Perimenopause and Diabetes

Patient Expert

Hot flashes and night sweats are the two hallmark symptoms of perimenopause. They also happen to be the hallmark symptoms of low blood sugar for someone with type 1 diabetes.  When the wind begins to blow and change is in air, what's a girl to do? Know as much as possible about the course, as you head into the winds of change

I have long suffered from being too cold.   In the middle of summer, I can be found sleeping with socks on, and no matter the temperature of the room, I have a sheet and blanket over me. On a hot steamy August night, I woke up feeling sweaty, and my Dexcom reading was 120. I took my blood sugar with my meter and it read 132. What? And this happened a couple more times.

I started to notice that I was feeling warmer and also I noticed that on some days, my blood sugars were roaring high, or roaring low, like I've never experienced.   I started to wonder if at 48, I might be seeing the symptoms for perimenopause.   With this trend in hand, I called my CDE, Judy, who is a CDE, RD and type 1 for over 50 years and who happens to be 60.   I knew if I needed to understand, or confirm this process, she'd be golden! Here's what Judy and I discussed about "the change."

Understanding perimenopause

To clarify the difference, menopause is when a woman does not have her period for a year; perimenopause is when the hormones begin to fluctuate as a woman begins to walk toward menopause. It can last for 3-5 years before a woman hits menopause.  For women with diabetes, perimenopause and menopause can make diabetes management more challenging.

The following is a list of symptoms that could affect every woman. While I'm listing quite a few, don't despair, you won't have them all, nor will you have all of them at the same time.

Menstrual irregularity. As ovulation become more erratic, periods becoming longer or shorter and flow may be light or profuse.   Some women may skip periods. Early perimenopause is defined by length of time, 7 days or more, having your period.   Late perimenopause is signaled by missed periods and intervals of 60 days or more between periods.

Hot Flashes.   This is what has prompted this blog! 65 to 75 percent of women will experience hot flashes. The intensity, duration and frequency vary. Hot flashes appear most often during late perimenopause. The difference between night sweats and hot flashes is that night sweats are severe hot flashes that drench nightclothes and sheets and are not associated with environment or fever.

Sleeplessness. Sleep is less sound, due to discomfort from hot flashes and nigh sweats, but some will experience restless sleep due to hormonal flux.

Moody blues. Some women will experience mood swings, irritability, or depression. Some of this can be associated with fatigue from sleep deprivation, or it could be associated with hormonal changes.

Urinary tract infections (UTI) and vaginal dryness. Because estrogen levels decrease, women become prone to UTIs and other vaginal infections. Women may experience trouble with self-lubrication and elasticity, making sex more painful.

Lack of lust. The good news here is that if your sex life is satisfying before perimenopause, it doesn't leave you. There may be more issues with emotional shifts, due to mood changes, but the desire is still there.

Don't give up your birth control!  Even with your cycle coming to end, there is a chance that you could still conceive, and women who are in their late 40s have a 90% chance of giving birth to a baby with Down Syndrome. The suggestion is to continue to use birth control until you have had no periods for 12 months.

Bone loss.   When estrogen levels decrease, your bone density decreases more quickly than you can replace it.

Changing cholesterol levels.  Lower estrogen levels often raise the LDL (low density lipid) cholesterol, aka "bad cholesterol."  Sadly, at the same time, high-density lipoprotein (HDL), or good cholesterol, decreases.   Because of these factors, perimenopause increases the risk for heart disease.

So what happens with diabetes?

When women with diabetes enter into perimenopause, they might struggle with the following:

Blood sugar swings. Estrogen lowers the blood sugar and progesterone increases blood sugar.   These two hormones will fluctuate so that the highs and lows are less predictable.

Urinary tract infections.   With estrogen going down and progesterone going up, blood sugars will tend to be higher. (On a personal note, I'm finding the highs and lows more extreme). If the blood sugar stays at a higher level, then the opportunity for yeast and infection becomes more prevalent.

Hot flashes.   How do you tell the difference between a low blood sugar and a hot flash? Test! It's been the strangest feeling to break out in a sweat and find out that my blood sugar is 120. It's also been recommended that I wear my CGM consistently so that I can see the trends better. Hot flashes are sensitive to some other things, too: caffeine, alcohol and smoking increase frequency, as does spicy food.

Some actions you can take to help curb symptoms and maintain a healthy body:

  • Increase your calcium intake to 1200 mg/ day.  Have a bone density test every two years.
  • Increase phytoestrogen foods. A study conducted in 2008 showed that women who received 60mg/day of a soy drink had a 52% reduction in hot flashes and night sweats.
  • Flax Seed, which is a phytoestrogen, also contains both lignans and omega 3 fatty acids. Recommended daily intake is 1-2 tablespoons. This is well worth reading!

Some women may experience increased breast pain, and as periods can be stronger and longer, more cramping. A natural pain reliever is Evening Primrose oil.   EPO is GLA, gamma linolenic acid that helps with general reproductive discomforts. I've started taking EPO for some breast pain, and it has made a difference.

Traditional Japanese diets of fish, soy and seaweed explain why Japanese women report less discomfort during perimenopause. Why? Because this diet is very high in phytoestrogens and omega-3s! According to, a small, but very well controlled study, showed women who had higher levels of omega-3 fatty acids had better bone density, better breast health and heart function, as well as reduced hot flashes. So look for great resources for fish or krill oil. Krill is less fatty and, therefore has fewer impurities, but be aware that krill is a crustacean, so if you have a seafood allergy, you want to avoid krill oil.   NPR had a great segment on about omega-3 fatty acids.

As with everything else I have done, I will head into this with a positive attitude. Leaving childbearing years isn't a loss. For me, it is slipping into more freedom with less concern. I'll exercise and begin to look at my health with a new lens, more focused on my bones, heart and mental health.   Life isn't getting harder, it's changing and just like I learned in sailing camp, you have to follow the wind and change the direction the sails.