Menopause and Diabetes: What's the Connection?

For many women, menopause calls to mind symptoms like hot flashes and night sweats. But the hormone changes that accompany menopause can also bring about less well-known changes in the body, including fluctuations in blood sugar.¹ 

What do these potential changes in blood sugar during menopause mean for women with existing diabetes? Can menopause increase a woman’s risk of developing diabetes? What role, if any, does weight gain play in all of this?

Knowing that the connection between menopause and diabetes may be unclear for many women, we reached out to menopause care specialist Shannon Brasil, MSN, RN, CNP, with some questions.

How Common is Diabetes During Midlife, Especially for Menopausal Women?

Nurse Brasil points to one study where diabetes occurred in about 1% of women prior to menopause but increased to 3.8% for women who went through natural menopause and 4% for those who went through surgical menopause.² “The prevalence of diabetes from pre-menopause to menopause almost doubles,” she says. “That’s pretty significant.”

Does Menopause Increase Diabetes Risk? If So, How?

According to Nurse Brasil, blood sugar changes that are triggered by decreased estrogen levels during menopause do seem to play a role in diabetes risk. In fact, research suggests women who go through menopause before age 40 may be up to four times as likely to develop type 2 diabetes than women who experience menopause at 55 or older. Diabetes risk falls 4% for each year added before menopause.³

“Estrogen helps to protect women from diabetes and other diseases,” Nurse Brasil explains. “The longer you can hold onto that estrogen, the lower your risk.”

But lower estrogen levels aren’t the only reason a woman’s risk of developing diabetes may go up during menopause, Nurse Brasil continues. Aging and weight play a part, too. “If you're a woman over 50, you're vulnerable because your body's changing,” Nurse Brasil says. “Some of your weight may shift to your midsection, which is a common symptom of menopause.⁴ Lack of hormones due to menopause may also slow your metabolism so you don't burn calories as effectively, which can also lead to weight gain.”⁵

Each of these factors — decreased estrogen, age and weight gain — can potentially increase a woman’s risk of developing diabetes. The fact that many women are dealing with all three during menopause illustrates why it’s important that women understand this risk.

What Are Some Other Factors That Can Increase Diabetes Risk During Menopause?

Another risk factor for diabetes is one that affects many women during menopause — poor sleep quality.⁶ “Poor sleep is really inherent during menopause,” Nurse Brasil says. “This can be due to hot flashes, an inability to turn our minds off, or other reasons.”⁷ She adds that lack of sleep can also contribute to weight gain (another diabetes risk factor), since women may be less likely to exercise when they’re tired.

Women who experienced gestational diabetes during pregnancy are also at increased risk of developing type 2 diabetes later in life, so Nurse Brazil advises letting your healthcare provider know about any history of gestational diabetes.⁸

How Does Menopause Affect Women Who Already Have Diabetes?

Because women with diabetes who are entering menopause may experience blood sugar fluctuations related to decreased estrogen, they may need to change the way they manage the disease.⁹ Even if your diabetes has been well-controlled for years, you might find yourself struggling to manage your blood sugar during menopause, Nurse Brasil cautions.

Since both uncontrolled diabetes and decreased estrogen can increase your risk of health problems, like heart disease, Nurse Brasil explains that it’s important that women with diabetes talk to their healthcare providers about whether they need to change the way they manage their blood sugar during menopause, or not.¹⁰

What Can Be Done to Manage Diabetes Risk During Menopause?

Nurse Brasil says she often sees patients with symptoms like irritability and sweating that they attribute to menopause, when in reality they’re due to diabetes. “Sometimes menopause symptoms and diabetes symptoms overlap. ¹¹ So, it's important that providers don't just assume it's menopause and do a proper workup to rule out other things, too.”

As for how women can lower their diabetes risk, Nurse Brasil suggests a proactive approach that starts before menopause. This approach can include:

• Lowering your intake of sugar, fat and alcohol
• Getting regular exercise, especially through activities like walking and climbing stairs
• Trying to get more sleep
• Getting an annual physical with testing for prediabetes as a proactive step to minimizing risk
• Increasing your intake of omega-3 fatty acids found in fish like salmon and mackerel (or supplements), which have been found to help reduce diabetes risk¹²

By making these lifestyle changes now, you may be able to mitigate your diabetes risk later.

“I think a lot of women don't even realize that they could be at risk for diabetes when they go through menopause,” Nurse Brasil says. “We can't help the fact that you're going to lose your estrogen eventually. But we can control other things like weight and exercise and try to come up with a good plan ahead of time. I think that's the key.”

Resources:

1. https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes/art-20044312
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3836104/
3. https://www.webmd.com/menopause/news/20170719/early-menopause-may-be-tied-to-type-2-diabetes
4. https://www.healthline.com/health/menopause/menopause-belly
5. https://www.webmd.com/menopause/guide/menopause-weight-gain-and-exercise-tips#:~:text=Reduced%20estrogen%20may%20also%20lower,a%20woman's%20resting%20metabolic%20rate.
6. https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes/art-20044312
7. https://www.sleepfoundation.org/women-sleep/menopause-and-sleep
8. https://www.menopause.org/for-women/menopauseflashes/bone-health-and-heart-health/diabetes-hits-women-hard-at-menopause-beat-it-back
9. https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes/art-20044312
10. https://www.adameetingnews.org/live-updates/session-coverage/research-indicates-reciprocal-links-between-diabetes-and-menopause-symptoms-onset/
11. https://www.adameetingnews.org/live-updates/session-coverage/research-indicates-reciprocal-links-between-diabetes-and-menopause-symptoms-onset/
12. https://www.menopause.org/for-women/menopauseflashes/bone-health-and-heart-health/diabetes-hits-women-hard-at-menopause-beat-it-back