Having diabetes is hard but being a women with diabetes is even harder, particularly during the menopause. The combined effects of diabetes and menopause on the body can be challenging for many women.

What is menopause?

Menopause is the phase of life after menstruation has stopped. It often happens for women around 50 years old and signifies the end of their reproductive years. Hormone levels and balance (i.e. estrogen and progesterone) will change at this period.

How does the menopause affect me and my diabetes?

The most common symptoms of menopause are flushing, mood swings and joint pain. For a woman with type 1 diabetes, menopause may be earlier than average. For a woman with type 2 diabetes, menopause may be later if they are overweight.

Menopause can affect women in different way but there are some common effects:

Fluctuations in blood glucose levels

Changes in your hormone levels can trigger fluctuations in your blood glucose levels. Oestrogen can improve insulin sensitivity, while high progesterone levels can cause insulin resistance. You may notice that your blood glucose level (BGL) is more variable and less predictable than before. The changes and the balance of the two hormones (oestrogen and progesterone) will affect how your body responds to insulin. Sometimes, women with type 1 diabetes suffer from more hypoglycaemia at peri-menopause (just before the onset of menopause) and will require insulin adjustment. Some symptoms and signs of menopause, such as mood swings, sweating, and a lack of concentration can be easily mixed up with the symptoms of hyperglycaemia or hypoglycaemia. It is important for you to test your blood glucose levels regularly and not to rely on your symptoms or your feelings. If your blood glucose level is outside your target range, speak to your diabetes team as soon as you can.

Weight gain

Increased insulin resistance and food cravings can cause weight gain for many women at this stage of their life. Excessive weight and a larger waistline can make diabetes much harder to manage.

Sleep problems

Hot flushes and night sweats can cause big problems with sleep and may result in your blood glucose levels being very high the next day, especially if this is coupled with stress.

Sexual problems

Out of target BGLs or the presence of heart or kidney disease can leave you tired, without energy and with less interested in sex. Returning BGLs to within the target range may improve mood and libido. Above target range BGLs can also damage the nerves of the cells that line the vagina, making arousal and orgasm more difficult. This problem is often exacerbated by vaginal dryness, a common symptom of menopause that causes pain during sex.

Around 33% of women with diabetes report increased vaginal dryness, but there are many preparations on the market that can be used to increase lubrication. Soap free wash, such as sorbolene-based products, can also help. For severe dryness vaginal suppositories and relaxation exercises may assist.

Hormone replacement therapy

Hormone replacement therapy can be useful during and after menopause, as well as topical hormonal creams or an oestrogen ring. Most types of hormone replacement therapy do not affect glucose tolerance.

Menopause can often be uncomfortable but it is an inevitable part of life for every woman, diabetes or not. Maintaining a healthy lifestyle by eating well and exercising can make a difference to your life and health. Try to prioritise yourself when you can – spend time with friends, grab a bike, go for a walk and take time to do things you enjoy.

Who else can help?

• Your doctor or practice nurse
• Diabetes healthcare team or diabetes educator
• Women’s health organisations such as Family Planning Australia
• Websites specific to women’s health issues such as www.menopause.org.au (to access list of menopause specialists), www.jeanhailes.org.au or www.whria.com.au.