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If you have type 1 diabetes and are going through menopause — or you’re trying to prepare yourself for that stage of life — you might be frustrated as you search for helpful related details. Research shows that a major complaint people with type 1 diabetes have during menopause is the lack of information about what to expect and how to handle the transition.
This article aims to fill the gaps. We’ll explain what menopause is and how it may be affected by type 1 diabetes. We’ll also discuss how to manage type 1 diabetes while going through menopause.
Menopause takes place when sex hormones change and the time for childbearing ends. The process occurs in three phases: perimenopause, menopause, and postmenopause.
During perimenopause, your body starts transitioning into menopause. You’ll start to produce less estrogen, a sex hormone that controls reproductive organs. As estrogen decreases, it affects the balance with another sex hormone, progesterone. During perimenopause, these hormone levels will fluctuate and lead to various symptoms, including:
Perimenopause usually begins in a person’s mid-40s and lasts about seven years.
You’re considered to be in menopause when you haven’t had a menstrual period for 12 months in a row. At this point, your body is producing very little estrogen and progesterone, and your ovaries aren’t releasing eggs.
Postmenopause is your life after menopause. You may still have some symptoms of the menopause transition, but they usually get milder over time. However, permanently low estrogen levels increase your risk of some health concerns, including:
Menopause usually occurs around age 51. If it happens before 45, it’s considered early menopause. Going through menopause before age 40 is called premature menopause. Some research suggests that people diagnosed with type 1 or type 2 diabetes at a young age are more likely to go through early menopause than people without diabetes. Also, people diagnosed with type 1 diabetes before their first menstrual period have a shorter reproductive period, or time when they’re able to have children.
If you’re living with type 1 diabetes, you already know that it’s crucial to monitor your blood sugar. Estrogen is important for increasing insulin sensitivity, or how well your cells respond to insulin. One 2023 study also indicates that estrogen helps insulin cross the walls of the blood vessels and reach the muscles to help control blood sugar.
During menopause, changes in estrogen levels can affect how your cells respond to insulin, causing fluctuations in blood sugar. You may need to adjust your insulin dose, and managing your blood sugar may be more difficult.
Members of myT1Dteam have noticed the effect of menopause on their blood sugar management. One member shared, “Realizing I’m deep in the throes of perimenopause and apparently the hormonal imbalance affects blood sugars horribly, like everything else, haha. Finally helps me understand why my sugars have been out of whack this year. Apparently it affects insulin resistance too.”
Another member shared, “I hit perimenopause about two years ago, and this year my sugars have been uncharacteristically out of whack.”
Other symptoms of menopause can also affect blood sugar management. Weight gain is common in menopause and can increase insulin resistance. Sleep problems related to menopause can also make your blood sugar levels go up and down.
Carefully monitoring your blood sugar is particularly important during the menopause transition. Some side effects of perimenopause, like hot flashes and palpitations (irregular heartbeats), are also symptoms of hypoglycemia, or low blood sugar. You should regularly measure your blood sugar and talk to your health care provider about managing hypoglycemic episodes during perimenopause.
Because of its effect on blood sugar, menopause can increase your likelihood of developing complications of type 1 diabetes such as infections, nerve problems, and certain diseases.
During menopause, it can be harder to control your blood sugar. High blood sugar can raise your risk of urinary tract or vaginal infections. Plus, lower estrogen levels make it easier for bacteria and yeast to grow in the urinary tract or vagina. This means you may have a higher risk of developing these infections.
Another complication of uncontrolled blood sugar in type 1 diabetes is nerve damage. Although diabetic nerve damage is most common in the legs and feet, it can also affect other areas of the body, including the walls of the vagina. This can lead to difficulties becoming aroused and achieving orgasm. Over half of people experience vaginal dryness during menopause, making problems with sex even worse.
Research has shown that people with type 1 diabetes are at a higher risk of heart disease, but researchers don’t completely understand why. One study showed that in people with type 1 diabetes, high blood sugar levels can lead the immune system to attack cells in the heart, raising the risk of heart disease. Estrogen is important in protecting against heart disease. During menopause, decreased estrogen may raise your risk of heart disease due to increases in blood cholesterol levels, blood pressure, and weight.
People with type 1 diabetes are more likely to develop osteoporosis (a condition of weakened, less dense bones). Type 1 diabetes is associated with lower bone mass and an increased risk of fractures. Menopause is also a major cause of osteoporosis, and people can lose up to 20 percent of their bone mass during menopause. This makes osteoporosis a major concern for postmenopausal people with type 1 diabetes.
Properly managing your blood sugar is very important to reduce the risk of diabetes complications. During menopause, you should regularly monitor your blood sugar and adjust your ratio of insulin to carbohydrates as needed.
Other approaches to managing diabetes are the same whether or not you’re going through menopause. You should eat a healthy diet that includes fruits, vegetables, healthy fats, and some carbs. By choosing foods lower in saturated fat, sugar, and salt, you can help reduce your risk of diabetes complications like heart disease.
Finally, regular exercise can help you control your blood sugar and reduce your risk of diabetes complications. It’s important to monitor your blood sugar because some forms of exercise cause sugar levels to rise, and others cause them to fall. Physical activity can also help improve your mental health.
You may have heard of using hormone replacement therapy (HRT) to treat symptoms of menopause. There are two main types of HRT — estrogen only and estrogen plus progesterone. HRT can help you manage symptoms, such as hot flashes and vaginal dryness, and help prevent osteoporosis. In addition, HRT may help with sugar regulation, but more research is needed in people with type 1 diabetes.
Having type 1 diabetes doesn’t prevent you from using hormone replacement therapy to treat menopause symptoms. It’s important to know that HRT can affect blood sugar levels, which may require adjusting your insulin dose, and it also carries certain risks. You should speak with your health care team to determine if HRT is right for you.
On myT1Dteam, the social network for people with type 1 diabetes and their loved ones, more than 3,700 people from around the world come together to ask questions, offer support and advice, and connect with others who understand life with type 1 diabetes.
Are you going through menopause and have type 1 diabetes? How has menopause affected your life with diabetes? Share your experience in the comments below, or start a conversation by posting on your Activities page.
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Sarika Chaudhari, M.D., Ph.D.
completed her medical school and residency training in clinical physiology at Government Medical College, Nagpur, India.
Learn more about her here.
Allison M. Dubner, Ph.D.
earned a B.A. in biology from Pomona College and a Ph.D. in integrated physiology from the University of Colorado Anschutz Medical Campus.
Learn more about her here.
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