Contributor: Chris Memering, BSN, RN, CDE
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We’ve all seen memes like this when it comes to menopause. But what happens when diabetes is thrown into the mix? How might menopause be different for the woman with Type 1 vs Type 2 diabetes, or is there a difference?
We know that the hormone changes monthly during menstruation can seriously mess with glucose management, especially for those living with Type 1 diabetes, so what happens when those hormones aren’t as predictable as our monthly cycle? What do you need to look for and discuss with your doctor?
So first, the definition. Menopause occurs when there is permanent cessation of having a period (menses) for 12 months. In general, this occurs around the age of 48-52. However, with both types of diabetes involved, the research tells us that menopause is likely to occur earlier. For those with Type 1, the mean age was found to be about 41-42 years of age, and with Type 2, 45-46 years of age (Prothina and Jennings, 2012). And menopause can start even early if there were irregular menstruation patterns before the age of 30. During the time leading up to menopause, periods may become more frequent, heavier, and longer. Other symptoms can occurs as well, including the well known hot flashes, vaginal dryness, hair and nail changes, night sweats, mood swings, and sleep disturbances. Sometimes these symptoms may be persistent enough that they disrupt your quality of life and if so, you should talk with your healthcare provider.
And what do those symptoms remind you of? Hot flashes? Night sweats? These vasomotor symptoms are really similar to symptoms of hypoglycemia, right? And as such, during the perimenopause stage (transition leading to menopause), your glucose meter may be your best friend. It is recommended that women, both with Type 2 and Type 1 diabetes, in perimenopause check their blood sugars more often. For those with Type 1 diabetes, or with Type 2 diabetes using insulin, it is also important to note that your insulin sensitivity can change, which may feel like your management is going out the window.
The symptoms associated with perimenopause and menopause may also be more severe when diabetes management is not optimal. With increases in HgbA1c, those with Type 2 diabetes were found to have more mental health symptoms, such as depression, mood swings, and anxiety, as well as physical symptoms, such as headaches and sleep disturbances (Bush, Floyd, and Rosasco, 2016).
Women with diabetes, especially long standing diabetes, may already have problems with sexual dysfunction. These changes, vaginal dryness and decreases in libido, may worsen during menopause and especially when glucose levels are elevated and not well managed. Think of it as another form of neuropathy and vascular disease, as along with the hormone changes, there is nerve damage and changes in blood flow. There are options that can be discussed with your healthcare team, which may or may not require hormone replacement therapy.
However, hormone replacement therapy (HRT) may not be such a bad thing to consider. As well as helping with symptoms of menopause that may be interfering with your quality of life, the studies (mostly in women with Type 2 diabetes) show that HRT can help to decrease LDL (the bad) cholesterol and decrease HgbA1c levels. We’ve also heard that our protection from heart disease goes away when we reach menopause; the use of HRT decreases the risks of heart attacks by 7%, as well as small vessel injury by 18% (Bush, Floyd, and Rosasco, 2016). Other complications related to diabetes may be decreased as well. That all being said, remember that there is an increased risk of breast cancer with the use of HRT. All the benefits and risks need to be discussed with your healthcare team.
After menopause, there are also increased risks to be aware of. The risk of osteoporosis and fractures increase in postmenopausal women. Women with Type 1 diabetes are at a higher risk for hip fractures due to lower bone mineral density in their femurs than those without diabetes or with Type 2 diabetes. Women with Type 2 diabetes have been shown in studies to have a more rapid rate of bone loss than those without diabetes. Medications used to treat Type 2 diabetes, specifically pioglitazone (Actos), also carry a higher risk of the development of osteoporosis, especially with high dosing or long term use. So you know that weight bearing exercise the ADA has been talking about for years to include with your aerobic workouts? This is where it comes into play. Weight bearing exercise helps keep bones strong. Supplementation with calcium and vitamin D may also be needed. A DEXA (dual-energy x-ray absorptiometry) scan can help you and your healthcare provider understand your degree of bone loss and help to monitor this. Your endocrinologist may even perform the DEXA scans in the office, as the risks go up for women with Type 1 diabetes. Falls resulting in fractures may also be increased with other complications of diabetes like peripheral neuropathy or vision and/or balance changes.
Along with the risks of osteoporosis and fracture, women post menopause have an increased risk of endometrial cancer when diabetes is involved. Women with Type 2 diabetes have a 1.5 times increased risk and those with Type 1 have a 13.3 times increased risk according to a study of Swedish women ages 50-74 (Prothina and Jennings, 2012). People with diabetes, particularly Type 2 diabetes, have been found to be at a high risk of cancers, such as pancreatic cancer, liver cancer, and to a lesser extent, but still higher risk than those without diabetes, colon and rectal cancers, breast cancer, and bladder cancer (Giovannucci, Harlan, Archer, Bergenstal, Gapstur, Habel, et al., 2010).
What else can you do to help with the changes associated with menopause? Regular exercise may help relieve symptoms, as well as help you manage your glucose goals. Frequent glucose monitoring will help you and your healthcare provider determine medication changes that may be needed. Changes in food choices, like avoiding spicy foods and alcohol may help with symptom management. Continued monitoring of blood pressure and HgbA1c at least every 6 months, and cholesterol annually are also still recommended as well as eye exams and exams to check for microvascular disease (think urine tests for kidney health and foot exams).
Diabetes care with menopause isn’t a lot of changes, but can throw you curveballs in terms of glucose management more than you’d like. We are women and menopause is going to happen if we are lucky enough to live long enough. So arm yourself with knowledge and don’t be afraid to ask questions and know your options. And if you need to let off that steam from the most recent hot flash, you know your peers are there for you, as well as some pretty funny internet memes.
Yours in great diabetes care,
Chris Memering, BSN, RN, CDE
Bush, S., Floyd, E., and Rosasco, R. 2016. Menopause and Diabetes? No Sweat! People Living with And Inspired by Diabetes, 2(2). 56-60.
Giovannucci, E., Harlan, D.M., Archer, M.C., Bergenstal, R.M., Gapstur, S.M., Habel, L.A. et al. 2010. Diabetes and Cancer; A Consensus Report. Diabetes Care, 33(7); 1674-1685.
Prothina, N.P. and Jennings, P. 2012. Understand the Effect of Menopause in Diabetes. Practice Nursing, 23(9); 34-37.
Chris Memering has been an RN since 2002. She has a Bachelor of Science Degree in Chemistry and Nursing and has worked as an Inpatient Diabetes Educator for the last 10 years and as a Certified Diabetes Educator for the last 8 years. Chris is a member of Sigma Theta Tau, the nursing honor society. Chris is also a member of the Diabetes Advisory Council for the state of North Carolina, and sits on various advisory boards, as well as recently serving as the Member Affiliates Liaison to the Board of Directors for AADE. Chris is currently in Grad School for a Master’s of Science in Nursing with a specialization in Diabetes Nursing at Capella University. Chris’s favorite holiday is Halloween which her whole family enjoys celebrating and is her eldest child’s birthday. When she is not busy with her two kids or doing her own schoolwork, Chris enjoys kicking back and watching movies.