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Feature Article

Menopause: how does it affect diabetes?

Rod Baber, Cheryl Phua

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Abstract

Available evidence from randomised controlled trials suggests that menopausal hormone therapy (MHT) in postmenopausal women improves glucose homeostasis and reduces the risk of type 2 diabetes. Although the primary indication for MHT is alleviation of menopausal symptoms, clinical trial evidence can help inform the risk–benefit considerations around prescribing MHT. 

Key Points

  • Menopausal hormone therapy (MHT) is principally indicated for the alleviation of troublesome menopausal symptoms. It should not be used as a treatment for diabetes, although clinical evidence can help inform the risk–benefit considerations around prescribing MHT.
  • Evidence suggests that oestrogen-only MHT may reduce the incidence of coronary heart disease and type 2 diabetes in postmenopausal women without diabetes who have undergone a hysterectomy and are aged 50 to 59 years or within 10 years of their last period. For women in this group who have an intact uterus, MHT combining oestrogen with a progestogen has a neutral to beneficial effect on both coronary heart disease and on the incidence of type 2 diabetes.
  • For women with diabetes aged 50 to 59 years or within 10 years of their last period, evidence suggests that oral oestrogens are more effective than transdermal oestrogens at improving glucose homeostasis and lipid profiles.
  • The International Menopausal Society recommends that the mode of delivery of MHT is based on individual patient risk factors and preferences. However, oral oestrogens are a first choice only in women with a low risk of cardiovascular disease. Transdermal oestrogen delivery is preferred in women with or without type 2 diabetes who have an increased risk of cardiovascular disease or who are obese.
  • A neutral progestogen should be a first choice in combined MHT to maximise the beneficial effects of oestrogen on glucose homeostasis and lipid profiles.
  • MHT should only be initiated after careful consideration of all risk factors in postmenopausal women who are older than 60 years or more than 10 years from their last period.

    *Refer to the text and relevant references provided for levels of clinical evidence for the recommendations.

    Picture credit: © Fertnig/iStockphoto.com
    Model used for illustrative purposes only

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