Diabetes, menopause and perimenopause: What to expect

Menopause marks the end of a woman’s menstrual cycle, which typically happens between the ages of 45 and 55 and can last, on average, about four years, starting with mild symptoms that can then become more pronounced.^1,2 Perimenopause refers to the transition leading up to menopause. 

Menopause can have a significant impact on many women's quality of life and daily functioning, as well as their physical, emotional, mental, and social well-being, with a variety of symptoms that change in intensity and duration.¹

Menopause symptoms and perimenopause symptoms are often similar. They may include²: 

• Changes in mood—irritability, depression, or mood swings
• Irregular periods or no periods
• Bone loss
• Changes in sexual function and desire (for menopause, vaginal dryness)
• Difficulty sleeping or insomnia
• Hot flashes
• Night sweats
• Changes in cholesterol levels
• Bladder problems –– increased risk of urinary infections

Early signs of menopause include irregular periods and changes in how often and how long you bleed, which are usually tied to a lack of ovulation.² When you haven't had your period for a whole year, you might be diagnosed with menopause.³ The most intense menopause symptoms happen in the first 1 to 2 years after your final menstruation.²

During menopause, your body goes through a decline in hormone production, especially estrogen and progesterone, which can lead to various physical changes in the body. This hormonal shift is a natural part of the menopausal process. 

For women with diabetes, perimenopause or menopause can affect your body in different ways, such as:

• Weight gain — Many women experience weight gain during menopause due to hormonal changes, lifestyle, and aging, which could require an adjustment to diabetes medications.⁴
• Blood sugar changes — The hormones such as estrogen affect how the cells in your body respond to insulin.^5,6 The absence of estrogen can cause insulin resistance, which raises blood glucose levels. Elevated blood glucose levels increase the risk of secondary complications.
• More frequent infections — High blood sugar levels, poorly managed diabetes, and the use of medications increase the likelihood of urinary tract infections after menopause.⁷ Plus, the decrease in estrogen levels can lead to changes in the vaginal microbiota, which makes it even easier for yeast and bacteria to thrive in the vagina and the urinary tract.⁸
• Sexual difficulties —Vaginal dryness can occur after menopause and cause pain during intercourse.^9,10 Diabetes has the potential to damage the nerves of the cells lining the vagina.¹¹ This can interfere with the ability to feel aroused or experience orgasm.
• Sleep issues — Perimenopause and menopause hot flashes, plus other symptoms, can make it difficult to sleep at night. Without enough sleep, it’s harder to manage blood sugar levels. Many women going through perimenopause also have insomnia symptoms.¹²

Some studies show that women with type 1 diabetes might experience menopause earlier, while others find no significant difference compared to women without type 1 diabetes.¹³ The duration of type 1 diabetes seems to matter—an early onset of type 1 diabetes may result in an earlier menopause.

Understanding how type 2 diabetes affects menopause is difficult because it’s associated with obesity, which typically delays menopause. Yet some studies hint that women under 45 with an early onset of type 2 diabetes might go through menopause earlier.¹³

Menopause and perimenopause may make it harder to manage your diabetes. Consult with a healthcare provider and align with them before you adopt any changes to your routine. Here are some tips that can help navigate diabetes and menopause:

1. Make healthy lifestyle choices

Healthy choices are an important part of any diabetes treatment plan.¹³ Follow a diabetes diet that includes vegetables, fruits, lean protein, low-fat dairy, and whole grains. Stay active, aiming for around 30 minutes of daily activity. Consult a healthcare provider before changing your diet or exercise plan.

A healthy diet and exercise plan can also help you manage your weight. Studies show that women who exercise and maintain their weight can often prevent high blood sugar levels and higher cholesterol during menopause.¹⁴

2. Check blood sugar frequently

Since hormones can make blood sugar levels fluctuate,⁶ you may need to check your levels more often. Mixing hypoglycemia and vasomotor symptoms—such as hot flashes—may result in unintentionally increased food intake, which raises blood sugar levels and increases body weight over time.¹⁵ Track your glucose levels, keep a log of your readings in a diabetes management app or logbook/diary to get the right treatment, and help your doctor decide if your diabetes medications need to be adjusted. Your doctor can also help you better understand the numbers you share with them.

3. Get screened for heart disease

The changes that come with perimenopause and menopause can often lead to weight gain and loss of sleep, leading to an increased risk of heart disease for people with diabetes.¹⁶ Talk to your physician about cholesterol and blood pressure screenings. Both are essential for managing heart disease risk and diabetes.

4. Ask your physician about medical therapy

Menopause and perimenopause symptoms, such as vaginal dryness, night sweats, and hot flashes, can be effectively managed with a variety of therapies, including hormone replacement therapy (HRT).³ Some research shows that HRT may also improve insulin sensitivity.¹⁷

Remember that HRT does have some risks.³ Potential risks include blood clots, certain types of cancer, and stroke. Talk with your healthcare team to find out if the benefits of HRT outweigh the risks for you.

Managing menopause and perimenopause symptoms with diabetes can be challenging. With your healthcare provider's support and by prioritizing your self-care, you can take action toward a healthier lifestyle.

Resources

1. Menopause. Accessed October 31, 2023. https://www.who.int/news-room/fact-sheets/detail/menopause

2. Santoro N, Roeca C, Peters BA, Neal-Perry G. The Menopause Transition: Signs, Symptoms, and Management Options. J Clin Endocrinol Metab. 2021;106(1):1-15. doi:10.1210/clinem/dgaa764

3. Crandall CJ, Mehta JM, Manson JE. Management of Menopausal Symptoms: A Review. JAMA. 2023;329(5):405. doi:10.1001/jama.2022.24140

4. Kapoor E, Collazo-Clavell ML, Faubion SS. Weight Gain in Women at Midlife: A Concise Review of the Pathophysiology and Strategies for Management. Mayo Clin Proc. 2017;92(10):1552-1558. doi:10.1016/j.mayocp.2017.08.004

5. Hormones and their affect on type 1 diabetes management. Beyond Type 1. Accessed October 31, 2023. https://beyondtype1.org/hormones-and-their-affect-on-type-1-diabetes-management/

6. De Paoli M, Zakharia A, Werstuck GH. The Role of Estrogen in Insulin Resistance. Am J Pathol. 2021;191(9):1490-1498. doi:10.1016/j.ajpath.2021.05.011

7. Boyko EJ, Fihn SD, Scholes D, Chen CL, Normand EH, Yarbro P. Diabetes and the Risk of Acute Urinary Tract Infection Among Postmenopausal Women. Diabetes Care. 2002;25(10):1778-1783. doi:10.2337/diacare.25.10.1778

8. Amabebe E, Anumba DOC. The Vaginal Microenvironment: The Physiologic Role of Lactobacilli. Front Med. 2018;5:181. doi:10.3389/fmed.2018.00181

9. Waetjen LE, Crawford SL, Chang PY, et al. Factors associated with developing vaginal dryness symptoms in women transitioning through menopause: a longitudinal study. Menopause. 2018;25(10):1094-1104. doi:10.1097/GME.0000000000001130

10. Goncharenko V, Bubnov R, Polivka J, et al. Vaginal dryness: individualised patient profiles, risks and mitigating measures. EPMA J. 2019;10(1):73-79. doi:10.1007/s13167-019-00164-3

11. Maiorino MI, Bellastella G, Esposito K. Diabetes and sexual dysfunction: current perspectives. Diabetes Metab Syndr Obes Targets Ther. 2014;7:95-105. doi:10.2147/DMSO.S36455

12. Ciano C, King TS, Wright RR, Perlis M, Sawyer AM. Longitudinal Study of Insomnia Symptoms Among Women During Perimenopause. J Obstet Gynecol Neonatal Nurs. 2017;46(6):804-813. doi:10.1016/j.jogn.2017.07.011

13. Lambrinoudaki I, Paschou SA, Armeni E, Goulis DG. The interplay between diabetes mellitus and menopause: clinical implications. Nat Rev Endocrinol. 2022;18(10):608-622. doi:10.1038/s41574-022-00708-0

14. Bajerska J, Chmurzynska A, Muzsik A, et al. Weight loss and metabolic health effects from energy-restricted Mediterranean and Central-European diets in postmenopausal women: A randomized controlled trial. Sci Rep. 2018;8(1):11170. doi:10.1038/s41598-018-29495-3

15. Dougherty P, Pastors JG. Women & diabetes. Menopause. What to expect, how to cope. Diabetes Self Manag. 2007;24(1):84-87. PMID: 17283513.

16. Kim C. Management of Cardiovascular Risk in Perimenopausal Women with Diabetes. Diabetes Metab J. 2021;45(4):492-501. doi:10.4093/dmj.2020.0262

17. Bitoska I, Krstevska B, Milenkovic T, et al. Effects of Hormone Replacement Therapy on Insulin Resistance in Postmenopausal Diabetic Women. Open Access Maced J Med Sci. 2016;4(1):83-88. doi:10.3889/oamjms.2016.024