Living with Type 1 Diabetes and menopause

What is the menopause?

Menopause takes place when you have stopped menstruating for at least 12 months and can also happen if you have had your womb or ovaries removed. The perimenopause is the period before menopause starts and it lasts several years, and during this time you may find that your menstrual pattern changes and is more irregular than usual.

Symptoms of perimenopause and menopause, include hot flushes and night sweats, anxiety, disrupted sleep, irritability, depression, weight gain, dry skin or rashes, reduced concentration and loss of confidence. Talk to your GP about what you are experiencing and what your options are.

How does menopause affect type 1 diabetes?

Menopause can have a big impact on blood glucose management and on insulin sensitivity. There needs to be more research into menopause and type 1, but we know that if your hormone levels are disrupted by menopause, that has an impact on every other system in your body, which can affect your type 1 diabetes.

As the levels of female hormones – oestrogen and progesterone – fall, it can be harder to manage your blood glucose levels and the insulin in your body can start to work less effectively which can lead to insulin resistance. Weight gain, especially around the middle, is a common symptom of menopause and this may also increase insulin resistance.

It’s helpful to understand how your blood glucose levels can be affected by the changes in your hormones. Using a glucose monitoring device like a continuous glucose monitor or flash glucose monitor and talking to others who are experiencing menopause can be a good way to help improve your glucose management.

Oestrogen, menopause and type 1 diabetes

The drop in oestrogen can lead to a risk of osteoporosis (bone fractures) and heart disease. Type 1 diabetes can increase this risk so ask your GP about getting your vitamin D and calcium levels checked.

One of oestrogen’s roles in the body is to maintain the thickness of the vagina wall and lubrication. As the hormone declines during menopause, this can cause vaginal dryness. For those living with type 1, the nerves to the vagina can be damaged by high blood glucose levels over time and sex can become painful. Treatments such as an oestrogen pessary or vaginal ring may help to reduce this discomfort, so speak to your GP.

Do you need more insulin during menopause?

Having lower oestrogen levels seems to increase insulin resistance, so you may become more sensitive to insulin during menopause. You may need to change your insulin to carb ratio (the amount of insulin you need to cover the carbohydrate you’ve eaten).

For example, in the past where you might have taken 1 unit of insulin for 10g of carbohydrate, during menopause this might change to 1.5-2 units. If you have previously gone through pregnancy, you may have had a similar experience of fluctuating glucose levels and insulin requirements.

Disturbed sleep, which is a common symptom of perimenopause, can also make your glucose levels fluctuate, which can mean you need to change how much insulin you’re taking.

Equally, anxiety or increased stress may have an effect on your glucose levels and how sensitive you are to insulin.

Can having type 1 diabetes cause early menopause?

It’s often said that type 1 diabetes causes early menopause – but this doesn’t appear to be the case. If you have a family history of early menopause, then there’s a high chance that you will go through early menopause too, you just happen to have type 1 diabetes as well.

The average age to start becoming aware of menopause ranges from 45-55. Some people start that journey earlier, some later. Some will have completed it by the time they’re 45, some will still be in a menopausal state when they are in their sixties. It depends on what’s normal for your family group.

How can I keep my blood sugar stable during menopause?

Type 1 tech

Make the most of technology to understand what your blood glucose levels are doing. Using a glucose monitoring device – whether that be a continuous glucose monitor (CGM) or flash glucose monitor – can help you keep your glucose levels in range. Depending on where you live, you should be able to get glucose monitoring on the NHS.

Using a smart insulin pen or insulin pump can also help you manage your insulin and glucose levels during menopause.

Diet

You can lower your risk of insulin resistance with small changes to your diet such as cutting down on processed foods, eating healthier fats, increasing the amount of fruit and veg you eat and reducing how much alcohol you drink. Everyone has individual food preferences; there isn’t one food or diet that can be recommended but it is worth including foods which are rich in vitamins and folic acid if and when you can.

Exercise

Keeping active is also recommended. If you’re able to do, gentle activity after a meal, like a walk, is a good way to help insulin do its job and help your body absorb carbs. If you can, doing other weight-bearing physical activity, such as dancing or low-impact aerobics, can also help your insulin to control your blood glucose more effectively and is good for bone health.

Try to find a form of exercise that you enjoy, and, if you can make that an activity that includes your friends who are in perimenopause, it may help with your mental health too. Balancing your stress hormones can contribute to maintaining your blood sugar levels so prioritise sleep and self-care if you are able to.

Find out more about type 1 diabetes, physical activity and exercise.

Can you take hormone replacement therapy if you have type 1 diabetes?

As with any treatment, hormone replacement therapy (HRT) may not be right for everyone. Having type 1 diabetes does not mean that you cannot take HRT.

HRT comes in a few different forms including tablets, skin patches, foams and gels. The two main types of HRT are:

• oestrogen combined with progestogen/progesterone
• oestrogen only (if you have had a hysterectomy)

If you’ve got a family history of breast, ovarian or uterine cancer, some of the available HRT may not be a suitable option. Speak to a GP with a specialist interest in reproductive health.

There are alternatives to HRT which may help symptoms such as bone health and sleep quality. These include taking supplements, such as vitamin D and magnesium, and eating a diet rich in protein, phytoestrogens and fruit and vegetables.

Can my blood glucose levels be affected by HRT?

HRT can impact blood glucose levels. Oestrogen-only HRT – usually only recommended if you’ve had a hysterectomy – may improve sensitivity to insulin and help you manage your levels.

Some treatments can cause lower blood glucose levels which feel like hot sweats. Ask your GP which is the best treatment option for you and whether you may need more regular check-ups.

How do you tell a hot flush from a hypo?

Some menopausal symptoms, such as hot sweats and palpitations, feel similar to hypoglycaemia. So you may need to check your blood glucose more often.

Using a CGM or a flash glucose monitor can make this easier because you can set alarms to alert you if your glucose levels are going too low or too high, and easily check them throughout the day.

If it’s a hypo, treat it as you normally would. If it’s a combined hypo and hot sweat, always treat the hypo first.

Get support

Living with type 1 diabetes and going through menopause doesn’t isn’t always easy. Talk to your GP in the first instance about your options for managing menopausal symptoms.

Your Diabetes Healthcare Team can advise on managing blood glucose levels and technology that can support you with this.

Connecting with others with type 1 who are going through a similar time of life might also be helpful. There are groups available on all social media platforms, online communities and forums which allow you to share your experiences and learn from others.