Hormonal fluctuations have a tremendous impact on your blood sugar levels and insulin needs — and your body experiences these fluctuations on a daily and monthly basis.

But there are certain phases of life where hormone fluctuations become very noticeable.

Puberty, menstruation, pregnancy, and menopause are four periods of life for women when your body’s natural hormonal changes leave a big mark on your diabetes management.

In this article, we’ll discuss how menopause affects your diabetes and what you can do to manage your blood sugars during this lengthy transition phase.

Perimenopause & Menopause

Perimenopause is the earlier stage of menopause, defined by irregular menstrual cycles which is a direct result of your body’s gradually declining ovarian function, according to Harvard Health.

Perimenopause generally lasts for three or four years, but for some women, it can persist for an entire decade.

The end of perimenopause is when a full year has passed since your last period, and this defines that you are officially in menopause. Menopause is also defined as when your ovaries have completely stopped producing progesterone and estrogen.

Hormone fluctuations of menstruation vs. perimenopause/menopause

“What’s happening hormonally during menopause,” explains Jennifer Smith, RD, CDE and co-author of Pregnancy with Type 1 Diabetes, “is the gradual decline of your estrogen production and overall estrogen levels.”

Let’s take a closer look at your hormone levels both before menopause and once menopause has begun.

During your reproductive years, estrogen levels are either rising or falling depending on where you are within the 4-week cycle of menstruation.

When estrogen levels rise during a normal monthly cycle, your body tells your ovaries to release an egg. Then, your body produces more progesterone in preparation for pregnancy.

If you do become pregnant, progesterone levels remain high and many women see this in their blood sugars, causing them to suddenly need more background insulin. 

If you don’t become pregnant, progesterone levels drop, and the monthly cycle begins again.

When you begin perimenopause, on your way to menopause, these hormone fluctuations become far less predictable.

By your late 30s, we don’t produce as much progesterone, explains Harvard Health. “The number and quality of follicles also diminish, causing a decline in estrogen production and fewer ovulations.

“As a result, by our 40s, cycle length and menstrual flow may vary and periods may become irregular. Estrogen may drop precipitously or spike higher than normal.”

Symptoms of perimenopause & menopause

Blood sugar fluctuations: “Things may seem a bit more up and down compared to how your blood sugars were during a normal month around your menstrual cycle,” explains Smith. “And this unpredictability can last for months and months as your body manages the gradual process of menopause.”

It is inevitable and critical that you work with your healthcare to gradually increase your insulin doses to meet your body’s new insulin needs.

“Things we also typically focus on for post-menopause are glucose control, keeping activity level up, and making healthy food choices to provide the body with adequate nutrients to work through this change of life,” says Smith. “Improving your diet so you’re eating less sugar will also help a lot, but you will also still need to work with your healthcare team to adjust your diabetes medications.”

Urinary tract infections & yeast infections: “With the changes in your blood sugar levels, menopause can also make you more prone to urinary tract infections (UTI) and vaginal yeast infections,” explains Smith.

“These two uncomfortable conditions are even more common after menopause when the big drop in estrogen changes the environment in your urinary tract and your vagina, making it easier for yeast and bacteria to grow.”

Persistently high blood sugars can easily create an overgrowth of yeast, so the first thing to do here is increase your insulin doses with your healthcare team’s support to get your blood sugars down, while also likely using an over-the-counter yeast infection treatment.

“With a UTI, the infection itself can also create stress which can increase your blood sugar levels further! Definitely contact your primary care team immediately if you suspect a UTI or severe yeast infection. UTI has to be treated with a prescription antibiotic. Over-the-counter medications for UTIs simply help relieve the symptoms, not the infection itself.”

Hot flashes and night sweats: About 35 to 50 percent of perimenopausal women experience incredibly uncomfortable “waves” of body heat, often accompanied by sweating and a sudden flushing red appearance in your cheeks and face. These hot-flashes usually last no more than 10 minutes but they can come and go constantly through the day, for a few years.

Vaginal dryness: Your vagina’s self-lubricating feature is really designed for the goal of pregnancy. As your hormone levels change, your body doesn’t produce those lubricating fluids as consistently. This dryness can be very uncomfortable — especially during intercourse — and can lead to itching and overall irritation.

Difficulty sleeping: A large percentage of women going through menopause have difficulty sleeping, often due to hot-flashes and sweating. Harvard Health, however, says overall insomnia can’t be blamed on menopause alone. Insomnia could easily be the result of aging and shifting sleep cycles, and it’s experienced by aging men, too.

Depression: While Harvard Health says there’s no real evidence to support the idea that changing estrogen levels could truly impact your mood, there does seem to be an increase in depression among women going through perimenopause, but surprisingly, the rate of depression in women older than 45 is less than those younger.

Heavy bleeding & fibroids: “With lower levels of progesterone to regulate the growth of the endometrium,” explains Harvard Health, “the uterine line may become thicker before it’s shed, resulting in very heavy periods.” Fibroids, which are non-cancerous tumors attached to the wall of your uterus, can become more common during perimenopause and menopause. Endometriosis can also develop during perimenopause, and cause pelvic and back pain as well as intense heavy bleeding.

Weight-gain: “Metabolism changes as we age, and for women post-menopause, this can lead to weight gain. Weight-gain also means becoming a bit more insulin resistant (depending on how much you gain), which can mean you’ll need an increase in your insulin doses, too,” explains Smith.

Other symptoms: Less proven to be linked to menopause but often reported by women during this time, is short-term memory problems, headaches, and difficulty concentrating. Harvard Health emphasizes though that it’s difficult to determine whether these symptoms are related to aging or hormonal changes.

Diabetes and menopause: What you can do

Menopause can make your diabetes management more challenging, but there are things you can do to make it easier

Measure your blood sugar more often

If your blood sugar is now less predictable than it used to be, measuring it more often can be very helpful. Get in the habit of measuring it regularly or talk to your medical team about getting a Continuous Glucose Monitor (CGM) that can send real-time blood sugar data to your phone and alert you to low or high blood sugars.

Talk to your doctor about adjusting your diabetes medication

If your average blood sugar level increases or decreases, you may need to adjust the dosage of your diabetes medications (injectable insulin or oral medications like Metformin or Victoza) or begin taking a new medication.

Treat the symptoms

Many of the symptoms of menopause (hot flashes, sleep problems, vaginal dryness, etc.) can be treated. Talk to your doctor about medication or lifestyle changes that can help reduce or even eliminate the symptoms.

Make healthy lifestyle choices

Eating a healthy diet and being physically active is always an important part of your diabetes management – especially in a period of your life where managing your blood sugar may be a little more challenging.

Try to aim for at least 20-30 minutes of physical activity per day. This doesn’t have to be “workouts”, anything that gets your heart rate up counts. Walking your dog, dancing to great music, or even vigorously vacuuming your home are all great ways to include physical activity in your daily routine.

Take it in stride and get support from your healthcare team

Like menstruation, perimenopause and menopause can create unpredictable fluctuations in your blood sugar. It can be very tedious and stressful! Work with your healthcare team to make gradual adjustments in your diabetes medication over the course of those months or years, and do the best you can!