Diabetes and menopause Factsheet

If you’ve been living with type 1 or type 2 diabetes for some time, it may become more challenging to manage your blood glucose levels during the perimenopause and menopause. This is because fluctuating levels of the hormones estrogen and progesterone can cause blood glucose levels to spike and fall. This makes it more difficult to keep diabetes well controlled, which has the potential to increase the likelihood of long-­term health risks.

Having diabetes doesn’t mean that you can’t take hormone replacement therapy (HRT). In fact, it can be particularly beneficial as it reduces your risk of cardiovascular disease, as well as improving your wellbeing and energy, which can improve glycemic control.

What to expect

Your experience of menopause is unique to you, but if you have diabetes, you might notice some of these common effects:

Fluctuating blood sugar levels
The hormones estrogen and progesterone affect the way the cells in your body respond to insulin. This can lead to unexpected changes in your blood glucose levels so look out for unexplained highs and lows in blood sugar levels, especially if you’re taking insulin or tablets such as gliclazide or glipizide.

Weight gain
Many women find that metabolic changes cause them to gain weight as they go through the perimenopause and menopause. This may make you more resistant to some of your medications. As a result, your doctor or diabetes nurse may need to review your dosage of insulin or diabetes medication, such as Metformin.

Sleep problems
If you suffer from hot flushes and night sweats during the perimenopause and menopause, there’s a good chance that these will disrupt your sleep. Lack of sleep can also reduce your energy levels and make it more difficult to control your blood glucose.

Infections
Diabetes increases the risk of urinary and vaginal infections, such as cystitis and thrush. This risk further increases during the perimenopause and menopause, when estrogen levels fall. As a result of these changes, the tissues around the vagina become more fragile and the natural balance of bacteria changes, leaving you more vulnerable to infections. In type 2 diabetes, recurrent urine infections and thrush can be a troublesome side effect of medications called ‘flozins’ (SGLT2 inhibitors). Flozins may be an important part of your long-­term type 2 diabetes treatment (they are also occasionally used to treat type 1 diabetes). Using vaginal estrogen regularly alongside these medications may help reduce the side effects of flozins, and help you tolerate them more easily.

Pain during sex
Over time, high blood sugar levels can damage the nerves in the vagina and cause the vaginal walls to become inflamed. As vaginal dryness is a common symptom during the perimenopause and menopause, the combination of these problems can make it hard to get aroused and achieve orgasm, and may also mean that penetration becomes uncomfortable or painful. If you’re experiencing vaginal dryness, vaginal moisturisers are completely safe to use for everyday comfort, and vaginal estrogen can be used safely at any age to maintain and restore lubrication and the stretchiness of your vagina.

How to manage diabetes during menopause

Here are some top tips for managing your diabetes and perimenopause or menopause:

Healthy lifestyle – eating a balanced diet, keeping active, reducing your alcohol intake and stopping smoking will help you to feel your best during the perimenopause and menopause, as well as keep your diabetes under control.

Vitamin D – taking 1,000iu of vitamin D daily has been shown to improve bone health, insulin sensitivity and immunity.

Regular testing – monitoring your blood sugar levels more regularly during the day (and sometimes at night) will help you see how they are affected by your menopause symptoms such as hot flushes and sleep disturbances. Keep track of these readings so you can share them with your doctor or diabetes nurse, who may wish to review your diabetes medication.

Hormone replacement – symptoms of your perimenopause or menopause are usually improved with HRT. Vaginal estrogen can be prescribed to relieve pain and soreness in your genital area and reduce the frequency of infections such as cystitis and thrush. As HRT replaces the hormones which are lost during and after menopause, it can also help to reduce your risk of osteoporosis, cardiovascular disease, dementia, and depression. This is particularly beneficial if you have diabetes, as you already have an increased risk of some of these conditions. For this reason, HRT should be considered an important part of your treatment plan and, as long as the benefits continue to outweigh any risks, it can be used for the rest of your life.