Contributor: Sarit Polsky, MD, MPH
The transition around menopause is the time in a woman’s life when the number of ovarian follicles (eggs) declines more rapidly, estrogen levels decrease, menstrual bleeding patterns change, and symptoms develop. Not only can it take years, but it can be confusing and uncomfortable. While the transition starts around age 47 in the general population, it may begin earlier in women with diabetes, particularly those diagnosed with diabetes before turning 20. Thus, you may be faced with a decision about how to manage your symptoms at a time in your life when you have many responsibilities related to home life, work, childcare, and eldercare. You may be experiencing physical and emotional discomfort from a combination of menopausal symptoms, as well as your responsibilities and obligations in life. So, how is a woman to decide about treatment for menopausal symptoms?
It is important to speak to a licensed medical professional before trying any treatment, whether over-the-counter or prescribed. (For more information on menopause symptoms, the definition of natural menopause, and how women with diabetes are affected, see Menopause in Women with Diabetes). You and your provider should try to sort out what symptoms are from menopause, diabetes, or other medical conditions to formulate the appropriate treatment plan. A provider can also assess if a new medication might cause an unfavorable interaction with any current medications.
Another key concept is that treatment should target the main symptoms you are experiencing and should be appropriate for the intensity of your symptoms. For example, if you have mild hot flashes that do not affect your ability to do usual tasks, treatment may not be pharmacologic. Instead, you could focus on environmental adaptations like wearing layers of clothing so that items can be removed when a hot flash occurs, using cooling devices like an air conditioner or fan, and recognizing and avoiding triggers for the hot flashes. If the hot flashes occur often and are severe, meaning they interfere with your ability to perform your daily activities, then pharmacologic treatment should be considered. In such a case, systemic menopausal hormone therapy (MHT) may be offered. As another example, if your main symptom involves vaginal discomfort (dryness, pain with intercourse, or burning), then vaginal lubricants or moisturizers without hormones can be tried first.
MHT refers to either estrogen replacement alone (for women who no longer have a uterus) or estrogen and progestin administration (for women who do). MHT should not be considered if you have certain types of cancer, a history of stroke, mini-stroke, or heart disease, or are more than ten years into menopause. MHT can be given as a pill, hormone patch, gel or lotion, or a spray. It also may be given locally through a low-dose of estrogen inserted into the vagina via a cream, tablet, capsule, or ring. There are multiple reasons you may opt for one type of MHT therapy over another, so your delivery method should be well thought out. If you work with children or pets, you may want to avoid MHT with gel, lotion, or spray because to avoid their exposure to your MHT. If you have liver issues, you may need to avoid MHT pills since they are processed through the liver. Other considerations are side effects, including vaginal bleeding, changes in mood, and bloating.
Deciding what type of treatment, if any, you will use to control menopausal symptoms will depend on your type of symptoms, their severity and frequency, your health conditions, contraindications, and personal views (to name a few things). If you aren't comfortable with MHT or you have a health condition that makes MHT risky, then other therapies should be considered. Depending on your symptoms, these could range from vaginal lubricants to cognitive behavioral therapy. If you decide to use MHT, your treatment should target your main concerns with the lowest dose possible to alleviate symptoms with few side effects. In all cases, you should consult your healthcare team to ensure successful and safe treatment.
Dr. Polsky is an Assistant Professor at the University of Colorado, Anschutz Medical Campus, specializing in Endocrinology, Diabetes, and Metabolism. She directs the Pregnancy & Women’s Health Clinic at the Barbara Davis Center, Adult Clinic and is interested in how diabetes affects women during the reproductive years, menopause, and post-menopausal stages. She maintains a clinical and research interest in women's health and diabetes. She believes that she is a medical advisor to her patients, and works together with them to provide comprehensive care for their conditions that takes into account medical expertise, patient safety, and quality of life.