The Link Between Menopause and Diabetes

Menopause brings many changes, and for women living with or at risk for diabetes, it can add a new layer of complexity to blood sugar management. Hormonal shifts during perimenopause and beyond can affect insulin sensitivity, weight, mood, and more. Here, we'll talk more about the connection between menopause and diabetes, along with how to adjust diabetes care throughout this transitional period.

What Happens During Perimenopause and Menopause?

Perimenopause is the time leading up to menopause, typically starting in your 40s but sometimes earlier. It can last several years, and during this time, your body experiences fluctuating hormone levels, especially estrogen and progesterone, which can cause a range of symptoms, such as:

• Irregular periods
• Hot flashes
• Night sweats
• Sleep disturbances
• Mood changes
• Weight gain
• Changes in libido
• Vaginal dryness
• Breast tenderness
• Headaches
• Declining fertility

Menopause is officially diagnosed after 12 consecutive months without a menstrual period, usually occurring between the ages of 45 and 55. At this point, the ovaries have significantly reduced hormone production, especially estrogen. At this time:

• Estrogen and progesterone stay low and can affect several bodily systems
• Ovulation and menstruation end
• Ongoing hot flashes and night sweats
• Bone density decreases
• The risk of heart disease increases
• Vaginal and urinary changes can occur
• Skin and hair changes occur

Although some symptoms eventually subside (i.e., hot flashes), others (i.e., an increased risk for cardiovascular disease) remain. Talk to your doctor to learn more about how you can take a proactive approach to your health as you near the perimenopausal period.

How Menopause Affects Blood Sugar

During perimenopause, the hormones estrogen and progesterone start to fluctuate, and during menopause, they begin to decline. Estrogen typically improves insulin sensitivity, so when it drops, insulin sensitivity decreases. This can make it more difficult to manage blood glucose levels and result in higher fasting glucose.

Menopause also often causes many women to gain weight, primarily due to the hormonal shift and a decreased metabolism. Since belly fat is closely linked to insulin resistance, this can put women at a greater risk of developing type 2 diabetes or make it more difficult to maintain target A1c levels.

Other things that can affect your blood sugar include increased stress, changes in mood, sleep disruptions, and changes in muscle mass associated with menopause.

The Relationship Between Diabetes and Menopause

Both perimenopause and menopause can affect blood sugar control, increase insulin resistance, and affect how your body responds to diabetes medications. That's why understanding this transition is especially important for women with prediabetes, diabetes, or those at risk. Working with your doctor as you're going through menopause is essential for making changes to diabetes management plans or adjusting lifestyle habits to help reduce your risk.

Can Menopause Symptoms Mask Symptoms of Diabetes?

Yes, many of the symptoms of menopause also overlap with common diabetes symptoms, which can lead to confusion and a misdiagnosis. For example, it's normal to feel temperature fluctuations in early menopause, but they can also be a sign of hypoglycemia. If you're going through perimenopause or menopause, it's crucial to talk to your doctor about any symptoms, especially if you have risk factors for diabetes.

Risk Factors for Type 2 Diabetes After Menopause

Some risk factors for developing type 2 diabetes after menopause include:

• Age-related decline in metabolism
• Drop in estrogen levels
• Decreased muscle mass
• Increased abdominal fat
• Slowed metabolism
• Poor sleep
• History of gestational diabetes
• Family history of diabetes
• High cholesterol
• High blood pressure
• Sedentary lifestyle
• Poor diet

Tips for Managing Diabetes During and After Menopause

It's important to understand how menopause affects diabetes, especially if you've already been diagnosed. Women with type 1 diabetes and women with type 2 diabetes should work closely with their doctors to manage blood sugar levels as drops in estrogen and progesterone occur. Some tips for managing menopause in people with diabetes or prediabetes include the following:

Monitoring Blood Sugar More Closely

Hormonal fluctuations can cause blood glucose levels to swing unpredictably, so you may notice that your usual patterns no longer apply, especially around your menstrual cycle or as it becomes irregular.

Therefore, it's essential to keep an eye on your blood sugar a bit more closely. You will likely need to adjust for hormonal changes and track new trends more carefully. Your doctor can provide you with more information on how to address blood sugar fluctuations during this time.

Make Adjustments to Medication or Insulin

Declining estrogen and progesterone change how your cells respond to insulin, so you may need to adjust your diabetes medications or insulin injections. If you notice persistent high blood sugar readings or chronic low readings despite following your usual regimen, schedule an appointment with your diabetes specialist. You may need to change insulin timing or explore alternative medications that improve insulin sensitivity or help with weight management.

Change Your Diet to Accommodate Hormone Differences

Eating habits that helped support stable blood sugar levels before menopause may also need to be reevaluated. However, it's recommended to work with your diabetes doctor before making changes to your diet to avoid even higher blood sugar levels. Some general recommendations that you can discuss include switching to an anti-inflammatory diet and seeing whether or not there are changes in how certain carbohydrates affect your blood sugar levels. Glycemic impact may change due to hormonal differences, so try keeping a food journal and checking your blood sugar more frequently after meals.

Prioritize Physical Activity

Regular exercise is one of the most powerful tools for managing both menopause symptoms and diabetes. For example, incorporating strength or resistance training can help you maintain (and build) muscle mass, regardless of whether you're in a menopausal state. Cardiovascular activity can also help decrease your risk of heart disease, and activities like yoga can alleviate stress or anxiety associated with both conditions. If you're new to exercise, always talk to a healthcare professional before starting a regimen. Your doctor may also recommend working with a physical trainer to help you establish new habits and ensure correct form.

Consider Hormone Replacement Therapy (HRT)

If you continue to struggle managing your blood sugar, your doctor may recommend hormone replacement therapy (HRT). However, its relationship with diabetes is complex. Some studies suggest estrogen therapy can improve insulin sensitivity, while others caution about cardiovascular risks. If you're considering HRT, speak with both your OB/GYN and diabetes care team to weigh the risks and benefits based on your health profile.

Emotional and Mental Health Considerations

Menopause and perimenopause can cause significant mood swings and also increase the risk of depression and anxiety. If you're living with diabetes, the emotional toll of both conditions can make things even more challenging. To help, consider joining a menopause support group and/or a diabetes support group. This can help you connect with other women with the same expeirence. Working with a mental health professional can also help, along with communicating with friends and family if you feel like you need help.

Tips for Women at Risk of Diabetes Entering Menopause

If you have risk factors for developing diabetes or currently have prediabetes, there are things you can do to help prevent type 2 diabetes from occurring or at least catch it early. Some tips for women who are at risk include:

• Get regular screenings (A1c levels, fasting glucose, etc.)
• Make lifestyle changes before menopause begins
• Prioritize sleep
• Find ways to manage stress levels
• Lose excess weight
• Move your body regularly
• Work with a doctor to improve gut health

When to See Your Doctor

Managing diabetes during perimenopause and menopause can be complicated, and while lifestyle changes are helpful, there are times when seeing your doctor is necessary. If you're experiencing any unusual symptoms or finding it difficult to control your blood sugar levels, don't hesitate to contact your doctor. Some additional signs you should schedule an appointment with your healthcare provider include:

• Sudden or unexplained changes in blood sugar levels. If your glucose readings become erratic, it could be due to hormonal shifts that require medication adjustments.
• Persistent or worsening menopause symptoms. If menopause symptoms interfere with daily life, it’s worth discussing options like hormone replacement therapy (HRT) or alternative treatments with your doctor.
• Weight gain that doesn’t respond to diet and exercise. Your doctor can assess whether an underlying issue is contributing.
• Signs of diabetes-related complications. These include increased thirst or urination, blurred vision, numbness or tingling in the feet, or frequent infections.
• Mental health concerns. If you feel overwhelmed, isolated, or hopeless, talk to your provider about mental health support or counseling referrals.

Menopause marks a major life transition, and for women living with diabetes or at risk of developing it, it’s a time to be especially proactive about their health. Keep regular check-ups with your doctor and don't hesitate to contact them if you notice anything unusual. In the meantime, Byram Healthcare can help simplify diabetes care with a range of high-quality diabetes products.