonal changes can cause various effects on your body, including:
- Changes in blood sugar level. The hormones estrogen and progesterone affect how the cells in the body respond to insulin. As such, after the menopause, changes in hormone levels can trigger fluctuations in your blood sugar level. You may notice that your blood sugar level is more variable or less predictable than before. Drops in estrogen hormone levels may make your body more resistant to insulin, requiring an increase in diabetes medication. This can be countered in part by a drop in progesterone levels, which may improve sensitivity to insulin. Because these changes are unpredictable, it is important to monitor the effects that menopause is having on blood glucose control during this period, either by home blood glucose monitoring, for those who test or by regular HbA1c checks.
- Weight gain. Some women gain weight during the menopausal transition and after menopause. This can increase the need for insulin or oral diabetes medication.
- Infections. Even before menopause, high blood sugar levels can contribute to urinary and vaginal infections. After menopause - when a drop in estrogen makes it easier for bacteria and yeast to thrive in the urinary tract and vagina - the risk is even higher.
- Sleep problems. After menopause, hot flushes and night sweats may keep you up at night. In turn, the sleep deprivation can make it tougher to manage your blood sugar level. If you are taking medication that can cause low blood sugar (hypoglycaemia), it is important that you check a blood sugar level during the night to rule out hypoglycaemia.
- Sexual problems. 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 compound the issue by causing pain during sex.
If you use home blood glucose testing, then monitor your blood glucose levels more regularly, document readings and discuss with your diabetes team in order to control your blood glucose levels through a combination of meal planning, exercise, and adjustment of oral diabetes medications or insulin. Menopause can throw your diabetes management plan out of balance due to the hormonal fluctuations. Many women find that they gain weight or become 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, be sure your meals are full of nutritious, low-fat foods and try to maintain or increase your level of activity. Start a walking program, join a health club, or think about taking up a sport or hobby that you've always wanted to try.
Hormone Replacement Therapy (HRT) in diabetes
HRT is a complicated issue. There are benefits and risks to taking HRT. HRT can greatly help with symptoms like flushing, but 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 HRT preparations carry different risks. There are oral tablets, transdermal patches or a cream form of HRT.
Many factors can influence the decision to use HRT, like whether you are at risk of diseases like cancer, heart disease and osteoporosis. Family history and lifestyle factors such as smoking, obesity and diet will also need to be taken into consideration. For diabetic women considering taking HRT, close consultation with their health care professionals is the first step in deciding whether traditional HRT is an appropriate treatment option.
More research is needed in fully understanding the effects of the menopause and HRT on risk of development of diabetes and diabetes control. Type 2 diabetes risk 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 with age (during menopausal years) and further increase risk of cardiovascular disease. A healthy lifestyle with good diet and exercise should be promoted.
For further reading please refer to www.patient.co.uk/health/menopause-and-hrt-leaflet