It is estimated that there are just under 34 million women in the United Kingdom (UK) in April 2020, of which just under 13.5 million are aged between 45-59 years (Office of National Statistics, 2020).
At some stage, all women who have a menstrual cycle will be going through the natural transition of menopause with the average age being 51 years, but around 1 in 100 women experience menopause before 40 years of age. This is known as premature menopause or premature ovarian insufficiency. The transition of the different stages is defined as; early perimenopause- menses (periods) in the last three months and changes or irregularities in menstrual patterns; followed by late perimenopause-no menses in the past three months but menses in the preceding 11 months; finally post-menopause- amenorrhoea (no periods) for at least 12 months. However, some women will go through surgically induced menopause by bilateral oophorectomy. According to the National Institute for Healthcare Excellence (NICE), eight out of ten women experience some symptoms of menopause which can typically last four years after their last period but can continue for up to 12 years for approximately 10% of women.
Menopause begins with endocrine changes and neurochemical alterations within the CNS after ovarian failure. These changes can have an impact on hormone levels: estradiol (E2), follicle-stimulating hormone (FSH), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), testosterone and androstenedione, although DHEA and DHEAS decline with age regardless of menopausal status. These hormonal changes can relate to symptoms such as vasomotor symptoms, mood, cognitive function and well-being, musculoskeletal, gut and urogenital symptoms and sexual difficulties.
What impact this has on diabetes
The declining ovarian function is known to increase the risk of diabetes, it is also known to further diminish glycaemic control. This is mainly due to how the menopause affects the woman’s body.
It is well known that menopause brings in a shift in the distribution of body fat particularly visceral fat which is a high-risk factor in many diseases. A reduction in energy from the breakdown of fat also occurs due to oestrogen deficiency. Estrogen is said to have a direct effect on the pancreatic beta cells that stimulate insulin secretion building insulin resistance. Premature menopause is said to increase the risk of diabetes by 32%.
Treatments for menopausal symptoms
Some women may look for help in managing symptoms of the menopause. There are many treatments that can help. Cognitive behaviour therapy (CBT) can be helpful for those suffering from anxiety and low mood. HRT is a recommended treatment for physical symptoms although a drug called clonidine is often used for hot flushes and sweating symptoms in those women taking HRT is a too high risk, however, there are alternative therapies including bioidentical hormones, but these are not currently promoted in the medical field. Whilst there is little evidence to suggest these treatments promote weight gain, menopause does. Appetite appears to be variable for women going through menopause and those taking oral treatment.
Benefits of hormone replacement therapy for women with type 2 diabetes
Several studies have looked at Hormone replacement therapy (HRT) and if this is helpful for women with T2DM, HRT is said to reduce new-onset cases of T2DM by around 30%. This is suggested to be due to HRT reducing the levels of abdominal fat and improving insulin resistance. Oral HRT is said to be more beneficial than transdermal, but it does carry risks and an individual assessment should be undertaken regards its risk and benefits.
Diets:
In the UK the Western diet is characterised by a reduction in plant-based whole foods, higher content in ready-to-use foods, fast foods, saturated fats, refined grains, sugar and salt which are unfavourable towards improving menopausal symptoms. Diet is a modifiable factor to support menopausal symptoms particularly foods that have bioactive compounds such as polyphenols and omega-3 has been reported to reduce low-grade inflammation.
Low carbohydrate diet
Diets low in carbohydrates (<130g/day or <26%/ day of total energy) seem to be associated with the greatest weight loss but concerns about achieving a high-fibre diet may be challenging, however, it is possible by consuming high-protein and high-fat plant-based sources. Also, low carbohydrate diets have an unfavourable lipid profile which could potentially increase CVD risk and the transition into menopause and having type two diabetes also increases this risk. Although evidence suggests the quality of dietary fats rather than quantity is more important, it is complicated because dietary fats are typically mixed with different types of fatty acid. Interestingly a mild low-carbohydrate diet (40% of total energy) was not associated with a decrease in fat mass, this may be because a low-carbohydrate diet is accompanied by higher consumption of protein which helps with muscle growth and fat loss, but it is worth mentioning increasing animal protein-rich foods may increase unfavourable lipid profiles mentioned above.
Mediterranean
A MedDiet containing 45-50% carbohydrates, 30% fats, <10% saturated fats and 20-25% protein of total energy per day is characterised by a richness in plant-based foods which results in a high intake of polyphenols. Adherence to a MedDiet is associated with better health-related quality of life outcomes such as improvements in depressive symptoms within three months, and VMS within 12 months this may be due to the antioxidant and fibre content which helps to improve menopausal symptoms, supports weight management and blood glucose control; additionally, this diet contains moderate consumption of red meat, ideally not processed, which contributes to adequate intakes of iron, vitamin B12 and essential amino acids.
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