Menopause and T1D

What is menopause?

Menopause takes place when you have stopped menstruating for at least 12 months and can also happen if you have had a full or partial hysterectomy (uterus and/or ovaries and fallopian tubes removed). The perimenopause stage is the period before menopause starts and it typically lasts several years, and during this time you may find that your menstrual pattern changes and is more irregular than usual.

Symptoms of perimenopause and menopause include hot flashes and night sweats, anxiety, disrupted sleep, irritability, depression, weight gain, dry skin or rashes, reduced concentration and loss of confidence. If you are going through perimenopause or menopause and are having difficulty managing the symptoms, set up an appointment with your healthcare provider to discuss your treatment options.

How does menopause affect type 1 diabetes?

Menopause can have a big impact on blood glucose management and on insulin sensitivity. There is unfortunately not enough research specifically about menopause and T1D, but it is known that if your hormone levels are disrupted by menopause, that has an impact on every other system in your body, which can affect your type 1 diabetes.

As the levels of hormones specifically – estrogen and progesterone – fall, it can be harder to manage blood glucose levels and insulin can start to work less effectively which can lead to insulin resistance. Weight gain, especially around the middle, is a common symptom of menopause and this may also increase insulin resistance.

It’s helpful to understand how your blood glucose levels can be affected by the changes in your hormones. Using an advanced glucose monitoring device like a  continuous glucose monitor (CGM) or flash glucose monitor (Flash GM) and talking to others who are experiencing menopause can be a good way to help improve your glucose management.

Estrogen, menopause and type 1 diabetes

The drop in estrogen can lead to a risk of osteoporosis (bone loss that can lead to increased risk of fractures) and heart disease. Type 1 diabetes can increase this risk so it’s recommended to discuss with your healthcare provider about getting your vitamin D and calcium levels checked.

One of estrogen’s roles in the body is to maintain the thickness of the vaginal wall and provide lubrication. As this hormone declines during menopause, it can cause vaginal dryness. For those living with T1D, the nerves to the vagina can be damaged by high blood glucose levels over time and penetrative sex can become painful. Treatments such as an estrogen pessary, bioidentical hormonal creams or a vaginal ring may help to reduce this discomfort, so speak to your healthcare provider if you are experiencing these symptoms.

Do you need more insulin during menopause?

Having lower estrogen levels seems to increase insulin resistance, so you may become more resistant to insulin during menopause. You may also need to change your insulin to carb ratio (the amount of insulin you need to cover the carbohydrates you’ve eaten).

For example, in the past where you might have taken 1 unit of insulin for 10g of carbohydrate, during menopause this might change to 1.5-2 units. If you have previously gone through pregnancy, you may have experienced similarly fluctuating glucose levels and insulin requirements.

Disturbed sleep, which is a common symptom of perimenopause, can also make glucose levels fluctuate, which can mean you might need to change how much insulin you’re taking.

Can having type 1 diabetes cause early menopause?

It’s been thought that type 1 diabetes causes early menopause – but this doesn’t appear to be the case. There is however some emerging evidence that people who are diagnosed with T1D before puberty (menarche) do experience menopause earlier. If there is a family history of early menopause, then there’s a higher chance that you will go through early menopause too, you just happen to have type 1 diabetes as well.

The average age to start becoming aware of menopausal symptoms ranges from 45-55. Some people start that journey earlier, some later. Some will have completed it by the time they’re 45, some will still be in a menopausal state when they are in their sixties. It depends on what’s normal for your family group, and every individual and body is different.

How can I keep my blood glucose stable during menopause?

Type 1 diabetes technology

Make the most of technology to understand what your blood glucose levels are doing. Using an advanced glucose monitoring device – whether that be a continuous glucose monitor (CGM) or flash glucose monitor (Flash GM) – can help you better keep your glucose levels in range.

Using an insulin pen or insulin pump can also help you manage your insulin and glucose levels during menopause, if you prefer that technology over multiple daily injections.

Diet

You can lower your risk of insulin resistance with small changes to your diet such as cutting down on processed foods, eating healthier fats, increasing the amount of fruit and vegetables you consume and reducing how much alcohol you drink. Everyone has individual food preferences; and there isn’t one food or diet that can be recommended to universally mitigate menopause symptoms and their affect on T1D management – but it is worth including foods that are rich in vitamins and folic acid when you can.

Exercise

Keeping active is also recommended. If you’re able, gentle activity after a meal, like a walk, is a good way to help insulin do its job and help your body absorb and process carbs. If you can, doing other weight-bearing physical activity, such as dancing or low-impact aerobics, can also help your insulin manage blood glucose more effectively and is good for bone health.

Try to find a form of exercise that you enjoy, and, if you can make that an activity that includes your friends who are also experiencing perimenopause or menopause, it may help with your mental wellbeing too. Balancing your stress hormones can contribute to better maintaining your blood glucose levels so prioritize sleep and self-care if you are able to.

Find out more about type 1 diabetes, physical activity and exercise.

Can you take hormone replacement therapy if you have type 1 diabetes?

As with any treatment, hormone replacement therapy (HRT) may not be right for everyone. Having type 1 diabetes does not mean that you cannot take HRT.

HRT comes in a few different forms including tablets, skin patches, foams and gels. The two main types of HRT are:

• estrogen combined with progestogen/progesterone
• estrogen only (if you have had a hysterectomy)

If you’ve got a family history of breast, ovarian or uterine cancer, some of the available HRT may not be a suitable option. Speak to a healthcare provider who specializes in reproductive health.

There are alternatives to HRT which may help symptoms such as bone health and sleep quality. Speak to your healthcare provider to learn more.

Can my blood glucose levels be affected by HRT?

HRT can impact blood glucose levels. Estrogen-only HRT – usually only recommended if you’ve had a hysterectomy – may improve sensitivity to insulin and help you manage your levels.

Some treatments can cause lower blood glucose levels which feel like hot sweats. Ask your healthcare provider or endocrinologist which is the best treatment option for you and whether you may need more regular check-ups.

How do you tell a hot flash from a hypoglycemic episode?

Some menopausal symptoms, such as hot sweats and palpitations, feel similar to hypoglycemia. So, you may need to check your blood glucose more often.

Using a CGM or a Flash GM can make this easier because you can set alarms to alert you if your glucose levels are going too low or too high, and easily check them throughout the day.

If it’s a hypoglycemic episode, treat it as you normally would. If it’s a combined hypoglycemic episode and hot sweat, always treat the low first.

Get support

Living with type 1 diabetes isn’t easy, and neither is going through menopause . Talk to your healthcare provider about your options for both managing menopausal symptoms.

Your healthcare team can advise on managing blood glucose levels and technology that can support you with this.

Connecting with others who have T1D and are going through a similar time of life might also be helpful. There are groups available on all social media platforms, online communities and forums which allow you to share your experiences and learn from others.

Information provided and reviewed by healthcare professional Dawn Adams.

*content taken from Breakthrough T1D UK and revised for the Canadian type 1 diabetes community