Healthcare professionals are urged to adopt a cautious and individualized approach when considering menopausal hormone therapy (HT) for women with diabetes, given the potential effects on glycemic control and cardiovascular health.
Dr. Erin Raney, PharmD, BC-ADM, BCPS, a professor at Midwestern University College of Pharmacy, highlighted the importance of a collaborative decision-making process during her presentation at the Association of Diabetes Care & Education Specialists annual meeting. She emphasized that managing menopausal symptoms in women with diabetes requires careful consideration due to the complex interplay between hormonal changes and metabolic health.
Impact on Glycemic Control
Menopause is associated with various metabolic changes, including increased insulin resistance and altered glucose metabolism. Studies suggest that menopausal HT may have a neutral to beneficial effect on glycemic control in women with type 2 diabetes.
A meta-analysis published in Diabetes Care found that HT was associated with a 0.56% reduction in HbA1c and a 20.7 mg/dL decrease in fasting glucose levels compared to non-users.
PubMed
However, the impact of HT on glucose regulation may vary depending on the type of estrogen or progestogen used and the route of administration. Therefore, healthcare providers should tailor HT regimens to the individual needs of each patient.
Cardiovascular Considerations
Women with diabetes are at an increased risk for cardiovascular disease (CVD), and this risk may be further influenced by menopausal HT. While some studies have suggested that HT may reduce CVD risk in certain populations, others have raised concerns about potential adverse cardiovascular outcomes.
For instance, a study published in The BMJ reported that oral estrogen-progestin therapy was associated with an increased risk of heart disease and venous thromboembolism.
BMJ
Given these considerations, Dr. Raney recommends using cardiovascular risk calculators to assess an individual’s risk before initiating HT. Additionally, she advises considering the use of diabetes medications such as GLP-1 receptor agonists, SGLT2 inhibitors, and metformin to mitigate cardiovascular risk.
Nonhormonal Alternatives
For women with diabetes who are not candidates for HT, nonhormonal therapies may be considered. Fezolinetant, a selective neurokinin-3 receptor antagonist approved for the treatment of vasomotor symptoms, has shown promise in managing menopausal symptoms without affecting glucose metabolism. However, data on its long-term safety and efficacy in women with diabetes are limited.
Other nonhormonal options include selective serotonin reuptake inhibitors (SSRIs), gabapentin, and oxybutynin. While these medications can alleviate menopausal symptoms, they may have side effects such as weight gain and increased blood pressure, which could affect diabetes management.
Collaborative Approach
Dr. Raney underscores the importance of a multidisciplinary approach in managing menopausal symptoms in women with diabetes. She advocates for involving endocrinologists, gynecologists, primary care providers, and diabetes care specialists in the decision-making process to ensure comprehensive care.
In summary, while menopausal HT may offer benefits for women with diabetes, it is essential to carefully evaluate the potential risks and benefits on an individual basis. Healthcare providers should engage in shared decision-making with patients, considering factors such as glycemic control, cardiovascular risk, and personal preferences to determine the most appropriate treatment strategy.
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