Updated March 04, 2008

Menopause
What to Expect, How to Cope

by Pat Dougherty, C.N.M., M.S.N., and Joyce Green Pastors, M.S., R.D., C.D.E.

Is it menopause or my diabetes?
One of the challenges for menopausal women who have diabetes is distinguishing between the symptoms of the two conditions. It is not uncommon to mistake menopause-related hot flashes or moodiness for symptoms of low blood glucose. Night sweats—hot flashes that occur at night—can interrupt sleep and lead to excessive daytime fatigue, which can also be mistaken for low blood glucose. If this leads to eating extra calories to raise a low blood glucose level, it could lead to high blood glucose and, over time, weight gain, if repeated on a regular basis.

The reduced estrogen levels that occur with menopause can directly cause or can raise a woman’s risk of vaginal dryness, vaginal infections, and urinary tract infections—but so can high blood glucose levels. While all of these conditions are treatable, the cause of the problem must be determined for proper management. Regular blood glucose monitoring can help women figure out whether low or high blood glucose levels may be causing their symptoms. Any woman who is experiencing chronically high blood glucose levels should address that issue first, with the help of her diabetes team, if needed.

Dealing with menopausal symptoms
But what if the symptoms are related to menopause and not high or low blood glucose levels? How does a woman with diabetes successfully treat the most common symptoms of the menopausal phase, including hot flashes, night sweats, moodiness or irritability, weight gain, and vaginal dryness? The answer depends on the severity of symptoms, as well as the degree of control the woman has over her diabetes. Women with poorly controlled diabetes are at increased risk of cardiovascular complications associated with hormone therapy, and are therefore less suitable candidates for this type of treatment.

Lifestyle changes are always the first step to help reduce the discomforts of menopause. The following changes can help make the menopausal transition easier:

• Remain (or become) physically active. Regular physical activity or exercise can help increase energy levels, improve mood, and combat weight gain.
• Substitute whole grains and fresh fruits and vegetables for processed and refined foods, both to help control blood glucose (and blood pressure) levels and to increase overall energy level.
• Use alcohol and caffeine in moderation or not at all, since they can trigger hot flashes and decrease sleep quality. If spicy foods have a similar effect, reduce your intake or avoid them altogether.
• Consume more legumes (beans and peas), soy foods, and flaxseed. These foods contain phytoestrogens, or chemicals found in plants that may act like estrogen in the body. Some women report that increasing the amounts of these foods in their diet decreases the frequency and severity of their hot flashes, although scientific studies have not confirmed this. (Phytoestrogen pills and powders are not recommended at this time because of safety concerns).
• Get adequate amounts of vitamins and minerals. To keep their bones strong, women going through menopause who are not receiving hormone therapy should be getting 1,200–1,500 milligrams of calcium and 800 international units of vitamin D each day (which can be provided by three to four 8-ounce servings per day of low-fat milk or yogurt). Women receiving hormone therapy should aim for 1,000 milligrams of calcium per day. Vitamin E and the B vitamins have also been suggested as beneficial for reducing menopausal symptoms, but the research does not currently provide strong support.
• Use of herbal teas or supplements may be helpful for treating hot flashes and night sweats. Research is limited, but herbal preparations such as black cohosh, garden sage, and motherwort are used in many Asian and European countries. However, you should speak with your doctor before beginning any sort of herbal regimen.
• If you are a smoker, stop smoking.

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Pat Dougherty is a Certified Nurse Midwife and Nurse Practitioner in the Department of Obstetrics and Gynecology, Division of Midlife Health, in the University of Virginia Health System. She is also certified as a Menopause Practitioner by the North American Menopause Society. Joyce Green Pastors is a Diabetes Nutrition Specialist with the Virginia Center for Diabetes Professional Education and an Assistant Professor of Medical Education in Internal Medicine, Division of Endocrinology at the University of Virginia School of Medicine.

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