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Melissa Yates, M.D. and Wanda Nicholson, M.D.
02-04-2011
- Menopause: the cessation of menses for 12 consecutive months (Carr).
- Surgical menopause: begins the day that both ovaries are surgically removed in a previously menstruating patient.
- Diabetes is the most common disease in the postmenopausal period (Wedisinghe).
- Women with type 1 diabetes have a greater incidence of premature menopause with a mean of 41.6 years, versus 51 years in women without diabetes (Dorman).
- Increased type 2 diabetes will cause increased prevalence of postmenopausal women with diabetes. Estimated 20% of women > 65 years will also have diabetes (Shih).
- Metabolic changes with menopause may contribute to development of diabetes: increased central body fat, increased LDL, and decreased HDL, and increased insulin resistance (Shih).
- Increased insulin resistance with relatively stable pancreatic insulin secretion after menopause may increase risk of developing type 2 diabetes (Wedisinghe).
- Endogenous sex hormones including higher bioavailable testosterone, higher estradiol, and lower SHBG are associated with incident diabetes in postmenopausal women and may be partially explained by higher adiposity and insulin resistance (Kalyani).
- 60% increased risk of metabolic syndrome in postmenopausal women (Carr).
- Post menopausal women with type 1 diabetes have a RR of 12.25 for hip fracture while type 2 diabetes have a relative risk of 1.70 (Nicodemus).
- Women with diabetes may have more menopausal hot flushes and vaginal dryness than women without diabetes.
- During the perimenopause, there may be an increase in glycemic swings because of the changing endogenous sex hormone levels (Shih).
- Due to increased risk of CVD after menopause, encourage control of CVD risk factors postmenopausally (Carr).
- Weight gain has stronger influence on risk of diabetes than menopause itself (Carr).
- Hormone replacement therapy (HRT) may be beneficial in women < 60 years with diabetes and without known CVD. Recommend lowest effective dose in this select group of women ( Wedisinghe ).
- Exogenous HRT may be associated with either favorable or unfavorable effects on glycemia depending on dose and route of treatment (Lindheim; Cagnacci).
- Due to increased risk of endometrial cancer in women with diabetes, couple estrogen therapy with progesterone therapy if uterus intact ( Wedisinghe ).
- For symptomatic vaginal dryness, recommend daily Replens and consideration of local estrogen therapy such as Vagifem or Estring which have a low systemic absorption of estrogen.
- With CVD or other risk factors, would recommend non-hormonal treatments such as venlafaxine, gabapentin or clonidine for hot flushes and vitamin D, calcium and bisphosphonates for osteoporosis (Wedisinghe).
- Any vaginal bleeding after starting HRT or in the postmenopausal period should be fully evaluated by a gynecologist.
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