As a woman with diabetes, you may have wondered how the disease affects menopause and vice versa. You also may have questions about taking hormones, especially after hearing the results of the Women’s Health Initiative (explained later in this article).
WHAT IS MENOPAUSE?
Menopause happens over the course of 8 to 10 years. The early phase is called perimenopause. In this phase, your body produces less estrogen, but you still have periods (though they may be irregular) and can become pregnant. Menopause is defined as the point when you have not had a period for 12 months. Menopause can be confirmed by blood tests that measure certain hormone levels in the body. Menopause can occur any time between the ages of approximately 40 and 70. The average age in the United States is about 50. Women with diabetes may enter menopause at a slightly younger age. A good predictor of when you will reach menopause is the age at which your mother did.
There are many symptoms of menopause. The most common are hot flashes, disturbed sleep, night sweats, headaches, emotional changes, vaginal dryness and the decreased ability to think clearly. Some women choose to undergo hormone replacement therapy, or HRT, during menopause. These hormones—estrogen and progestin—replace the hormones that your body no longer makes. Taking hormones protects your bones from calcium loss, which could lead to osteoporosis. Hormones also eliminate many of the symptoms of menopause, such as hot flashes (which are easy to confuse with hypoglycemia), night sweats and vaginal dryness.
As you probably have noticed, your menstrual cycle affects your blood glucose. The changes in your hormone levels during menopause also can affect your blood glucose. You may have heard that women with diabetes cannot take hormones because of their effect on blood glucose levels. It is true that HRT can have some effect on blood glucose levels, and some women have to adjust their blood glucose-lowering medications. But most of the time, HRT doses are so low that they are safe for women with diabetes. Your health care provider will determine whether HRT is appropriate for you.
The Women’s Health Initiative
HRT has been in the news over the past year because of the results of the Women’s Health Initiative. This large research study, conducted by the National Institutes of Health (NIH), found that women who take estrogen and progestin have a higher risk for heart attack or stroke in the first year of HRT. They also have a higher risk for breast cancer after four years of HRT than women who do not take HRT. “Until recently, hormone replacement therapy (HRT) with combinations of estrogen and/or progestin in postmenopausal women was thought to decrease risk of heart attack,” explains Elizabeth Bashoff, MD, of Joslin Diabetes Center. “Newer research, particularly the recently released results of the Women’s Health Initiative, has shown the opposite—HRT can increase a woman’s risk of heart disease and stroke and is not recommended for long-term preventive use in women with or without diabetes.”
Because of these findings, some women stopped taking hormones after talking with their health care providers. Other women talked with their providers and decided to stay on HRT if the doses were low and the HRT was used only for a short time. In light of the results of this study and the concern expressed by women and their health care providers about the use of HRT, experts now recommend that women take the lowest dose of hormones for the shortest amount of time to control the symptoms of menopause. “Short-term use of HRT to relieve menopausal symptoms is still useful, and can be used safely for that purpose in women with diabetes,” concludes Dr. Bashoff.
A new government-maintained web site www.fda.gov/womens/menopause—provides information about HRT and questions to ask your health care providers. To request written information, call (800) 994-9662. There is information and help available, so you can make the right choices for you and your health.
Other approaches
Some women use soy-based or other natural products to relieve their symptoms. There are mixed results on the benefits of these products. Medications, such as antidepressants, taken at low doses can be used to relieve hot flashes. Not smoking and avoiding alcohol and caffeine can also help.
If you are experiencing symptoms of menopause, talk with your health care provider about HRT and its associated risks and benefits. Let your provider know how severe your symptoms are and how much they are affecting your quality of life and your diabetes control. Questions that you may want to ask include:
- Do I need to take medications to protect my heart now that I am in menopause?
- Do I need to take medications to protect my bones?
- Are there any natural products I can take to decrease my symptoms?
- Are there other medications I can take to decrease my symptoms?
- Do I need to adjust my diabetes medication during menopause?
- What are the possible risks associated with HRT?
- What are the benefits associated with HRT?
After you talk with your provider about HRT, weigh the risks and benefits and decide what is right for you.
