Diabetes is a chronic and progressive disorder and is well known for its systemic impact on a wide range of issues leading to complications like heart disease, stroke, and kidney disease. But diabetes can also impact menstrual health of women at multiple levels and vice-versa. Menstrual irregularity can affect blood sugar levels, which means it can easily become a vicious cycle.
In an exclusive interaction with OnlyMyHealth editorial team, Dr Suhail Durani, Consultant Endocrinology, Fortis Memorial Research Institute and Fortis C-Doc, explains the link between diabetes and a woman's menstrual cycle. Here is what he shared.
Women with diabetes are at a risk of developing a condition called anovulation. This means that ovulation, the process where the ovary releases an egg into the fallopian tube, is not happening. Such women can develop fertility complications also. Anovulation in turn causes increase in the levels of oestrogen, which can lead to a thick endometrium (lining of the uterus) thereby leading to heavy and prolonged bleeding during menstruation. This cascading effect can impact the overall health of diabetic women and can lead to anaemia. Persistently increased levels of oestrogen over years can also increase the risk of developing uterine cancer in the later years of life.
Moreover, diabetic women tend to be obese which is a strong risk factor for Polycystic Ovarian Disease (PCOD). The amalgamation of obesity & PCOD in a diabetic woman is a major contributing factor in causing hormonal imbalance that leads to anovulation and irregular menstruation.
Similarly different phases of the menstrual cycle can impact blood sugar levels to a varying degree. The four important hormones that regulate normal menstrual cycle are oestrogen, progesterone, luteinizing hormone (LH), and follicle stimulating hormone (FSH) and each of these hormones impact blood sugars and sensitivity to insulin differently as their levels fluctuate throughout the entire month-long cycle. Particularly during the second phase of the menstrual cycle (called luteal phase), the levels of progesterone hormone are higher, which, in turn, is associated with increased insulin resistance. This response is known as luteal phase insulin resistance and people with type 1 diabetes tend to be more sensitive to such a state. Luteal phase insulin resistance can lead to fluctuating blood sugar levels. Moreover, an increased progesterone level can also trigger food cravings for simple carbohydrates thus further contributing to poor blood sugar control.
Long menstrual cycle & diabetes
Recent large-scale studies suggest that there may be a link between long and irregular menstrual cycles and the risk of developing type 2 diabetes. Irregular and long menstrual cycles are strong indicators of hyperinsulinemia, a state of increased insulin levels. Hyperinsulinemia along with hormonal imbalance trigger a cascade of events that eventually lead to insulin resistance, a state in which the body is unable to use insulin to control blood glucose levels effectively.
The presence of these risk factors like insulin resistance state, obesity or overweight, physical inactivity, and eating unhealthy diet are strong predictors of development of type 2 diabetes mellitus.
How to improve blood sugar levels during periods?
It is important that women with diabetes should take control of their blood glucose levels throughout the menstrual cycle.
Women with diabetes should maintain a regular exercise regimen throughout the menstruation or whenever their blood glucose levels begin to peak.
It is commonly seen that the appetite increases before the menstrual period. In order to curb blood glucose levels from rising, people with diabetes should try to avoid consuming refined carbohydrates.
If a person is taking insulin, they may need to alter their dosage throughout their menstrual cycle as well as manage their intake of carbs. Frequent blood sugar monitoring is of paramount importance especially during periods.
Lastly, a person should contact a doctor if they have diabetes and are experiencing irregular or unusual menstrual cycles. A health care provider should also be contacted if diabetic women are finding it difficult to manage their blood glucose levels throughout their menstrual cycle.