Is Hormone Therapy Safe for Diabetic Patients During Menopause?

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Hormone replacement therapy is one of the treatment options for women with menopausal symptoms. Doctors in the past were cautious to prescribe hormone replacement therapy (HRT) to diabetic women experiencing menopausal symptoms. This was because diabetes is associated with the risk of developing cardiovascular diseases and HRT was also associated with cardiovascular diseases. However, diabetes is no longer a definitive reason to withhold HRT. There is still a gap in research done on the use of HRT and Type 1 diabetic women. 


Hormone Replacement Therapy (HRT) and Diabetes

Like any other treatment, Hormone replacement therapy is not safe for everyone. Women are advised to speak to a medical doctor before using hormone therapy. Not only diabetic women with menopause should be cautious with HRT, but women with cancer in their family history as well. Especially women with a high risk for breast, ovarian, and uterine cancer

Some studies suggest that HRT can be beneficial for treating symptoms of menopause for Type 2 diabetic women. There is a paucity of information regarding using HRT for women with Type 1 diabetes. Before commencing a patient on treatment, a doctor will first weigh the risks vs. benefits of the treatment for the patient. Sometimes the benefits outweigh the risks, which is why it is important for women with risks to see a doctor. 


Controlling Blood Glucose Levels While on HRT

When a woman is diagnosed with diabetes it is very important for them to control their blood glucose levels to avoid complications. Complications for diabetes mellitus can become serious, such as diabetic foot ulcers, neuropathy, and nephropathy. Most diabetic patients experience a tingling or burning sensation at the tip of their fingers or at the bottom of their feet. This can be avoided when controlling blood glucose levels.

Hormone replacement therapy is often prescribed for a few years. During that time diabetic women must monitor their blood glucose levels more regularly. Seeing an endocrinologist is advised to help monitor diabetic patients on HRT. 


Who Should Not Take HRT?

Hormone replacement therapy is not recommended for women who have a risk of developing cancer. Or women who have had or currently have hormone-dependent cancer such as breast, ovarian, and uterine cancer. 


Effect of Menopause on Glucose Homeostasis and Diabetes

Glucose homeostasis is defined as blood sugar regulation. This is where the body (pancreas) will work together to keep the blood glucose levels in a normal range. 

Fasting normal blood glucose range: 4-6mmol/L

Post-meal normal blood glucose range: below 8 mmol/L (1 hour after eating)

The exact effect of menopause on glucose homeostasis in women is still controversial after extensive research. 


Effect of Menopause on Insulin Resistance

Research on the effect of menopause on insulin resistance is limited. A small study indicated that insulin resistance was present in only half of the post-menopausal women tested, compared to the women tested pre-menopausal. The reason why women with menopause can become insulin resistant is because of increased visceral fat during menopause. The menopause transition and the early post-menopausal stage are associated with weight gain, especially central obesity. This will increase the risk for post-menopausal women to develop cardiovascular disease.

Individuals with insulin resistance need more levels of insulin to maintain normal blood glucose levels, this can result in Type 2 diabetes mellitus. Oestrogen and HRT can improve fat distribution in post-menopausal women preventing the increase in central body fat (visceral fat). Research regarding the effect of effect of HRT on glucose homeostasis is controversial. There have been no effects reported on oestrogen replacement therapy on insulin sensitivity for post-menopausal women. On the contrary, women without diabetes taking oestrogen alone were more insulin resistant than women not on HRT. 


Effect of Menopause on Insulin Secretion

There is a scarcity of studies done on menopausal women and insulin secretion. Research indicates that menopause alters pancreatic insulin secretion. However, because hepatic insulin clearance (insulin taken up by the liver) was lower in women post-menopause, plasma insulin concentrations during the IVGTT (intravenous glucose tolerance test) did not change compared to those in per-menopausal women. An IVGTT is a test to estimate insulin sensitivity based on intravenous glucose infusion. 


Type 2 Diabetes and Menopause

Menopause increases the risk of developing Type 2 diabetes. Listed are a few physiological and metabolic reasons why menopause can lead to Type 2 diabetes.

  • Changes in the distribution of body weight – During the transition of menopause and during the menopause stage there is a shift in the distribution of fat. There is an increase in visceral fat.
  • Reduction in energy from the breakdown of fat – Oestrogen deficiency increases fat storage and decreases fat oxidation.
  • Less physical activity – Women tend to become less active during menopause.
  • Decreased muscle mass – Women become less active during menopause, resulting in a decrease in muscle mass.
  • Increases chronic systematic inflammation – Visceral fat is an active tissue that produces hormones and cytokines. This can lead to the development of insulin resistance.
  • Insulin resistance – This happens when the body is less sensitive to insulin and blood glucose levels are constantly higher than the normal range.
  • Pancreas is under pressure – Research has indicated that beta-cells (insulin-secreting cells) of post-menopausal women must work harder to compensate for insulin resistance. This might increase the risk of developing Type 2 diabetes. 
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