Hormonal changes in the perimenopause – the lead up to the menopause – can affect your blood sugar levels. This can make it harder for some women to manage their diabetes during the perimenopause.
Menopause is usually reached when a woman has stopped having any periods for 12 months. It is caused by a fall in production of the hormone oestrogen and is a normal part of ageing, which usually occurs between ages 45 and 55.
Is there a link between menopause and diabetes?
Changing body shape can be one of the menopausal symptoms affecting some women before and after the menopause (post menopause).This can change where your body stores fat. And in women with and without diabetes, it can cause something called insulin resistance.
Insulin resistance can lead to higher blood sugar levels. Although it often affects women living with obesity or overweight, it can also affect women of a healthy weight. Often, you may not have any symptoms of insulin resistance.
How does the menopause affect diabetes?
Levels of the female hormones (most notably oestrogen and progesterone) fall dramatically during the menopause. Changes to our hormones can affect our blood sugar levels and make managing diabetes more difficult. But some people living with diabetes have told us that advice and support for managing the condition through the menopause just isn’t there.
Our Diabetes Research Steering Groups (DRSGs) have uncovered that the impact of changing hormones on diabetes management isn’t well understood, and that this is holding back care. There’s an urgent need for research in this area to help inform new guidance and better support people. That’s why we’re taking action.
In 2023, we plan to bring together researchers, healthcare professionals, and people living with diabetes to delve into this research gap and find the most pressing questions on diabetes and the menopause that must be answered to begin improving care.
Can the perimenopause and the menopause cause type 2 diabetes?
The perimenopause and the menopause don’t cause diabetes. But the hormonal changes in some women can lead to menopausal changes like carrying more weight round the middle especially – and higher blood pressure. These are both risk factors for type 2 diabetes – which also include age and ethnicity.
Keeping active, stopping smoking and eating well is the simplest way to:
- Help your body use the insulin your body makes or the insulin you take – if you have diabetes – more effectively.
- Help blood sugar levels be more stable whether you have diabetes or not.
- Reduce your risk of type 2 diabetes.
- Reduce your risk of heart disease and boost bone strength (falling oestrogen levels during perimenopause can increase your risk of heart disease and weaken bones)..
Getting support to reduce your risk of type 2 diabetes
Trying to eat well and keep active and looking after yourself – along with life’s other responsibilities can feel like a mountain if you have distressing menopausal symptoms.
If that’s the case, it’s sensible to contact your GP to talk about your options. You can also find out where to get more support on the NHS menopause page. You can also chat to one of our helpline advisors who can listen and support you.
As oestrogen levels fall, your body can become less responsive to insulin and fluctuations in hormone levels during perimenopause mean some women experience rapid changes from high to low blood sugar levels for no apparent reason
Oestrogen helps protect the heart by allowing the blood vessels to widen. So higher blood pressure and higher cholesterol levels due to lower levels of oestrogen can be an effect of menopause.
And if you have diabetes, more weight – particularly around your middle, higher blood pressure and smoking can increase your blood sugar levels.
Here are things you can do that can help manage diabetes during the perimenopause:
Check blood sugar levels more often
Discuss HRT as an option
Get the support you need
If you have diabetes, changes during the perimenopause often makes managing your blood sugar more difficult.
Is it a hot flush or a hypo?
It can be made worse because the menopause symptoms some women experience such as hot sweats and palpitations can be easily confused with a hypo. So, you may need to check your blood glucose more frequently to avoid taking hypo treatments unnecessarily.
Using a flash glucose monitor or continuous glucose monitor means it’s easier for you to keep an eye on your blood sugar levels without doing so many finger prick tests. Find out who may qualify for tech on the NHS.
As oestrogen levels fall, your body can become less responsive to insulin, known as insulin resistance. Symptoms may include higher blood sugar levels or HbA1c.
If you take insulin, your healthcare team can adjust your treatment to help with insulin resistance.
Metformin and menopause
Metformin can be a very effective treatment for menopausal women because it helps to manage insulin resistance, and there is some evidence it may help women with type 2 diabetes living with obesity who have or are at risk of developing breast cancer.
Hormone replacement therapy (HRT) is a safe treatment for most people and can be very effective at relieving the menopause symptoms.
Can HRT help you manage your diabetes?
Like any treatment, HRT isn’t suitable for all women, whether they have diabetes or not, and will not normally be recommended for women with a history of breast or ovarian cancer or cancer of the womb.
There is some evidence to suggest that HRT can be beneficial for treating menopausal symptoms in women with type 2 diabetes. But there is little information for treating symptoms in women with type 1 diabetes.
The most comprehensive review of existing research is nearly 10 years old and found a lack of evidence around the use of HRT in women with type 1 diabetes.
But the NHS suggests that in most people the risks are small and are usually outweighed by the benefits. We would suggest discussing the possibility of HRT with your GP or diabetes team who can talk you through the risks and benefits, taking account of all aspects of your medical history.
Can HRT affect your blood glucose levels?
There are different types of HRT which can replace one or more of the hormones, so it is possible HRT can affect your blood sugars. As with all medicines it is important to read the patient information leaflet that come with any HRT you’ve been prescribed.
For example, if you read the leaflet that comes with Evorel (Estradiol) oestrogen patches, it specifies that if you have diabetes, you may need more regular check-ups with your doctor.
Diabetes as well as lower oestrogen levels increases your risk of heart disease and breaking your bones after the menopause.
So it’s particularly important to think about your diet and consider cutting down on refined and processed foods and increasing fruit, vegetables, and wholegrains.
It’s also important to ensure your diet contains sufficient vitamin D and calcium. Government advice is for all women to consider taking vitamin D during the autumn and winter months.
Eating well can help prevent insulin resistance and help you manage your blood sugar levels.
Being physically active is good for your diabetes and can help you manage your blood sugar levels during the perimenopause. It can also help to keep your bones strong.
Some people with diabetes worry about hypos and exercise but it has been shown to really help both people with diabetes and menopausal women. We have some guidelines to reassure you on page on how exercise can affect blood sugar levels.
Looking after yourself is always particularly important when you have diabetes. And so is getting the diabetes care you need to manage menopausal changes.
Spend some time before any doctor’s appointment thinking about the things related to ‘your’ diabetes and menopausal symptoms that are important to ‘you’ and ask for the help, advice, and support you need to achieve your aims.
We know from listening to women that the menopause and perimenopause symptoms can have a big impact on your daily life and we are here for you. Contact our helpline on 0345 123 2399. And use the menopause support information on the NHS website.
Still have more questions or things you're not sure about on Menopause and diabetes after reading this page? Let us know by emailing firstname.lastname@example.org