Menopause + Type 2 Diabetes
As a person with diabetes who menstruates, one of the most complicated things you may struggle with is the constant fluctuation of hormone levels throughout your menstrual cycle. Unfortunately, the start of menopause doesn’t simplify this struggle.
The transition from menstruation to peri-menopause to menopause will happen over the course of many years which means the impact on your blood sugar and insulin needs will be gradual and unpredictable.
Like menstruation, there is no one-size-fits-all approach to adjusting insulin and medication doses in response to menopause—but there are a variety of general expectations and things to be aware of.
Here, we’ll discuss how menstruation can affect diabetes management and tips to help manage the impact on your overall health and well-being.
What is menopause?
While menopause is, in the simplest sense, the phase of life during which you are no longer ovulating and can longer become pregnant.
While we tend to think of the female reproductive system as menstruating vs. menopausal, it’s not quite that simple.
- Menstruation: Your fertile years, generally starting in the early teens to mid-40s.
- Perimenopause: The start of menopause where fertility gradually declines and periods become irregular, lasting anywhere from 2 to 10 years.
- Menopause: Starting in your mid-40s-to-50s when it’s been 12 months since your last period, lasting an average of five years. Women with diabetes have a higher prevalence of early menopause.
- Postmenopause: The continuation of menopause, when it’s been at least 12 months since your last period. This phase continues for the rest of your life.
Symptoms of menopause can include:
- Irregular periods
- Decreased sex drive (libido)
- Vaginal dryness and pain during sex
- Hot flashes, night sweats
- Insomnia and disrupted sleep
- Chills
- Irritability, anxiety, depression
- Weight gain and slowed metabolism
- Thinning hair and dry skin
- Breasts appearing less full
- Breast tenderness
- Increased risk of urinary tract infections
- Decreased concentration and memory abilities
And last but not least: noticeable fluctuations in your blood sugar levels and insulin needs that can change from week-to-week and month-to-month throughout this transition to menopause.
If you thought managing your blood sugar around your relatively predictable menstrual cycle was challenging, the fluctuating hormones of perimenopause and menopause will keep you equally hard at work.
Let’s Look at the Hormones
While menopause generally starts when a person is anywhere between 45 to 60 years old, your hormone levels that regulate menstruation actually start changing in your late 30s.
In order to understand what’s happening to your body during menopause, it’s important to understand these five hormones.
| Hormone | Function | During Menopause |
| Estrogen | Stimulates growth of egg follicles, maintains thickness of vaginal wall and lubrication, maintains mucus membrane that lines uterus | Production fluctuates unpredictably for many years, eventually decreasing to very low levels |
| Progesterone | Prepares lining of uterus to accept a fertilized egg | Production stops completely when there is no ovulation and after final menstrual period |
| Testosterone | Contributes to estrogen production, maintaining libido and bone/muscle mass | Production gradually declines starting in mid-20s, reaching half its peak by menopause |
| Luteinizing Hormone (LH) | Triggers ovulation and hormone levels to support pregnancy | Production gradually increases as estrogen and progesterone levels decrease |
| Follicle Stimulating Hormone (FSH) | Stimulates the growth of eggs in the ovaries | Production gradually increases as estrogen and progesterone levels decrease |
How Menopause Affects Insulin Resistance + Blood Sugar Levels
As a person with type 2 diabetes, the impact of menopause on your blood sugars can vary considerably from one person to the next depending on your body’s current level of insulin resistance, insulin production and medication regimen.
- Taking insulin: Your insulin needs will change not only from week to week—as you’ve experienced with your menstrual cycle—but also during the different phases as your body transitions from perimenopause to postmenopause. The changes between your total daily insulin usage during menstruation vs. perimenopause vs. menopause may be just a few units different or it may be many units. These changes should be made carefully and gradually with support from your health care team.
- Taking other diabetes medications: If you currently take diabetes medication or no medications at all, the transition to menopause may mean your body needs further support to manage your target blood sugar levels. This could mean increasing the dosages of your existing medications or starting a new medication.
Here’s what you can expect in terms of when and why your body might need more support from insulin or another diabetes medication:
Menstruation: Most people see an increased need for insulin in the days right before their period starts. Learn more about menstruation and diabetes.
Perimenopause: “Your total daily insulin needs will likely increase during these years of gradually transitioning to menopause,” explains Jennifer C. Smith, RD, CDCES, a diabetes coach at Integrated Diabetes Services and co-author of Pregnancy with Type 1 Diabetes.
The same hormones that fluctuate every 28 days during your menstrual cycle will now fluctuate on a much less predictable schedule. This unpredictable nature means your insulin needs will fluctuate, too. This is, without a doubt, the most challenging aspect of transitioning to menopause.
“Some months, you may have a heavier cycle, heavier bleeding,” explains Smith. “The heavier your cycle, the higher your insulin needs will likely be. Other months, your cycle may be lighter and you’ll experience no symptoms and far less insulin resistance.”
Just as you did during your menstrual cycle, it can be helpful to track what you experience, the adjustments you make in your insulin doses with support from your health care team and how those adjustments helped your blood sugars.
Menopause/Postmenopause: Once you are truly in menopause—it’s been 12 months since your last period—your insulin needs will likely decrease and become more predictable.
“When the dramatic end to your estrogen and progesterone production occurs, you will no longer experience those sudden bouts of insulin resistance,” explains Smith.
“Once those hormones are no longer on that transitioning rollercoaster, things will even out. Many people will find their overall basal insulin needs decrease during menopause and postmenopause.”
*Please note: Talk to your health care team before making any changes in your insulin regimen. Insulin dose adjustments should be made carefully and thoughtfully to prevent unexpected hypo- and hyperglycemia.
The long-term health concerns of menopause
While the most infamous symptoms of menopause are hot flashes, weight gain, and insomnia, menopause can impact your memory, your bone strength, your ability to enjoy having sex and your overall mood.
However, aside from controversial hormone replacement therapy (which may be safe for some and not safe for others), managing your lifestyle habits can help lessen the severity of those classic menopause symptoms.
“Menopause is universal,” says Felicia Gersh, M.D., a gynecologist at Integrative Medical Group.
“There’s no way you can escape it as you get older. It’s not just about reproductive functions ending, it’s about a whole new life stage for a person when they don’t have ovarian hormones to support every organ system of their body. You can help counter the impact by potentially starting hormone replacement therapy and by focusing on every lifestyle choice to optimize health.”
“There’s a low-grade chronic state of inflammation associated with menopause progression and the aging process of people who menstruate. So there’s a whole array of symptoms, and it can really change a person’s life and really create a reduced quality of life.”
Gersh points out that hormones are very intertwined with how your brain functions.
“In some, night sweats and hot flashes can continue for up to 20 years,” says Gersh. “The average is about four to five years, which is bad enough.”
“And of course, other symptoms of menopause will never resolve. They actually only get worse with time, for example, vaginal dryness and sexual dysfunction. For some, your mood never returns to normal,” says Gersh bluntly.
“Most people, as they transition into menopause will have some word-finding problems like they can’t remember their nouns like, ‘What was that called again?’ That kind of thing. They just can’t get the noun out, but they’re very good at adjectives. That usually will stabilize.”
More concerning issues are heart attacks, fractures, weight gain and dementia.
“By age 65, about 75 percent of [people who were assigned female at birth] have high blood pressure,” explains Gersh. “And by age 75, 85 percent have high blood pressure. [People who were assigned female at birth] make up 80 percent of all the individuals that end up having an osteoporotic fracture.”
Estrogen is also very important for burning body fat, which means your body becomes better at storing fat in menopause. Estrogen also helps regulate your appetite, contributing further to your body’s improved ability to gain weight.
These stark messages from Gersh might be overwhelming, but she says the more you focus on improving your lifestyle habits and overall health, the more you lessen the long-term health concerns associated with menopause.
Lifestyle habits to ease the transition of menopause
In her work to support people who experience menopause, Gersh passionately encourages her patients to focus on the daily lifestyle habits that help at any age—but these habits become even more impactful during menopause.
“We can’t avoid menopause, but we can try to delay it a little bit by having the best diet and lifestyle during the earlier years of life and leading up to menopause,” explains Gersh.
“We also want to go into menopause with what I call ‘a good health savings account’ because not every person has the same experience in menopause. Some people actually do seem to do pretty well. They don’t end up breaking bones or getting dementia or having a heart attack.”
Gersh emphasizes focusing on healthy habits earlier in life can hugely improve the overall health of your bones, muscles, heart, brain and fitness level before hitting menopause. Your overall health before you experience menopause largely determines your health during menopause. It can reduce the severity of your menopause symptoms, like hot flashes.
“For those who are very obese and metabolically unhealthy, statistically have more night sweats and hot flashes than women who are more optimally healthy when they do enter into the menopausal year. So we want to start out doing healthy things long before menopause in anticipation by recognizing that these health choices earlier in life really matter for the rest of your life.”
Gersh recommended lifestyle habits are things you’ve likely heard and read a million times before. Before and during menopause, dedicating your energy to adopting and embracing healthy lifestyle habits can have a huge impact on the symptoms and risks you experience:
- Supplements: To maintain healthy bones and muscles, getting an adequate amount of omega-3, vitamin D, magnesium, calcium and basic antioxidants from vitamins is critical.
- Mental health: Working on stress levels and emotional wellbeing is important. Meditation, biofeedback and tapping are just some tools that can help manage anxiety and stress.
- Weight-management: Losing weight if you are overweight or maintaining your current weight is going to be more challenging in menopause, but it can affect every other part of your health. Making weight management a true priority in your life before and during menopause is worth the work.
- Nutrition: Eating a balanced diet very high in plants, including soy, is vital to reducing your risk of high blood pressure, heart attack and fractures. Gersh points to research that found people who ate soy every day experienced fewer hot flashes during menopause, as it contains phytoestrogen which can help compensate for your body’s lack of estrogen.
- Exercise: Getting daily exercise to counter your body’s lack of fat-burning estrogen will help prevent and reduce the tendency to gain weight in menopause. Regular exercise is also critical for managing blood pressure, cholesterol, insulin sensitivity and long-term brain health.
- Sleep: Getting enough sleep has a big impact on your appetite, energy, mood and more. If you’re struggling to sleep well, talk to your healthcare team about options. Remember, one of the best remedies for better sleep is getting more exercise and drinking less alcohol.
- Alcohol: Reducing your alcohol consumption to the standard recommendations can have a tremendous impact on your overall physical health and emotional well-being.
- Get support: Talk to your health care team! Get support when you need it for stress and depression, nutrition and exercise, or improving blood sugar health by fine-tuning your medication regimen.
“So you can’t get away with stuff after menopause,” says Gersh. “So you have to do it all. Nutrition and fitness and sleep and stress. As much as possible.”
