If you’ve noticed higher blood sugar levels shortly before or during your period, or if your blood sugars are bouncing up and down as you approach menopause, join the club. Diabetes and your menstrual cycle are closely intertwined, thanks to fluctuating levels of hormones. In fact, if you’re a woman who has diabetes or who is at risk of diabetes, brace yourself for a somewhat bumpy ride as you navigate your menstrual cycle over the course of your life. The good news? There are steps you can take to help ensure smooth sailing.
Two main hormones regulate your menstrual cycle: estrogen and progesterone. These two hormones are secreted by the ovaries. Estrogen thickens the lining of the uterus in preparation for a possible pregnancy. It has other functions, too, such as regulating bone and vaginal health. Progesterone is also needed to prepare the uterus for pregnancy, and it helps to maintain the lining of the uterus throughout pregnancy. These hormones can affect how your body responds to insulin, and are responsible for the blood sugar ups and downs that you may notice at different times of the month, or when you are nearing or in menopause.
Premenstrual syndrome (PMS)
As you approach “that time of the month,” you might experience premenstrual syndrome, or PMS. PMS starts about one to two weeks before your period. It affects about 90% of women at some point in their lives, bringing a combination of physical, emotional, and psychological factors with it. Symptoms include irritability, mood swings, depression, fatigue, bloating, breast tenderness, and food cravings.
PMS is likely caused by changes in hormone levels, as well as chemical changes in the brain. Both can, in turn, cause erratic blood sugars. In addition, changes in appetite, food cravings, and feelings of fatigue can make it more likely that you stray from your eating and exercise plans.
What you can do:
• The severity of PMS can vary from woman to woman. If your symptoms are severe, talk with your doctor about medicines that can help, including birth control pills.
• If you take insulin, you may need a temporary increase in your dose during this time to help keep your blood sugars in a healthy range.
• Try to establish a regular physical activity routine, including aerobic (cardio) exercise, as well as resistance or strength training.
• Choose healthy foods, and limit salty or sugary foods, caffeine, and alcohol, which can worsen symptoms.
• Get enough sleep (at least 8 hours each night).
• Dietary supplements, such as folic acid, vitamin E, vitamin B6, magnesium, and calcium may help relieve symptoms, as can certain herbal supplements, such as black cohosh, chasteberry, and evening primrose oil. But check with your doctor first before taking any of these.
A few days before your period starts, you may notice that your blood sugars are higher (maybe even much higher) than usual. Once again, you have estrogen and progesterone to thank for this. In general, the balance of these hormones prior to menstruation increases insulin resistance, although some women notice the opposite effect: increased insulin sensitivity. If you have Type 1 diabetes, you may notice that your periods last longer and your flow is heavier than women who don’t have diabetes. Higher blood sugar levels can increase the risk for developing a yeast infection, too.
What you can do:
• One of the best ways to deal with monthly blood sugar fluctuations is to track them. In other words, keep tabs on your cycle and how your blood sugars respond. A calendar or a journal can work, and yes, there are apps for this. Check out Clue, Period Tracker, or Glow. Figuring out patterns may take a few months.
• If you’re particularly plagued by swings in blood sugars, consider using a continuous glucose monitor (CGM). A CGM measures glucose levels in real time throughout the day and night, providing readings at any time and helping you and your health-care team spot trends. CGMs are generally covered by insurance for most people with Type 1 diabetes, and are starting to be covered by some plans for those with Type 2. Professional CGMs are also available through your provider to wear for a few days to help you get a better picture of your blood sugars.
• Once you identify the “nuances” of your cycle on your blood sugar, check with your provider or diabetes educator about actions you can take. If you take insulin, for example, you’ll likely need to increase your dose. By how much and for how long will depend on your cycle. If you have Type 2 diabetes and are not taking insulin, it’s possible that you’ll need a medication adjustment (if you take diabetes pills, for example).
• Focus on lifestyle adjustments, as well — physical activity, cutting back on carbs, dealing with stress and cravings, and getting enough sleep can help.
Perimenopause and menopause
The “change of life” is a bittersweet time for most women. Dealing with emotional and physical changes can be challenging, as can managing diabetes. The time leading up to menopause (perimenopause) involves unstable levels of estrogen and progesterone; as a result, you may be dealing with an increase in both insulin sensitivity and insulin resistance. In addition, many women find that they gain weight before and during menopause. Weight gain can occur because of hormonal changes, but also due to a change in muscle mass and lifestyle factors. Weight gain can, in turn, cause higher blood sugar levels. To top it off, hot flashes and night sweats can make it harder to manage blood sugars. On a side note, perimenopause and menopause cause a drop in estrogen, which raises the likelihood of urinary tract infections (UTIs) and yeast infections.
What you can do:
• Checking your blood sugars regularly (maybe more often than usual) is a key step in identifying patterns and trends. This information can help you and your provider make decisions about tweaks to your diabetes treatment plan. As mentioned above, using a CGM can be helpful, as well.
• Talk with your provider about ways to manage menopausal symptoms, including hot flashes and night sweats. Weigh the risks and benefits of using hormone replacement therapy (which are the same for women with and without diabetes), as well as non-hormonal therapies (which also have risks and benefits).
• Consider using an app to help you track symptoms and come up with a treatment plan. MenoPro, myPause, and Menopause View are a few to check out.
• Be prepared for other health issues that can appear at this time, such as heart disease, osteoporosis, urinary incontinence, and changes in sexual function. Keep up with regular provider appointments and exams to help catch and treat problems early on. Ask your provider about cholesterol-lowering medications, if necessary, as well as medications to prevent osteoporosis.
• Focus on establishing a healthful eating and physical activity plan. Your calorie needs will likely drop, along with muscle mass. Changing how much, when, and the types of foods that you eat can prevent or minimize weight gain. Staying active helps you maintain your muscle and bone mass, manage your weight, and better cope with stress and other emotional aspects of menopause.