During the menopausal transition and postmenopause, hot flashes and night sweats affect up to 70% of women. There’s evidence that diabetes risk increases with the severity of these vasomotor symptoms, night sweats in particular.
Five experts discussed vasomotor symptoms and other links between Menopause and Diabetes during a Scientific Sessions virtual symposium. The presentation can be viewed by registered meeting attendees at ADA2020.org through September 10, 2020. If you haven’t registered for the Virtual 80th Scientific Sessions, register today to access all of the valuable meeting content.
Kristen Gray, PhD, MS, Core Investigator in Health Services Research and Development, Department of Veterans Affairs Puget Sound Health Care System, and Assistant Professor in the Department of Health Services at the University of Washington School of Public Health, said vasomotor symptoms associated with menopause are thought to be due to a narrowing of the thermoneutral zone, the threshold between temperatures triggering sweating and shivering. The result is that even small increases in core body temperature can trigger a hot flash, she said.
“[Vasomotor symptoms] can have pretty profound impacts on women’s lives,” said Dr. Gray, including changes to sleep patterns, quality of life, sexual function, mood, and cognition.
Because there’s significant overlap between the symptoms of diabetes and menopause, women with both conditions may not be able to discern the etiology of a particular symptom, noted Sarit Polsky, MD, MPH, Director of the Pregnancy and Women’s Health Clinic, Barbara Davis Center for Diabetes at the University of Colorado. Dr. Polsky discussed the effects of diabetes on menopause symptoms and onset, and on bone health.
“Diabetes does appear to affect the onset of menopause, especially with longer duration of diabetes,” she said.
The European Prospective Investigation into Cancer and Nutrition (EPIC) study, which incorporated data from more than 258,000 women in 10 countries between 1992 and 2000, found that women diagnosed with diabetes before age 20 had an increased risk of early menopause. Young girls diagnosed with diabetes before age 10 had a 59% increased risk of early menopause, while women diagnosed at age 50 or older had a decreased risk of early menopause.
Conversely, multiple studies indicate that early onset of menopause is associated with a greater risk of type 2 diabetes, said Dragana Lovre, MD, Assistant Professor of Medicine–Endocrinology at Tulane University School of Medicine. The Dongfeng-Tongji Cohort Study in China reported a 20% greater risk of type 2 diabetes in women who entered menopause before age 45.
Dr. Lovre presented information on menopause hormone treatments to improve beta-cell function in obese postmenopausal women.
“The best evidence that estrogen deficiency predisposes for type 2 diabetes is that menopause hormone therapy delays type 2 diabetes,” she said.
Melissa Wellons, MD, MHS, Associate Professor of Diabetes, Endocrinology, and Metabolism at Vanderbilt University Medical Center, discussed the effects of diabetes on ovarian aging. Autoimmune destruction, glucose toxicity, and negative effects on insulin are the most potentially damaging aspects of diabetes pathophysiology on the ovary, she said.
Insulin receptors are thought to be present in ovarian follicles and stimulate ovarian follicular growth, Dr. Wellons explained, and insulin stimulation may be a contributing factor to polycystic ovarian syndrome. Ovaries appear to be more polycystic, with more antral follicles, in patients with type 1 or type 2 diabetes.
Taulant Muka, MD, MPH, PhD, Research Group Leader, Cardiometabolic Health, Institute of Social and Preventative Medicine at the University of Bern, reviewed data on the association between steroid sex hormones and type 2 diabetes risk in women. Research has shown that women with high levels of estradiol but lower levels of dehydroepiandrosterone have an almost 60% increased risk of developing type 2 diabetes, whereas women with high levels of both do not have an increased risk, he said.