Menopause and Diabetes: Thriving Through “The Change”

April 28, 2025 | By Corinna Cornejo

Perimenopause, the transition phase of menopause, often starts very subtly. We might notice a shift in our menstruation cycles, experience unexpected swings in our emotions, or ride out the occasional hot sensation rippling across our bodies. Glucose levels can rise and stay stubbornly high without a clear explanation. Weight gain materializes.

To those new to menopause and perimenopause, these effects can look like our diabetes management has gone astray. What we can’t easily see is that, in the background, our reproductive hormones are beginning to fluctuate. Eventually, these fluctuations settle and we reach the end of menopause, when we no longer menstruate.

How menopause progresses varies widely and unpredictably. It’s a process influenced by each individual woman’s biology, state, and health habits. This makes it difficult to anticipate the changes it brings or figure out the best way for each one of us to respond.

There are a few things to know about menopause and diabetes.

Menopause Is A Natural Biological Process

How long menopause lasts varies widely.

Generally, this process, which ultimately brings a woman’s reproductive years to an end, starts in the 40s and can last anywhere from seven to fourteen years.^[1]

Over that time the ovaries produce less and less reproductive hormones, particularly estrogen and progesterone. Menstrual cycles become irregular. The amount of menstrual flow can become erratic. Menopause is complete only after a year has passed since the last cycle.

For women living with diabetes these hormonal changes affect our glucose levels. They can drive glucose levels up, making our tried-and-true ways of managing our diabetes ineffective. Fluctuations in estrogen have an impact on insulin sensitivity, which can lead us to changing how we dose insulin and other medications. Ultimately, these changes in estrogen levels can increase insulin resistance and lead to weight gain. 

Menopause Can Feel Chaotic

The most visible menopausal symptoms are hot flashes and mood swings. Often they seem like they come out of nowhere – illogical and unanticipated.

When a hot flash happens it sends an intense sensation of warmth across our upper body, neck and face. Our skin gets flush and we are left drenched in sweat. At first, we might think these symptoms are the effects of hyperglycemia. Only after checking our glucose levels can we eliminate high glucose levels as the cause.

Mood swings often accompany menopause also. It can take the form of feeling irritable, tearful, and moody without any obvious trigger. Other times our energy simply drains away or we have difficulty concentrating. These symptoms leave us wondering if hyper- or hypoglycemia is to blame. Again, only by checking our glucose levels can we consider a cause besides our diabetes.

Managing Diabetes Throughout Menopause

The hormonal changes that come with menopause directly affect our glucose levels. Whether we experience visible symptoms or not, we know that managing diabetes is made more difficult by the hormonal changes that come with menopause.

As we begin preparing for menopause, the initial advice we receive is very familiar. It’s all the common actions that go into actively managing diabetes.

• Actively monitor glucose levels
• Exercise regularly
• Eat a balanced diet
• Get enough sleep and rest
• Actively manage stress levels
• Stay hydrated

Our day-to-day health habits can be effective in helping us move through menopause. But as the changes in hormones progress, these practices might become less and less effective.

The Medical Response

As we find it harder and harder to manage these menopausal effects, hormone replacement therapy (HRT) might be an option to consider. Research suggests the HRT can improve glucose levels^[2] in women with type 2 diabetes and insulin sensitivity.^[3]

With HRT, hormones are administered to supplement what the body produces. Most commonly estrogen alone is administered, but sometimes HRT can use a combination of estrogen and progesterone. These replacement hormones can be administered as a pill, patch, cream, or gel.

But it isn’t completely risk-free. HRT is associated with increased risks for thrombosis (blood clots), cardiovascular disease, and breast cancer. 

Because of its complexity, women considering HRT should consult with a specialist to weigh the potential benefits and risks. Discuss the different options when it comes to the specific hormones, how they will be administered, and limiting the length of treatment.  To get the most benefit, try to start the conversation early on, ideally during perimenopause.

The Cultural Response

Often overlooked, there is growing evidence that our cultural views and social experiences related to women’s health can shape how we experience menopause.

When menopause is stigmatized or seen as a negative marker of aging, women are less likely to seek support or treatment. By staying silent and hiding their symptoms they play into fears of being seen as weak, less important, or incompetent. And they don’t receive any of the potential benefits that can come from medical treatment or social support.

This is not to say that societal beliefs alone can erase the very real physical, emotional, and mental effects of the hormonal changes that come with menopause. But rather, to acknowledge that by tapping into positive cultural beliefs and expectations, women can experience menopause more positively.

Social factors seen as supporting a more positive menopausal experience include:

• Strong social support networks
• Positive cultural beliefs and expectations related to aging and the physical changes it brings
• Accommodations and supportive culture in the workplace and social settings

Supportive cultures treat menopause and aging with reverence. They see these transitions as a sign of deepening wisdom. They celebrate women taking on a new role, beyond childbearing and raising.

Women in these cultures exhibit more resilience^[4] and experience less distress^[5] as they go through menopause.

Every Woman’s Experience Is Unique

Much like with diabetes, each woman’s experience of menopause will be unique. Their experience will result from a combination of biology, state of health, state of mind, community, beliefs, and expectations.

Also like diabetes, the transition through menopause calls for active management. Which will bring together a personalized combination of self-care, social support, and medical care.

The key, as with managing your health overall, is to actively tune into your body’s changes. Seek out information and support – from both your healthcare team and your community. Find out what works best for you. And embrace the transition as an opportunity to reassess/revise/reinvent how you manage your health and diabetes.

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Sources as they appear in the article:

1. National Institute on Aging. What is menopause? National Institute on Aging. Published September 30, 2021. https://www.nia.nih.gov/health/menopause/what-menopause

2. Ferrara A, Karter AJ, Ackerson LM, Liu JY, Selby JV. Hormone Replacement Therapy Is Associated With Better Glycemic Control in Women With Type 2 Diabetes: The Northern California Kaiser Permanente Diabetes Registry. Diabetes Care. 2001;24(7):1144-1150. doi:https://doi.org/10.2337/diacare.24.7.1144

3. Bitoska I, Krstevska B, Milenkovic T, et al. Effects of Hormone Replacement Therapy on Insulin Resistance in Postmenopausal Diabetic Women. Open Access Macedonian Journal of Medical Sciences. 2016;4(1):83-88. doi:https://doi.org/10.3889/oamjms.2016.024

4. Arnot M, Emmott EH, Mace R. The relationship between social support, stressful events, and menopause symptoms. Sánchez-Rodríguez MA, ed. PLOS ONE. 2021;16(1):e0245444. doi:https://doi.org/10.1371/journal.pone.0245444

5. Bridge Magazine. Cultural perspectives on menopause. Continence Foundation of Australia. Published August 30, 2022. https://www.continence.org.au/news/cultural-perspectives-menopause