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Mental Health and Emotional Wellbeing in Menopause with Diabetes

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Those diagnosed with diabetes may have unique mental health challenges. There is the emotional impact of regimental eating with restraint in order to maintain optimal blood glucose. There are lifestyle changes that must be considered to act synergistically with the new nutritional changes. This may lead to a range of emotions, including anxiety, frustration, and sadness. One could even imagine a sense of loss and a loss of control as well. The constant management of blood glucose levels and dietary restrictions can lead to stress. Those living with diabetes may also have fear about potential complications, such as neuropathy (nerve issues), retinopathy (eye issues), or cardiovascular issues. This can create anxiety and affect daily life. Diabetes can affect interpersonal relationships. Partners, family members, and friends may struggle to understand the condition, which can lead to conflict or tension.

The hormonal changes of perimenopause and menopausal hormones can affect mood and sleep, which can have their own unique challenges on mental health. The transition of menopause to postmenopause can be a time of great hormonal fluctuation and change. This transition is difficult for most women, with or without diabetes. There is a lot to unpack here.

Fluctuations in the hormones estrogen, progesterone, and testosterone can affect blood glucose changes and hence, affect mood. Estrogen, progesterone, and testosterone play significant roles in regulating mood in the perimenopausal/menopausal time period. Let’s investigate how these hormones generally work and how they affect blood glucose and mood.

Estrogen affects the production and regulation of neurotransmitters, particularly serotonin, which plays a crucial role in mood regulation. Fluctuations in estrogen can impact serotonin levels, influencing emotional stability. Estrogen also interacts with the dopamine system, which is linked to pleasure and reward, potentially affecting mood and motivation. Estrogen helps regulate the body’s response to stress. Reduced estrogen can lead to changes in blood glucose, which can affect mood. Changes in estrogen levels can impact cortisol production, influencing mood and anxiety levels. Estrogen generally enhances insulin sensitivity, which helps the body use glucose more effectively. Higher estrogen levels are often associated with better blood glucose management.

Progesterone can have the opposite effect of estrogen by promoting insulin resistance, particularly in the luteal phase of the menstrual cycle when progesterone levels rise. This can lead to higher blood glucose levels. During menopause, when progesterone levels are lower and more unpredictable, so can its effects on blood glucose. During perimenopause, progesterone levels decline significantly, which can lead to imbalances between estrogen and progesterone. This imbalance can contribute to mood swings, irritability, and anxiety.

In premenopausal women, progesterone levels rise during the luteal (after ovulation) phase of the menstrual cycle. The decline in progesterone during menopause removes this stabilizing influence, potentially leading to mood instability.

 Progesterone is converted into allopregnanolone, a neurosteroid that enhances the action of GABA, an inhibitory neurotransmitter that promotes relaxation and a sense of calm. Lower levels of progesterone can lead to decreased GABA activity, contributing to feelings of anxiety and agitation. Progesterone may also influence serotonin levels, which are crucial for mood regulation. Changes in progesterone can affect serotonin receptors, potentially leading to mood disturbances.

The decline in progesterone during menopause can lead to increased anxiety and feelings of restlessness. This may be exacerbated by sleep disturbances, which are common during menopause. Progesterone is known to have a calming effect and can promote better sleep. Its decline can lead to insomnia or disrupted sleep patterns, which can further affect mood and emotional stability.

All of these hormonal fluctuations during perimenopause and menopause can have a significant impact on mental health.

Strategies for Coping with Emotional Changes

Living with a chronic medical condition can be emotionally taxing. Add to this the changes that come with menopause, both physically and emotionally, and this time of life can be doubly taxing, and it is unique to women. What strategies can be used to help women with diabetes who are perimenopausal or menopausal cope with these changes? 

First, mindfulness or “observing your thoughts, feelings, bodily sensations, and surroundings.” This is the dictionary definition of mindfulness. In short, try to be aware of what you are experiencing and know that these subtle, and not so subtle, changes are a normal, natural process of life’s changes. Meditation, or allowing your body to become calm in a state of heightened awareness through concentration, can help women adjust to and process some of the changes their bodies are experiencing. Not all women experiencing these new changes will have the insight to be able to coach themselves through this. Insight is a very important part of self-care.

Another very helpful strategy to help with the changes of perimenopause and menopause is to seek professional support. Therapy and counseling in conjunction with diabetes education can be very helpful. Many women tend to blame the new-found emotional changes on their “hormones” when in fact, there is a complex interplay with hormones, blood glucose, life stressors and changes, and other external forces that may or may not be able to be quantified. Having mental health and health care professionals (such as your gynecologist) in conjunction with a diabetes specialist can be helpful to tease out the nuances of the different factors that interplay to make this time of life very challenging.

Women with diabetes experiencing perimenopause and menopause will also benefit from a community of support. Partners and friends, who may not be menopausal or living with diabetes themselves, may need to be educated about the challenges of both in order to be empathic. It can be very helpful for your partner to know about some of the classic menopausal symptoms and how changes in one’s environment (reducing the room temperature, using fans, selecting appropriate clothing, etc) can ameliorate some of the discomforts of this challenging time.

Organizations such as DiabetesSisters, which “provide a nurturing space where women can learn, share experiences, and build the confidence to manage their diabetes” can be quite helpful and offer specialized support. After all, diabetes and menopause have unique experiences and are not static. It is important to navigate the changes of both as women transition. 

It is important to take a holistic approach to learning how to cope with the physical and emotional challenges during the perimenopause to postmenopause transition. For many women, this will be a continuum of changes that elicit different emotional and physical responses. Learning to cope using some of the above tactics will help make this transition smoother and easier to navigate.


About the Author

Dr. Mala Freeman-Kwaku, lead physician at Arboretum Gynecology, has over 22 years of experience specializing in gynecologic care, including treating uterine fibroids, heavy menstrual bleeding, and menopausal symptoms. A graduate of the University of Virginia and Georgetown University Medical Center, she transitioned from a group practice to create a more intimate healthcare environment, successfully rebranding her practice while maintaining patient loyalty. Skilled in hysteroscopy and advanced procedures like the Sonata fibroid ablation, she shares her expertise as a speaker for Gynesonics and through her private consulting firm, MFK Advising Group, LLC. Dr. Freeman-Kwaku is married with four children, enjoys traveling, and remains active in her church and community.

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Dr. Mala Freeman-Kwaku
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