“I wish someone had talked to me about the changes to expect during menopause” is a common concern I hear from people living with diabetes. 

While robust research is lacking in this area, we do know people who live with type 1 diabetes (T1D) and menstruate experience glucose changes surrounding their cycle — and during perimenopause, menopause, and postmenopausal times in their lives — likely, in part, from fluctuating hormone levels.  

Each stage of life can be different for each person, and bothersome physical symptoms, including hot flashes, interrupted sleep, mood changes, and others, may accompany hormone changes. 

Here, we’ll dig into the most commonly asked questions about age-related hormone changes fielded by Natalie Bellini, DNP, BC-ADM, CDCES, an endocrine nurse practitioner at University Hospitals who has lived with T1D for over 50 years.   

 

What hormone changes occur in people with ovaries as they age? 

After puberty, hormones cycle monthly with ovulation and menstruation to support fertility. Key hormones include estrogen and progesterone, which together maintain and regulate sexual and reproductive health. 

Aging will lead to ovaries producing less of these hormones and eventually stop releasing eggs. This results in the following stages, which are collectively referred to as “menopause.” 

 

 

How do hormone changes affect diabetes management? 

Estrogen can improve insulin sensitivity, while progesterone can cause insulin resistance. This means that in the two weeks before your period, as progesterone levels rise, you may notice more insulin resistance and higher glucose levels.  

During your period, progesterone levels decrease, and after your period, estrogen levels increase. With these changes, you’ll likely become more sensitive to insulin again. 

“Menstruation may cause blood glucose to increase in the second half of your cycle, then decrease during menstruation,” said Bellini. “If your cycle is normal, then it may be easier to predict the insulin changes each month. However, many people with diabetes do not have a ‘normal’ 28-day cycle.” 

During perimenopause, glucose levels can become more erratic and unpredictable. This happens as your estrogen and progesterone levels change. While some cycles may release an egg, others may not. “This can be a very challenging time with changing hormone levels. There is no pattern, and it can be much tougher to manage blood sugars,” she said.  

Finally, during menopause, estrogen declines, and this can lead to increased insulin resistance. You may also notice weight gain which can add to insulin resistance, higher fasting glucose levels, and more difficulty with after-meal glucose spikes. During this time, it’s common to need an increase in insulin ratios. 

 

What is hormone replacement therapy, and who is it recommended for? 

Hormone replacement therapy (HRT) is used to supplement hormones (estrogen and/or progesterone) that are less than they were before a person experiences perimenopausal and menopausal-related changes. 

Providers typically prescribe HRT for short- to medium-term use (about 5–10 years) in healthy people with ovaries under age 60 or within 10 years of menopausal symptoms. 

 

Can hormone therapy cause cancer or heart disease? 

Many people wonder about this or have heard that HRT can cause serious health problems. HRT is considered to be generally safe in women who don’t have risk factors.  

That said, some research shows a link between these conditions, such as the Women’s Health Initiative (WHI), which began in the 1990s and followed more than 160,000 postmenopausal women to study the long-term effects of hormone therapy.  

There were two main arms of the study. One included estrogen and progestin (for those with a uterus), while the other was estrogen-only (for those without a uterus). 

The study ended early in 2002 after researchers discovered an increased risk of breast cancer, heart disease, stroke, and blood clots, explained Bellini, “And hormone replacement therapy prescriptions plummeted overnight.” 

“The problem was that the average age of the persons enrolled was 63. This is after menopause, and most were not having menopausal symptoms. They were already at a higher risk for breast cancer, heart disease, and clots.” Understandably, experts found the study to be misleading. 

More recent studies have shown that, with personal risk factors taken into account, the health risks of HRT for many women in their 40s and 50s are low. 

 

I’m peri-menopausal — is this the “safe window” of time to start hormone therapy? 

“Yes, if hormone therapy is started earlier, there are lower risks of heart disease, cancer, and bone issues,” said Bellini. “This is why it’s recommended for healthy people under 60 years of age to take it for no more than 10 years.” 

  

Who shouldn’t use hormone therapy?  

If you have any of the following conditions, the potential benefits of HRT may not outweigh the risks. HRT is not recommended for anyone with a history of the following conditions:   

  • Breast cancer 
  • Stroke 
  • Heart attack
  • Blood clots 
  • Liver disease 

  

What are the different types of hormone therapy? 

Estrogen-only therapy and combined estrogen-progesterone therapy are the two main types of hormone replacement therapy. 

While estrogen-only therapies can be taken by people who no longer have a uterus, estrogen-progesterone combination therapies are prescribed for those who have a uterus. That’s because this combination helps to prevent the lining of the uterus from thickening, which can raise the risk of endometrial cancer.  

 

HRT therapies are delivered in one of two ways: 

 

 

The American College of Obstetricians & Gynecologists recommends using the lowest effective dose of estrogen and checking in with your prescribing provider each year about its continued use. 

Additionally, smoking raises the risk of complications and can also alter the absorption of oral estrogen. If you’re a smoker, patches are the preferred therapy. 

  

What are the benefits of hormone therapy? 

Hormone therapy can help ease many uncomfortable symptoms of menopause like hot flashes, night sweats, vaginal dryness, and uncomfortable intercourse. According to Bellini, there are other potential benefits, too.  

 

HRT can help with: 

  • Bone health  
  • Sex drive 
  • Sleep 
  • Emotional well-being 
  • Memory 

 

While HRT may help to regulate cycles, it can also lead to more stable glucose levels.  A 2023 review and meta-analysis of 19 trials included 1,412 postmenopausal women with T1D or T2D. The study found that hormone therapy: 

  • Reduced A1C levels by about 0.56% 
  • Lowered fasting glucose by about 20 mg/dl 

 

Why is this topic ill-addressed in T1D care? 

While you may assume hormone changes would be on the agenda to discuss at your endocrinologist’s office, they may not be.  

Even though it’s known that people of menstruating age and older see glucose changes related to hormones — it’s not a heavily researched area. It’s also a topic often discussed with a gynecologist, which may lead to a disconnect on how age-related hormone changes impact glucose management. 

Knowing what to expect can help you to be more open about your concerns and advocate for your care. This way, you can make an informed and supported decision regarding hormone therapy while more research is underway.