Menopause and diabetes: EMAS clinical guide

Area of Science:

• Endocrinology
• Metabolic Health
• Women's Health

Background:

• Menopause is associated with metabolic shifts, including increased central adiposity and decreased energy expenditure.
• These changes can lead to impaired insulin sensitivity and secretion, elevating the risk of type 2 diabetes mellitus (T2DM).
• The independent role of menopause versus aging in T2DM risk and the safety of menopausal hormone therapy (MHT) in diabetic women remain subjects of debate.

Purpose of the Study:

• To review the impact of menopause on metabolic parameters and T2DM risk.
• To examine T2DM's effect on the age of menopause.
• To evaluate MHT's influence on T2DM risk and outline management strategies for postmenopausal women with T2DM.

Main Methods:

• A comprehensive literature review was conducted.
• Expert opinions were gathered and synthesized through a consensus process.

Main Results:

• Menopause triggers metabolic changes, including increased central fat distribution and reduced energy expenditure, contributing to T2DM risk.
• Menopausal hormone therapy (MHT) demonstrates beneficial effects on glucose metabolism and may postpone T2DM onset.
• MHT administration in women with T2DM requires individualized assessment based on cardiovascular disease (CVD) risk.

Conclusions:

• Postmenopausal women with T2DM require management focused on lifestyle interventions, supplemented by pharmacotherapy tailored to individual characteristics and comorbidities.
• For women with T2DM and low CVD risk, oral estrogens may be suitable; transdermal 17β-estradiol is preferred for those with CVD risk factors like obesity.
• Progestogens with neutral glucose metabolism effects (e.g., progesterone) are recommended for MHT in this population.