Dr. Alice Cheng explores the connection between Type 1 diabetes, menopause, and sexual health, including the influence of hormones on blood sugar levels, strategies for managing fluctuations, and options for symptom management. She also addresses additional health considerations during and after menopause, the impact of diabetes on sexual health, and available treatments for related issues.
Speaker: Dr. Alice Cheng, MD, FRCPC
Speaker: Dr. Alice Cheng, MD, FRCPC
0:00
foreign0:03
hello and welcome to diabetes deep Dives0:06
my name is Candice and I am from0:08
diabetes Canada I'm so pleased that you0:10
are joining us today0:13
diabetes deep Dives is a series of0:15
videos designed to dive deeper and0:17
Beyond the surface of different areas of0:19
diabetes management we're exploring0:21
those burning questions you may have by0:24
featuring Dynamic and engaging guests0:26
with knowledge or lived experience on0:29
the topic0:30
our goal is to share information in ways0:33
that will spark continued interest and0:34
learning and leave you with practical0:36
tips and tools that you can easily use0:38
we'll be dropping a new video every0:40
month so subscribe to our YouTube0:42
channel and click on the notification0:44
Bell to be notified about new content0:46
you can also check us out on social0:48
media to find out when the next one will0:50
be posted on our YouTube channel0:52
just a reminder that the information0:54
shared in these videos in no way0:57
replaces the advice and direction that1:00
you have from your Healthcare team if1:02
you have questions about your care1:04
please speak to your healthcare provider1:06
and team to make sure that you are1:07
getting the best advice1:10
in this video we are going to hear from1:12
Dr Alice Chang about the intersection1:14
between type 1 diabetes menopause and1:17
Sexual Health we know that diabetes and1:19
Sexual Health are not topics that1:21
everyone talks about so we are happy and1:23
excited for this discussion1:26
Dr Chang is an endocrinologist at1:28
Trillium health partners and Unity1:30
Health Toronto as well as an associate1:32
professor at the University of Toronto1:35
she's been involved in the development1:36
of the diabetes clinical practice1:38
guidelines since 2003.1:41
in this video Dr Chang discusses the1:43
hormones involved in menstruation1:45
perimenopause and menopause how these1:48
hormones affect living with diabetes1:50
other health concerns related to1:52
menopause and how that impacts diabetes1:55
management and tips for living well1:57
during menopause and Beyond2:01
we hope that you find this discussion2:03
enlightening and that it helps you to2:05
successfully manage your journey with2:07
diabetes and now over to Dr Chang2:10
welcome everyone to this presentation2:12
entitled menopause in type 1 diabetes2:15
what to expect and what you can do2:18
presented by diabetes Canada my name is2:21
Dr Alice Chang an endocrinologist from2:23
the University of Toronto and it is my2:25
pleasure today to be sharing this2:27
information with you2:29
now if we think about the hormonal2:31
stages of life particularly in women we2:34
think about things such as puberty2:36
pregnancy2:38
perimenopause and menopause these are2:41
the hormonal stages that a woman may go2:44
through over the course of her lifetime2:47
now in all of these stages a common2:50
theme is that the hormones are changing2:53
so the question then becomes how do2:55
hormones sex hormones in particular2:57
affect diabetes3:01
well to answer that let's think about3:03
the menstrual cycle3:05
I'm going to take you back to biology3:07
class from high school to remind you3:10
about the hormones involved in the3:12
menstrual cycle occurring in the first3:14
place3:15
so here on the diagram on the right3:17
you'll see on the top two hormones3:19
listed LH and FSH those are the3:22
pituitary hormones the hormones that are3:24
coming from the brain to help sort of3:27
Mastermind the entire cycle3:29
the middle chunk is looking at estradiol3:32
and progesterone which are estrogen and3:34
progesterone which are hormones that3:37
come from the ovaries which is also very3:39
important in the cycling that occurs3:42
now day one of the cycle is actually the3:45
first day of bleeding and if we start at3:48
day one you'll notice in the middle3:50
panel that the red line the estradiol3:52
starts to rise over time and that rise3:56
over time is triggered by changes in FSH3:59
and LH in the pituitary and that rise in4:03
estradiol happens slowly over time and4:05
then suddenly around just before day 144:08
there's a surge in the estradiol4:11
and a surge in LH and that surge results4:15
in ovulation so ovulation is the popping4:18
out of the egg4:19
once the egg has popped out the4:22
remaining cells where the egg used to be4:24
in the ovary starts to transform and4:26
starts making a hormone known as4:28
progesterone as shown here in the orange4:30
dotted line and the progesterone levels4:32
start to rise rise rise after ovulation4:36
the progesterone hormone is responsible4:38
for the PMS symptoms that we experienced4:40
before a period4:42
now those cells that are making4:44
progesterone only live for 14 days4:46
so 14 days after the egg has been4:49
released and those cells start making4:51
progesterone 14 days later those cells4:53
die and when the cells die the4:55
progesterone level drops and that drop4:57
in progesterone level is what triggers4:59
the bleeding to occur5:01
so in the first phase of the cycle5:03
what's deemed the follicular phase5:05
what's happening is that the estrogen5:07
levels are rising slowly and that's5:09
building the lining of the uterus in5:12
preparation for potential pregnancy5:14
and then once progesterone is made after5:17
ovulation progesterone doesn't build the5:19
lining progesterone matures the lining5:21
prepares it for potential embedding of5:24
an embryo but then 14 days later if it's5:27
not used the drop in progesterone allows5:30
the shedding of that lining to occur so5:33
this is the menstrual cycle a reminder5:35
from high school biology class5:37
follicular phase is the first half of5:39
the cycle the middle is ovulation for a5:41
day and then you've got the luteal phase5:43
which is the phase with high5:44
progesterone5:46
okay so therefore how does this impact5:49
the glucose levels well there's a5:53
gradual increase in estrogen in that5:54
follicular phase which actually raises5:56
insulin resistance so you become more5:59
resistant to insulin slowly in that6:01
first half of the cycle but once6:03
progesterone starts to rise it's a very6:05
insulin resistant hormone and you find6:08
that your blood sugars tend to go higher6:10
and you need to give yourself more6:11
insulin but once that drop in6:13
progesterone occurs which triggers6:15
shedding of the lining or your period6:17
then that drop in insulin resistance6:21
means that you suddenly become more6:22
sensitive to insulin and your insulin6:24
requirements go down6:26
so this is what the pattern that I'm6:29
sure many of you have observed yourself6:31
with respect to your cycle6:34
so then therefore the impact on blood6:36
glucose is obviously different depending6:38
on what part of the cycle that you're in6:40
but the time period just before your6:43
period6:44
tends to be when your sugars are the6:46
highest and that could be just three6:48
days before or for some ladies it's up6:50
to 10 days or even 14 days before their6:53
period so as soon as the progesterone6:55
starts to go up they start to notice an6:56
impact on their blood sugars6:58
however once the period starts then7:02
there's an Abrupt drop in the blood7:03
glucose levels which of course have to7:05
be accounted for7:07
so from an insulin dose adjustment7:09
perspective during the PMS time which is7:13
the time when the progesterone levels7:15
are rising not only is it giving you7:17
insulin resistance but I think many of7:19
us can can attest to the fact that there7:22
are also cravings for food that may7:24
occur particularly carbohydrates so7:27
therefore one needs to account for that7:28
of course when you're carb counting and7:31
then also there needs to be an increase7:33
in the insulin and for those who are7:35
very regular you can actually predict7:36
that and have a different basal program7:39
for example for those of you on a pump7:41
to be able to account for that7:43
pre-period period of time and then you7:46
have to change that basal setting once7:49
the period starts7:51
so that's when you're cycling regularly7:54
but what happens in perimenopause and in7:58
menopause7:59
so I'm going to direct you to a fabulous8:02
website called menopause and you dot CA8:05
which is actually created by the Society8:07
of Obstetricians and gynecologists of8:09
Canada so a very credible Source8:11
well-designed website designed for8:14
people the general public and gives8:16
really up-to-date expert advice on8:20
menopause in terms of definitions and8:22
potential treatments etc etc so a great8:25
place to help guide you for any8:27
questions that you may have8:29
so what exactly is menopause so8:32
menopause is technically a clinical8:35
definition based on not having a period8:38
for 12 months8:40
now from a blood test perspective what8:42
you could identify is an elevated FSH8:45
which is one of the hormones that comes8:47
from the pituitary and the FSH is high8:50
in response to low estrogen from the8:53
ovaries that are pooping out and no8:56
longer working because they've run out8:57
of eggs8:58
and the official diagnosis of menopause9:02
though is having no period for 12 months9:04
and with that can come a high FSH 95 of9:08
the time it happens after the age of 459:10
and the average age is around 51 in9:13
North America9:15
but leading up to menopause there is a9:18
time period known as perimenopause9:20
perimenopause is usually in your 40s and9:23
is associated with and this is the9:25
visual that I use in my head and when9:27
I'm explaining it to my patients just9:29
imagine it's like your ovaries are like9:31
a car running out of gas and it's sort9:33
of sputtering9:35
so every now and then it pops out an egg9:37
but it's not doing it in a in a in a9:40
regular fashion like it did previously9:42
and therefore your periods are just9:45
unpredictable9:46
they could happen two months later they9:49
could happen six weeks they could happen9:51
two weeks so it could be shorter it9:53
could be longer it's just no longer the9:56
regular cycle that many of you may have9:58
had previously which also means that10:01
during that time it becomes harder to10:03
predict when a period is going to show10:05
up and your hormones are doing funny10:07
things and it's just a potentially10:10
difficult time for many women and there10:13
are symptoms associated with those10:15
changes in hormones so there are10:18
potential menopausal slash10:19
perimenopausal symptoms and this is10:22
taken from the menopause and you website10:24
and I hate to share this part of the10:26
information with you but these symptoms10:27
can last between six months up to 1510:30
years depending on the individual and10:33
the symptoms are shown for you here in10:35
the red block Red Box10:37
the most common one that we tend to hear10:39
about of course is hot flashes night10:41
sweats however there are other things10:43
such as sleep disturbances which can be10:45
quite common fatigue is another one that10:48
people may describe just not thinking as10:50
clearly as they previously did some10:52
people can get mood swings joint aches10:55
and pains I mean there's a variety of10:56
symptoms that can come with the10:58
perimenopause slash menopause and it's11:01
usually a result of just fluctuating11:03
hormones and that reduction in estradiol11:06
or estrogen overall as well as the loss11:08
of progesterone11:10
now the challenge in diabetes is that11:14
the irregular menstrual cycles makes it11:16
very difficult for you to predict what11:18
your blood sugars are going to do11:19
whereas when your periods were regular11:21
you were able to say okay you know11:23
checking my calendars is about the time11:24
when I'm going to need to increase my11:25
insulin but then in the perimenopause11:28
because you cannot predict when your11:30
period is going to show up it's going to11:31
be harder to do that prediction the11:34
other thing is hot flashes become very11:36
difficult to differentiate from low11:39
blood sugar hypoglycemia11:41
and that becomes a confusing aspect as11:43
well so what can you do about it11:46
it's just check a lot frequent11:49
monitoring of blood glucose is going to11:50
be your best way certainly to11:52
differentiate vasomotor symptoms of hot11:55
flashes with that of the low blood sugar11:57
continuous glucose monitoring may be11:59
particularly helpful during this period12:01
of time when things are just wonky and12:03
you need to be able to make adjustments12:05
in a fairly quick manner12:07
increase insulin doses or reduce insulin12:10
doses as needed based on what's12:12
happening with your sugars12:14
and then living healthy so regular12:17
physical activity eating healthy all of12:19
these things can certainly help lessen12:22
some of those perimenopausal symptoms12:24
but it definitely is difficult to12:28
address12:30
hormone replacement therapy is of course12:32
on the table for those women who suffer12:36
a lot from perimenopausal slash12:38
menopausal symptoms and when I say12:40
suffer a lot meaning it's affecting12:41
their quality of life affecting their12:43
ability to function then hormone12:45
replacement therapy is something that12:47
could be discussed with your physician12:48
and certainly someone living with12:50
diabetes could still take it this would12:52
be the same advice we would give any12:53
woman who's having significant12:55
perimenopausal symptoms and that could12:58
come in the form of low-dose birth12:59
control or it could come in the form of13:02
low-dose hormone replacement therapy as13:04
we might use in menopause itself13:09
and then what about menopause and13:11
diabetes so that's sort of perimenopause13:13
and the symptoms that can go with it but13:15
once it's menopause menopause and13:16
there's been no period for 12 months the13:19
only good thing is that the hormonal13:21
fluctuations of the unpredictable Cycles13:23
there's no longer an issue so at least13:25
from that perspective things are stable13:28
however you may still experience hot13:30
flashes for many years to come and that13:33
is still hard to differentiate from13:35
hypoglycemia and therefore frequent13:37
testing is necessary as well some women13:40
may find over the course of13:42
perimenopause into menopause a weight13:44
gain or it's harder to lose weight13:47
so with weight changes that could also13:49
impact your insulin resistance so again13:51
the main strategy Is frequent testing of13:53
the sugars and being aware of what might13:55
happen13:57
the other thing with menopause though is13:59
to remember other health issues that may14:01
come independent of diabetes with14:04
menopause so asking about getting your14:07
bone marrow density testing checking for14:09
osteoporosis making sure you're getting14:11
proper mammograms based on approved14:13
timings to rule out any breast masses or14:16
breast cancer and also recognizing that14:18
cardiovascular risk factor control is14:21
critical throughout your life of14:22
diabetes but particularly as you enter14:24
menopause because one is older at that14:27
time so making sure that things like14:29
blood pressure and cholesterol are well14:31
controlled that you're not smoking and14:33
then of course again the healthy14:35
lifestyle and the body weight14:37
but in terms of treatment of menopause14:39
itself it's no different for those with14:42
diabetes and without so if hormone14:44
replacement therapy is right for you and14:46
it's a discussion you've had with your14:48
team then by all means you can go ahead14:50
and use it it may impact your blood14:52
sugars because again that treatment will14:55
involve estrogen and progesterone but14:57
now you know how those two hormones can14:58
impact your blood sugars and then you15:00
can just check and adjust your insulin15:03
requirements accordingly15:05
but what about sexual function because15:07
that's the other aspect that can15:09
certainly change in the context of15:12
menopause but frankly even before15:15
menopause sexual function and female15:17
sexual dysfunction is more common than15:20
perhaps we realize15:22
so if we think about female sexual15:23
dysfunction these are some of the15:25
statistics that are out there in terms15:27
of how common it can occur15:29
and it's common as you can see here and15:33
these can be grouped into things like15:34
hypoactive sexual desire disorder female15:37
arousal disorder orgasmic disorder or15:40
sexual pain disorder so this is15:41
referring to the different phases of the15:44
sexual response that a woman may have15:47
now specifically in diabetes though15:49
female sexual dysfunction may be common15:51
because of other things that can come15:54
with diabetes that can of course impact15:56
sexual function so if there are15:58
blockages and arteries that could affect16:00
circulation if there is damage to16:02
nervous system then that could reduce16:04
sensation16:06
high blood sugars can reduce lubrication16:09
can result in yeast infections which of16:10
course would not be very pleasant from a16:12
sexual function perspective there may be16:14
issues around body image or fear of16:17
hypoglycemia and then of course the the16:20
mental health aspects are critical in16:22
diabetes and depression and anxiety can16:25
obviously impact sexual function and16:27
then there may be medications that some16:29
are using not necessarily specific to16:31
diabetes but other medications that can16:34
impact sexual function16:36
but what about specific to menopause16:38
well specific to menopause the two big16:40
ones that often come up as vaginal16:42
dryness or reduced sex drive16:46
now strategies to address this so16:49
hormone replacement therapy is probably16:50
one of the best strategies to address16:52
the vaginal dryness and that could be16:54
just local treatment so vaginal creams16:57
that could then reintroduce some16:59
estrogen to the vaginal wall which would17:01
then help with lubrication and avoid the17:04
dryness or perhaps systemic treatment17:06
pills if hot flashes and other systemic17:11
symptoms are a major issue of course17:14
lubricants would be very useful to make17:17
the sexual experience more enjoyable and17:20
again the the usual motherhood17:21
statements of regular physical activity17:23
and lifestyle interventions just giving17:25
you more energy and feeling good about17:27
yourself and and those endorphins and17:29
just feeling happy overall is obviously17:31
going to also be helpful for sexual17:34
function17:35
now in terms of the reduced sex drive I17:37
mean the female sex drive is very17:39
complicated it would be like looking at17:41
the cockpit of an airplane and there are17:44
multiple components there's the17:45
biological there's the psychological17:47
there's the social and there's also the17:50
contextual so it's not as simple as17:52
replace a hormone and boom the sex drive17:54
is back so when there is reduced sex17:57
drive it's important to determine all17:58
the things that may in fact be affecting18:00
that18:01
there could also be a an official18:04
diagnosis of something called hypoactive18:07
sexual desire disorder18:09
which is officially defined as an18:11
absence of sexual fantasies absence of18:13
desire for sexual activity but very18:16
importantly causing distress and a18:19
minimum of six months18:21
many women may experience the first two18:23
but it doesn't really bother them it18:25
doesn't bother their partner but in that18:26
case it's not a disorder however if it18:29
is causing distress and it is chronic18:32
then this could be defined as hypoactive18:34
sexual desire disorder and there18:37
actually is this screener that exists18:40
online that you could look for where if18:43
you answer yes to the first four18:45
questions but more importantly no to the18:48
question number five then it could be18:51
diagnosed as generalized hypoactive18:54
sexual desire disorder and the no to18:56
number five is important so it needs to18:58
not be secondary to a recent operation19:01
mental health considerations medications19:04
pregnancy19:06
etc etc etc so it needs to not have19:08
another explanation then in that case it19:11
could be defined as hypoactive sexual19:13
desire disorder19:16
but what are the strategies to address19:18
reduced libido whether it's in the form19:20
of hsdd or just generally speaking19:22
reduce libido I think discussing it with19:25
your Healthcare team is important19:26
because there may be certain tests that19:28
need to be done to rule out other causes19:30
if the thyroid is not working properly19:32
if the blood sugars are very high19:34
if there are psychosocial things that19:36
are going on that are impacting it then19:39
all of those things could potentially be19:42
treated or reversible so it's important19:44
to check out other potential causes and19:46
then if there's not much to find then19:48
cognitive behavioral therapy can be very19:51
helpful Sex Therapy can be helpful and19:53
of course things like vaginal lubricants19:55
because painful sex is obviously not19:57
going to be enjoyable and then only in19:59
those who are post-menopausal women then20:01
testosterone low dose could be20:03
considered if it's officially diagnosed20:05
as hypoactive sexual desire disorder20:10
so to summarize hormones affect diabetes20:13
a lot and we went through the menstrual20:16
cycle and a reminder that there's an20:18
increase in insulin requirements20:19
particularly for the up to two weeks20:21
prior to a period but the perimenopause20:25
then is that transition time when things20:27
are fluctuating considerably and that's20:29
also when symptoms can be quite strong20:32
and therefore the only strategy you20:35
really have is to test a lot and then to20:38
adjust your insulin accordingly to20:41
smooth things out one can try things20:43
like low-dose birth control pills or20:45
low-dose hormone replacement therapy but20:48
again that's a discussion with your team20:51
to see if it's appropriate for you it's20:53
the same discussion we would have with20:54
any woman even outside of diabetes and20:57
the presence of diabetes would not20:59
exclude you so of course you could use21:01
those if necessary menopause is21:04
officially No period for 12 months and21:06
at that point make sure that you're21:08
considering other things that can come21:09
with age which would be checking for21:12
osteoporosis ensuring that your21:14
cardiovascular health is well managed21:17
and of course mammograms to screen for21:19
breast cancer and then finally sexual21:22
dysfunction is an issue that women may21:24
have even before menopause but certainly21:26
with menopause and is an important21:29
discussion to have with your health care21:30
team21:32
so thank you very much for your kind21:34
attention and I hope that this21:36
presentation was useful for you21:38
thank you so much for joining us to dive21:40
deeper into diabetes and menopause21:42
please take the opportunity to let us21:44
know what you learned what you liked and21:47
how we can do better in the comments21:48
section below21:50
if you have ideas for other topics you'd21:52
like to learn more about you can include21:54
that in your comments as well21:56
if you are looking for more resources21:58
about diabetes management please visit22:01
our website at diabetes.ca you can also22:03
email us at info diabetes.ca or call our22:07
info line at 1-800-benting that's22:12
1-800-226-8464 and speak to one of our22:15
information and support Specialists who22:17
can address your needs thanks again for22:19
joining us and see you next time22:21
foreign22:23
[Music]
foreign0:03
hello and welcome to diabetes deep Dives0:06
my name is Candice and I am from0:08
diabetes Canada I'm so pleased that you0:10
are joining us today0:13
diabetes deep Dives is a series of0:15
videos designed to dive deeper and0:17
Beyond the surface of different areas of0:19
diabetes management we're exploring0:21
those burning questions you may have by0:24
featuring Dynamic and engaging guests0:26
with knowledge or lived experience on0:29
the topic0:30
our goal is to share information in ways0:33
that will spark continued interest and0:34
learning and leave you with practical0:36
tips and tools that you can easily use0:38
we'll be dropping a new video every0:40
month so subscribe to our YouTube0:42
channel and click on the notification0:44
Bell to be notified about new content0:46
you can also check us out on social0:48
media to find out when the next one will0:50
be posted on our YouTube channel0:52
just a reminder that the information0:54
shared in these videos in no way0:57
replaces the advice and direction that1:00
you have from your Healthcare team if1:02
you have questions about your care1:04
please speak to your healthcare provider1:06
and team to make sure that you are1:07
getting the best advice1:10
in this video we are going to hear from1:12
Dr Alice Chang about the intersection1:14
between type 1 diabetes menopause and1:17
Sexual Health we know that diabetes and1:19
Sexual Health are not topics that1:21
everyone talks about so we are happy and1:23
excited for this discussion1:26
Dr Chang is an endocrinologist at1:28
Trillium health partners and Unity1:30
Health Toronto as well as an associate1:32
professor at the University of Toronto1:35
she's been involved in the development1:36
of the diabetes clinical practice1:38
guidelines since 2003.1:41
in this video Dr Chang discusses the1:43
hormones involved in menstruation1:45
perimenopause and menopause how these1:48
hormones affect living with diabetes1:50
other health concerns related to1:52
menopause and how that impacts diabetes1:55
management and tips for living well1:57
during menopause and Beyond2:01
we hope that you find this discussion2:03
enlightening and that it helps you to2:05
successfully manage your journey with2:07
diabetes and now over to Dr Chang2:10
welcome everyone to this presentation2:12
entitled menopause in type 1 diabetes2:15
what to expect and what you can do2:18
presented by diabetes Canada my name is2:21
Dr Alice Chang an endocrinologist from2:23
the University of Toronto and it is my2:25
pleasure today to be sharing this2:27
information with you2:29
now if we think about the hormonal2:31
stages of life particularly in women we2:34
think about things such as puberty2:36
pregnancy2:38
perimenopause and menopause these are2:41
the hormonal stages that a woman may go2:44
through over the course of her lifetime2:47
now in all of these stages a common2:50
theme is that the hormones are changing2:53
so the question then becomes how do2:55
hormones sex hormones in particular2:57
affect diabetes3:01
well to answer that let's think about3:03
the menstrual cycle3:05
I'm going to take you back to biology3:07
class from high school to remind you3:10
about the hormones involved in the3:12
menstrual cycle occurring in the first3:14
place3:15
so here on the diagram on the right3:17
you'll see on the top two hormones3:19
listed LH and FSH those are the3:22
pituitary hormones the hormones that are3:24
coming from the brain to help sort of3:27
Mastermind the entire cycle3:29
the middle chunk is looking at estradiol3:32
and progesterone which are estrogen and3:34
progesterone which are hormones that3:37
come from the ovaries which is also very3:39
important in the cycling that occurs3:42
now day one of the cycle is actually the3:45
first day of bleeding and if we start at3:48
day one you'll notice in the middle3:50
panel that the red line the estradiol3:52
starts to rise over time and that rise3:56
over time is triggered by changes in FSH3:59
and LH in the pituitary and that rise in4:03
estradiol happens slowly over time and4:05
then suddenly around just before day 144:08
there's a surge in the estradiol4:11
and a surge in LH and that surge results4:15
in ovulation so ovulation is the popping4:18
out of the egg4:19
once the egg has popped out the4:22
remaining cells where the egg used to be4:24
in the ovary starts to transform and4:26
starts making a hormone known as4:28
progesterone as shown here in the orange4:30
dotted line and the progesterone levels4:32
start to rise rise rise after ovulation4:36
the progesterone hormone is responsible4:38
for the PMS symptoms that we experienced4:40
before a period4:42
now those cells that are making4:44
progesterone only live for 14 days4:46
so 14 days after the egg has been4:49
released and those cells start making4:51
progesterone 14 days later those cells4:53
die and when the cells die the4:55
progesterone level drops and that drop4:57
in progesterone level is what triggers4:59
the bleeding to occur5:01
so in the first phase of the cycle5:03
what's deemed the follicular phase5:05
what's happening is that the estrogen5:07
levels are rising slowly and that's5:09
building the lining of the uterus in5:12
preparation for potential pregnancy5:14
and then once progesterone is made after5:17
ovulation progesterone doesn't build the5:19
lining progesterone matures the lining5:21
prepares it for potential embedding of5:24
an embryo but then 14 days later if it's5:27
not used the drop in progesterone allows5:30
the shedding of that lining to occur so5:33
this is the menstrual cycle a reminder5:35
from high school biology class5:37
follicular phase is the first half of5:39
the cycle the middle is ovulation for a5:41
day and then you've got the luteal phase5:43
which is the phase with high5:44
progesterone5:46
okay so therefore how does this impact5:49
the glucose levels well there's a5:53
gradual increase in estrogen in that5:54
follicular phase which actually raises5:56
insulin resistance so you become more5:59
resistant to insulin slowly in that6:01
first half of the cycle but once6:03
progesterone starts to rise it's a very6:05
insulin resistant hormone and you find6:08
that your blood sugars tend to go higher6:10
and you need to give yourself more6:11
insulin but once that drop in6:13
progesterone occurs which triggers6:15
shedding of the lining or your period6:17
then that drop in insulin resistance6:21
means that you suddenly become more6:22
sensitive to insulin and your insulin6:24
requirements go down6:26
so this is what the pattern that I'm6:29
sure many of you have observed yourself6:31
with respect to your cycle6:34
so then therefore the impact on blood6:36
glucose is obviously different depending6:38
on what part of the cycle that you're in6:40
but the time period just before your6:43
period6:44
tends to be when your sugars are the6:46
highest and that could be just three6:48
days before or for some ladies it's up6:50
to 10 days or even 14 days before their6:53
period so as soon as the progesterone6:55
starts to go up they start to notice an6:56
impact on their blood sugars6:58
however once the period starts then7:02
there's an Abrupt drop in the blood7:03
glucose levels which of course have to7:05
be accounted for7:07
so from an insulin dose adjustment7:09
perspective during the PMS time which is7:13
the time when the progesterone levels7:15
are rising not only is it giving you7:17
insulin resistance but I think many of7:19
us can can attest to the fact that there7:22
are also cravings for food that may7:24
occur particularly carbohydrates so7:27
therefore one needs to account for that7:28
of course when you're carb counting and7:31
then also there needs to be an increase7:33
in the insulin and for those who are7:35
very regular you can actually predict7:36
that and have a different basal program7:39
for example for those of you on a pump7:41
to be able to account for that7:43
pre-period period of time and then you7:46
have to change that basal setting once7:49
the period starts7:51
so that's when you're cycling regularly7:54
but what happens in perimenopause and in7:58
menopause7:59
so I'm going to direct you to a fabulous8:02
website called menopause and you dot CA8:05
which is actually created by the Society8:07
of Obstetricians and gynecologists of8:09
Canada so a very credible Source8:11
well-designed website designed for8:14
people the general public and gives8:16
really up-to-date expert advice on8:20
menopause in terms of definitions and8:22
potential treatments etc etc so a great8:25
place to help guide you for any8:27
questions that you may have8:29
so what exactly is menopause so8:32
menopause is technically a clinical8:35
definition based on not having a period8:38
for 12 months8:40
now from a blood test perspective what8:42
you could identify is an elevated FSH8:45
which is one of the hormones that comes8:47
from the pituitary and the FSH is high8:50
in response to low estrogen from the8:53
ovaries that are pooping out and no8:56
longer working because they've run out8:57
of eggs8:58
and the official diagnosis of menopause9:02
though is having no period for 12 months9:04
and with that can come a high FSH 95 of9:08
the time it happens after the age of 459:10
and the average age is around 51 in9:13
North America9:15
but leading up to menopause there is a9:18
time period known as perimenopause9:20
perimenopause is usually in your 40s and9:23
is associated with and this is the9:25
visual that I use in my head and when9:27
I'm explaining it to my patients just9:29
imagine it's like your ovaries are like9:31
a car running out of gas and it's sort9:33
of sputtering9:35
so every now and then it pops out an egg9:37
but it's not doing it in a in a in a9:40
regular fashion like it did previously9:42
and therefore your periods are just9:45
unpredictable9:46
they could happen two months later they9:49
could happen six weeks they could happen9:51
two weeks so it could be shorter it9:53
could be longer it's just no longer the9:56
regular cycle that many of you may have9:58
had previously which also means that10:01
during that time it becomes harder to10:03
predict when a period is going to show10:05
up and your hormones are doing funny10:07
things and it's just a potentially10:10
difficult time for many women and there10:13
are symptoms associated with those10:15
changes in hormones so there are10:18
potential menopausal slash10:19
perimenopausal symptoms and this is10:22
taken from the menopause and you website10:24
and I hate to share this part of the10:26
information with you but these symptoms10:27
can last between six months up to 1510:30
years depending on the individual and10:33
the symptoms are shown for you here in10:35
the red block Red Box10:37
the most common one that we tend to hear10:39
about of course is hot flashes night10:41
sweats however there are other things10:43
such as sleep disturbances which can be10:45
quite common fatigue is another one that10:48
people may describe just not thinking as10:50
clearly as they previously did some10:52
people can get mood swings joint aches10:55
and pains I mean there's a variety of10:56
symptoms that can come with the10:58
perimenopause slash menopause and it's11:01
usually a result of just fluctuating11:03
hormones and that reduction in estradiol11:06
or estrogen overall as well as the loss11:08
of progesterone11:10
now the challenge in diabetes is that11:14
the irregular menstrual cycles makes it11:16
very difficult for you to predict what11:18
your blood sugars are going to do11:19
whereas when your periods were regular11:21
you were able to say okay you know11:23
checking my calendars is about the time11:24
when I'm going to need to increase my11:25
insulin but then in the perimenopause11:28
because you cannot predict when your11:30
period is going to show up it's going to11:31
be harder to do that prediction the11:34
other thing is hot flashes become very11:36
difficult to differentiate from low11:39
blood sugar hypoglycemia11:41
and that becomes a confusing aspect as11:43
well so what can you do about it11:46
it's just check a lot frequent11:49
monitoring of blood glucose is going to11:50
be your best way certainly to11:52
differentiate vasomotor symptoms of hot11:55
flashes with that of the low blood sugar11:57
continuous glucose monitoring may be11:59
particularly helpful during this period12:01
of time when things are just wonky and12:03
you need to be able to make adjustments12:05
in a fairly quick manner12:07
increase insulin doses or reduce insulin12:10
doses as needed based on what's12:12
happening with your sugars12:14
and then living healthy so regular12:17
physical activity eating healthy all of12:19
these things can certainly help lessen12:22
some of those perimenopausal symptoms12:24
but it definitely is difficult to12:28
address12:30
hormone replacement therapy is of course12:32
on the table for those women who suffer12:36
a lot from perimenopausal slash12:38
menopausal symptoms and when I say12:40
suffer a lot meaning it's affecting12:41
their quality of life affecting their12:43
ability to function then hormone12:45
replacement therapy is something that12:47
could be discussed with your physician12:48
and certainly someone living with12:50
diabetes could still take it this would12:52
be the same advice we would give any12:53
woman who's having significant12:55
perimenopausal symptoms and that could12:58
come in the form of low-dose birth12:59
control or it could come in the form of13:02
low-dose hormone replacement therapy as13:04
we might use in menopause itself13:09
and then what about menopause and13:11
diabetes so that's sort of perimenopause13:13
and the symptoms that can go with it but13:15
once it's menopause menopause and13:16
there's been no period for 12 months the13:19
only good thing is that the hormonal13:21
fluctuations of the unpredictable Cycles13:23
there's no longer an issue so at least13:25
from that perspective things are stable13:28
however you may still experience hot13:30
flashes for many years to come and that13:33
is still hard to differentiate from13:35
hypoglycemia and therefore frequent13:37
testing is necessary as well some women13:40
may find over the course of13:42
perimenopause into menopause a weight13:44
gain or it's harder to lose weight13:47
so with weight changes that could also13:49
impact your insulin resistance so again13:51
the main strategy Is frequent testing of13:53
the sugars and being aware of what might13:55
happen13:57
the other thing with menopause though is13:59
to remember other health issues that may14:01
come independent of diabetes with14:04
menopause so asking about getting your14:07
bone marrow density testing checking for14:09
osteoporosis making sure you're getting14:11
proper mammograms based on approved14:13
timings to rule out any breast masses or14:16
breast cancer and also recognizing that14:18
cardiovascular risk factor control is14:21
critical throughout your life of14:22
diabetes but particularly as you enter14:24
menopause because one is older at that14:27
time so making sure that things like14:29
blood pressure and cholesterol are well14:31
controlled that you're not smoking and14:33
then of course again the healthy14:35
lifestyle and the body weight14:37
but in terms of treatment of menopause14:39
itself it's no different for those with14:42
diabetes and without so if hormone14:44
replacement therapy is right for you and14:46
it's a discussion you've had with your14:48
team then by all means you can go ahead14:50
and use it it may impact your blood14:52
sugars because again that treatment will14:55
involve estrogen and progesterone but14:57
now you know how those two hormones can14:58
impact your blood sugars and then you15:00
can just check and adjust your insulin15:03
requirements accordingly15:05
but what about sexual function because15:07
that's the other aspect that can15:09
certainly change in the context of15:12
menopause but frankly even before15:15
menopause sexual function and female15:17
sexual dysfunction is more common than15:20
perhaps we realize15:22
so if we think about female sexual15:23
dysfunction these are some of the15:25
statistics that are out there in terms15:27
of how common it can occur15:29
and it's common as you can see here and15:33
these can be grouped into things like15:34
hypoactive sexual desire disorder female15:37
arousal disorder orgasmic disorder or15:40
sexual pain disorder so this is15:41
referring to the different phases of the15:44
sexual response that a woman may have15:47
now specifically in diabetes though15:49
female sexual dysfunction may be common15:51
because of other things that can come15:54
with diabetes that can of course impact15:56
sexual function so if there are15:58
blockages and arteries that could affect16:00
circulation if there is damage to16:02
nervous system then that could reduce16:04
sensation16:06
high blood sugars can reduce lubrication16:09
can result in yeast infections which of16:10
course would not be very pleasant from a16:12
sexual function perspective there may be16:14
issues around body image or fear of16:17
hypoglycemia and then of course the the16:20
mental health aspects are critical in16:22
diabetes and depression and anxiety can16:25
obviously impact sexual function and16:27
then there may be medications that some16:29
are using not necessarily specific to16:31
diabetes but other medications that can16:34
impact sexual function16:36
but what about specific to menopause16:38
well specific to menopause the two big16:40
ones that often come up as vaginal16:42
dryness or reduced sex drive16:46
now strategies to address this so16:49
hormone replacement therapy is probably16:50
one of the best strategies to address16:52
the vaginal dryness and that could be16:54
just local treatment so vaginal creams16:57
that could then reintroduce some16:59
estrogen to the vaginal wall which would17:01
then help with lubrication and avoid the17:04
dryness or perhaps systemic treatment17:06
pills if hot flashes and other systemic17:11
symptoms are a major issue of course17:14
lubricants would be very useful to make17:17
the sexual experience more enjoyable and17:20
again the the usual motherhood17:21
statements of regular physical activity17:23
and lifestyle interventions just giving17:25
you more energy and feeling good about17:27
yourself and and those endorphins and17:29
just feeling happy overall is obviously17:31
going to also be helpful for sexual17:34
function17:35
now in terms of the reduced sex drive I17:37
mean the female sex drive is very17:39
complicated it would be like looking at17:41
the cockpit of an airplane and there are17:44
multiple components there's the17:45
biological there's the psychological17:47
there's the social and there's also the17:50
contextual so it's not as simple as17:52
replace a hormone and boom the sex drive17:54
is back so when there is reduced sex17:57
drive it's important to determine all17:58
the things that may in fact be affecting18:00
that18:01
there could also be a an official18:04
diagnosis of something called hypoactive18:07
sexual desire disorder18:09
which is officially defined as an18:11
absence of sexual fantasies absence of18:13
desire for sexual activity but very18:16
importantly causing distress and a18:19
minimum of six months18:21
many women may experience the first two18:23
but it doesn't really bother them it18:25
doesn't bother their partner but in that18:26
case it's not a disorder however if it18:29
is causing distress and it is chronic18:32
then this could be defined as hypoactive18:34
sexual desire disorder and there18:37
actually is this screener that exists18:40
online that you could look for where if18:43
you answer yes to the first four18:45
questions but more importantly no to the18:48
question number five then it could be18:51
diagnosed as generalized hypoactive18:54
sexual desire disorder and the no to18:56
number five is important so it needs to18:58
not be secondary to a recent operation19:01
mental health considerations medications19:04
pregnancy19:06
etc etc etc so it needs to not have19:08
another explanation then in that case it19:11
could be defined as hypoactive sexual19:13
desire disorder19:16
but what are the strategies to address19:18
reduced libido whether it's in the form19:20
of hsdd or just generally speaking19:22
reduce libido I think discussing it with19:25
your Healthcare team is important19:26
because there may be certain tests that19:28
need to be done to rule out other causes19:30
if the thyroid is not working properly19:32
if the blood sugars are very high19:34
if there are psychosocial things that19:36
are going on that are impacting it then19:39
all of those things could potentially be19:42
treated or reversible so it's important19:44
to check out other potential causes and19:46
then if there's not much to find then19:48
cognitive behavioral therapy can be very19:51
helpful Sex Therapy can be helpful and19:53
of course things like vaginal lubricants19:55
because painful sex is obviously not19:57
going to be enjoyable and then only in19:59
those who are post-menopausal women then20:01
testosterone low dose could be20:03
considered if it's officially diagnosed20:05
as hypoactive sexual desire disorder20:10
so to summarize hormones affect diabetes20:13
a lot and we went through the menstrual20:16
cycle and a reminder that there's an20:18
increase in insulin requirements20:19
particularly for the up to two weeks20:21
prior to a period but the perimenopause20:25
then is that transition time when things20:27
are fluctuating considerably and that's20:29
also when symptoms can be quite strong20:32
and therefore the only strategy you20:35
really have is to test a lot and then to20:38
adjust your insulin accordingly to20:41
smooth things out one can try things20:43
like low-dose birth control pills or20:45
low-dose hormone replacement therapy but20:48
again that's a discussion with your team20:51
to see if it's appropriate for you it's20:53
the same discussion we would have with20:54
any woman even outside of diabetes and20:57
the presence of diabetes would not20:59
exclude you so of course you could use21:01
those if necessary menopause is21:04
officially No period for 12 months and21:06
at that point make sure that you're21:08
considering other things that can come21:09
with age which would be checking for21:12
osteoporosis ensuring that your21:14
cardiovascular health is well managed21:17
and of course mammograms to screen for21:19
breast cancer and then finally sexual21:22
dysfunction is an issue that women may21:24
have even before menopause but certainly21:26
with menopause and is an important21:29
discussion to have with your health care21:30
team21:32
so thank you very much for your kind21:34
attention and I hope that this21:36
presentation was useful for you21:38
thank you so much for joining us to dive21:40
deeper into diabetes and menopause21:42
please take the opportunity to let us21:44
know what you learned what you liked and21:47
how we can do better in the comments21:48
section below21:50
if you have ideas for other topics you'd21:52
like to learn more about you can include21:54
that in your comments as well21:56
if you are looking for more resources21:58
about diabetes management please visit22:01
our website at diabetes.ca you can also22:03
email us at info diabetes.ca or call our22:07
info line at 1-800-benting that's22:12
1-800-226-8464 and speak to one of our22:15
information and support Specialists who22:17
can address your needs thanks again for22:19
joining us and see you next time22:21
foreign22:23
[Music]
Category Tags: Blood Sugar & Insulin, Special Populations;