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Menopause

Menopause marks the completion of a natural process that women go through as the child-bearing years come to an end and the ovaries cease to release eggs every month. The hormones estrogen and progesterone, which prepare the uterus for pregnancy, decrease considerably, although small amounts of estrogen may still be produced. Prior to menopause, the hormonal changes that a woman experiences during her monthly cycles often follow her own individual pattern: One woman will have a period every 26 days which may last four to five days while another woman's may occur every 31 days and last six to seven days. This pattern often changes dramatically as a woman approaches menopause. Some women begin to experience hormonal fluctuations in their mid-to-late thirties but the majority of women notice changes starting in their early forties.

Menopause takes place when you have not menstruated for 12 months. For most women in North America, this occurs around 51 years of age. Women with type 1 diabetes may experience menopause earlier than average. Women with type 2 diabetes may reach menopause later than average if they are above a healthy weight, as estrogen levels do not decrease as rapidly in women who are overweight.

During peri-menopause, the years leading up to menopause, surges and reductions in estrogen and progesterone can affect women in various ways: Mood changes, increased PMS signs, menstrual periods that are more or less frequent, heavier or lighter blood flow during menstruation. These hormonal changes can affect women with diabetes by causing blood glucose to fluctuate. For some women this is scarcely noticeable as estrogen and progesterone production is reduced gradually over the years. However, for many women, fluctuations in blood glucose can mean that they need to blood test more frequently and make appropriate adjustments to maintain a comfortable balance. For women with type 1 diabetes, more frequent hypoglycemia may be the first sign that hormone levels are decreasing and insulin adjustment may be necessary.

Not all women will experience hypoglycemia, however. Women with type 2 diabetes may experience weight gain, often related to a reduction in physical activity, and this may cause an overall increase in blood glucose. This is a time when many women are actually diagnosed with diabetes. If you have such variations in hormone levels that, despite your best efforts, you find it is impossible to achieve the blood glucose range that you obtained formerly, your physician may recommend hormone replacement therapy (HRT). Whether or not to use HRT is a decision each woman needs to make in consultation with her physician.

Reducing the Discomforts of Peri-Menopause

Here are some suggestions that may reduce the discomforts of peri-menopause:

  • Eating well-balanced meals that form the basis of managing your diabetes may also play a role in helping you to feel better at this time.
  • Cutting out alcohol and caffeine may help reduce hot flashes.
  • Consuming more legumes (beans, chickpeas etc) and soy products may also decrease the discomforts associated with menopause as these foods contain phytoestrogens (plant estrogens).
  • Being physically active may help to increase energy levels and give you a mental lift.

There has been an increasing interest in recent years in complementary therapies to reduce the discomforts associated with this time and many women have found that certain vitamins and herbal products are helpful. However, the effects of many preparations on diabetes management are unknown.

Confusing Menopause and Blood Glucose Changes

Sometimes women with diabetes, especially those recently diagnosed, may confuse the signs of menopause with some of the symptoms of low or high blood glucose. For example, if you are occasionally dizzy, sweating, find it hard to concentrate, are unusually irritable, is this due to hormonal changes, high or low blood glucose? If you are waking up in the night, hot and sweaty, is this menopause or low blood glucose? The only way to know for sure is to test your blood glucose. If you have type 2 diabetes and are not taking insulin, night sweats are unlikely to be a result of low blood glucose. Fatigue can be associated with menopause and with high blood glucose levels. Again, testing your blood glucose is the safest step to take. However, it is not conducive to emotional well-being to be testing your blood glucose every hour and wondering about your symptoms, so a balanced approach is important. Your doctor or diabetes educator will be able to help you decide how often you may need to test by looking at your blood test records or A1C results.

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