Rita has type 2 diabetes. She had learned to deal with it but was now going through menopause. Her gynecologist suggested hormone replacement therapy, but she just wasn’t sure. What were the risks? She had heard that these hormones could cause cancer. And how would it affect her diabetes and the A1C level she had worked so hard to achieve?

Menopause is a process, not an event. It proceeds slowly, often lasting 8 to 10 years. It begins when your body slows down its production of estrogen and progesterone, the hormones that set the stage for pregnancy. Ovulation and menstruation become irregular. Some months you may ovulate and have a period, other months you may not. It can begin before you turn 40, but many women continue to menstruate well into their 50s or 60s. The average age for U.S. women having their last period is 51. Your mother’s age at menopause is highly predictive of yours.

Menopause can throw your diabetes management plan out of balance. That’s because you may have learned to adjust your plan around your normal hormonal fluctuations. And the hormones that keep your menstrual cycle going - estrogen and progesterone - can also affect blood glucose levels.  In some women, high levels of progesterone and other progestin hormones may decrease the body’s sensitivity to insulin.

High levels of estrogen tend to improve insulin sensitivity. As you start the transition of menopause,  you’ll want to pay close attention to the effects it will have on your blood glucose levels.
Some women find that they gain weight during menopause.

This can increase the need for insulin or oral medication. Many women find that they need to eat less and exercise more to maintain their weight. But this time of life can be very positive for many women. They are free from some of their responsibilities and can spend more time taking care of themselves.

Facing New Risks. Without so much progesterone circulating through your body, you may have greater insulin sensitivity.

That’s good news. But losing estrogen can increase your insulin resistance. And the lack of these hormones can also cause other changes, some of which can affect diabetes complications.

Having diabetes increases your risk for heart attack and stroke two to four times above the risk for people without diabetes.

Women without diabetes are protected against cardiovascular disease until menopause. But this is not the case for women with diabetes. Diabetes overrides the protective effect of estrogen. If you have diabetes, your risk for heart attack and heart disease is six times that of a woman without diabetes.

Total cholesterol levels tend to rise and levels of “good,” or HDL,  cholesterol tend to drop after menopause.  For some women, hormone replacement therapy may increase triglycerides, a common problem in type 2 diabetes. High blood glucose levels can make this situation even worse. Keeping your blood glucose, blood pressure, and cholesterol levels on target can help.

Estrogen also helps to maintain strong bones. As estrogen levels fall, your bones can lose some of the minerals that hold them together. This can lead to osteoporosis, a condition in which bones are brittle and easily broken. Eating calcium-rich foods, taking calcium supplements, and participating in regular weight-bearing exercise,  such as walking,  can help.

Hormone replacement therapy can increase bone density and lower your risk of osteoporosis. Other medications to combat osteoporosis are available.

Many women with diabetes find they are more prone to vaginitis and yeast infections once they enter menopause. Yeast and bacteria can irritate the vaginal lining if they grow out of control. They thrive in warm, moist places with a good supply of food (glucose). Even before menopause, you are more likely to develop yeast infections when your blood glucose levels are high. After menopause, the risk increases. That’s because estrogen normally nourishes and supports the vaginal lining.
Without it, yeast and bacteria have an easier time growing.