Menopause is a process, not an event. It is the natural way your body responds to a changing physiology. It can be a trying period for most women both emotionally and physically, but if you have diabetes, it can be even more challenging.
Menopause proceeds slowly, often spanning a period of 5 to 10 years. It begins as your body slowly decreases the production of estrogen and progesterone, the hormones that regulate your menstrual cycle and set the stage for pregnancy. When this happens, ovulation and menstruation becomes irregular. You may find that you ovulate one month and have a period, but then may go several months without any period or signs of ovulation. Some women begin menopause before 40, but others continue to ovulate and menstruate well into their 50s or even 60s. The average age for most women to have their last period is 51.
This may be a difficult time if you have diabetes. Maybe you have finally figured out how to adjust your eating schedule, insulin plan and exercise routines around your hormonal fluctuations. You have learned how estrogen and progesterone can affect your blood glucose levels. Progesterone tends to decrease insulin sensitivity and estrogen tends to increase it. With these hormone levels now changing, your blood glucose can be thrown way off balance.
As you go through menopause, you may face new risks, and some of the risks of diabetes may become more serious. Diabetes itself, for example, increases your risk for heart attack and stroke two to four times above that for people without diabetes. Estrogen protects against heart disease. As your estrogen supply diminishes, your risk of cardiovascular disease increases. After menopause, women without diabetes have the same risk of heart attack as men. If you are a postmenopausal woman with diabetes, you have twice the risk of heart disease and stroke as a man without diabetes.
When you lose estrogen, levels of total cholesterol tend to rise, and good cholesterol tends to drop. If you do not practice good blood glucose control, your cholesterol levels can become even worse. You also face a greater risk of osteoporosis after menopause.
Women with diabetes face a greater risk of yeast and vaginal infections than women without diabetes, and as you pass through menopause, your risk can increase even further. Without a good supply of estrogen to keep the vaginal lining healthy, yeast and bacteria have an easier time growing there uncontrolled.
Symptoms of menopause include hot flashes, moodiness, short-term memory loss, and wide swings in blood glucose levels. You may have more episodes of low blood glucose that are stronger and more frequent, especially during the middle of the night. Sleep is often disturbed. You may also notice more vaginal dryness and pain during intercourse.
What You Should Do
If you begin to experience some of the symptoms of menopause, there are several steps you can take to minimize the discomfort, keep your diabetes on an even keel, and prevent the worsening of the complications of the diabetes. First and foremost, monitor your blood glucose levels regularly and keep your blood glucose under control. Make sure your doctor and dietitian know what you are experiencing. You may need adjustments in your insulin plan, your meal plan or perhaps your oral medication.
If you are prone to vaginal and bladder infections, bathe regularly and try to keep fecal bacteria from coming into contact with your urethra or vagina. Try including a low-fat yogurt in your diet. Some believe the bacteria in yogurt can keep the yeast in your digestive tract at bay and prevent vaginitis. The extra calcium in yogurt is an added bonus in preventing osteoporosis.
Consider hormone replacement therapy. This can be a difficult decision that requires careful consideration of the risks and benefits. Estrogen can decrease the risk of heart disease, stroke, osteoporosis, and vaginitis, but it can also increase the risk of breast and uterine cancers. Progesterone given along with estrogen can diminish the risk of uterine cancer. Your risk of dying from heart disease may be greater than your increased risk of cancer induced by hormone therapy.
To make this decision, you may need to discuss your options with your doctor. If you have a family history of heart disease, you may very well benefit from hormone replacement therapy. However, if there is a strong risk of breast cancer or blood clotting in your family, you may not want to increase that risk by taking hormone supplements.
If you do opt for hormone replacement therapy, be aware that you may have to readjust your blood glucose management plan to accommodate the additional hormones. Estrogen increases insulin sensitivity, but progesterone decreases it. You and your doctor should discuss an approach that works best for you.
After menopause, make sure to keep up with your regular diabetes care plan of good blood glucose control, regular exercise, and a healthy eating plan. You may also want to consider adding some tests or taking some tests more frequently:
As you go through menopause, you lose estrogen. Estrogen can protect against osteoporosis or porous bones. This condition is more common in women as they age, and if you have diabetes, you may face an additional risk of osteoporosis.
Your risk of osteoporosis as you age increases if you are a smoker, thin, fair-skinned, have experienced early menopause, have been on steroid therapy or have prolonged bouts of high blood glucose levels. Your risk is further increased if you do not take in enough calcium, have a history of anorexia or bulimia, or have a diet high in alcohol and caffeine or very low fats
Osteoporosis does not really have symptoms, unless it affects the bones of the back. If this happens you may experience backache or notice that you are becoming shorter or more round-shouldered. In rare cases, you may experience a sudden onset of severe back pain
What You Should Do
The best way to prevent osteoporosis from occurring or getting worse is to engage in regular weight-bearing exercise. This can help build up your body mass and bone density. Talk to your doctor or exercise physiologist about what might work for you. Even lifting 1kg to 2kg weights can help improve your bone strength. This need not require any over exertion.
For many exercises, you can sit in a chair and lift a 1kg weight repeatedly. Consult with an exercise specialist to learn how to lift weights correctly. If you smoke, stop smoking. Smoking can prevent calcium absorption by your bones and leave your bones fragile and thin.
Eat a balanced meal plan that has enough calcium, phosphorous and vitamin D. Talk to your dietitian about what foods will provide these nutrients. Of course, the time to begin eating better is even before osteoporosis sets in. if you do not do so already, keep your blood glucose levels under control.
Consider hormone replacement therapy. Estrogen prevents the loss of calcium and bone deterioration. Talk to your doctor about whether the benefits outweigh the risks for you
Sources and References
The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette
Diabetes and Menopause by C Kim, S Park and C Karvonen-Gutierrez
Diabetes in Menopause: Risks and Management by D Pavlour, D Goulis et al
Osteoporosis-Associated Fracture and Diabetes by S Kurra, D Fink and E Siris