Menopause and Diabetes

These infections are not related to sexual activity or personal hygiene.

Hormone Replacement Therapy. You may have a hard time trying to decide whether to take hormone replacement therapy. It is a complicated issue. On one hand, estrogen can decrease the risk of osteoporosis and vaginitis and alleviate hot flashes.

On the other hand, it can increase the risk of breast cancer and uterine cancer. When estrogen and progesterone are administered together and in the correct doses, the risk of cancer of the uterus or endometrium is reduced. Research on this very important issue is ongoing; not all questions are answered. Earlier studies suggested that hormone replacement therapy protected against heart disease. But more recent controlled studies indicate that hormone replacement therapy may actually increase your risk for heart disease and stroke.

The current recommendation is to take the smallest dose of hormone replacements for the least amount of time possible to control symptoms. There are different types of hormonal therapies available.  Most combine estrogen and progesterone.

Some treatments also include small amounts of testosterone,  which helps improve bone mass and may improve sex drive.

For some women, estrogen and progesterone replacement can cause frequent or irregular bleeding, even after menopause is complete. Sometimes, bleeding occurs at the start of treatment and disappears as therapy continues. Along with the protection these hormones can give you, there are also potential effects on blood glucose levels,  although these are usually minor. There is evidence that estrogen replacement increases insulin sensitivity. Adding a progestin hormone may counteract this. Blood glucose monitoring will help you figure out the

Hormone Replacement Therapy and Diabetes
After menopause, if you use hormone replacement therapy, add these tests to your diabetes plan. Any tests that give abnormal results should be repeated more frequently.

  •   Have your A1C tested two to four times a year. This test tells you about your blood glucose levels over the long term.
  •   Have your cholesterol and triglyceride levels checked as recommended by your provider. The progesterone in hormone replacement therapy can sometimes cause cholesterol levels to rise.
  •   Have yearly eye exams and kidney function tests.
  •   Have a yearly mammogram to detect breast cancer.
  •   Have a yearly Pap smear and gynecologic examination to detect cancer of the cervix, uterus, endometrium, and ovaries.

Whether you decide to use hormone replacement therapy is up to you. Many factors can influence your decision. If you have a personal history of breast or endometrial cancer or blood clotting problems, hormone replacement therapy may not be for you.

If you have a family history of breast cancer or have had uterine fibroids or fibrocystic breasts,  you should know that hormone replacement therapy increases your risk for also developing these problems. On the other hand, if you have a personal or family history of osteoporosis or suffer from hot flashes, hormone replacement therapy may be in order.

As a woman with diabetes, you need to play an active role in your overall health care throughout menopause and beyond.

You have more at stake during this time in your life than do women without diabetes. As with other issues related to your sexual health, it’s important that you discuss concerns with your provider and other health care team members.

Martha M. Funnell, MS, RN, CDE
Michigan Diabetes Research and Training Center
University of Michigan Medical School
Ann Arbor, Michigan

Robert M. Anderson, EdD
Michigan Diabetes Research and Training Center
University of Michigan Medical School
Ann Arbor, Michigan

Shereen Arent, JD
National Director of Legal Advocacy
American Diabetes Association

American Diabetes Association Complete Guide to Diabetes

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