My Journey Through Perimenopause and Postmenopause with Type 1 Diabetes

Menopause is a significant and often challenging transition for all women, but for those managing diabetes, the journey brings unique complexities. From fluctuating hormones affecting blood glucose levels to increased risks for heart disease and bone density loss, the intersection of diabetes and menopause requires a thoughtful, holistic approach. Over the past several articles, we’ve explored essential topics like mental health, heart health, bone density, treatments, and lifestyle adjustments, all aimed at supporting women through this life stage. But while clinical information is invaluable, there’s nothing quite like hearing from women who have lived through these experiences themselves.
In this article, a woman living with type 1 diabetes shares her personal story and insights around navigating menopause. She shares insights into how she has managed the physical, emotional, and medical challenges she’s faced. Her voice reminds us that while every woman’s experience is unique, the shared wisdom of those who’ve walked this path can provide strength, encouragement, and practical tips for others. Join us as we hear from an expert who lives it every day—women like you.
Navigating perimenopause while managing type 1 diabetes was something I had not fully anticipated. I did not realize how dramatically fluctuating hormones would impact my blood glucose levels until perimenopause hit me.
At age 50, I went on a yoga retreat in Costa Rica, excited to relax. But something felt off. My body was changing in unfamiliar ways – bloating, an irregular cycle, and the anxiety of seeing my blood glucose levels swing unpredictably. Being out of my routine and in a different country made the changes more noticeable.
When I got home, conversations with other women led me to wonder – was this perimenopause? Could this stage of life be the reason my blood glucose, weight, mood, and sleep were all out of order?
Understanding Perimenopause Through Postmenopause
I learned that the menopause process is all about hormones. My body had begun to produce less estrogen, which regulates menstrual cycles, and the ovaries started running low on eggs. But it does not happen all at once. There are three stages of menopause1:
- Perimenopause: This transitional period, which marks the initial stages of menopause, can last for years — sometimes even a decade. You may start to have menopause-like symptoms like irregular periods, hot flashes, and more.
- Menopause: You have reached menopause when you have not had a menstrual period for one full year (in the absence of any other medical condition or medication that would have an impact on your periods). Your ovaries have stopped producing most of their estrogen and no longer release eggs.
- Postmenopause: Once you have reached menopause, you enter the post-menopausal stage. Your symptoms will lessen and may eventually go away — though you are now at an increased risk for conditions like osteoporosis and heart disease.
Low estrogen2 is often a tell-tale sign that you are approaching menopause. Symptoms may include:
- Breast tenderness.
- Weak or brittle bones.
- Hot flashes and night sweats.
- Insulin resistance
- Irregular periods or no periods.
- Headaches, trouble concentrating.
- Fatigue, drowsiness, trouble sleeping.
- Mood changes, irritability, and depression.
- Vaginal dryness, leading to painful intercourse (dyspareunia).
Uncovering The Connection Between Perimenopause and Diabetes
Perimenopause, the transitional phase before menopause, is marked by fluctuating hormones like estrogen and progesterone. As a woman living with type 1, I found this hormone rollercoaster wreaked havoc on my blood glucose levels. Insulin sensitivity is lower when estrogen levels drop and progesterone levels increase, leading to insulin resistance. Suddenly, what used to work in my daily routine was no longer enough.
Typical signs of perimenopause – night sweats, mood swings, and poor sleep – can also mimic hypoglycemia symptoms. It was confusing and frustrating, making it harder to manage both diabetes and hormonal changes.
Seeking Support: A Lifeline
Even though I was experiencing clear symptoms, I thought I could manage them by improving my lifestyle habits, focusing on nutrition, adding in some herbs, and prioritizing self-care. That worked for about a year – until it did not.
As I approached my 52nd birthday, I was using more insulin, and my previous strategies for keeping my blood glucose steady were no longer effective. My basal rate increased by 50%, but even with this adjustment, I struggled to maintain consistent levels. My A1C required constant effort to manage, and it was exhausting. The relentless feedback from my glucometer and CGM started to wear on my spirit and motivation. It affected my mood, energy, and focus, and I developed joint pain and a frozen shoulder, which seemed to come out of nowhere. My confidence took a hit, and I began to feel disconnected from both my relationships and managing diabetes.
Unfortunately, my gynecologist was not trained to address how this stage would impact managing type 1. Once I suspected perimenopause was affecting my diabetes, I leaned into my background as a health and hormone coach to find answers. At that point, I had only a vague understanding of hormone replacement therapy (HRT) and what other options I could take. I chose to advocate for myself by consulting a trusted hormone specialist and requesting hormone testing at my next appointment with a new gynecologist who focuses on women’s health in later life.
This was a notable change. The tests revealed that declining estrogen levels were contributing to my insulin resistance and weight gain, and my other hormones, like progesterone and testosterone, were also out of balance.
Learning The Myths and Facts: HRT Decisions
In 2002, a landmark study3 challenged the belief that HRT protected women from heart disease and chronic illness. The Women’s Health Initiative found that estrogen plus progestin, synthetic forms of hormone replacement, increased the risk of heart disease and breast cancer. However, experts like Dr. Felice Gersh4 argue that bioidentical hormone replacement is crucial for women, emphasizing estrogen’s anti-inflammatory properties and its role in protecting the heart, brain, immune system, insulin sensitivity, bones, and gut health. Since every cell in a woman’s body has estrogen receptors, the entire body feels the impact when estrogen levels drop during menopause.
After extensive research and consultations, I chose bioidentical hormone replacement therapy (BHRT) to replenish my hormones. Once I understood the facts and benefits, the decision was easy. It significantly eased my perimenopausal symptoms and helped stabilize my blood glucose in postmenopause.
Managing My Type 1 Diabetes Beginning In Perimenopause Takes A Well-Rounded Approach
Here is what continues to help me:
- Regular Monitoring: Keeping a close eye on my blood glucose levels and adjusting insulin as needed is essential. My insulin requirements increased, but tracking patterns helped me regain management.
- Foundation of Health: I needed to build strong daily habits. I focused on balancing meals, getting enough sleep, staying hydrated, optimizing vitamin and mineral levels, and reducing stress to avoid cortisol spikes. Strength training became key for better insulin sensitivity. It was important to have these habits in place before considering hormone replacement so I could get the best results and improve blood glucose management.
- Bioidentical Hormone Replacement Therapy: Hormone replacement played a key role in managing both my perimenopausal symptoms and blood glucose levels. However, exploring all options and consulting with a knowledgeable provider before starting is important.
- Community and Education: I leaned on my network and joined forums. The DiabetesSisters community is one space where women can share their experiences and find guidance during this transitional phase.
- The Importance of Advocacy: One of the hardest lessons I learned was the importance of advocating for my own health. Many healthcare professionals are not trained to understand the intersection of perimenopause and type 1 diabetes. I had to keep asking questions, push for hormone testing, and find specialists who understood my unique challenges.
Embrace the Change – With a Plan
Perimenopause can bring significant changes, but it does not have to be frustrating or isolating. This became a time of growth for me, and I now help others facing the same challenges.
If you are managing perimenopause or menopause with diabetes, you are not alone. With the right care, education, and support, you can confidently manage your hormone health and thrive with diabetes.
References:
- Cleveland Clinic April 5, 2024 https://health.clevelandclinic.org/menopause-stages
- Cleveland Clinic 02/08/2022 https:/my.clevelandclinic.org/health/body/22353-estrogen
- https://functionalmedicinecoaching.org/podcast/felice-gersh-080
- https://integrativemgi.com/services/menopausal-transitions
Bio:
Melissa Slemp is a certified nutritional and hormone health coach, personal trainer, and founder of Abundant Health with Melissa. She helps women 40+ with type 1 diabetes feel empowered and live well despite their diagnosis. Having managed T1D since age 14, Melissa understands how health impacts every area of life.
She hosts the Type 1 in Midlife podcast, sharing personal insights and expert tips to help women redefine diabetes as they age. In her free time, she enjoys beach walks, sunsets with wine, and dark chocolate, alongside her husband David, who also manages type 1, daughter Sarah, and their energetic dog Kona.
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