Menstruation, Menopause & Diabetes

Ask any woman: It can be difficult to weather "that time of the month" and "the change." But managing these episodes when you have diabetes adds a whole set of complications. Here's what you need to know to make these two experiences smooth sailing.

A new wrinkle to your menstrual cycle

Some women with diabetes find their blood sugar levels don't stay steady over the week before and during their period. "Most commonly, we see women having higher blood sugars pre-period, and then these drop down when they begin to menstruate," says William Petit, MD, medical director of the Joslin Diabetes Center affiliate at The Hospital of Central Connecticut. The culprit: those fluctuating hormones that accompany your cycle.

But not everyone is the same, and you need to determine how your body is affected. "Each woman needs to recognize her own pattern," says Dr. Petit, because the effects can be variable.

To see if hormones affect your blood sugar levels, make a note of the days when you have your period in your blood glucose record book. Here, you should already be recording blood sugar levels (as instructed by your doctor, generally at least two to four times a day) as part of your standard diabetes management. You can look for emerging patterns and speak to your endocrinologist or other healthcare practitioner about the best plan for managing your diabetes at various times of the month to keep blood glucose levels optimal.

What's menopause got to do with it?

Often referred to as "the change of life," menopause, too, can influence blood glucose levels. "The effects are less direct," says Dr. Petit, and it's more likely that women feel unwell because of menopausal symptoms, which can be quite severe in some women.

However, menopausal symptoms such as hot flashes, sleep problems, fatigue caused by lack of sleep, moodiness, short-term memory loss and generally not feeling great can be mistaken for low blood sugar. You don't want to correct them by consuming unnecessary extra calories (which could cause hyperglycemia and ultimately lead to weight gain), so it's important to determine whether fluctuating hormones or menopausal symptoms are at the root of your symptoms. Monitor your blood glucose levels closely and work with your doctor to develop a management plan.

What's more, the hormonal changes of menopause can affect a woman's sexual function, which may already be dampened in someone with diabetes. Lower levels of estrogen decrease the blood supply to the vagina, which in turn reduces vaginal lubrication and can make sex painful. In addition, falling hormone levels can contribute to decreased arousal. The majority of women can manage these symptoms without going on hormone replacement therapy, says Mario Skugor, MD, an endocrinologist with the Cleveland Clinic in Ohio. However, "if you have severe symptoms that are interfering with your life, talk to your doctor to see if a hormone patch might be a good option for you," he advises.

As a woman gets older, and often around the time of menopause, she has a tendency to gain weight. "The closer you are to your ideal weight, the better you will be in terms of controlling your diabetes," says Dr. Petit. This applies whether you are in menopause or not, especially if you have type 2 diabetes. Moderate, healthy eating and increased physical activity can help you achieve a healthy weight.

Menopausal women, too, should measure blood glucose levels frequently and keep a log of their levels. If you do make changes to your diet or exercise plan, be sure to inform your doctor, as losing weight and increasing exercise frequency could reduce your insulin needs.

With diabetes, maintaining tight control is always your best tack. Indeed, a woman who reins in her condition will be able to better recognize when vacillating hormones are affecting blood sugar. And good news: "If a woman with diabetes learns about her body's fluctuations and adjusts her insulin accordingly, she shouldn't have to face additional problems each month and at menopause," says Dr. Skugor.

More: Get help from the Diabetes, Juvenile Diabetes and Menopause & Perimenopause message boards.

Resources: American Diabetes Association, Diabetes and Women's Sexual Health; Mayo Clinic, How Lifestyle and Daily Routine Affect Blood Sugar