Women living with diabetes often complain of high blood sugars during different phases of their menstrual cycle. A survey conducted way back in 1996 reported that more than 1/3rd women with type 1 diabetes make premenstrual adjustments in their insulin dosages.
Personally I face many challenges and exacerbations in my blood sugars weeks before my periods. And I have heard so many young women complain glycaemic excursions during their menstrual cycles especially during a phase called Pre-menstrual syndrome (PMS).
A regular menstrual cycle has different cyclical phases usually ranging between 21 to 35 days and often varies among women. It is best measured by the number of days between your periods. Commonly women have a regular cycle of 28 days which includes 3-4 days of menstruation (periods). During a month-long cycle, hormonal fluctuations result in ovulation and then menstruation. These hormonal fluctuations can affect other body systems as well as the reproductive system. Women living with diabetes may experience some unique menstrual challenges as a result of these complex hormonal interactions.
A regular menstrual cycle has different cyclical phases usually ranging between 21 to 35 days and often varies among women. It is best measured by the number of days between your periods. Commonly women have a regular cycle of 28 days which includes 3-4 days of menstruation (periods). During a month-long cycle, hormonal fluctuations results in ovulation and then menstruation. These hormonal fluctuations can affect other body systems as well as the reproductive system. Women living with diabetes may experience some unique menstrual challenges as a result of these complex hormonal interactions.
1. Blood Sugar Levels are often difficult to control at different times in the month
I often get frustrated chasing my blood sugar graphs on a continuous glucose monitor weeks before my periods—sometimes few days to more than a week. Despite taking a high dosage of insulin I feel unsuccessful to achieve the perfect blood glucose levels. This difficult glycaemic control is a real thing and I’m sure I’m not alone.
There are a series of hormonal changes during our menstrual cycle and the cyclical surge and downfall of certain hormones determine the process of ovulation.
After ovulation which usually occurs around the 13-15th day of your cycle, there is an increase in the levels of the hormone progesterone. The progesterone levels are naturally higher during the second half of the menstrual cycle and are responsible for relative insulin resistance. This physiologic response is known as luteal phase insulin resistance.
Various studies have explored the link between progesterone and insulin resistance. The changes in the level of the estrogen and progesterone hormones can induce a temporary phase of insulin resistance which can last for up to a few days and then drop off.
Most females complain of increased requirements of insulin to combat this resistance and hence complain of hyperglycemia.
How to overcome it?
Ughh… Too hard no doubt!
I too suffer from similar challenges of premenstrual insulin resistance and I always have to keep altering my basal insulin requirements on the insulin pump. Some days the resistance is so stubborn that I have to take double the dose of insulin I usually take.
It is important you discuss this with your gynecologist and get worked up for a condition often seen among people with diabetes called PCOS- Polycystic ovarian syndrome (which I will be discussing as a separate topic).
Every woman has a different experience during this phase, some are able to manage their insulin requirements well but some just can’t. Do not beat yourself for it!
Because once the hormone levels fall back in range and the storm subsides, the insulin sensitivity improves. I often try to exercise/ do any form of relaxing activity to manage this stressful phase.
- Irregular cycles – a common complaint among women living with diabetes.
The reproductive years are the years between the first period, also called menarche to the onset of menopause which is the time where you stop your periods.
If you are living with type 1 diabetes you are likely to experience a slightly shorter span of reproductive years compared to women without diabetes. It has been suggested that more than 1/3rd teenage girls with type 1 diabetes will have irregular menstrual periods.
Better glycaemic control and with right planning with your doctor women living with diabetes can have a normal planned pregnancy if they desire.
- Coping up with mood swings & periods-
Different stages of the menstrual cycle may have different effects on your blood glucose levels, mood swings and the effect can also vary from person to person and from month to month.
PMS makes some people feel moodier than usual and others bloated and achy. For some, it causes intense mood swings that interfere with daily life. While research estimates about 75% of women have PMS during their reproductive years, only 3 to 8 % develop severe depressive symptoms and anxiety.
- Blame the Sertonin!
Changes in estrogen and progesterone levels also influence serotonin levels. This is a neurotransmitter that helps regulate your mood, sleep cycle, and appetite. Low levels of serotonin are linked to feelings of sadness and irritability.
How to combat this?
- If you don’t already, start keeping track of your menstrual cycle and your emotions throughout its different stages
- Supplementing with Vitamin B-6 might also help with PMS symptoms.
Foods rich in vitamin B are fish, chicken and turkey, fruit, fortified cereals
- Several lifestyle factors also seem to play a role in PMS symptoms like regular sleep, exercise and adequate nutrition.
- If other treatment options aren’t helping, taking an antidepressant especially Selective Serotonin Receptor Inhibitors (SSRI)may help.
- Hormonal pills-
If you take a contraceptive pill, you may experience a different effect on your blood glucose levels than when you weren’t taking the pill.
There are various forms of contraceptive pill available and most of them increase your body’s insulin resistance, making it harder to control your blood sugar.
In general, it is considered safe to use these methods if you have diabetes. It is just important to be aware that using a hormonal contraceptive may change your glycaemic control.
Make sure to pay extra attention to your blood sugar when you are starting or changing your hormonal contraceptive method.
- You are not alone! You got to combat the taboos & myths.
We need to together build a better community to promote learning, share best practices, build partnerships and provide the opportunity to together tackle the taboos of periods.
Yes! Let’s talk, period.
For a large number of girls and women in India, menstrual hygiene continues to be an issue that’s neither discussed nor addressed. It’s time serious efforts were made to push it up the priority list.
Better hygiene = Stronger females
Before I end – start tracking some important things:
Essential things to track- on Apps / make your own journal-
- Cycle length
- Period length and heaviness
- Blood sugar
- Any other symptoms you might be concerned about
People with diabetes should commit to monitoring many aspects of their own day-to-day health.
For more detailed discussions regarding managing diabetes & your menstrual cycle get in touch with your Endocrinologist & Gynaecologist!
Let’s work in collaboration to fix those hormones!
– Dr Apoorva Gomber