Hormonal changes are common throughout the lifespan. Puberty is typically humans’ first major hormonal shift in early adolescence. This shift causes all kinds of changes, which impact diabetes management quite significantly. Another very common hormonal shift is menopause, which occurs in people with a uterus. And, of course, menopause is affected by and affects diabetes management.
Menopause basics
There is a phase right before menopause called perimenopause, which can last up to a decade for some women. During this phase, hormones start to shift, and menstruation becomes irregular. Once menstruation has been absent for one year, you’ve transitioned to menopause. Some of the challenges and symptoms experienced in menopause are:
- Hot flashes/night sweats
- Weight gain
- Mood swings
- Issues sleeping
- Sexual dysfunction
How type 1 diabetes impacts menopause
There have been a few studies that concluded women with type 1 diabetes experience menopause at earlier ages than women without diabetes.1,2 Other studies have shown no difference in the age of onset of menopause between women with and without t1d.3 The risks are person-dependent and based on multiple factors.
Multiple studies also showed that the following increased the risk of early-onset menopause for women with diabetes:
- Higher doses of insulin
- Microalbuminuria (protein spilling into urine – an early marker of kidney dysfunction)
- Ovarian dysfunction (may be caused by hyperglycemia or microvascular complications)4
How menopause impacts type 1 diabetes
Due to hormone fluctuations, blood sugars can be difficult to manage, and what seems to work one week may not work the following week. Additionally, if you experience weight gain, this will increase insulin resistance and cause you to need more insulin. However, one study found that postmenopausal women with T1D needed less insulin than before menopause.5 As with many variables that affect glucose levels, it is likely to vary from person to person.
Hormone replacement therapy (HRT)
For women with T1D who want to use hormone replacement therapy (HRT) to help minimize symptoms of menopause, there is not a lot of research available to describe what should be expected. One study, which reviewed the case of one woman with T1D, found that HRT made it more difficult for her to manage her glucose levels.6 A review of multiple studies found that HRT was associated with reduced fasting glucose. Still, there were no conclusions on how glucose management was affected for women with T1D due to the small sample size.7
In summary
Menopause and its relationship to type 1 diabetes are not well-studied nor fully understood. What we do know is that it may increase the likelihood of early-onset menopause and likely make glucose levels more variable and difficult to manage. It will be beneficial to talk to a healthcare professional who can help guide you through this time in your life. Happy belated Women’s Day? (smiles tentatively)
- Predictors of the Age at which Natural Menopause Occurs in Women with Type 1 Diabetes: The Pittsburgh Epidemiology of Diabetes Complications (EDC) Study
- Effect of Glycemic Treatment and Microvascular Complications on Menopause in Women With Type 1 Diabetes in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Cohort
- Age at menopause in women with type 1 diabetes mellitus: the OVADIA study
- Gonadal dysfunction in women with diabetes mellitus
- Differences in insulin dosing in women with type 1 diabetes before and after the menopause
- The Deterioration of the Glycemic Profile during Hormone Replacement Therapy in a Patient with Fulminant Type 1 Diabetes
- Effect of Postmenopausal Hormone Therapy on Glucose Regulation in Women With Type 1 or Type 2 Diabetes: A Systematic Review and Meta-analysis
Written and clinically reviewed by Marissa Town, RN, BSN, CDCES
