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Diabetes Therapy
Published in: Diabetes Therapy 6/2019

Open Access 01-12-2019 | Insulins | Brief Report

Type 2 Diabetes Mellitus and Menopausal Hormone Therapy: An Update

Authors: Stavroula A. Paschou, Nikolaos Papanas

Published in: Diabetes Therapy | Issue 6/2019

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Abstract

During menopausal transition, various phenotypical and metabolic changes occur, affecting body weight, adipose tissue distribution and energy expenditure as well as insulin secretion and sensitivity. Taken together, these can predispose women to the development of type 2 diabetes mellitus (T2DM). Many women in midlife experience climacteric symptoms, including hot flashes and night sweats. Menopausal hormone therapy (MHT) is then indicated. MHT has a favourable effect on glucose homeostasis in both women without and with T2DM. T2DM was considered in the past as a cardiovascular disease (CVD) equivalent, which would suggest that women with T2DM should not receive MHT. This notion may still deter many clinicians from prescribing MHT to these patients. However, nowadays there is strong evidence to support an individualised approach after careful evaluation of CVD risk. In older women with T2DM (> 60 years old or > 10 years in menopause), MHT should not be initiated, because it may destabilise mature atherosclerotic plaques, resulting in thrombotic episodes. In obese women with T2DM or in women with moderate CVD risk, transdermal 17β-oestradiol could be used. This route of delivery presents beneficial effects regarding triglyceride concentrations and coagulation factors. In peri- or recently post-menopausal diabetic women with low risk for CVD, oral oestrogens can be used, since they exhibit stronger beneficial effects on glucose and lipid profiles. In any case, a progestogen with neutral effects on glucose metabolism should be used, such as natural progesterone, dydrogesterone or transdermal norethisterone. The goal is to maximise benefits and minimise adverse effects.
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Metadata
Title
Type 2 Diabetes Mellitus and Menopausal Hormone Therapy: An Update
Authors
Stavroula A. Paschou
Nikolaos Papanas
Publication date
01-12-2019
Publisher
Springer Healthcare
Published in
Diabetes Therapy / Issue 6/2019
Print ISSN: 1869-6953
Electronic ISSN: 1869-6961
DOI
https://doi.org/10.1007/s13300-019-00695-y

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