Diabetes and Menopause

October is Menopause Awareness Month, and October 18 is World Menopause Awareness Day. Established in 2014 by the International Menopause Society, this observance is dedicated to raising awareness about a normal yet largely misunderstood stage of a woman’s life. It’s a time to honor the transition between the conclusion of menstruation to the beginning of maturation. Unfortunately, for many women, it’s a time that is feared, whispered about, and defined by myths. Add diabetes to the mix and you have a whole new layer of challenges to navigate. These are all excellent reasons to be kind to yourself during the different stages of menopause.

A woman is said to be postmenopausal one year after her final menstrual period. Menstruation irregularities are familiar to women who developed type 1 diabetes (T1D) in adolescence. These women may have experienced delayed and inconsistent mensuration and won’t be surprised to learn they are twice as likely as women without diabetes to experience an early menopause. Whether you’re 45 or 51, diabetes and menopause can initiate a slew of symptoms including fluctuations in blood glucose levels, weight gain, yeast and urinary tract infections, sleep problems, and vaginal dryness.

In my book, “The Smart Woman’s Guide to Diabetes, Authentic Advice on Everything from Eating to Dating and Motherhood,” I shared research on the challenges of menopause from the article “Diabetes & Menopause, What to Expect and How to Cope,” by Pat Dougherty, CNM, MSN, and Joyce Green Pastors, MS, RD, CDE.

“Both the perimenopausal and postmenopausal periods may present additional challenges for women who have diabetes. For one thing, the hormonal fluctuations that are common to perimenopause can affect blood glucose levels. For another, some symptoms of menopause are the same as or easily confused with the symptoms of high or low blood glucose levels, so the cause must be determined before corrective action can be taken. In addition, both diabetes and menopause raise a woman’s risk of osteoporosis, so women with diabetes must be proactive about taking steps to keep their bones strong. Lack of sleep, whether related to menopause, stress, or something else, can disrupt diabetes control. And menopause is often associated with weight gain, which can make blood glucose control more difficult.”

The good news is that knowledge is power. The more you understand about this stage of life, the less anxious you will feel.

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Common questions about diabetes and menopause

Some common questions for women with type 1 and type 2 diabetes are answered below:

Q: Can I use hormone replacement therapy to lessen the symptoms of menopause?

A: That depends. Hormone therapy (HT) can be used to alleviate severe menopausal symptoms, especially unrelenting hot flashes, night sweats, and vaginal dryness. For women with diabetes, it’s recommended that the lowest possible effective dose is used. The type of estrogen, route, dose, and duration of administration should carefully be assessed, discussed, and decided considering the underlying risk factors, treatment goals, and patient’s wishes.

Q: What can I do naturally to reduce symptoms?

A: A study published by the International Menopause Society states “there is good evidence to support lifestyle changes (diet and exercise) and cessation of smoking and excessive alcohol consumption to decrease the incidence of these diseases. In addition, there is compelling evidence to suggest that menopausal hormone therapy (MHT) may be considered as part of this overall strategy.”

Along these lines:

Maintain a healthy lifestyle with diet and exercise.
Manage vitamin D levels to make sure you’re getting enough.
Maintain consistent blood glucose monitoring.
Consider hormone therapy replacement.
Be aware of your mental well-being. Seek help if you’re feeling depressed, be kind to yourself, and use mindfulness techniques.

Dr. Liz Stephens, an endocrinologist who has lived with T1D for years, has this advice:

“Menopause is unpredictable, which is especially challenging for women with diabetes. I encourage my patients to practice gratitude when things are going well. To accept the unpredictability and take a moment to be grateful. Practice mindfulness to manage the fluctuating emotions of menopause.”

Q: Does menopause increase a risk of developing type 2 diabetes?

A: It’s complicated. It’s hard to separate the effects of menopause from the effects of age, weight, and other changes that occur in your body during menopause and put you at greater risk of type 2 diabetes:

Your metabolism slows and you don’t burn calories as efficiently, which can lead to weight gain.
Much of the weight you gain is in your belly. Having more belly fat makes your body more resistant to the effects of insulin.
Your body releases insulin less efficiently.
Your cells don’t respond as well to the insulin you produce.

In “Unwell Women: Misdiagnosis and Myth in a Man-Made World,” Elinore Cleghorn writes “Menopause marks the beginning of a liberatory, transformative, and empowering stage of womanhood. Myths about the depletion of women’s worth that have shrouded menopause for too long should now be consigned to history.”

As women living with diabetes, we know that scientific facts and data don’t tell the whole story. The first step toward feeling empowered during the menopause process is to educate yourself. Several resources are included here. Living well with chronic illness requires ceaseless attention and effort, as well as a healthy state of mind. We only have one body, and it will serve us well to treat our bodies with kindness and compassion.