Type-2 Diabetes and Hormone Replacement Therapy (HRT)

Some women in perimenopause or menopause have type 2 diabetes, which is linked to heart disease risk. Some people believe HRT also has the same link.

However, there’s good news for women who have been prescribed hormone replacement therapy. According to studies, it’s been determined that the same link to a higher risk of heart disease is not the case.

What Happens to Women During Menopause?

As women go through perimenopause heading into menopause itself, the change in hormone levels surging through the body can lead to certain other changes. Among them, women can begin to gain weight. Where a woman might once have had a slim waist, her waist circumference can dramatically increase, as body fat isn’t absorbed in the same way as when there were regular amounts of estrogen in the body. This extra body fat can gradually increase a woman’s risk for type 2 diabetes.

Studies have shown that women have a higher risk of developing diabetes when they go through menopause early. Changes in glucose can be dramatic in those who enter menopause before age 40 compared with women between 50 and 54 years old. Those women have a 32% higher risk of developing type 2 diabetes. Women who have had hysterectomies were also shown to have a 57% increased risk of diabetes compared with those who naturally went through menopause with or without HRT.

What Effect Does HRT Have on Type 2 Diabetes?

While women with type 2 diabetes in menopause have notable changes in their body fat, specifically in the abdominal region, their insulin levels are also affected. Studies have been done on women who were given HRT on a short-term basis to see how it would affect their condition. The results showed that when the women received HRT that included only estrogen, their blood glucose levels were improved. This shows that there is a beneficial link between HRT and diabetes in women who have already gone through menopause.

Although in the past, medical professionals believed that HRT was a predictor for women developing cardiovascular disease, this is no longer believed to be the case. Doctors were once reluctant to prescribe hormone therapy to women in perimenopause or menopause due to those fears. The opposite was determined, as women with type 2 diabetes have been shown to benefit from the therapy. It can help to reduce abdominal fat and improve fasting glucose.

However, studies have also shown that women older than 60 who have type 2 diabetes should not be prescribed HRT, as it could potentially have adverse effects.

Why Does Menopause Increase Women’s Risk for Type 2 Diabetes?

There are several reasons why women have an increased risk for type 2 diabetes once they have reached menopause. As the body’s levels of estrogen shrink, that risk increases. The following can also elevate that risk:

• Body weight changes: Menopausal women see their weight shift when they gain a few pounds. Visceral fat can begin to develop, leading to their bodies shifting from pear-shaped to apple-shaped. This is dangerous and can increase the risk of type 2 diabetes and heart disease.
• Less energy and fat breakdown: The decline of estrogen during menopause can cause women’s energy levels to become depleted. This, in turn, also leads to fat breaking down less than during the childbearing years.
• Decrease in muscle mass: Menopause leads to women experiencing a notable decrease in their muscle mass. This is a normal part of aging also known as sarcopenia.
• Increased inflammation: An increase of inflammation in the body occurs after menopause, which can result in insulin resistance.
• Pressure on the pancreas: According to animal studies, the pancreas is under more pressure after menopause due to having to work that much harder when insulin resistance occurs. It’s believed that if there is a genetic predisposition to type 2 diabetes, women are at a greater risk of developing the condition during this time in their lives.

What Can Women Do?

Women can benefit from taking HRT after menopause. Those who have undergone hysterectomies can benefit when given hormone therapy that only includes estrogen. However, those who still have their uterus should be prescribed hormone therapy with both estrogen and progesterone.

Studies have shown that women tend to do better when given patch therapy instead of oral options. However, those with type 2 diabetes have been shown to benefit more from oral therapy.

It’s important to talk to your doctor about your options for HRT during menopause.