Menopause and diabetes risk: what hormonal changes mean for your health

Menopause marks the end of a woman's reproductive years. There are significant hormonal changes involved with perimenopause (the transition phase leading to menopause) and menopause. These can affect overall health, including an increased risk of developing type 2 diabetes.

“Women who undergo natural menopause have a higher risk of type 2 diabetes than premenopausal women of the same age³,” says Professor Merlin Thomas from the Department of Diabetes at Monash University. “Earlier menopause, particularly before age 45, is associated with an even greater risk of diabetes. Women with premature menopause have among the highest risks of future diabetes.”⁴

“Type 2 diabetes happens when the body can no longer control blood glucose levels,” explains Professor Thomas. “Insulin is the hormone responsible for regulating blood sugar levels. As oestrogen levels decline during menopause, the body may become less efficient at using insulin.

“However, this is just one piece of the puzzle. Menopause is associated with many different changes in a women’s body. Some of these can increase the risk of developing diabetes.” These include:

• A tendency to put on extra fat.
• Changes in the distribution of fat in the body. Extra fat can be deposited ‘out of place’ inside and around the major organs of the body. This compromises the organs’ ability to maintain healthy glucose levels, even if your body weight doesn’t change.
• Increased resistance to the hormones that normally control glucose levels.
• Disturbed sleep patterns.

“Excess fat can be harmful to the pancreas and may damage the cells that produce insulin,” says Professor Thomas.

“During menopause, the body can become less able to use insulin properly. When this happens, and is combined with excess body fat, it can sometimes lead to diabetes.

A similar thing can happen during pregnancy, when some women develop gestational diabetes. This type of diabetes usually goes away after the baby is born, but it can be a sign that the person may be more likely to develop diabetes later in life, such as during menopause.”

“Around three in four women going through the menopause experience hot flushes and night sweats,” says Professor Thomas. “Women reporting more frequent or severe vasomotor (constriction and dilation of blood vessels) symptoms have a significantly greater incidence of diabetes.⁵

This may be because disrupted and restricted sleep can reduce insulin sensitivity, activate stress pathways and promote daytime hunger leading to weight gain.”

If you already have diabetes, its management should not change when you go through the menopause. “Diabetes management should continue to be focused on protecting the body from the effects of diabetes, using medication, diet and lifestyle change,” says Professor Thomas.

“However, menopause is also associated with increased risk of heart disease, so there should be an increased focus on lowering this risk, through exercise and healthy eating.”

The best results come from multifactorial approaches that include some or all of these interventions:

Reduce excess fat: “The best way to reduce the risk of type 2 diabetes is to reduce excess fat in your body,” says Professor Thomas. “Some people can achieve this through diet and lifestyle changes. Many people can also benefit from medications that can help them to lose a significant amount of excess fat.”

Hormone replacement therapy (also called menopausal hormone therapy): “HRT can be very effective in reducing hot flushes and night sweats. Research indicates that HRT can also lower the incidence of new-onset type 2 diabetes in perimenopause and menopause by roughly 20% to 30%.”⁶

Keep an eye on mental health: “The risk of depression and anxiety increases during the menopause. Poor mental health and stress can lead to overeating and inactivity, as well as direct effects on hormonal function. Without dealing with mental illness and stress, no intervention will be effective,” says Thomas.

While hormonal changes during menopause can increase the risk of type 2 diabetes, there are practical steps you can take to protect your health. Healthy lifestyle habits, managing menopause symptoms and seeking support when needed can all help reduce your risk and support healthy ageing.

The Australasian Menopause Society offers information and support for women in menopause and perimenopause.

Diabetes Australia has resources and information about diabetes prevention and how to manage it.