These findings fit with what Kathryne Sanserino, MD, an assistant professor of obstetrics and gynecology and a menopause specialist at Stanford Health Care in California, sees in her practice.
“Women with diabetes or other cardiometabolic conditions often have a more complicated symptom picture in midlife,” says Dr. Sanserino, who wasn’t involved in the research. “They are frequently dealing with poor sleep, fatigue, joint and muscle pain, urinary symptoms, and sexual concerns all at once. The combined effect on quality of life can be significant,” she says.
Researchers Measured Blood Sugar and Menopause Symptoms at the Same Time
The study included 296 South Korean women ages 45 to 64. Researchers classified 220 of them as having either type 2 diabetes or prediabetes, on the basis of their fasting blood glucose and A1C levels (a measurement of average blood sugar over the previous three months). They compared this first group with a control cohort of 76 women who had neither condition. Close to 70 percent of the participants were postmenopausal, meaning they hadn’t had a menstrual period for at least one year.
All participants completed an online questionnaire about menopause symptoms and how severe they were on a scale of 0 to 4. Pre- and perimenopausal women answered questions about 72 symptoms, whereas postmenopausal women answered questions about 65 symptoms. Symptoms fell into three broad categories:
- Physical, such as hot flashes and night sweats
- Stress-related, such as headaches and insomnia
- Emotional, such as anxiety or trouble concentrating
Women taking hormone therapy and those with uncontrolled blood sugar, diabetes complications, depression, diagnosed sleep disorders, or medically induced menopause were excluded.
Women With Diabetes or Prediabetes Reported More Physical Symptoms
Women with diabetes or prediabetes reported:
- More total menopause symptoms: About 20 symptoms on average from the full possible list, compared with about 16 symptoms for women in the control group.
- Higher overall symptom severity: An average score of 36.5 (out of a possible total 152), compared with a severity score of 26.1 for women in the control group.
- More stress-related physical symptoms: Including severe headaches, dizziness, fatigue, and difficulty falling or staying asleep. But these symptoms were not rated as more severe than those of women in the control group.
- Similar mood and cognitive symptoms: All women reported similar levels of anxiety, irritability, depression, or trouble concentrating, in number and severity.
The difference appeared largest among postmenopausal women. Those with diabetes or prediabetes reported about 19 symptoms, compared with about 14 among postmenopausal women with normal blood sugar, and their average severity score was about 34, compared with 22.
While the findings reflect what many women with type 2 diabetes experience, they should be interpreted with caution, says Sanserino. “The study was small and cross-sectional — it can show associations, but it cannot tell us what causes what,” she says.
Prediabetes or type 2 diabetes may flag women who need closer evaluation for a heavier overall physical symptom burden, says Sanserino. “That’s useful to know. It does not show that diabetes worsens menopause itself.”
Diabetes and Menopause Symptoms Can Be Hard to Tell Apart
When a woman enters menopause, her periods stop and the production of certain sex hormones, including estrogen, drops significantly. These hormone changes can lead to a range of symptoms, the most well-known being hot flashes and night sweats — issues that could theoretically be worsened by diabetes.
“Estrogen helps the brain and blood vessels work together to control the body’s internal thermostat. As estrogen levels fall during menopause, that thermostat becomes more sensitive, so small changes in body temperature can trigger flushing, sweating, and a racing heart,” says Genevieve Neal-Perry, MD, PhD, a reproductive endocrinologist at UNC Fertility in Chapel Hill, North Carolina, who was not involved in the study. “Diabetes may add to the problem because it can affect the nerves and blood vessels involved in temperature control.”
Many physical symptoms of diabetes and menopause can also overlap, Sanserino says, including:
- Sweating, heart palpitations, and low energy
- Increased urinary frequency and urgency
- Increased risk of vulvovaginal infections
- Changes in sexual function
The Connection May Run in Both Directions
Diabetes and menopause symptoms may influence each other rather than follow a simple cause-and-effect pattern, says Stephanie S. Faubion, MD, the director of the Mayo Clinic Center for Women’s Health in Jacksonville, Florida, who was not involved in the study.
The connection appears to work both ways: Insulin resistance and high insulin levels may make hot flashes and night sweats more likely, while women with more frequent or severe hot flashes and night sweats may be more likely to develop diabetes later.
Sanserino agrees that the relationship likely goes in both directions. “Severe hot flashes disrupt sleep, and poor sleep drains energy, which makes exercise, food choices, and diabetes self-care harder,” she says.
The Strengths and Limitations of the Study
A strength of the study is that it asked women not just which symptoms they had, but also how severely those symptoms affected their lives, compared with earlier research that focused only on the timing or stage of menopause.
But the study had some limitations. It was a small group of South Korean women only, so the results may not generalize to women of other ethnic backgrounds. Additionally, the average body mass index was 23, so the results could differ for women with higher body weight.
Participants with and without diabetes also had substantially different medication use (those with diabetes and prediabetes took more medicines), which could have affected their symptoms.
Finally, the study cannot show cause and effect. Because researchers measured blood sugar and symptoms at a single point in time, they cannot tell whether diabetes worsened symptoms, menopause affected blood sugar, or other factors influenced both.
Can Managing Diabetes or Its Risk Factors Ease Menopause Symptoms?
Both menopause and diabetes deserve treatment, says Sanserino. “No one [with prediabetes or type 2 diabetes] should be told she has to lose weight or fix her A1C before she can get help for menopause symptoms. That is not, nor ever should be, a prerequisite,” she says.
On the other hand, there is some evidence that lifestyle changes may help ease menopause symptoms.
“Losing just 5 percent of your body weight through healthy eating and regular physical activity can make a big difference for women with type 2 diabetes after menopause,” says Dr. Neal-Perry.
Even a modest amount of weight loss can improve blood sugar, reduce harmful belly fat, and lower inflammation, and it may also decrease the frequency and severity of hot flashes, she says.
Additionally, a healthy diet, regular movement, adequate sleep, and stress management can reduce hot flashes, improve sleep, and lower the risk of heart disease. “In other words, the same lifestyle changes can help you feel better now while also protecting your long-term health,” says Neal-Perry.
What Women With Diabetes Can Ask Their Doctor
Sanserino encourages women struggling with menopause and diabetes to talk with their doctor. “They should not assume their symptoms are just part of having diabetes and have to be tolerated,” Sanserino says.
Before a medical appointment, it may help to track when symptoms occur and whether they line up with meals, diabetes medications, glucose readings, or sleep disruptions. Also note urinary, vaginal, sexual, or mood symptoms, which can be easy to leave out of the discussion.
Questions to ask your healthcare provider, according to Sanserino:
- Could this be menopause, diabetes, my medications, or some combination?
- For women taking diabetes medications, it’s worth asking: Should I check my glucose when I have a hot flash or night sweat?
- What hormonal and nonhormonal treatments are options for me?
- Does my diabetes change which treatments are appropriate?
- If I have vaginal dryness, urinary urgency, or recurrent urinary tract infections, would local vaginal estrogen help? It treats those symptoms directly, has a different safety profile, and works differently from systemic hormone therapy.
- How do sleep, nutrition, activity, and weight fit into my plan?
The plan should be individualized, says Sanserino. “Midlife women are whole people. Sometimes we can pin a symptom to one cause. More often, though, the answer is ‘yes, and,’ and treatment is aimed at more than one target,” she says.
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