You may not realize that these hormonal changes can affect other body functions as well. This is especially true with regards to women living with diabetes, who are faced with unique challenges and risks when it comes to their reproductive cycle.
This article looks at how the reproductive cycle can affect a person’s ability to control diabetes and, conversely, how diabetes affects a person’s reproductive cycle, and the risk of certain gynecological concerns, including cancer.
Blood Sugar Increases During Your Period
If you have problems controlling your blood sugar the week before your period, it may not be caused by anything you are doing. It may, in fact, be due to changes in your hormone levels.
Roughly halfway through the menstrual cycle, ovulation occurs. At that point, progesterone levels increase. Increases in progesterone are, in turn, associated with increased insulin resistance.
That means that during the second half of your cycle (called the luteal phase) when progesterone levels are naturally higher, you may experience some insulin resistance. This response is known as luteal phase insulin resistance. People with type 1 diabetes tend to be more sensitive to this.
Luteal phase insulin resistance can lead to a hyperglycemic event in which your blood sugar spikes even if you are adhering to your routine diet and exercise plan.
An increase in progesterone can also trigger food cravings for simple carbohydrates and may cause you to lose your motivation to exercise. This can further contribute to poor glycemic (blood sugar) control.
If you are living with diabetes, it is important to be mindful of your diet and exercise during the luteal phase. If you are on diabetes medications, it is extra important to check your blood sugar regularly to maintain glycemic control.
Hormonal Contraception and Insulin Resistance
In the same way that natural hormonal fluctuations can affect glycemic control, the use of hormonal contraceptives—including birth control pills, contraceptive patches, and contraceptive rings—may do the same.
These hormonal contraceptives contain forms of estrogen, progesterone, or both. Some studies have shown that estrogen, as well as progesterone, can trigger insulin resistance, making it harder to control your blood sugar.
In general, it is absolutely fine to use these forms of birth control if you have diabetes. Still, it is important to be aware of their effect on glycemic control. Pay extra attention to your blood sugar whenever you are starting or changing hormonal contraceptive methods.
Late Period, Early Menopause
If you are living with type 1 diabetes, you are likely to experience menopause sooner compared to those living with type 2 diabetes or those without diabetes. Studies show that this type of diabetes causes the premature aging of blood vessels and, in turn, the premature aging of the ovaries that produce eggs.
In addition, people with type 1 diabetes are more likely to experience menarche (the onset of menstruation) at a later age. This further narrows the window during which conception and pregnancy can occur.
A person with type 1 diabetes is also more likely to have irregular periods than those without. A 2011 study in Reproductive Biology and Endocrinology suggests that more than a third of teenagers with type 1 diabetes will have irregular menstruation. Scientists don’t yet fully understand why this is.
Weight and Irregular Periods
Although type 2 diabetes can occur in women who are not overweight, it is more commonly associated with being overweight or obese.
Unlike type 1 diabetes in which your body doesn’t produce enough insulin, type 2 diabetes is the result of insulin resistance in which your liver, muscles, and fat don’t respond well to insulin that is being produced.
When you are overweight, the greater volume of body fat generates larger amounts of hormones that directly contribute to insulin resistance. This, in turn, causes your pancreas to produce even more insulin.
For reasons not fully understood, high levels of insulin can interact with hormones that regulate menstruation, leading to irregular or missed periods. In some cases, there may even be anovulation in which a person doesn’t ovulate.
People with polycystic ovarian syndrome (PCOS) are at a particularly high risk of insulin resistance and type 2 diabetes.
Risk for Endometrial Cancer
Endometrial cancer is the most commonly diagnosed gynecologic cancer and one that is most often occurs after menopause.
If you have type 2 diabetes, you are at an increased risk of endometrial cancer. The increased risk is thought to be associated with insulin resistance and chronically high insulin levels.
With that said, the risk is especially high if you are significantly overweight or obese. Being overweight or obese can trigger an imbalance between estrogen and progesterone that not only interferes with menstruation but can cause the lining of the uterus (called the endometrium) to overgrow, leading to endometriosis.
Endometriosis is linked to an increased risk of endometrial cancer. The same is true if you have abnormally high estrogen levels and abnormally low progesterone levels common in people with obesity.
Summary
Diabetes can affect normal menstruation, and menstruation can affect diabetes control. It’s a Catch-22 situation that can make life challenging for people living with diabetes.
Prior to your period, increases in progesterone can lead to temporary insulin resistance and a spike in your blood sugar. The same is true if you have diabetes and use hormonal contraceptives that further increase progesterone levels.
On the flip side, diabetes can increase the risk of irregular periods and anovulation (no ovulation) due to an imbalance in estrogen and progesterone levels. With type 1 diabetes, there is also an increased risk of delayed menarche (late onset of menstruation) and early menopause.
Type 2 diabetes is also linked to an increased risk of endometrial cancer irrespective of a person’s weight. The risk only increases if a person is overweight or obese.
