5 Things Women Need to Know About Diabetes and Their Period

A typical menstrual cycle lasts about 28 days with a normal range of 21 to 35 days. It is best measured by the number of days between your periods. During this approximately month-long cycle, hormonal fluctuations trigger ovulation and then menstruation. These hormonal fluctuations can affect other body systems and functions as well as your reproductive system. Women living with diabetes may experience some unique menstrual challenges as a result of these complex hormonal interactions.

Illustration of ovaries and uterus
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1. Your Blood Sugar Level May Be More Difficult to Control at Certain Times of the Month

Are you frustrated with chasing your glycemic control in the week before your period?​ Are you wondering why your blood sugars are off when you aren't doing anything differently than you did last week?

This difficult glycemic control is a real thing—you are not imagining it. 

The reason why your blood sugar may be more difficult to control the closer you get to your period has to do with the hormonal changes of your menstrual cycle. Roughly halfway through your menstrual cycle ovulation occurs. At that point in your cycle, your progesterone levels increase.

Studies have shown that progesterone is associated with increased insulin resistance. That means that during the second half of your cycle after ovulation (the luteal phase) when your progesterone levels are naturally higher you will have some relative insulin resistance. This physiologic response is known as luteal phase insulin resistance.

Luteal phase insulin resistance will often naturally result in more hyperglycemic episodes even if you are not changing your exercise and diet in any way.

But there is an even bigger luteal phase challenge for women living with diabetes.

The same increase in progesterone that causes you to be temporarily more resistant to insulin also will likely cause you to have food cravings for simple carbohydrates and may cause you to lose your motivation to exercise. 

insulin resistance + food cravings + decreased activity = poor glycemic control

Over time, this cyclical poor control can increase your risk of diabetic complications.

If you are living with diabetes, It is very important to be mindful of your diet and exercise regime during the luteal phase of your menstrual cycle. Women with type 1 diabetes may be more sensitive to this menstrual cycle-related insulin resistance. However, if you are on oral medication for your diabetes you likely are not checking your blood sugar regularly, so you may not be aware of cyclical poor glycemic control.

2. Hormonal Contraception Can Increase Insulin Resistance

If your own hormonal fluctuations can affect your glycemic control it should be no surprise that exogenous hormones can have a similar effect. During your menstrual cycle, the most significant insulin resistance is seen during the luteal phase when your progesterone levels are highest. However, some studies show that estrogen, as well as progesterone, can also cause insulin resistance. The hormonal contraceptive methods that contain estrogen and progesterone include:

  • oral contraceptive pill
  • contraceptive patch
  • contraceptive vaginal ring

The hormonal contraceptive methods that contain only progesterone include:

  • Mirena
  • Nexplanon
  • Depo-Provera
  • Progesterone only pill

Any of these hormonal contraceptive methods may increase your body's insulin resistance, making it harder to control your blood sugar. In general, it is OK to use these methods if you have diabetes. It is just important to be aware that using a hormonal contraceptive may change your glycemic control. Make sure to pay extra attention to your blood sugar when you are starting or changing your hormonal contraceptive method.

3. Late Period, Early Menopause

Have all your friends started getting their periods? Are you wondering why you haven't gotten yours yet? It may be your diabetes at work.

If you are living with type 1 diabetes you are likely to experience a slightly shorter span of reproductive years compared to women without diabetes and even women living with type 2 diabetes. Your reproductive years are the years between your first period, also called menarche, and the onset of menopause.

Unfortunately, we don't yet understand exactly why this happens, but despite improvements in diabetes management and glycemic control, studies support a delayed onset of menarche in type 1 diabetes. This is especially true the younger you are when you are diagnosed with type 1 diabetes.

In addition to a delayed menarche, you may also have more irregular menstrual periods than your friends without diabetes. It has been suggested that more than one-third of teenagers with type 1 diabetes will have irregular menstrual periods.

4. Weight Gain Can Cause Irregular Periods

Although type 2 diabetes can occur in women who are not overweight, it is likely that if you are living with type 2 diabetes you are struggling with your weight. Weight loss can be challenging but not impossible for women with type 2 diabetes. Unlike type 1 diabetes where your body doesn't produce enough insulin, if you are living with type 2 diabetes your body is resistant to insulin.

When you are overweight your excess fat or adipose tissue produces hormones that increase your insulin resistance. This insulin resistance then triggers your pancreas to produce more insulin. Although we don't understand exactly how it happens, these increased insulin levels interact with the hormones that control your menstrual cycle. When your cyclic hormonal fluctuations are interrupted you will not ovulate and If you do not ovulate you will not have a regular period. 

Your type 2 diabetes may be part of a condition called polycystic ovarian syndrome or PCOS. If you have PCOS, you have an imbalance in your ovarian hormone production. This imbalance prevents regular ovulation resulting in irregular menstrual cycles. This condition is also associated with elevated insulin levels due to overproduction of insulin because of underlying insulin resistance. Often, the more overweight you are, the less frequently you will ovulate and the more irregular your periods will become.

5. Increased Risk for Endometrial Cancer

Endometrial cancer is the most commonly diagnosed gynecologic cancer. It occurs infrequently in women under 50 years old and is most commonly diagnosed in women after menopause. 

If you are living with type 2 diabetes you are at an increased risk of developing endometrial cancer and this risk is independent of your BMI. This increased risk is thought to be associated with the insulin resistance and elevated insulin levels of type 2 diabetes. 

Your risk is even further increased if you are significantly overweight. An elevated BMI can lead to irregular or anovulatory menstrual cycles. During these cycles, the lining of your uterus is exposed to estrogen without the protective effect of progesterone, leading to more endometrial growth. And if that's not enough, your fat or adipose tissue makes extra estrogen. The more overweight you are, the more extra estrogen you produce.

Over time, this extra estrogen exposure can lead to endometrial cancer. 

Frequently Asked Questions

  • Are women with PCOS more likely to have diabetes?

    Yes, PCOS affects insulin function and can lead to diabetes. Over 50% of women with PCOS develop type 2 diabetes by the time they are 40.

  • What are some risk factors for type 2 diabetes?

    Risk factors for diabetes include a family history of the disease, being overweight, age (45 or older), leading a sedentary lifestyle, having ever had gestational diabetes, and race, including those of Black, Hispanic, American Indian, and Alaska Native descent.

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