It is estimated that over one billion females will be in menopause transition or postmenopause by 2030.1 About 8 in 10 females will experience menopause symptoms which can persist and change throughout menopause.2 Menopause is often not considered in the context of diabetes. However, Ms Wendy Bryant, Lifestyle Medicine Practitioner from Mater Hospital, North Sydney, discussed the bidirectional relationship between diabetes and menopause, and how both can be optimally managed.
The bidirectional relationship between menopause and diabetes
During menopause, levels of the key female hormones oestrogen and progesterone decline. This affects multiple body systems, with low oestrogen causing sleep deprivation, insulin resistance and vascular eMects. This can results in commonly reported menopausal symptoms such as changes in body shape and weight, sleep disorder, fatigue, mood swings, hot flashes and night sweats.3,4 While studies have found no clear link between menopause and diabetes risk, Ms Bryant said that the effects of oestrogen depletion on the body may confer an increased risk of diabetes (Figure 3).5,6
While studies investigating the association between T1D and age of menopause onset have not found significant consistency. However, diabetic microvascular complications such as microalbuminuria or retinopathy, are associated with earlier onset menopause.8,9 This is hypothesised to reflect impacts of elevated glucose levels and microvascular effects, contributing to the depletion of ovarian follicles.7
Considerations for optimal management of menopause and diabetes
For cooccurring menopause and diabetes, patients should first be stratified by cardiovascular risk to inform management, including lifestyle modification (Figure 4).
“We all need to remember that lifestyle is one of the most important factors for both menopause and diabetes […] in our management, we often miss this step and move straight to medication.”
– Wendy BryantIn addition to lifestyle interventions, medication and other treatments may also be considered. The use of hormone replacement therapy (HRT) for menopause has also been shown to decrease the risks of T2D, and cardiovascular disease when initiated in women aged 50 to 59 years.7,10,11 In menopausal patients, choice of diabetes medications must consider side effects, to avoid exacerbating menopause symptoms. For example, women with genitourinary diabetes symptoms may be more prone to urinary tract infections in menopause due to low oestrogen levels. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) should be used cautiously in these patients. If a menopausal patient is receiving a glucagon-like peptide-1 (GLP-1) agonist, Ms Bryant suggested that they should engage in resistance training up to four times a week to maintain their muscle mass. Alongside these interventions, healthcare professionals should also mitigate triggers of menopausal symptoms. This might include ensuring the patient has a cooling sleeping environment and avoiding the consumption of spicy food. Ms Bryant emphasised that menopausal patients do not receive thorough follow up. Diabetes educators can help ensure that patients are followed up regularly for both diabetes and menopausal management. This way, their treatment strategies can be modified as their symptoms change post-menopause.
