Managing diabetes across female reproductive stages

Hormonal fluctuations across the female reproductive lifespan lead to physiological adjustments that impact insulin sensitivity and glucose metabolism, generating unique challenges in diabetes management. Although current guidelines focus primarily on diabetes care during pregnancy, they lack tailored recommendations for addressing glycaemic variability associated with menstrual cycles, contraceptive needs, and menopause. Low rates of prepregnancy counselling, limited contraceptive guidance, and underuse of hormone replacement therapy further complicate care for women with diabetes. Here we examine these care gaps, identify unmet needs across reproductive stages, and suggest research directions to develop comprehensive, stage-specific management strategies that better support women's health and improve diabetes outcomes throughout the reproductive years.