While slightly more men are diagnosed with both type 1 and type 2 diabetes, the impact of diabetes on women’s health can be particularly complex. A woman’s hormonal and physical makeup presents unique challenges in managing blood glucose levels. Credentialled Diabetes Educator, Angela Blair, explores how hormonal changes throughout puberty, the childbearing years, and menopause can affect diabetes management, and what women can do to support their health. 

Ages and stages 

Hormones that control the menstrual cycle can have a significant effect on glucose levels. Many women notice fluctuations, with levels rising in the days before their period, when hormones are at their highest, and falling once menstruation begins. The extent of these changes varies from person to person. 

Tracking your cycle alongside your glucose levels can help identify patterns. If you use insulin, you may need to adjust your doses before and during your period to avoid highs or lows. 

The emotional and physical symptoms of the premenstrual phase can also affect diabetes management. For some it causes food cravings, fatigue, and reduced physical activity. To manage these effects: 

• Reduce intake of alcohol, caffeine, salt, and chocolate 

• Prioritise physical activity and relaxation 

• Eat plenty of fresh fruit and vegetables 

• Discuss other treatment options with your healthcare team 

Contraception and planning ahead 

Birth control is an important issue for women with diabetes because there are greater risks for a woman with diabetes and her baby when a pregnancy is unplanned. While all contraceptive options are available to women with diabetes, the best choice will depend on individual health and preferences. 

Some women with conditions like peripheral vascular disease may not be suited to certain hormonal contraceptives. Speak with your doctor or diabetes educator to find the right option for you. For more resources, visit: pregnancyanddiabetes.com.au 

Menopause and glucose management 

Menopause affects all women at some point at the end of their reproductive years. The most common symptoms of menopause are flushing, mood swings and joint pain. Menopause also brings hormonal shifts that can affect glucose levels and sometimes mimic the symptoms of high or low glucose, such as sweating, light-headedness, and poor concentration. 

• Type 1 diabetes: Menopause may start earlier than average, and women may experience hypoglycaemia more frequently as oestrogen levels drop. More frequent hypos can be the first sign that a woman is entering menopause. 

• Type 2 diabetes: Menopause may occur later, particularly in women who are overweight. 

Insulin and medication adjustments may be needed as hormone levels settle. Around 25% of women experience severe hot flushes that require treatment, talk to your doctor if this is affecting your quality of life. 

Related health concerns 

Vaginal and urinary tract infections

High glucose levels can lead to an increased risk of vaginal and urinary tract infections. Often this type of infection can be the first sign of undiagnosed type 2 diabetes. Your GP will prescribe treatment to manage the infection; however, if BGLs remain high the infection may reoccur. 

Polycystic Ovarian Syndrome (PCOS) 

PCOS is a complex hormonal condition linked with insulin resistance and a higher risk of developing type 2 diabetes. It affects 12–18% of reproductive-aged women, and up to 21% in some high-risk groups such as Aboriginal and Torres Strait Islander women. 

Common symptoms include: 

• Irregular or absent periods 

• Acne, excess facial/body hair, and scalp hair loss 

• Difficulty becoming pregnant 

• Mood swings 

• Weight gain 

• Sleep apnoea 

Treatment starts with healthy eating, introducing regular physical activity, the oral contraceptive pill, medication to block hormones such as testosterone, infertility medications, metformin for insulin resistance, support, and counselling.  

Visit jeanhailes.org.au or pcosaa.org for more information. 

Vaginal dryness 

High glucose levels, menopause, oral contraceptives, and stress can contribute to dryness. To help with dryness use soap-free wash such as sorbolene-based products for vaginal and anal skin. 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 

Sexual dysfunction (or difficulties in functioning normally) 

While often discussed in men, sexual dysfunction also affects up to 42% of women with diabetes. Initially, out of target glucose levels or the presence of heart or kidney disease can leave a woman tired, without energy, and less interested in sex. Returning levels to within the target range may improve mood and libido.  

Neuropathy can also lead to vaginal dryness making sexual intercourse painful and difficult. There are many preparations on the market that can be used to increase lubrication. For severe dryness vaginal suppositories and relaxation exercises may help. For those women taking insulin the fear of hypoglycaemia during intercourse can become a barrier. Checking your glucose levels and or eating some extra carbohydrate before or after intercourse can be reassuring and stop some of these fears. 

Taking charge of your health 

Self-care tips 

• Find out how your cycle affects your glucose levels by tracking them regularly to see if you can find a pattern 

• Speak with your doctor about switching to a monophasic oral contraceptive with consistent hormone levels, if needed 

• Reduce alcohol, caffeine, and chocolate, which can impact mood and glucose levels

• Stick to regular meal and exercise patterns to reduce glucose swings. 

Who can help? 

• Your doctor or practice nurse 

• Diabetes healthcare team or diabetes educator 

• Accredited Practising Dietitian 

• Women’s health organisations such as Family Planning 

• Visit menopause.org.au for specialist lists, or whria.com.au for reproductive health resources 

• Call the NDSS Helpline on 1800 637 700 to speak to a diabetes educator or a dietitian.