Navigating Menopause and Perimenopause with Diabetes

Menopause causes many hormonal changes in women, which can make managing blood glucose levels even more complicated

Maybe you’ve noticed your blood glucose levels fluctuate when your period is coming, or that you crave chocolate or other carb-heavy foods when it’s that time of the month. But what happens when your menstrual cycle seems to be going haywire, with a heavier, lighter, or more irregular flow, and you’re approaching midlife?

You could be experiencing perimenopause, the time when a woman’s body decreases hormone production and when egg production slows down. Perimenopause is the body’s transition to menopause, when the reproductive process permanently ends. During this shift, diabetes and menopause can complicate one another.

What are perimenopause and menopause?

Menopause happens when a woman has missed a period for 12 months in a row; perimenopause is the transition into menopause, but it’s not always a straight path. Some women can be in perimenopause for years, experiencing periods here and there, with changes in flow or frequency.

Perimenopause can last for eight to ten years before menopause. It typically occurs for women between the ages of 45 and 55, though some women begin experiencing perimenopause in their 30s.

The symptoms of perimenopause can include sore breasts, sex issues (such as vaginal dryness or little to no interest in intercourse), peeing problems (such as frequent urination or urinating while coughing or sneezing), disrupted sleep, moodiness, and hot flashes. Hot flashes can cause you, in an instant, to go from feeling serene and comfortable to scorching and sweaty.

How does menopause affect diabetes?

Weight gain is common with menopause, but what is more common and worrisome is an increase in abdominal (belly) fat, says Ekta Kapoor, an endocrinologist, menopause specialist, and associate professor of medicine at the Mayo Clinic. Additional abdominal fat makes the body more insulin resistant. Women may find they need additional insulin or medications to keep their blood glucose levels in range.

• Tip: If your blood glucose levels are changing in ways you haven’t experienced since before perimenopause or menopause, talk to your healthcare professional about whether you need to adjust or change your diabetes medications, particularly if you’ve gained weight or aren’t as active as you were previously.

The hormone changes during menopause can cause hot flashes and sweating that may be disruptive to sleep. Sleeplessness is very common during menopause, and can negatively affect many critical aspects of diabetes and overall health. To learn more about sleep and how to improve your sleep, check out this article from Adam Brown.

Menopause also brings higher risks of increased blood pressure and heart disease, Kapoor adds — two health complications that women with diabetes are already more likely to develop. Speak with your healthcare professional about what you can do to keep your heart and arteries healthy.

Be aware of vaginal or urinary infections, especially yeast or urinary tract infections. Both diabetes and hormone changes during menopause can increase the risk of these infections.

Remember to check your blood glucose levels if you’re feeling sweaty or moody. Something that you think is related to high or low blood sugars may be related to menopause instead (and may not require a dose of insulin or some glucose tabs to treat).

How to manage menopause with diabetes:

• Measure blood glucose levels frequently

• Talk with your healthcare professional about adjusting insulin or medication dosing

• Exercise daily, eat a balanced diet, and don’t smoke

• Measure blood pressure regularly

• Monitor changes in weight

Does diabetes affect menopause?

It’s unclear how diabetes may affect the timing of perimenopause and menopause. A 2001 study found that women with type 1 diabetes undergo menopause earlier than women without diabetes, but research in 2014 did not support that conclusion. However, the 2001 research was done at a time when current diabetes technologies (such as continuous glucose monitors, insulin pumps, and even fast-acting insulin) were either less common, less sophisticated, or not yet invented. With these tools, it’s now possible for people with diabetes to have blood sugar readings closer to those of people without diabetes. This may explain why diabetes doesn’t always play a role in when perimenopause and menopause occur.

What is the role of hormone therapy?

Perimenopause symptoms can last several years beyond menopause, though some people sail through the transition without much discomfort. Others are so bothered by the side effects that they seek medical attention and take hormone therapy (HT) – such as supplemental estrogen with or without a progesterone-like hormone – to reduce symptoms.

There is no specific recommendation on HT for women with diabetes. According to a 2012 review of medical research, “there is a lack of evidence around the use of HT in women with type 1 diabetes,” calling for more research in the area.

Women with type 2 diabetes “are more vulnerable to having the disease worsen after menopause due to weight gain and increase in belly fat. This risk can be reduced somewhat by using HT,” Kapoor said. A 2001 study of more than 15,000 women with type 2 diabetes found that women in their 60s who were taking HT had average A1C levels that were lower than women who were not on HT.

Advice on navigating menopause, with or without diabetes

“Just as I advise all my patients going through menopause, pay attention to lifestyle,” said Kapoor. “Especially in their 40s and 50s, women should pay an even greater attention to what they eat and how much they exercise. Women who enter menopause already overweight face an uphill task to try to keep their weight at a healthy level.”

Kapoor suggests getting at least 30-45 minutes of aerobic exercise at least five days a week, and to keep a close eye on food intake. Because of the metabolic and hormonal changes that come with menopause, eating the same way in midlife as you did as a younger person will very likely bring on weight gain.

“Oftentimes, women will say, ‘I haven’t changed anything; I’m eating the same way I used to in my 20s or 30s,’ and that is exactly why,” said Kapoor, “People need to cut back on calories as they get older.” The type of food on our plate can determine the daily caloric intake; eating a diet with more carbohydrates tends to be calorie-dense. Kapoor advises lower carb eating to manage weight or to lessen weight gain before and during menopause.

“My biggest advice for weight management for women going through menopause is related to lifestyle: healthy eating habits and a regular exercise program,” Kapoor concluded.

About Cheryl

Cheryl Alkon is a seasoned writer and the author of the book Balancing Pregnancy With Pre-Existing Diabetes: Healthy Mom, Healthy Baby. The book has been called “Hands down, the best book on type 1 diabetes and pregnancy, covering all the major issues that women with type 1 face. It provides excellent tips and secrets for achieving the best management” by Gary Scheiner, the author of Think Like A Pancreas. Since 2010, the book has helped countless women around the world conceive, grow and deliver healthy babies while also dealing with diabetes.

Cheryl covers diabetes and other health and medical topics for various print and online clients. She lives in Massachusetts with her family and holds an undergraduate degree from Brandeis University and a graduate degree from the Columbia University Graduate School of Journalism.

She has lived with type 1 diabetes for more than four decades, since being diagnosed in 1977 at age seven.