Did you know that a woman spends 30% of her life in menopause and that a third to a half of all women alive today in Canada are in menopause or peri-menopause?
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 is menopause?
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 time of menopause (age 53 years), that it is not because of something else like pregnancy (yikes!), thyroid dysfunction (can be more common in those with diabetes) or polycystic ovarian syndrome (commonly associated with diabetes with irregular periods, infertility and facial hair).
Peri-menopause 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 peri-menopause. This means that sometimes symptoms like hot flashes and trouble sleeping can start with a woman who has type 1 in her early or mid -40’s. Other symptoms of menopause are fatigue, mood changes, forgetfulness, urogenital symptoms (vaginal dryness or urinary infections), decreased bone density and joint pain.
How can you distinguish between the signs of menopause and some of the signs of diabetes?
For women with Type 1 (or type 2 who are on 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 doctors in menopause about how to keep healthy bones. This can include the use of vitamin D supplements, calcium and regular weight bearing exercise and the need for other medications.
What about hormone replacement?
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 risk versus benefits with her doctor.
There are many options available to help with menopausal symptoms, including pills, creams and patches for estrogen. Sometimes vaginal dryness can be treated with just estrogen cream locally. This can improve quality of life and may reduce recurrent urinary infections that can happen related to intercourse. A consensus statement has recently been issued about hormone replacement:
It is important to bring up menopause if you are having symptoms and they are affecting your diabetes control.