Diabetes and the menstrual cycle

Top things to know:

• Diabetes is a lifelong disease that impacts the way glucose is used in the body
• Long, irregular menstrual cycles and heavy periods can be symptoms of diabetes as it progresses
• Unmanaged, it can lead to serious consequences that affect many areas of the body, including the heart, eyes, kidneys, blood vessels, nerves, and teeth

What is diabetes?

Diabetes, also known as diabetes mellitus, is a lifelong disease that affects the way the body uses glucose (sugar). Glucose is very important. When it isn’t regulated properly, glucose builds up in the blood, causing symptoms and, eventually, health problems.

Glucose is regulated by a hormone called insulin, which is produced in the pancreas (1). When a person has diabetes, their bodies either do not produce enough insulin, or do not respond normally to the insulin that their body is producing. When too much glucose is in the blood, this is known as hyperglycemia. People with untreated diabetes experience hyperglycemia. When too little glucose is in the blood, this is known as hypoglycemia.

Globally, about 9 in 100 adults have a form of diabetes (1,2). Unmanaged diabetes can lead to serious problems affecting the heart, eyes, kidneys, blood vessels, nerves, and teeth (3-5). Uncontrolled diabetes can also affect the menstrual cycle (6,7).

Early diagnosis and treatment can help reduce these risks, and some forms of diabetes are preventable. Diagnosis happens through blood tests from a healthcare provider.

Tracking the length of your menstrual cycle and any other symptoms in Clue can help your healthcare provider in forming a diagnosis and a treatment plan.

Blood sugar, insulin, and the menstrual cycle

Some studies have suggested that people may be more sensitive to insulin during the first half of the cycle (follicular phase), and less sensitive during the second half (luteal phase) (8-10). Other studies found no difference (11-13). More research is needed (14,15).

In any case, tracking blood sugar levels along with the cycle can help someone know if their insulin needs fluctuate with their cycle. Diabetics who experience changes in cravings might also be conscious of how these changes impact what they eat, and how that then affects their insulin needs.

Diabetes and Polycystic Ovary Syndrome (PCOS)

Diabetes and PCOS are related diseases. In some cases this could be due to body weight, but many other factors may play a role, such as genetics (16-18). It’s therefore important for people with either disease to keep an eye out for any symptoms of the other. People with diabetes might pay special attention to any excess hair growth on the body or face (hirsutism) (19). People with PCOS may benefit from regular screenings for diabetes or prediabetes. New symptoms can provide important information for the diagnosis and management of either condition.

Types of Diabetes

There are different types of diabetes.The three most common forms of diabetes are type 1, type 2, and gestational diabetes.

Type 1 diabetes

Type 1 diabetes is usually diagnosed in childhood, but may also be diagnosed in adults (20-22). It happens when the pancreas doesn’t function properly and can’t produce enough insulin to regulate blood sugar. Research isn’t clear on what causes type 1 diabetes, but factors include family history, genetic predisposition, and environmental exposures, such as exposure to certain viruses (3,23,25).

Type 2 diabetes

Type 2 diabetes is usually diagnosed in adulthood, but is becoming more common in children and adolescents due to childhood obesity (1,22,25). Type 2 diabetes develops when cells lose their ability to use insulin properly. This is called insulin resistance. The body then adjusts by making more insulin. With type 2 diabetes, the pancreas may lose the ability to make insulin.

Type 2 diabetes is usually triggered by lifestyle factors. Weight gain, being overweight or obese, having excessive abdominal fat, having a diet high in fat and sugar, and not getting enough exercise can all heighten the risk of developing type 2 diabetes (25-28). People may also be more likely to develop this type of diabetes if they have a family history of the disease, or if they have polycystic ovary syndrome (PCOS) or menstrual periods that are infrequent or highly unpredictable (6,29).

Gestational diabetes

Gestational diabetes is temporary and occurs during pregnancy. The hormones produced during pregnancy make the body’s cells more resistant to insulin (30). Gestational diabetes usually goes away when pregnancy ends, but it should be monitored during pregnancy to protect the health of the pregnant person and their baby. Gestational diabetes occurs in about 7 in 100 pregnancies in the USA, but can be as common as 14 in 100 pregnancies in some populations (3). Someone is more likely to develop it if they have a family history of it or if they are overweight or obese (22). People with gestational diabetes have a higher risk of developing type 2 diabetes after their pregnancy, and should be regularly screened for diabetes throughout their adult lives (30,31).

Symptoms of diabetes: what you might notice

Types 1 and 2 symptoms

In the early stages of diabetes, symptoms may be mild and easy to ignore. They tend to become progressively worse over time. In any case, it’s important to discuss any early symptoms with a healthcare professional, even when they aren’t bothersome. Common symptoms of diabetes include:

• Increased hunger and thirst
• Frequent urination
• Unexplained weight loss (type 1)
• Weight gain (type 2)
• Blood sugar fluctuations, which can lead to irritability, feeling unwell, and fainting (1,3,22).

Other symptoms that may develop as the disease progresses include:

• Long, irregular menstrual cycles
• Very heavy and long periods
• Fatigue
• Cuts and bruises that heal slowly
• Blurred vision
• Recurrent yeast infections (1,7,32-36).

Symptoms of type 1 diabetes tend to appear suddenly in young people, and more gradually in adults (3). Type 2 diabetes usually begins mildly in everyone, becoming more noticeable over time (3).

Adolescents with type 1 diabetes may experience their first menstrual period (menarche) about 1-2 years later than average (7,32,37-39). Adults with type 1 diabetes may also experience the end of their cycles (menopause) about six years earlier than average (7,16,37).

Gestational diabetes symptoms

A person may not experience any symptoms of gestational diabetes or may confuse them with normal pregnancy symptoms (3,30,40). A healthcare provider should check for it as part of basic pregnancy care (3,30). If you are planning to become pregnant, talk to your healthcare professional to know if you are at an increased risk.

Why get it checked out

Unmanaged diabetes can damage the body, but getting diagnosed early on and receiving proper treatment can prevent much of this damage.

Getting diagnosed early may prevent the development of “full-blown” type 2 diabetes. Some people may get diagnosed with “prediabetes” or “intermediate hyperglycemia,” which means that their blood glucose levels are high but not high enough for them to be considered diabetic. People with prediabetes may be able to prevent type 2 diabetes (41). A pre-diabetic phase might also happen in type 1 diabetes, but research on this is less clear (42).

Early symptoms of diabetes may be very mild, and not seem like a concern. Left untreated, the disease usually progresses and complications can become serious. Unmanaged diabetes may lead to diseases affecting the heart, eyes, kidneys, blood vessels, nerves, and teeth (3,4). Some cases of unmanaged diabetes may lead to disability and even death (43). Early treatment and careful management of blood sugar levels will help to minimize symptoms and prevent complications.

People with diabetes are at risk for certain complications during pregnancy if their blood sugars are not well managed. People with diabetes looking to become pregnant should postpone pregnancy until their blood sugars are tightly controlled, as uncontrolled diabetes is associated with an increased risk to the baby such as birth defects. Poor control of diabetes during pregnancy is associated with hydramnios (a condition where amniotic sac contains too much fluid), or macrosomia (being a very large baby), and risks to the mother such as high blood pressure and preterm labor. It is important to talk to your healthcare provider if you are planning on becoming pregnant if you have diabetes or prediabetes (44).

How diabetes is diagnosed

A healthcare provider will probably ask questions about symptoms and medical and menstrual history, and perform a simple physical exam. If they think diabetes or pre-diabetes may be present, they will likely perform a blood test. Tests for diabetes can include testing blood sugar when you have been fasting (not eating for 8 hours), a random test unrelated to meals, or measurement of a test called hemoglobin A1C, which assess the average blood glucose over the past 2-3 months.

Diabetes treatment and management

Diabetes type 1 is a lifelong disease; type 2 diabetes is typically a chronic, on-going condition, but weight loss (if overweight or obese) and exercise can potentially reverse the course of the disease. Careful management can help to minimize symptoms and prevent future complications. Many cases of diabetes can also be prevented with lifestyle changes.

Medications

Type 1 diabetes—and sometimes type 2—are managed with injections of the hormone insulin. These injections help to regulate the blood sugar. For type 2 diabetes, most people require prescription oral medications to help the body regulate blood sugar.

For people with irregular periods and cycles, hormonal birth control might be prescribed to regulate the cycle (7). If irregular periods are associated with excess body hair, the diagnosis of polycystic ovary syndrome (PCOS) should be considered. Medications are always used in combination with diet and weight management (45,46).

Lifestyle changes

Diet and exercise can be extremely helpful in the prevention of type 2 diabetes (1,3,47). Moderate weight loss has been shown to cut the risk of type 2 diabetes in half for those who are overweight (26). For those who already have diabetes (type 1 or 2), eating healthy food and engaging in regular exercise can help reduce the risk of complications (1,3). Replacing simple carbohydrates and processed food with whole grains, vegetables, some fruits, fish, lean cuts of meat, and low-fat dairy can help keep blood sugar in balance and help with weight reduction. Exercise can also help regulate weight and blood sugar (38). If you are diabetic or at risk of diabetes, you and your healthcare provider should come up with a personalized plan that will fit your needs (48).

Self-regulation

People with diabetes should commit to monitoring many aspects of their own day-to-day health. For those with diabetes type 1, this will mean checking blood sugar several times a day. For those with diabetes type 2, blood sugar is also regularly monitored. It also means paying close attention to food and to the symptoms of low versus high blood sugar. It is important not to smoke or to consume alcohol in excess as these activities can exacerbate symptoms and make their diabetes more difficult to manage (49,50). Paying close attention to oral, eye, and foot health is also important for diabetics, as people with poorly controlled blood sugar are prone to gum disease, foot sores, and eyesight problems that should be addressed as early as possible (3,51).

What to track

Essential to track

• Cycle length
• Period length and heaviness
• Cravings

Helpful to to track

• Fatigue
• Blood sugar
• Weight
• Any other symptoms you might be concerned about

Download Clue to track your menstrual cycle and symptoms