A woman’s reproductive life can be divided into menarche, perimenopause and menopause/post menopause. Menarche marks the beginning with the first menstrual cycle, and with each cycle, an egg is typically released from the ovaries. Menopause marks the end and occurs because there are a limited number of eggs in the ovaries. When they run out, there is no more cycling and the periods stop.
Several years before the last egg is released, the ovaries start to behave irregularly. That phase is known as perimenopause. During perimenopause, ovulation is not consistent and the timing can be earlier or later than expected. This means that the period can come earlier or later than expected. The levels of two key hormones – estrogen and progesterone – also fluctuate unpredictably during this time. This can cause symptoms of low estrogen that resolve when levels return to normal. Imagine a car running out of gas and sputtering – it goes then stalls then goes again.
A woman is classified as having menopause when one year passes from the last menstrual period. The average age of natural menopause in Canada is around 52 years. Symptoms of menopause are caused by the lack of estrogen and progesterone. These include hot flashes, vaginal dryness, sleep disturbances, mood changes and memory problems to name a few. Different women experience menopause differently. Some women have few or no symptoms, while others have debilitating symptoms for many years.
So how does this affect diabetes? First, it can smooth out blood sugar levels. Hormone changes that occur with the menstrual cycles vary the sensitivity to insulin throughout the month. The absence of these changes eliminates one of the causes of varying sugars. Second, some menopause symptoms such as hot flashes – sweating, heat and dizziness – are very similar to the symptoms of a low blood sugar. Often the only way that a woman can know if it’s a low blood sugar or a hot flash is to check the sugar at the time.
The most important consideration has nothing to do with blood sugars. The lack of estrogen and progesterone changes the body so that fat is stored more around the mid-section. This increases the risk of high cholesterol, high blood pressure, heart disease and stroke. These changes are important for anyone living with diabetes to assess and treat. However, they are particularly important when one enters menopause.
Menopause is a natural phase in a woman’s life. Understanding the changes can empower you to have better conversations with your health care team to address any concerns that may come up.
About the author
Alice Cheng
Alice Cheng is an endocrinologist at Trillium Health Partners and Unity Health Toronto. She is an Associate Professor at the University of Toronto and co-host of the podcast series, Diabetes Care on Air.
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