Did you know that a woman spends 30% of her life in menopause and that one-third to one-half of all women alive today in Canada are in menopause or perimenopause?
Of course, many of these women also have diabetes. Just like other times when hormones are changing – such as in adolescence and pregnancy – managing menopause and diabetes can be a challenge during this life stage.
What are menopause and perimenopause?
Menopause is a permanent stopping of periods because the ovaries no longer respond to the brain telling them to produce eggs. Women should be sure that if their periods stop, especially before the average age of menopause (53 years), that it is not because of something else, such as:
- Pregnancy,
- Thyroid dysfunction (this can be more common in those with diabetes, or
- Polycystic ovarian syndrome (this is commonly associated with diabetes; symptoms include irregular periods, infertility and facial hair).
Perimenopause refers to the years leading up to menopause and just after. Women with type 1 diabetes go into menopause a few years earlier than the rest of the population and symptoms of menopause can begin in perimenopause. This means that some menopausal symptoms can start in a woman who has type 1 diabetes in her early or mid-40’s.
What are the symptoms of menopause?
The most common menopause symptoms include:
- Hot flashes
- Trouble sleeping
- Night sweats
- Fatigue
- Mood changes
- Forgetfulness
- Vaginal dryness
- Urinary tract infections
- Decreased bone density
- Joint pain
Can menopause increase the risk of diabetes?
Perimenopause and menopause do not actually cause diabetes. However, hormonal changes in some women can lead to weight gain, higher blood pressure, sleep disturbances and depression. These are all risk factors for type 2 diabetes.
How can you distinguish between the signs of menopause and some of the signs of diabetes?
For women with type 1 diabetes (or those with type 2 diabetes who take medications that can cause low blood sugars) it is particularly important to distinguish between hot flashes and sweats from menopause, and sweats from low blood sugars. It is important to test your blood sugar to tell the difference. As well, women with type 1 are already at increased risk of low bone density as they age, and both type 1 and type 2 of increased fractures, so they need to talk to their doctor about how to maintain healthy bones. This can include the use of vitamin D supplements, calcium and regular weight bearing exercise and the need for other medications.
How is menopause treated?
The issue of hormone replacement is complex. If a woman has not had her uterus removed and she wants to take hormone replacement, she will need to replace both estrogen and progesterone to prevent cancer of the uterus. Estrogen alone can be used in women with no uterus. Hormone replacement is the most effective way to improve the menopausal symptoms. Each woman needs to assess the risks and benefits with her doctor.
There are many options available to help with menopausal symptoms. The most common one is estrogen, which can be administered by pills, creams or patches. Sometimes, vaginal dryness can be treated with estrogen cream locally. This can improve quality of life and may reduce recurrent urinary infections that can happen related to intercourse.
In 2021, new Managing Menopause guidelines were published by the Society of Obstetricians and Gynaecologists of Canada and the Canadian Menopause Society. Ask your doctor if they are familiar with these latest recommendations in order to help you with your symptoms.