Women’s Health: Diabetes and Periods
By Cheryl Alkon
What’s “typical” with periods? How can diabetes affect the menstrual cycle? Learn from experts about what to pay attention to if you are a woman with diabetes
Every body is different, and that’s the case when it comes to diabetes, periods, or any other biological process. But, as Dr. Emily Jungheim says, “it’s normal to get a period every month” – for women who are within the age range for childbearing, from the onset of their first period until menopause. Dr. Jungheim is a board member of the Society for Reproductive Endocrinology and Infertility and a professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine.
When your period arrives, it is possible that it can cause your blood sugars to soar or your body to crave certain foods. But the important thing is to actually have a monthly period, Dr. Jungheim said. Pay attention to certain things, such as different forms of birth control, pregnancy, breastfeeding, weight gain or loss, different health conditions, and menopause/perimenopause, which can cause the body to stop ovulating, and therefore, not have a period.
For most women – with or without diabetes – monthly periods occur every 21 to 35 days, and last from two to seven days, according to the Mayo Clinic. With that being said, each woman’s period is different, and cycles can be inconsistent at times, especially following a woman’s first period and as she approaches menopause.
Periods and diabetes: what’s typical, what’s not?
“Women with diabetes are at higher risk for menstrual abnormalities due to what is called anovulation,” Dr. Jungheim said. Anovulation is when ovulation, a normal part of the menstrual cycle where the ovary releases an egg into the Fallopian tube, does not occur. “This is really important, as ovulation is required for pregnancy. When women aren’t ovulating regularly and predictably, it can make it harder to get pregnant.” On the flip side, if you don’t have a period then you won’t know when you are more fertile, or more likely to conceive when having sex.
“If someone with diabetes notices that she is experiencing vaginal bleeding more often than every month, or less often than every month, she should see her healthcare professional for further investigation,” said Dr. Jungheim. However, know that women can sometimes have periods that are more or less frequent than what is considered the average experience. Learn what is normal for you, and be aware of period changes that aren’t typical for you.
A doctor who focuses on the female reproductive system is a gynecologist; a doctor who oversees pregnancy and childbirth is an obstetrician. Some healthcare professionals specialize in both and are known as obstetrician-gynecologists or Ob-Gyns. A doctor who specializes in fertility and infertility is a reproductive endocrinologist.
As a refresher, the menstrual cycle is a monthly hormonal process that ensures a woman can get pregnant. It is counted from the first day of your period, which occurs when blood and tissue lining the uterus sheds and flows out of the vagina. This process lasts for several days, and is the time when women use menstrual products such as pads, tampons, menstrual cups or sponges, or period underwear. After the period ends, hormone levels of estrogen and progesterone fluctuate. During the menstrual cycle, the body prepares to release an egg in a process called ovulation. This egg can then be fertilized by sperm to create an embryo, which ultimately grows into a fetus, and later, a baby.
Since the menstrual cycle is what determines when a woman is fertile and when she is not, problems with your period indicate the cycle isn’t progressing the way it is supposed to.
If you’re experiencing anovulation (no ovulation, so no period), there can be many reasons, diabetes-related or not, that could be causing it. “That’s where a visit to a good ob-gyn or a reproductive endocrinologist is imperative so that these factors can be considered, appropriate diagnostic tests ordered, and an individualized plan can be developed,” Dr. Jungheim said. “How diabetes impacts or changes these factors is very specific to the individual.”
Women with type 2 diabetes have higher rates of obesity, which is often associated with polycystic ovarian syndrome, said Veronica Brady, an assistant professor at the University of Texas Cizik School of Nursing and a spokesperson for the Association of Diabetes Care & Education Specialists (ADCES). The most common symptom of polycystic ovarian syndrome is irregular periods. “Sometimes women [with type 2 diabetes] may experience issues with conception, which could be due to irregular periods,” Brady said.
Women with type 1 diabetes who are underweight may experience irregular periods as well, as a normal body weight is needed to maintain the menstrual cycle and support pregnancy, Brady added.
How does menstruation affect diabetes management?
Dr. Jungheim again stressed how every person with diabetes is different. Some women experience premenstrual symptoms, a week or two before the period begins, that can cause cravings for certain foods and may impact mood, while others do not.
“In my practice, as well as in the literature, it has been noted that prior to starting their cycle, many women report that their blood glucose levels run higher,” said Brady. Women using insulin pumps may have to increase their basal rates two to three days before their period starts, to cover higher blood sugars. “I usually advise women who are on insulin therapy and notice an increase in blood glucose readings to increase their basal (long-acting) insulin by 10 to 20 percent (depending on how high their blood glucose readings are) for two to three days prior to their menstrual period, and to maintain the higher dose throughout their period,” she said.
Some women with type 1 diabetes may also notice that, at the start of their period, their blood glucose is lower. They may need to decrease their basal insulin for the first one to two days, and then they may need more insulin for the next three to five days, Brady added.
“If someone is having difficulty maintaining stable blood sugar levels, they should keep a menstrual diary and match it up with their blood sugar data,” she said. You can use an app – consider one from this list – or use a pen and paper to note trends and match them to where you are in your menstrual cycle. If you aren’t having periods at predictable intervals after three months of tracking, or your periods occur more often than every 24 days or so, reach out to a healthcare professional.
“If someone notes an association [between blood sugar levels and their menstrual cycle], she may want to talk to her healthcare professional about options for controlling the hormonal shifts that occur with menstrual cycles,” said Dr. Jungheim.
What can someone with diabetes do to make having her period easier each month?
Periods can cause a variety of issues that affect people differently. Before a woman’s period arrives, it can cause issues known as premenstrual syndrome, which include moodiness, sadness, anger, pain or discomfort, tender breasts, abdominal bloating, acne flareups, weight gain due to water retention or constipation, or diarrhea. Once a period arrives, it can cause abdominal pain or cramps, heavy bleeding, or migraines. Over the counter pain relievers and warm compresses to the abdomen can help soothe cramping and abdominal discomfort. But in terms of specific advice for women with diabetes, “the primary thing to consider is to manage your blood glucose as much as possible,” said Brady.
If you are having irregular periods – which Brady defines as not having a period for more than three months and you are not pregnant or in perimenopause or menopause – talk to your healthcare professional. Periods that are heavy (those which last for five to seven days with large clots, or instances of bleeding a couple times a month) should also be discussed with a healthcare professional, she said.
“There are lots of [treatment] options that are available” to help with period problems, said Jungheim. “Sometimes it can be trial and error to find the right answer, but often if we are persistent we can find a solution that works for the individual.”
Does diabetes affect anything about menstruation or menstrual symptoms?
Just like maintaining normal blood glucose levels, menstrual cycles are the result of an intricate series of hormone signals, explained Dr. Jungheim. “People with diabetes are at higher risk for having irregular or unpredictable menstrual cycles, and in medicine we refer to the menstrual cycle as ‘the fifth vital sign,’ after blood pressure, heart rate, respiration rate and temperature.” If you are not having regular monthly cycles, or if your monthly cycles are changing significantly from what is normal for your body – either because they are more frequent or less so – seek advice from your healthcare team.