Contributor: Sarit Polsky, MD, MPH
The menopausal transition can be a confusing time for a woman. She may experience uncomfortable symptoms that she does not realize are associated with this transition in life. Many women also don’t realize that they may have symptoms for years before they actually have their last menstrual periods. It also usually coincides with a stage of life that in and of itself is associated with many personal and sometimes professional obligations. At such a busy time, women sometimes think their symptoms are from something else, like stress. If you add diabetes into the mix, this confusion can increase because some of the symptoms are common to both menopause and diabetes. So, let’s try to answer some common questions.
What is natural menopause?
Natural menopause is when menstrual periods stop permanently and there are no obvious pathologic or physiologic causes, but this permanence is determined after at least consecutive 12 months without a period. The reason the menstrual periods stop is because all (or nearly all) of the ovarian follicles (eggs) are gone and estrogen levels decrease. It usually occurs around age 51. Symptoms of menopause include hot flashes, sweating, sleep disturbance, depression, vaginal dryness, sexual dysfunction, changing in thinking (memory, concentration), and joint pain.
How are women with diabetes affected by menopause?
The studies are inconsistent, but sometimes women with diabetes undergo menopause at an earlier age. Women with diabetes may have a difficult time deciphering if symptoms are from menopause or from hypoglycemia, such as with hot flashes and sweating. They may also find it hard to tell if symptoms are from menopause or from diabetes complications, like vaginal dryness and decreased libido.
What are the treatment options for menopause?
Some treatments are over-the-counter, which means that a provider does not need to write a prescription. Though many herbal and complementary therapies have been studied, there has not been a consistent benefit seen with them. Some treatments include non-hormonal based prescription drugs, like certain antidepressants which can help with hot flashes. Finally, there are hormone-based prescription treatments. Hormone replacement therapy (HRT) includes estrogen and sometimes progestin (to protect the uterine lining in women who have a uterus). HRT use is limited in duration and can increase the risk for some serious medical conditions. HRT can be delivered in pills, patches, gels/lotions, suppositories, and vaginal rings. There aren’t enough studies in women with diabetes. It is very important for women to consult medical providers about the options available to them and to make sure they do not start therapies contraindicated for their particular circumstances.
What else should one consider?
When menopause occurs in women with diabetes, they are especially vulnerable to other conditions like brittle bones (osteopenia/osteoporosis), cardiovascular disease, and dementia.
Menopause can present some physical and emotional discomfort in women with diabetes. While some symptoms are well-known, others may not be common knowledge. Women with diabetes may have trouble determining what is causing some symptoms because the symptoms themselves may occur from diabetes and/or from menopause. Fortunately, there are licensed professionals who can help women navigate these discomforts.
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.