MENOPAUSE And BLOOD GLUCOSE

Does menopause affect glucose control? Is diabetes more prevalent after menopause?

Dr Angela Murphy answers these questions.

Let us first make sense of all the terms that get used during this period.

MENOPAUSE – this is officially the time when the ovaries have stopped working and reproductive life is at an end. A woman is said to be in menopause when she has not had a period for a year. The average age range of menopause is 45 – 55 years.

PERI-MENOPAUSE – this is the time before menopause when oestrogen levels start to decline and some symptoms of this may occur, e.g. sleep disturbances, night sweats, hot flashes and mood changes. This can start 8-10 years before menopause.

POST-MENOPAUSE – this is the time after menopause and is life-long.

EARLY MENOPAUSE – is when menopause occurs before age 45 years

PREMATURE MENOPAUSE occurs before age 40 years. It can be due to surgical removal of or damage to the ovaries from radiation or infection. In many instances this is genetic or autoimmune.

MENOPAUSE

Cause

Natural menopause occurs due to aging of the ovaries and a decrease in the production of oestrogen. Surgical menopause occurs if both ovaries are removed.

Symptoms

Menopausal symptoms are traditionally divided into:

Vasomotor – this includes hot flashes (sudden sensation of heat in body) and night sweats (these can be in the day as well)

Mood changes – new onset or worsening anxiety and depression; insomnia.

However, there is a long list of other symptoms which women may experience such as local vaginal dryness and urinary problems; headaches; decreased libido; decreased concentration; hair thinning or falling out and, the one concern almost all women have, weight gain.

CHANGES IN A WOMEN’S BODY AT MENOPAUSE

The decrease in oestrogen levels causes less energy to be used in the body and thus, there is a risk for an increase in weight. This weight being gained is all fat and accumulates around the abdomen. This is what can cause insulin resistance.

IS DIABETES MORE COMMON AFTER MENOPAUSE?

There is a definite relationship between oestrogen levels and blood glucose levels. If a woman has other risks such as a family history of diabetes it is a good idea to be screened for diabetes.

IS DIABETES WORSE CONTROLLED AFTER MENOPAUSE?

An increase in insulin resistance may contribute to a deterioration in HbA1c.

MENOPAUSE TREATMENT

Menopausal hormone therapy (MHT) can reduce insulin resistance, abdominal fat and improve glucose metabolism, as well as other cardiovascular risk factors such as blood pressure and cholesterol levels.

MHT comes in various combinations:

OESTROGEN ONLY – oestrogen is the hormone that gives most relief to symptoms and overall benefit. Only women who have had their womb removed can use this.  

OESTROGEN PLUS PROGESTERONE – women who still have their wombs have to take progesterone to stop the unopposed oestrogen effect on the lining of the womb which could cause cancer.

MHT can be given either as a pill or patch. Oestrogen alone is also available as a gel. The advantage of giving MHT through the skin (transdermally) is that it does not get metabolized through the liver and this reduces its overall side-effect profile. For women concerned only about vaginal dryness, oestrogen is available as vaginal creams or pessaries. As this is only absorbed locally, side-effects are much lower.

Overall side-effects of MHT are low, especially if used at the time of menopause, the lowest effective dose, shortest time necessary and transdermally. There is always concern about the risk of:

Breast cancer – risk is seen with more than 5 years of continuous use of combination MHT and increases in the over 60 years age group. In most instances, women who have had breast cancer or have a first degree relative (mother or sister) with breast cancer are not given MHT. Routine mammograms are essential.

Blood clots – all MHT can increase the risk of thrombosis, but this is rare in the 50–59-year age group. If a woman has had a blood clot or has a strong family history of blood clots, then she should not use MHT.

MHT is the most effective therapy for controlling the symptoms of menopause. Additionally, it prevents osteoporosis and given at the time of menopause provides cardiovascular protection.  Each woman should discuss the pros and cons with her doctor. MHT should improve overall glucose control but, again, there can be a variable response.  As always, a healthy lifestyle remains the key component to diabetes control.