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Medically Reviewed by Elizabeth Gomez MSN, FNP-BC
Menopause is a completely natural stage of life. This transition involves complex hormonal changes, and if you have diabetes, it can significantly affect your blood sugar levels. Many women with type 1 and type 2 diabetes experiencing menopause find that their condition has become more difficult to manage.
The symptoms of menopause can be very intense and profoundly disrupting, a fact that is too rarely acknowledged in our culture. And menopause’s impact on diabetes management is even less commonly appreciated.
This article will explore the ways that menopause and diabetes interact, and practical steps that you can take to help make steady your blood sugar and ease the transition.
The Three Stages of Menopause
Menopause is the point in a woman’s life when she stops menstruating. This change does not occur all at once — instead, experts talk about a “menopausal transition,” with a beginning, middle, and end:
- Perimenopause is the beginning of the transition, during which hormonal changes begin to take effect, and you may feel the classic menopausal symptoms, such as hot flashes and unpredictable changes to your menstruation. According to the National Institutes of Health, perimenopause usually begins between the ages of 45 and 55, and it generally lasts four to eight years.
- Menopause is the first year after your last period. It’s impossible to predict which period will be your last, so it can only be recognized retroactively.
- Post-menopause is the end of the transition — technically, it will last for the rest of your life. Although you’ve stopped having periods, you may continue to feel lingering menopausal symptoms.
All three stages can noticeably affect your blood sugar management. The three stages of the menopausal transition are associated with different changes and symptoms, and different people will experience these stages differently.
Menopause and Hormones
Fluctuations in hormone levels can have strong effects on glucose metabolism and insulin sensitivity. The menopausal transition can be an especially difficult time for blood sugar management, just like puberty and the monthly menstrual cycle.
Since puberty, your body has regularly secreted the hormones estrogen, progesterone, and testosterone to help regulate your fertility. Menopause represents the end of this stage of your life, and significant hormonal changes come with it. Your body will gradually (or suddenly) create and use less of these hormones. They will be replaced by higher levels of other hormones, including luteinizing hormone and follicle stimulating hormone.
The transition, however, is not always smooth. During perimenopause, your body may create even more estrogen than usual, even though estrogen levels will eventually drop to a very low level by the time of post-menopause.
The unpredictability of this process is what causes blood sugar surprises.
Menopause and Blood Sugar Management
During the menopausal transition, the best advice is probably to expect the unexpected. As your hormone levels shift, you may find that your insulin sensitivity fluctuates rapidly. You may experience more blood sugar highs and lows than normal. During perimenopause, your cycles will be unpredictable, as will the glycemic consequences of erratic hormone levels. Heavy cycles with heavy insulin resistance can follow lighter cycles with lighter insulin resistance.
The changes can seem chaotic: Estrogen lowers blood sugar, but progesterone increases it, and your body will create less of both hormones as menopause approaches, except when it’s creating more. It’s confusing!
But, generally speaking, women that use insulin can probably expect their insulin needs to rise during perimenopause and then decline in post-menopause.
Post-menopause should bring a gradual glycemic steadying. The loss of your monthly period should reduce the blood sugar fluctuations associated with the menstrual cycle, and it’s possible that you will require less insulin to control your blood sugar.
The bottom line: test your blood sugar often, communicate with your doctor, and be ready to adjust your diabetes management habits, including diet, exercise, and medication.
Diabetes and the Symptoms of Menopause
Everyone experiences menopause differently. The symptoms of menopause will be very intense and uncomfortable for some, but hardly noticeable for others. An incomplete list includes:
- Hot flashes
- Night sweats
- Hair loss
- Vaginal dryness or discomfort
- Disturbed sleep
- Loss of sex drive
- Mood swings
- Weight gain
For more detail, we recommend this excellent overview from Everyday Health.
The important thing to note is that many of these symptoms either overlap with or interact with the symptoms of low or high blood sugar. If you’re experiencing night sweats, mood swings, vaginal dryness, or disturbed sleep, it can be difficult to tell which condition is causing your discomfort at any one time, or whether or not both diabetes and menopause are combining to exaggerate the effects. The symptoms of one condition can also exacerbate the other; for example, if menopause causes weight gain or disturbed sleep, it could make your blood sugar management more difficult.
You should be ready for the unexpected, and eager to ask your doctor for help with symptoms. It is also wise to check your blood sugar more frequently — and ask your doctor about a continuous glucose monitor, if you don’t already have one.
Diabetes and Early Menopause
Women with type 1 and type 2 diabetes are more likely to experience early menopause, and a 2022 study (PDF) suggests that the earlier you are diagnosed, the earlier you are likely to enter menopause. Diabetes of any type can “affect ovarian aging,” leading to an early onset of the menopausal transition.
The Cleveland Clinic states that “early menopause” occurs before the age of 45, while “premature menopause” occurs before the age of 40. Both conditions are associated with more severe menopausal symptoms. Early and premature menopause also increase the long-term risks of conditions such as osteoporosis and heart disease, because such women will spend more years without the protective benefits of estrogen.
If you’re experiencing early or premature menopause, there’s nothing you can do to reverse the transition, but healthy eating, exercise, and glucose management habits can help ease the transition and improve your long-term health. Some experts also advise more aggressive treatment with hormone therapy.
Menopause and Long-Term Health Risks
Menopause creates new health challenges for women. According to Everyday Health, postmenopausal women face heightened risks of several health issues:
- Heart disease
- Osteoporosis (weak, brittle bones)
- Weight gain (especially around the belly and internal organs)
- Urinary tract infection
- Urinary incontinence
Every one of these conditions is of heightened relevance to people with diabetes. Cardiovascular disease is already the number one cause of death in people with diabetes, and women with diabetes also experience higher rates of osteoporosis. Weight gain, of course, is significantly associated with the progression of type 2 diabetes, and with glucose management frustrations in type 1 diabetes. Even urinary tract infections and incontinence can pose increased risks, given diabetes’ tendency to dull the body’s ability to fight infections.
There is also a complex relationship between menopause and diabetes itself. Menopause increases the risk of type 2 diabetes as well as related metabolic conditions, such as hypertension and high cholesterol.
All healthy postmenopausal adults are advised to make healthy diet and exercise decisions to help reduce their risk of conditions such as heart disease and osteoporosis. That advice might go double for women with diabetes. The menopausal transition is a great time to get serious about losing weight and improving your fitness.
Hormone Therapy
There is one treatment available that both provides general relief for the symptoms of the menopausal transition and reduces the risk of long-term consequences like osteoporosis: hormone therapy. There are many forms of hormone treatment for menopause — pills, patches, creams, sprays, injections, and more — but they all aim to supplement women with some of the hormones that their bodies are ceasing to create, particularly estrogen.
A generation ago, hormone therapy was widely prescribed, but its use dropped dramatically after a 2002 study suggested that it created major long-term risks such as breast cancer. As explained in a 2023 article in The New York Times Magazine, though, dozens of more recent studies have validated the treatment as a safe option for many women. The North American Menopause Society states that “benefit-risk ratio is favorable for women who initiate hormone therapy close to menopause (ages 50-59, typically) but becomes riskier with time since menopause and advancing age.” Many doctors, however, remain reluctant to prescribe the therapy to any of their patients.
For women with pre-existing type 2 diabetes, there is evidence that hormone therapy improves glycemic control: a 2001 study found that women using the therapy had an A1C of 7.9 percent, while similar women who had not used it had an A1C of 8.5 percent. And hormone therapy also reportedly reduces diabetes risks.
The blood sugar benefits of hormone therapy are, however, considered secondary. Hormone therapy is not approved for glycemic control alone, and your doctor will likely only consider prescribing it if you are experiencing significant symptoms, such as hot flashes.